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Sunday, June 30, 2013
Depression: If You Don't Mind, It Doesn't Matter
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Saturday, June 29, 2013
Q&A Session at HealthTap.com
What is the cause of pregnrncy?
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Q&A Session at HealthTap.com
Is there chances that it will attack me again??
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Q&A Session at HealthTap.com
Second day of lexapro and have impotence. Will it go away? What should I do?
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Friday, June 28, 2013
Q&A Session at HealthTap.com
Sharp pain after 2 month of lasek sergery?
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Fluke or Trend: 5ARIs vs Prostate Cancer
Well, in a case-control study published 10 days ago in the British Medical Journal, the authors concluded that use of 5ARIs to treat lower urinary tract symptoms also lowered Gleason score 2-7 prostate cancer. This was an expected outcome. What was unexpected was that 5ARI use did not increase risk of Gleason 8-10 prostate cancer in the ensuing 4yrs. Recall that while both the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial demonstrated that regular use of 5ARIs can lower prostate cancer risk by up to 1 in 4, they also increased high grade prostate cancer risk.
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Thursday, June 27, 2013
Think FAST: Aspirin +/- Clopidogrel?
So what's a TIA? Transient ischemic attack. It's a small or minor or mini-stroke in which you regain your function in less than a few hours and return to baseline w/o any function loss or impairment. The problem with the TIA is that it's a warning shot across the bow. It's the canary in the mine. In a not so small percentage of patients who've suffered a TIA, they go on to sustain a massive stroke in the next few days to weeks, up to a third in a year, w/complete permanent loss of function.
But then what? Your evaluation is negative but you still had that event. What's your next step? In the past, we've discussed the option of aspirin vs warfarin. However, in a randomized placebo controlled study published early online in the New England Journal of Medicine, the authors concluded that aspirin + clopidogrel prevented more ischemic strokes than aspirin alone. Better yet, there was no increase risk of hemorrhagic strokes. To arrive at their conclusion, the authors randomized 5,170 participants avg 62yo to either aspirin alone or aspirin + clopidogrel. Within the 1st 90 days of treatment, offering clopidogrel to 29 participants would prevent one stroke.
God forbid you're (un)lucky enough to have a TIA. Ask your doc about using dual anti-platelet agents to prevent a stroke.
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Wednesday, June 26, 2013
Q&A Session at HealthTap.com
What is considered high fever on a one year old?
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Fluke or Trend? Vitamin D vs Heart Disease
It turns out that there are plenty of studies linking low vitamin D to greater risk of death from all-causes & from heart disease. However, these observation studies don't demonstrate cause & effect. But as the Rolling Stones say, you can't always get what you want. So in this case, I'll settle for an observational study published this month in the American Journal of Medicine in which the authors concluded that 25OH vitamin D less than 21ng/mL was linked to an increase risk of all-cause & cardiovascular mortality.
Yet despite the fact that this study supports the trend of studies linking vitamin D to our health, there's still no conclusive proof of cause & effect. So what are we to do in the meantime? Well, the good news is that unless you exceed 100ng/mL, it's unlikely that you'll suffer from hypercalcemia & other maladies. In other words, vitamin D supplementation appears to be safe, as far as we currently know. Which then makes it easier to consider supplementation if we don't have time to wait around for a cause & effect trial. Of course, this is something that should be discussed w/your family physician. And don't forget to think like Goldilocks. You want your 25OH vitamin D level just right, not too high & clearly, not too low.
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Tuesday, June 25, 2013
Q&A Session at HealthTap.com
Are there any causes of erectile dysfunction that are preventable?
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Fluke or Trend? Lifestyle vs Heart Disease in Diabetes
Really? Are we sure? Couldn't this just be a fluke outcome? After all, the trend in studies is that of benefit from lifestyle modifications. How could this one come out against diet & exercise? Well, the authors followed for almost 10 years 5,145 (wo)men avg age 59 w/avg body mass index 36 (obese by definition) who'd had diabetes for an average of 5yrs already. These participants had been randomized to either intensive lifestyle intervention focusing on weight loss via diet & exercise vs the control group who were given standard diabetic education.
However, those in the intervention group who lost weight & kept it off did demonstrate greater decrease in A1c as well as better fitness & cardiovascular risk factors (aside from LDL). And while it's not clear whether the egg came before the hen or vice versa, those in the intensive intervention group had a lower rate of cardioprotective medication use. Could that lower rate of use led to the lack of difference in heart disease outcomes? Or perhaps, the lower need for medications was a result of benefit gained from intensive interventional change in lifestyle. If you're a cynic and look for trends, check out the editorial for plausible reasons to explain this fluke.
As for me, I look at all the benefits gained from lifestyle modifications and the lack of harm, too. I believe this study is a fluke in that it didn't show benefit in heart disease. But just you wait & see. Given a large enough study for a long enough period of time w/great enough inter-group differences . . .
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Monday, June 24, 2013
Q&A Session at HealthTap.com
Is it rare for an 18 year old male to have a low testosterone level of 200?
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Does depo-testosterone cyp have the same half life as testosyetone cyp?
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Testosterone & Women's Brain Function
But what about women? Well, my disclaimer is that the following info has not been published in a peer reviewed journal but rather was presented at last week's meeting of endocrinologists. The authors randomized 92 healthy postmenopausal women avg 60yo who had both normal cognitive function and as well, had not taken any systemic hormone therapy, to 0.22g of testosterone as a transdermal gel or to a placebo for 26wks.
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Sunday, June 23, 2013
Q&A Session at HealthTap.com
What would happen if testosterone is abnormally high?
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my dad has a heart condition. will a removal of a testi affect his heart.?
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