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How does #exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood #pressure

https://bjsm.bmj.com/content/early/2018/12/05/bjsports-2018-099921

In analyses that combined all populations, antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions (mean difference −3.96 mmHg, 95% CrI −5.02 to −2.91). Compared with control, all types of exercise (including combination of endurance and resistance) and all classes of antihypertensive medications were effective in lowering baseline SBP. Among hypertensive populations, there were no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise. There was no detectable inconsistency between direct and indirect comparisons. Although there was evidence of small-study effects, this affected both medication and exercise trials.

Conclusions The effect of exercise interventions on SBP remains under-studied, especially among hypertensive populations. Our findings confirm modest but consistent reductions in SBP in many studied exercise interventions across all populations but individuals receiving medications generally achieved greater reductions than those following structured exercise regimens. Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications. Generalisability of these findings to real-world clinical settings should be further evaluated.

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Application of #mindfulness in a tier 3 obesity service improves eating behaviour and facilitates successful #weight-loss

https://academic.oup.com/jcem/advance-article/doi/10.1210/jc.2018-00578/5167368

There were statistically significant improvements (p=0.009) in self-reported eating behaviour (driven by improvements in ‘fast-foodism’ [p=0.031]) and reduction in body-weight (3.06kg [SD 5.2kg], p=0.002) at 6-months following completion of the group sessions. This was statistically more (p=0.036) than 6-month weight loss in control group (0.21kg). Participants reported improved self-esteem and confidence in self-management of body-weight.

Conclusion
Application of mindfulness-based eating behaviour strategies, taught at group sessions within a tier 3 obesity service, resulted in significant improvement in eating behaviour, and facilitated subsequent weight-loss over 6-months. Such a novel strategy has potential for scalability to the wider obese population.

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Diet #soft drink is associated with increased odds of proliferative diabetic #retinopathy

https://onlinelibrary.wiley.com/doi/epdf/10.1111/ceo.13154

.Results:Of the 609 participants (mean age stan-dard deviation: 64.6 11.6 years; males = 210),285 (46.8%) and 190 (31.2%) consumed diet andregular soft drink, respectively. A total of230 (37.8%), 36 (5.9%), 154 (25.3%), 28 (4.6%)and 146 (24.0%) had no DR, mild non-proliferative DR (NPDR), moderate NPDR, severeNPDR and proliferative DR (PDR), respectively.High diet soft drink consumption was indepen-dently associated with increased likelihood ofhaving PDR (odds ratio = 2.51, 95% confidenceinterval = 1.05–5.98), compared to no consump-tion. In contrast, regular soft drink was not associ-ated with DR or DME.Conclusions and Relevance:Consuming >4 cans(1.5 L)/week of diet soft drink is associated with amore than twofold risk of having PDR in patientswith diabetes. Longitudinal studies are needed tofurther elucidate the association and its underpinning mechanism

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#Fluoroquinolone Antibiotics: Safety Communication - Increased Risk of Ruptures or Tears in the #Aorta Blood Vessel in Certain Patients

https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm628960.htm

RECOMMENDATION:
Healthcare professionals should:

Avoid prescribing fluoroquinolone antibiotics to patients who have an aortic aneurysm or are at risk for an aortic aneurysm, such as patients with peripheral atherosclerotic vascular diseases, hypertension, certain genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome, and elderly patients.

Prescribe fluoroquinolones to these patients only when no other treatment options are available.

Advise all patients to seek immediate medical treatment for any symptoms associated with aortic aneurysm.

Stop fluoroquinolone treatment immediately if a patient reports side effects suggestive of aortic aneurysm or dissection.

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Persistent #fatigue induced by #interferon-alpha: a novel, inflammation-based, proxy model of chronic fatigue syndrome

https://www.sciencedirect.com/science/article/pii/S0306453018301963

Highlights

•Baseline fatigue is not associated with the development of persistent fatigue after IFN-α.

