Ketogenic diets are what’s cooking for drug-refractory epilepsy

Story by Bruce Jancin, reporting from the International Epilepsy Congress.

There are new developments in a long-established form of epilepsy therapy.

Other top stories:

1. Possible role of enterovirus infection in acute flaccid myelitis cases detected High levels of enterovirus peptides were found in the cerebral spinal fluid of individuals with AFM.

2. Maternal factors impact childhood skin microbiota Factors including delivery method and breastfeeding influenced the bacterial composition of children’s skin up to age 10 years.

3. Asthma hospitalization in kids linked with doubled migraine incidence Data from 11 million U.S. pediatric inpatients showed a doubled rate of migraine diagnoses among kids hospitalized for asthma.

4. Signals of gut microbiome interaction with experimental Alzheimer’s drug prompt new trial The first reporting of microbiome data in an Alzheimer’s drug trial opens the door for further investigation.

You can contact the MDedge Daily Medical News team by emailing us at [email protected], or by following us on Twitter at @MDedgeTweets.

PCPs play role in identifying severe, difficult-to-treat asthma

Story by Jeff Craven, reporting from the Cardiovascular & Respiratory Summit by Global Academy for Medical Education.

Primary care providers are seeing patients with severe asthma and should learn to recognize and diagnose these patients.

Other top stories:

1. Midlife hypertension is associated with subsequent risk of dementia Elevated blood pressure in midlife is associated with risk of subsequent dementia, but whether the risk is treatable is unclear. 

1. Study: Cardiac biomarkers predicted CV events in CAP The results suggest a change in usual practice is needed to reduce cardiovascular community-acquired pneumonia complications. 

1. Treatment of episodic cluster headache deviates from recommendations Among patients with episodic cluster headache, use of acute medications is high, but use of preventive medications is low. 

1. Procalcitonin advocated to help rule out bacterial infections Use of procalcitonin may help decrease lumbar punctures and antibiotic exposure.

You can contact the MDedge Daily Medical News team by emailing us at [email protected] or by following us on Twitter @MDedgeTweets. 

Is a rigid HPV vaccination schedule really necessary? Story by Bruce Jancin, reporting from the annual meeting of the European Society for Pediatric Infectious Diseases.

Delayed administration of the second dose of an HPV vaccine had no negative impact on the magnitude of the immune response.

Other top stories:

1. Women are underrepresented as lead authors in oncology trials 

   The proportion has been increasing but still lags behind the proportion of female oncologists in the United States.

2. Dupilumab found effective for adolescents with moderate to severe AD 

   Rates of skin infections were higher in the placebo group, compared with the treatment groups.

3. Exposure to outdoor air pollutants linked to increased emphysema 

   Being exposed to outdoor air pollutants was associated with increases in emphysema as assessed via CT imaging.

4. Favorable Ebola results lead to drug trial termination, new focus 

   Two of four therapeutics showed greater survival, prompting termination of the initial trial and randomization of new patients to these two drugs.

You can contact the MDedge Daily Medical News team by emailing us at [email protected] or by following us on Twitter @MDedgeTweets.

Beyond sunscreen: Skin cancer preventive agents finding a role
by Ted Bosworth, reporting from the 2019 annual summer meeting of the American Academy of Dermatology.

A growing list of skin cancer chemopreventive agents is expanding options for risk management.

Other top stories:

1. Mediterranean diet improves cognition in patients with type 2 diabetes
   The association was significant in those with effective glycemic control. 
2. Quarterly intravenous eptinezumab prevents migraine
   Results from a pair of dose-ranging, randomized studies showed one IV eptinezumab dose cut migraine recurrences for 3 months.
3. Oral semaglutide monotherapy delivers HbA1c improvements in type 2 diabetes compared with placebo
   Adult patients with type 2 diabetes showed significant improvements in HbA1c compared with placebo.
4. Ambulatory BP monitoring slightly better than in-office measures for predicting cardiovascular outcome
   It's probably best to save these techniques for specific patients.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Undiagnosed COPD may change heart function before heart attacks occur
by Michele B. Sullivan

Screening patients admitted for acute coronary syndromes with respiratory measures could identify those at risk for undiagnosed COPD. 

