Death and Cardiac Arrest in U.S. #Triathlon Participants, 1985 to 2016: A Case Series
http://annals.org/aim/article/2654457/death-cardiac-arrest-u-s-triathlon-participants-1985-2016-case

A total of 135 sudden deaths, resuscitated cardiac arrests, and trauma-related deaths were compiled; mean age of victims was 46.7 ± 12.4 years, and 85% were male. Most sudden deaths and cardiac arrests occurred in the swim segment (n = 90); the others occurred during bicycling (n = 7), running (n = 15), and postrace recovery (n = 8). Fifteen trauma-related deaths occurred during the bike segment. In men, risk increased substantially with age and was much greater for those aged 60 years and older (18.6 per 100 000 participants). Death or cardiac arrest risk was similar for short, intermediate, and long races (1.61 vs. 1.41 vs. 1.92 per 100 000 participants). At autopsy, 27 of 61 decedents (44%) had clinically relevant cardiovascular abnormalities, most frequently atherosclerotic coronary disease or cardiomyopathy

Deaths and cardiac arrests during the triathlon are not rare; most have occurred in middle-aged and older men. Most sudden deaths in triathletes happened during the swim segment, and clinically silent cardiovascular disease was present in an unexpected proportion of decedents

Effect of Post– #Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among #Obese Women
A Randomized Clinical Trial
http://jamanetwork.com/journals/jama/article-abstract/2654382

The rate of obesity among US women has been increasing, and obesity is associated with increased risk of surgical site infection (SSI) following cesarean delivery. The optimal perioperative antibiotic prophylactic regimen in this high-risk population undergoing cesarean delivery is unknown

Participants were randomly assigned to receive oral cephalexin, 500 mg, and metronidazole, 500 mg (n = 202 participants), vs identical-appearing placebo (n = 201 participants) every 8 hours for a total of 48 hours following cesarean delivery Among 403 randomized participants who were included (mean age, 28 SD, 6 years; mean BMI, 39.7 SD, 7.8), 382 (94.6%) completed the trial. The overall rate of SSI was 10.9% (95% CI, 7.9%-14.0%). Surgical site infection was diagnosed in 13 women (6.4%) in the cephalexin-metronidazole group vs 31 women (15.4%) in the placebo group (difference, 9.0% 95% CI, 2.9%-15.0%; relative risk, 0.41 95% CI, 0.22-0.77; P = .01). There were no serious adverse events, including allergic reaction, reported in either the antibiotic group or the placebo group.

Conclusions and Relevance Among obese women undergoing cesarean delivery who received the standard preoperative cephalosporin prophylaxis, a postoperative 48-hour course of oral cephalexin and metronidazole, compared with placebo, reduced the rate of SSI within 30 days after delivery. For prevention of SSI among obese women after cesarean delivery, prophylactic oral cephalexin and metronidazole may be warranted

Hepatitis B virus #core -related antigen levels predict progression to liver #cirrhosis in hepatitis B carriers
http://onlinelibrary.wiley.com/doi/10.1111/jgh.13989/full

Several hepatitis B virus (HBV) markers have been identified as risk factors for progression to liver cirrhosis in patients with chronic HBV infection. We clarified the predictive impact of HBV markers on progression to cirrhosis in HBV carriers

Eighty-four patients progressed to cirrhosis (FIB-4 index >3.6) during the follow-up period. Hepatitis B surface antigen (HBsAg), HBV DNA, hepatitis B virus core-related antigen (HBcrAg), and basal core promoter (BCP) status, but not genotype and precure status, were significantly associated with progression to cirrhosis in univariate Cox proportional hazards models. Multivariate Cox proportional hazards models adjusted for HBV genotype, HBsAg, HBV DNA, HBcrAg, precore status, and BCP status indicated that HBsAg ≥3.0 log IU/ml (HR, 0.53; 95% confidence interval (CI), 0.30–0.94) and HBcrAg ≥3.7 log U/ml (HR, 3.28; 95% CI, 1.60–6.75) are independently associated with progression to cirrhosis. In the HR spline curve analysis, HR and 95% CI gradually increased as HBcrAg levels increased. Conversely, HRs and 95% CIs for HBsAg and HBV DNA did not show this tendency as their levels increased.
Conclusions

Elevated HBcrAg levels in HBV carriers increases the risk for progression to cirrhosis. HBcrAg is an excellent predictor of the development of cirrhosis

Serum #magnesium is associated with the risk of #dementia
http://m.neurology.org/content/early/2017/09/20/WNL.0000000000004517

To determine if serum magnesium levels are associated with the risk of all-cause dementia and Alzheimer disease Our study population had a mean age of 64.9 years and 56.6% were women. During a median follow-up of 7.8 years, 823 participants were diagnosed with all-cause dementia. Both low serum magnesium levels (≤0.79 mmol/L) and high serum magnesium levels (≥0.90 mmol/L) were associated with an increased risk of dementia (hazard ratio HR 1.32, 95% confidence interval CI 1.02–1.69, and HR 1.30, 95% CI 1.02–1.67, respectively).