•IFN-α-induced persistent fatigue is associated with increased baseline IL-10.

•Patients who develop persistent fatigue experience greater increases in IL-6 and 10 in response to IFN-α.

•Persistently fatigued patients recover at a similar rate, but from a more severe acute response to the initial trigger.

•Once established, neither the persistent fatigue phenotype, nor CFS, are associated with peripheral immune activation.

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Association Between #Antidepressant Drug Use and Hip #Fracture in Older People Before and After Treatment Initiation

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2719274

Of the 408 144 people in the register who were included in the study, 257 486 (63.1%) were women, with a mean (SD) age of 80.1 (7.2) years. Antidepressant users sustained more than twice as many hip fractures than did nonusers in the year before and year after the initiation of therapy (2.8% vs 1.1% and 3.5% vs 1.3%, respectively, per actual incidence figures). In adjusted analyses, the odds ratios were highest for the associations between antidepressant use and hip fracture 16 to 30 days before the prescription was filled (odds ratio, 5.76; 95% CI, 4.73-7.01). In all separate analyses of age groups, of men and women, and of individual antidepressants, the highest odds ratios were seen 16 to 30 days before initiation of treatment, and no clear dose-response relationship was seen.

Conclusions and Relevance The present study found an association between antidepressant drug use and hip fracture before and after the initiation of therapy. This finding raises questions about the association that should be further investigated in treatment studies.

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Association between intake of non-sugar #sweeteners and #health outcomes: systematic review and meta-analyses of randomised and non-randomised controlle

https://www.bmj.com/content/364/bmj.k4718

To assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children.

..For all other outcomes, no differences were detected between the use and non-use of NSSs, or between different doses of NSSs. No evidence of any effect of NSSs was seen on overweight or obese adults or children actively trying to lose weight (very low to moderate certainty). In children, a smaller increase in body mass index z score was observed with NSS intake compared with sugar intake (−0.15, −0.17 to −0.12; two, n=528, moderate certainty of evidence), but no significant differences were observed in body weight (−0.60 kg, −1.33 to 0.14; two, n=467, low certainty of evidence), or between different doses of NSSs (very low to moderate certainty).

Conclusions Most health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Future studies should assess the effects of NSSs with an appropriate intervention duration. Detailed descriptions of interventions, comparators, and outcomes should be included in all reports.

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Persistent #vasomotor symptoms and #breast cancer in the Women's Health Initiative

https://journals.lww.com/menopausejournal/Abstract/publishahead/Persistent_vasomotor_symptoms_and_breast_cancer_in.97437.aspx

Results: Through 17.9 years (median) follow-up, 1,399 incident breast cancers were seen. Women with persistent VMS (VMS median duration 10+ years) (n = 9,715), compared to women with never VMS (n = 15,784), had a higher breast cancer incidence (hazard ratio HR 1.13 95% confidence interval CI 1.02-1.27). While breast cancer-specific mortality was higher in women with persistent VMS (HR 1.33 95% CI 0.88-2.02), the difference was not statistically significant. Persistent VMS status had no influence on breast cancer overall survival (HR 1.02 95% CI 0.81-1.29).

Conclusion: Women with persistent VMS are more likely to be diagnosed with breast cancer than women who never experienced VMS, but not more likely to die from breast cancer.

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The importance of measuring hand and foot #function over the disease course in #rheumatoid arthritis: An eight‐year follow‐up study

https://onlinelibrary.wiley.com/doi/10.1002/acr.23764

To assess function using the Signals of Functional Impairment (SOFI) instrument over eight years and to study clinical variables associated with the change. Also to study change over time of the SOFI items.