Source: COPD: Journal of Chronic Obstructive Pulmonary Disease 

Other top stories:

1. Medical societies urge action to reduce gun violence
   Comprehensive criminal background checks for all firearm purchases, freedom to counsel patients are key asks.
2. Lancet joins movement to reject 'manels'
   The Lancet Groups also issued a diversity pledge, aiming to include more women, people of color, and colleagues from lower-and middle-income countries. 
3. Sleep disorder treatment tied to lower suicide attempt risk in veterans
   Previous research has explored the link between sleep disturbances and suicide attempts, but less has been done to look at specific sleep problems.
4. White and black patients have similar rates of giant cell arteritis
   A new study with a larger sample size of black individuals puts previous findings into question.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Urine albumin testing is crucial for patients at risk for CKD, but drop the 24-hour urine test
by Randy Dotinga

An update on diagnosing, managing, and treating patients with comorbid hypertension and diabetes.

Other top stories:

1. NSAIDs a significant mediator of cardiovascular risk in osteoarthritis
   NSAID use could be responsible for a significant proportion of the increased risk of cardiovascular disease associated with osteoarthritis.
2. Vitamin D supplementation may improve ulcerative colitis
   The findings are based on a placebo-controlled trial involving 60 patients with active disease.
3. FDA panel backs Descovy as HIV PrEP for men and transgender women who have sex with men
   The panel balked at endorsing the combo for PrEP for cisgender women, who weren't included in the clinical trial.
4. Sleep aids and dementia: Studies find both risks and benefits
   An update on diagnosing, managing, and treating patients with comorbid hypertension and diabetes.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

mRNA technology for respiratory vaccines impresses

First-ever mRNA vaccines against avian H10N8 and H7N9 influenza viruses show favorable safety and immunogenicity. 

Other top stories:

1. CDC finds that too little naloxone is dispensed
   Many patients at risk for overdose are not offered the potentially life-saving treatment, according to an analysis of national retail pharmacy data.
2. USPSTF reaffirms recommendation against pancreatic cancer screening in asymptomatic adults
   The task force reaffirmed its 2004 guideline against screening in asymptomatic adults.
3. When normal urinalysis is a red flag
   Experts zeroed in on three presenting features as potential predictors of invasive bacterial infection outcomes.
4. Benzodiazepines, hypnotics don't increase Alzheimer's pathology
   The drugs were not associated with Alzheimer's pathology, but were associated with a trend toward greater loss of neurons in the nucleus basalis.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

COPD adds complexity to shared decision making for LDCT lung cancer
Current guidelines stress the importance of shared decision making, with discussion of the risks and benefits of screening.

Other top medical news:

1. Survey: Burnout gets personal for 68% of physicians
   Young primary care providers, beware. 
2. Antiepileptic drug outcomes have remained flat for 3 decades
   Dr. Martin J. Brodie says, "We don't treat the whale; we treat the spout."
3. Lynch syndrome screening shows low efficiency in elderly
   And discontinuing reflex CRC screening for Lynch syndrome in patients over the age of 80 could be feasible.
4. The states of health care: Ranking the best and worst
   Minnesota has more than just 10,000 lakes to brag about, the results of a WalletHub analysis suggest.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Older patients who stop statins may be increasing their cardiovascular risk

Discontinuation of statins was associated with an increased risk of hospital admission for a cardiovascular event. 

Other top stories:

1. Physicians who receive coaching are less exhausted, less likely to burn out
   Physicians who received 3.5 hours of professional coaching sessions had lower levels of emotional exhaustion and overall burnout.
2. Too many blood cultures ordered for pediatric SSTIs
   Culture draws were associated with a 20% increase in hospital length of stay.
3. Atogepant shows safety, efficacy for migraine prevention
   Atogepant is the first drug from its small-molecule class to undergo advanced clinical testing for migraine prevention.
4. Poll: Medicare-for-all sees slight drop in support
   Public option currently has higher favorability than Medicare-for-all.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Critics say hospital price transparency proposal 'misses the mark'

by Gregory Twachtman

The proposal from CMS would require hospitals to make public both their list prices and the prices they negotiate with payers. 

Other top stories:

1. AI technology meets AFib detection
   An AI-enabled ECG model suggests clinical implications for early identification of atrial fibrillation.
2. Placental bacteria not linked to adverse pregnancy outcomes
   But the researchers found significant associations between delivery-associated vaginal bacteria and preeclampsia and preterm birth.
3. Posttraumatic headache may be associated with reduced pain thresholds
   Symptoms of photophobia and allodynia are more severe in patients with posttraumatic headache, compared with healthy controls.
4. Higher dietary vitamin A linked to lower SCC risk
   The results of the large prospective cohort study support "the protective role of vitamin A against squamous cell carcinoma development."

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.