Conclusions: Both low and high serum magnesium levels are associated with an increased risk of all-cause dementia. Our results warrant replication in other population-based studies

Childhood onset #inflammatory bowel disease and risk of #cancer: a Swedish nationwide cohort study 1964-2014
http://www.bmj.com/content/358/bmj.j3951

To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood bowel disease had first cancers, compared with 2256 (1.5 per 1000 person years) in the general population comparators (hazard ratio 2.2, 95% confidence interval 2.0 to 2.5).

Hazard ratios for any cancer were 2.6 in ulcerative colitis (2.3 to 3.0) and 1.7 in Crohn’s disease (1.5 to 2.1). Patients also had an increased risk of cancer before their 18th birthday (2.7, 1.6 to 4.4; 20 cancers in 9405 patients, 0.6 per1000 person years). Gastrointestinal cancers had the highest relative risks, with a hazard ratio of 18.0 (14.4 to 22.7) corresponding to 202 cancers in patients with inflammatory bowel disease. The increased risk of cancer (before 25th birthday) was similar over time (1964-1989: 1.6, 1.0 to 2.4; 1990-2001: 2.3, 1.5 to 3.3); 2002-06: 2.9, 1.9 to 4.2; 2007-14: 2.2, 1.1 to 4.2).

Conclusion Childhood onset inflammatory bowel disease is associated with an increased risk of any cancer, especially gastrointestinal cancers, both in childhood and later in life. The higher risk of cancer has not fallen over time

#Corticosteroids for treatment of sore #throat: systematic review and meta-analysis of randomised trials
http://www.bmj.com/content/358/bmj.j3887

To estimate the benefits and harms of using corticosteroids as an adjunct treatment for sore throat

10 eligible trials enrolled 1426 individuals. Patients who received single low dose corticosteroids (the most common intervention was oral dexamethasone with a maximum dose of 10 mg) were twice as likely to experience pain relief after 24 hours (relative risk 2.2, 95% confidence interval 1.2 to 4.3; risk difference 12.4%; moderate quality evidence) and 1.5 times more likely to have no pain at 48 hours (1.5, 1.3 to 1.8; risk difference 18.3%; high quality). The mean time to onset of pain relief in patients treated with corticosteroids was 4.8 hours earlier (95% confidence interval −1.9 to −7.8; moderate quality) and the mean time to complete resolution of pain was 11.1 hours earlier (−0.4 to −21.8; low quality) than in those treated with placebo.

The absolute pain reduction at 24 hours (visual analogue scale 0-10) was greater in patients treated with corticosteroids (mean difference 1.3, 95% confidence interval 0.7 to 1.9; moderate quality). Nine of the 10 trials sought information regarding adverse events. Six studies reported no adverse effects, and three studies reported few adverse events, which were mostly complications related to disease, with a similar incidence in both groups.

Conclusion Single low dose corticosteroids can provide pain relief in patients with sore throat, with no increase in serious adverse effects. Included trials did not assess the potential risks of larger cumulative doses in patients with recurrent episodes of acute sore throat

The Mortality and Myocardial Effects of #Antidepressants Are Moderated by Preexisting #Cardiovascular Disease: A Meta-Analysis
https://www.karger.com/Article/Abstract/477940

ADs disrupt multiple adaptive processes regulated by evolutionarily ancient biochemicals, potentially increasing mortality. However, many ADs also have anticlotting properties that can be efficacious in treating cardiovascular disease. We conducted a meta-analysis assessing the effects of ADs on all-cause mortality and cardiovascular events in general-population and cardiovascular-patient samples Seventeen studies met our search criteria. Sample type consistently moderated health risks. In general-population samples, AD use increased the risks of mortality (HR = 1.33, 95% CI: 1.14-1.55) and new cardiovascular events (HR = 1.14, 95% CI: 1.08-1.21). In cardiovascular patients, AD use did not significantly affect risks. AD class also moderated mortality, but the serotonin reuptake inhibitors were not significantly different from tricyclic ADs (TCAs) (HR = 1.10, 95% CI: 0.93-1.31, p = 0.27). Only “other ADs” were differentiable from TCAs (HR = 1.35, 95% CI: 1.08-1.69). Mortality risk estimates increased when we analyzed the subset of studies controlling for premedication depression, suggesting the absence of confounding by indication.