During the first year, there was a mean improvement in SOFI of 2.7 (SD 5.7) (p<0.001). Worse scores in DAS28 and HAQ at baseline were associated with this improvement (r2≤ 0.11). During the next seven years, there was a mean deterioration in SOFI of 1.5 (SD 4.9) (p<0.001). Based on change scores, finger flexion, pincer grip, and toe‐standing were the most important items to measure, explaining 58–61% of the total SOFI score and were also associated with radiographic changes at the eight‐year follow‐up.

Conclusion
Function as assessed with SOFI improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot tasks were associated with joint destruction at the eight‐year follow‐up. Measures of hand and foot function will complement self‐reported and medical data both in clinical work and in long‐term research studies.

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Reassessment of risk for #stroke During Follow-up of Patients With Atrial #Fibrillation

http://annals.org/aim/article-abstract/2720037/reassessment-risk-stroke-during-follow-up-patients-atrial-fibrillation?doi=10.7326%2fM18-1177

Background: International guidelines suggest that oral anticoagulants (OACs) can be omitted for patients with atrial fibrillation (AF) without a CHA2DS2-VASc score greater than 0 (men) or 1 (women) (1, 2). However, stroke risk is not static among patients with AF, and about 90% develop at least 1 new risk factor before presentation with ischemic stroke (3). Therefore, patients with AF who have a CHA2DS2-VASc score of 0 (men) or 1 (women) at baseline and acquire more comorbidities over time would no longer be “low-risk.”

Objective: To investigate incidence of an increase in CHA2DS2-VASc score to at least 1 (men) or 2 (women) among patients with newly diagnosed AF and a baseline score of 0 (men) or 1 (women).

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#ACTH Gel in Resistant Focal Segmental #Glomerulosclerosis After Kidney Transplantation.

https://www.ncbi.nlm.nih.gov/pubmed/29894413

Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab.

RESULTS:
We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were whites, and 8 (38%) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis and 10 (50%) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50%) patients achieved complete or partial remission.

CONCLUSIONS:
Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.

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One in 10 adults in US has #food #allergy, but nearly 1 in 5 think they do

https://www.eurekalert.org/pub_releases/2019-01/arh-oi1122718.php

..Researchers discovered that only half of adults with convincing food allergy had a physician-confirmed diagnosis, and less than 25 percent reported a current epinephrine prescription.

Researchers also found that nearly half of food-allergic adults developed at least one of their food allergies as an adult.

"We were surprised to find that adult-onset food allergies were so common," says Dr. Gupta. "More research is needed to understand why this is occurring and how we might prevent it."

The study data indicate that the most prevalent food allergens among U.S. adults are shellfish (affecting 7.2 million adults), milk (4.7 million), peanut (4.5 million), tree nut (3 million), fin fish (2.2 million), egg (2 million), wheat (2 million), soy (1.5 million), and sesame (.5 million).

Our data show that shellfish is the top food allergen in adults, that shellfish allergy commonly begins in adulthood, and that this allergy is remarkably common across the lifespan," says Dr. Gupta. "We need more studies to clarify why shellfish allergy appears to be so common and persistent among U.S. adults.

Peer #victimization and its impact on adolescent #brain development and psychopathology

https://www.nature.com/articles/s41380-018-0297-9

Chronic peer victimization has long-term impacts on mental health; however, the biological mediators of this adverse relationship are unknown. We sought to determine whether adolescent brain development is involved in mediating the effect of peer victimization on psychopathology.. Repeated measures ANOVA revealed time-by-victimization interactions on left putamen volume (F = 4.38, p = 0.037). Changes in left putamen volume were negatively associated with generalized anxiety (t = −2.32, p = 0.020).

Notably, peer victimization was indirectly associated with generalized anxiety via decreases in putamen volume (95% CI = 0.004–0.109). This was also true for the left caudate (95% CI = 0.002–0.099). These data suggest that the experience of chronic peer victimization during adolescence might induce psychopathology-relevant deviations from normative brain development. Early peer victimization interventions could prevent such pathological changes.

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#Commensals Suppress Intestinal Epithelial Cell #Retinoic Acid Synthesis to Regulate Interleukin-22 Activity and Prevent Microbial Dysbiosis

https://www.cell.com/immunity/fulltext/S1074-7613(18)30526-0?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1074761318305260%3Fshowall%3Dtrue

Retinoic acid (RA), a vitamin A metabolite, regulates transcriptional programs that drive protective or pathogenic immune responses in the intestine, in a manner dependent on RA concentration. Vitamin A is obtained from diet and is metabolized by intestinal epithelial cells (IECs), which operate in intimate association with microbes and immune cells.

Here we found that commensal bacteria belonging to class Clostridia modulate RA concentration in the gut by suppressing the expression of retinol dehydrogenase 7 ( Rdh7) in IECs. Rdh7 expression and associated RA amounts were lower in the intestinal tissue of conventional mice, as compared to germ-free mice. Deletion of Rdh7 in IECs diminished RA signaling in immune cells, reduced the IL-22-dependent antimicrobial response, and enhanced resistance to colonization by Salmonella Typhimurium.

Our findings define a regulatory circuit wherein bacterial regulation of IEC-intrinsic RA synthesis protects microbial communities in the gut from excessive immune activity, achieving a balance that prevents colonization by enteric pathogens

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How ‘#Dry January’ is the secret to better sleep, saving money and losing weight

https://m.sussex.ac.uk/news/all?id=47131

“The simple act of taking a month off #alcohol helps people drink less in the long term: by August people are reporting one extra dry day per week. There are also considerable immediate benefits: nine in ten people save money, seven in ten sleep better and three in five lose weight.

“Interestingly, these changes in alcohol consumption have also been seen in the participants who didn’t manage to stay alcohol-free for the whole month - although they are a bit smaller. This shows that there are real benefits to just trying to complete Dry January.”

The University of Sussex research showed that:

93% of participants had a sense of achievement;
88% saved money;
82% think more deeply about their relationship with drink;
80% feel more in control of their drinking;
76% learned more about when and why they drink;
71% realised they don’t need a drink to enjoy themselves;
70% had generally improved health;
71% slept better;
67% had more energy;
58% lost weight;
57% had better concentration;
54% had better skin.

The brilliant thing about Dry January is that it’s not really about January. Being alcohol-free for 31 days shows us that we don’t need alcohol to have fun, to relax, to socialise. That means that for the rest of the year we are better able to make decisions about our drinking, and to avoid slipping into drinking more than we really want to.

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Factors Associated With #Recurrence of Primary Biliary #Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival

https://www.gastrojournal.org/article/S0016-5085(18)35089-3/fulltext

PBC recurred in 22% of patients after 5 years and 36% after 10 years. Age at diagnosis <50 years (hazard ratio HR, 1.79; 95% CI, 1.36–2.36; P < .001), age at liver transplantation <60 years (HR, 1.39; 95% CI, 1.02–1.90; P = .04), use of tacrolimus (HR, 2.31; 95% CI, 1.72–3.10; P < .001), and biochemical markers of severe cholestasis (bilirubin ≥100 μmol or alkaline phosphatase >3-fold the upper limit of normal) at 6 months after liver transplantation (HR, 1.79; 95% CI, 1.16–2.76; P = .008) were associated with higher risk of PBC recurrence, whereas use of cyclosporine reduced risk of PBC recurrence (HR, 0.62; 95% CI, 0.46–0.82; P = .001). In multivariable Cox regression with time-dependent covariate, recurrence of PBC significantly associated with graft loss (HR, 2.01; 95% CI, 1.16–3.51; P = .01) and death (HR, 1.72; 95% CI, 1.11–2.65; P = .02).

Conclusions
Younger age at the time of diagnosis with PBC or at liver transplantation, tacrolimus use, and biochemical markers of cholestasis after liver transplantation are associated with PBC recurrence. PBC recurrence reduces odds of graft and patient survival. Strategies are needed to prevent PBC recurrence or reduce its negative effects.