Conclusions: The results support the hypothesis that ADs are harmful in the general population but less harmful in cardiovascular patients

Efficacy of #individualised diets in patients with #irritable bowel syndrome: a randomised controlled trial
http://bmjopengastro.bmj.com/content/4/1/e000164

Patients with irritable bowel syndrome (IBS) are often placed on diets guided by food intolerance assays, although these have not been validated. We assessed the effects of individualised diets in patients with IBS guided by a leucocyte activation test

Peripheral venous blood was analysed using a leucocyte activation test; individual foods were reported to produce positive or negative results. Participants were randomised to a 4-week diet with either individualised guidance to eliminate foods with positive assay results and allow foods with negative assay results (intervention), or with individualised guidance, matched in rigour and complexity, to eliminate foods with negative assay results and allow foods with positive assay results (comparison)

The intervention group had significantly greater increases in mean GIS score after 4 weeks (0.86 vs comparison; 95% CI 0.05 to 1.67; p=0.04) and 8 weeks (1.22 vs comparison; 95% CI 0.22 to 2.22; p=0.02). The intervention group also had significantly greater reductions in mean SSS score at 4 weeks (–61.78 vs comparison; 95% CI –4.43 to –119.14; p=0.04) and 8 weeks (–66.42 vs comparison; 95% CI –5.75 to –127.09; p=0.03). There were no significant differences between intervention and comparison groups in mean AR or QOL scores. A reduction in neutrophil elastase concentration was associated with reduced symptoms.

Conclusions Elimination diets guided by leucocyte activation tests reduced symptoms. These findings could lead to insights into the pathophysiology of IBS

Particulate Matter Air #Pollution and the Risk of Incident CKD and Progression to #ESRD
http://m.jasn.asnjournals.org/content/early/2017/09/21/ASN.2017030253

Elevated levels of fine particulate matter <2.5 µm in aerodynamic diameter (PM2.5) are associated with increased risk of cardiovascular outcomes and death, but their association with risk of CKD and ESRD is unknown

In analyses of baseline exposure (median, 11.8 interquartile range, 10.1–13.7 µg/m3), a 10-µg/m3 increase in PM2.5 concentration was associated with increased risk of eGFR<60 ml/min per 1.73 m2 (hazard ratio HR, 1.21; 95% confidence interval 95% CI, 1.14 to 1.29), CKD (HR, 1.27; 95% CI, 1.17 to 1.38), eGFR decline ≥30% (HR, 1.28; 95% CI, 1.18 to 1.39), and ESRD (HR, 1.26; 95% CI, 1.17 to 1.35). In time-varying analyses, a 10-µg/m3 increase in PM2.5 concentration was associated with similarly increased risk of eGFR<60 ml/min per 1.73 m2, CKD, eGFR decline ≥30%, and ESRD. Spline analyses showed a linear relationship between PM2.5 concentrations and risk of kidney outcomes. Exposure estimates derived from National Aeronautics and Space Administration satellite data yielded consistent results.

Our findings demonstrate a significant association between exposure to PM2.5 and risk of incident CKD, eGFR decline, and ESRD

#Carbohydrate -last meal pattern lowers postprandial glucose and insulin excursions in type 2 #diabetes

http://drc.bmj.com/content/5/1/e000440

There are limited data regarding the timing of carbohydrate ingestion during a meal and postprandial glucose regulation

The incremental areas under the curve for glucose (iAUC0–180) and incremental glucose peaks were 53% and 54% lower, respectively, when carbohydrate was consumed last compared with carbohydrate consumed first (3124.7±501.2 vs 6703.5±904.6 mg/dL×180min, p<0.001; 34.7±4.1 vs 75.0±6.5 mg/dL, p<0.001) and 44% and 40% lower, respectively, compared with the all components together condition (3124.7±501.2 vs 5587.1±828.7 mg/dL×180min, p=0.003; 34.7±4.1 vs 58.2±5.9 mg/dL, p<0.001). Postprandial insulin excursions were lower (iAUC0–180: 7354.1±897.3 vs 9769.7±1002.1 µU/mL×min, p=0.003) and GLP-1 excursions higher (iAUC0–180: 3487.56±327.7 vs 2519.11±494.8 pg/mL×min, p=0.019) following the carbohydrate-last meal order compared with carbohydrate first.

Conclusion The carbohydrate-last meal pattern may be an effective behavioral strategy to improve postprandial glycemia

Does current #smoking predict future #frailty? The English longitudinal study of ageing
https://academic.oup.com/ageing/article/doi/10.1093/ageing/afx136/4062212/Does-current-smoking-predict-future-frailty-The

smoking is the single most preventable cause of morbidity and mortality. The evidence on independent associations between smoking in later life and incident frailty is scarce of 2,542 participants, 261 and 2,281 were current smokers and non-smokers, respectively. The current smokers were significantly frailer, younger, with lower BMI, less educated, less wealthy and lonelier compared with non-smokers at baseline. In multivariable logistic regression models adjusting for age and gender, current smokers were twice as likely to develop frailty compared with non-smokers (odds ratio (OR) = 2.07, 95% confidence interval (CI) = 1.39–3.39, P = 0.001). The association is attenuated largely by controlling for socioeconomic status. Smoking remains significantly associated with incident frailty in fully adjusted models including age, gender, socioeconomic status, alcohol use, cognitive function and loneliness (OR = 1.60, 95% CI = 1.02–2.51, P = 0.04). The relationship is however attenuated when taking account of non-response bias through multiple imputation.

Conclusions
current smokers compared with non-smokers were significantly more likely to develop frailty over 4 years among community-dwelling older people. Given that smoking is a modifiable lifestyle factor, smoking cessation may potentially prevent or delay developing frailty, even in old age