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Microglia and #amyloid precursor protein coordinate control of transient #candida cerebritis with memory deficits

https://www.nature.com/articles/s41467-018-07991-4#ref-CR4

Bloodborne infections with Candida albicans are an increasingly recognized complication of modern medicine. Here, we present a mouse model of low-grade candidemia to determine the effect of disseminated infection on cerebral function and relevant immune determinants.

We show that intravenous injection of 25,000 C. albicans cells causes a highly localized cerebritis marked by the accumulation of activated microglial and astroglial cells around yeast aggregates, forming fungal-induced glial granulomas. Amyloid precursor protein accumulates within the periphery of these granulomas, while cleaved amyloid beta (Aβ) peptides accumulate around the yeast cells..

Mice infected with C. albicans display mild memory impairment that resolves with fungal clearance. Our results warrant additional studies to understand the effect of chronic cerebritis on cognitive and immune function

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Knee #osteoarthritis and #menopausal hormone therapy in postmenopausal women
a nationwide cross-sectional study

https://journals.lww.com/menopausejournal/Abstract/publishahead/Knee_osteoarthritis_and_menopausal_hormone_therapy.97442.aspx

The incidence of osteoarthritis (OA) increases after menopause, and may be related to hormonal changes in women. Estrogen deficiency is known to affect the development of OA, and menopausal hormone therapy (MHT) is suggested to be related to the development of OA. However, the relationship between knee OA and MHT remains controversial. The association between knee OA prevalence and MHT was investigated using large-scale national data.

Results: In the multiple logistic regression models, the OA odds ratio was 0.70 for the MHT group (95% confidence interval 0.50-0.99), compared with the non-MHT group.

Conclusions: The prevalence of knee OA was lower in participants with MHT than in those without MHT

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Draft Recommendation Statement
Hepatitis #B Virus Infection in Pregnant #Women: Screening

https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-b-virus-infection-in-pregnant-women-screening

Importance
Screening for HBV infection during pregnancy identifies women whose infants are at risk of perinatal transmission. Data from a nationally representative sample showed a prevalence of maternal HBV infection of 85.8 cases per 100,000 deliveries from 1998 to 2011 (0.09% of live-born singleton deliveries in the United States).1, 2 Although there are guidelines for universal infant HBV vaccination, rates of maternal HBV have increased annually by 5.5% since 1998.1, 2 Persons infected with HBV during infancy or childhood are more likely to progress to chronic infection. Chronic HBV infection increases long-term morbidity and mortality by predisposing infected persons to cirrhosis of the liver and liver cancer.

USPSTF Assessment
Using a reaffirmation process, the USPSTF concludes with high certainty that the net benefit of screening for HBV infection in pregnant women is substantial.

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Predictors of Clinically Significant #Echocardiography Findings in Older Adults with #Syncope: A Secondary Analysis

https://www.journalofhospitalmedicine.com/jhospmed/article/175074/hospital-medicine/predictors-clinically-significant-echocardiography

Regression analysis identified five predictors of significant findings: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%).

CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography.

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Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type #Calcium Channel Antagonists, and Biguanides With Rates of #Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2719703

Drug repurposing is potentially cost-effective, low risk, and necessary in psychiatric drug development. The availability of large, routine data sets provides the opportunity to evaluate the potential for currently used medication to benefit people with serious mental illness (SMI).

To determine whether hydroxylmethyl glutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), L-type calcium channel (LTCC) antagonists, and biguanides are associated with reduced psychiatric hospitalization and self-harm in individuals with SMI.

Conclusions and Relevance This study provides additional evidence that exposure to HMG-CoA RIs, LTCC antagonists, and biguanides might lead to improved outcomes for individuals with SMI. Given the well-known adverse event profiles of these agents, they should be further investigated as repurposed agents for psychiatric symptoms.