The top stories you need to know for summer vacation season. 

1. Sunscreen ingredients found in bloodstream, but health impact unknown
   But are serum evaluations of topically applied sunscreen ingredients clinically relevant?
2. Tick-borne disease has become a national issue
   Seven new tick-borne pathogens were discovered or introduced between 2004 and 2016.
3. 'Tis the season -- for fireworks injuries
   Children aged 10-14 years have the highest rate of fireworks-related injuries treated in emergency departments.
4. Cryptosporidiosis infections spike during summer swim season
   Outbreaks of cryptosporidiosis have continued to rise in the United States over the past decade. 

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

Today's top story:

Could some elderly skip statins based on negative risk markers?

by Andrew D. Bowser

Elderly patients with no or low CAC, low galectin-3, or no carotid plaque have a low risk of atherosclerotic cardiovascular disease.

Source: The Journal of the American College of Cardiology (Volume 74, Issue 1, 9 July 2019, Pages 1-11). You can read the academic source by clicking here. 

Other top headlines from around MDedge:

1. Risk of cardiac events jumps after COPD exacerbation
   Acute COPD exacerbations are associated with an increased risk of major adverse cardiac events in the 4 weeks after the exacerbation.
2. Claims data suggest endometriosis ups risk of chronic opioid use
   Women with endometriosis had a nearly 4-fold higher rate of chronic opioid use compared with those without endometriosis.
3. VOC-sniffing necklace may support early detection of hypoglycemia
   The device performs the same trick as diabetes alert dogs -- minus the pup.
4. Increased cancer death linked to radioactive iodine therapy
   Radioactive iodine therapy is associated with a dose-dependent increase in the risk of death from solid cancers, particularly breast cancer. 

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

Daily medicine news for 07/02/2019

Helping patients stay with their diabetes regimens: Communicate, educate, and use technology

Physicians offer insight and advice on helping patients with diabetes take their medications as directed.

Other top stories from around MDedge:

1. Surprise! High-fat dairy may protect against metabolic syndrome
   People who consumed whole milk/high-fat dairy were significantly less likely to develop metabolic syndrome.
2. Long-term trend: Women receiving fewer pelvic exams
   The percentage of women receiving pelvic exams fell significantly from 1988 to 2017.
3. CAROLINA findings reaffirm linagliptin's safety, free glimepiride of CV-risk stigma 
   There are still concerns about glimepiride-related weight gain and hypoglycemia.
4. ACIP approves meningococcal booster for persons at increased risk
   The committee recognizes the challenges of meningococcal outbreaks on college campuses.

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

The top story in medicine:

Infections linked with transition to psoriatic arthritis

In women, these associations included salmonella infection, sepsis, and uveitis; in men, they included gangrene, encephalitis, and hidradenitis suppurativa.

Other top stories from around MDedge:

1. ACIP approves flu vaccine recommendations for 2019-2020 season
2. ACIP endorses catch-up hepatitis A vaccinations
3. FDA issues warning to insulin pump cybersecurity weakness
4. Siblings of bipolar disorder patients at higher cardiometabolic disease risk

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

The top story in medical news:

An automated immunoassay predicts amyloid status with similar accuracy in all stages of Alzheimer's disease

Other top headlines from around MDedge:

Inhaled corticosteroid use may reduce lung cancer risk in patients with COPD

Exposure to inhaled corticosteroids was associated with a reduced risk of developing lung cancer in patients with chronic obstructive pulmonary disease.

More than half of U.S. adults have never received HIV screening
The rate of HIV screening remains suboptimal in the United States, especially in rural areas with disproportionately high rates of the disease.

Almost half of Americans express doubts about vaccines

Close to half of American adults say that they have some doubt about the safety and efficacy of vaccines.

Orthopedic complications in sickle cell disease require prompt action

Orthopedic crises are common in patients with sickle cell disease, and consultation with an orthopedic surgeon is an important part of disease management.

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

The top story in clinical medicine:

New findings suggest that SGLT2 and GLP-1 drugs have no effect on cardiovascular outcomes for black patients with type 2 diabetes. However, the analysis comes with important limitations.

Click here to read the full story.

The data were reported by Basem Mishriky, MD, who is a clinical assistant professor in the department of internal medicine at Eastern Carolina University Brody School of Medicine. 

Source: Presentation at the 2019 annual scientific sessions of the American Diabetes Association 

The top news from around MDedge:

1. Significant declines in HPV infections, CIN2+, and anogenital warts have occurred after the introduction of HPV vaccine programs, some because of herd effects.
2. Medicare Advantage may have worse hospital readmission rates than traditional Medicare.
3. About 1 in 4 youths prescribed stimulants also use the drugs nonmedically.
4. Patient education and fewer tablets prescribed significantly reduced the number of opioid tablets taken compared with no education. 

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

Medical cannabis legalization is outpacing medical evidence. So, how should health care providers handle patients' requests for cannabis treatment? You can find the story by clicking here. 

Other top stories in medicine from MDedge. 

1. Measles incidence has slowed as summer begins
New York continues to be the measles hot spot, with more than half of the new cases last week occurring there.

2. Penicillin-susceptible Streptococcus pneumoniae most common cause of bacteremic CAP
Narrow-spectrum aminopenicillins should be used specifically to treat children hospitalized from suspected bacterial CAP.

3. Two trials support shorter DAPT without aspirin after stent
The results back dual-antiplatelet therapy with a twist: continuing a P2Y12 inhibitor instead of aspirin.

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

Today's top stories in medicine:

Patients concerned about clinician burnout Burnout among health care providers was concerning to 74% of 2,007 survey respondents. Just over half said that they could tell when a provider was burned out, and 80% felt that the quality of their care was affected when their provider was burned out.

Food insecurity tied to migraine in young adults 
Data were collected from a cross-sectional, nationally representative set of 14,786 young adults in the United States aged 24-32 years who participated in the 2008 National Longitudinal Study of Adolescent to Adult Health. In all, 1,647 study participants (11%) reported food insecurity; the prevalence of migraine in this group was 23.9%, compared with a prevalence of 13.6% in participants who did not report food insecurity.
Source: JAMA Neurology. 2019 June 24. doi: 10.1001/jamaneurol.2019.1663

Anticholinergic drugs linked to dementia in older populations 
A large pharmacoepidemiologic study found an association between anticholinergic drug exposure and dementia risk in people aged 55 years or older. This was a nested case-control study of 58,769 patients with dementia and 225,574 matched controls. Prescription data related to 56 different drugs with strong anticholinergic properties, Exposure to antipsychotics (adjusted odds ratio, 1.70), bladder antimuscarinics (aOR, 1.65), antiepileptics (aOR, 1.39), antiparkinson agents (aOR, 1.52), and anticholinergic antidepressants (aOR, 1.29) was associated with an increased risk of dementia.
Source: JAMA Internal Medicine 2019 June 24, doi: 10.1001/jamainternmed.2019.0677

Imaging remission decried as ticket to RA overtreatment
The case for using ultrasound or MR to find inflammatory signatures in joints that can function as treatment targets collapsed earlier in 2019 with publication of results from IMAGINE-RA (An MRI-guided Treatment Strategy to Prevent Disease Progression in Patients With Rheumatoid Arthritis), a multicenter Danish study that randomized 200 RA patients in remission to either a conventional, disease activity-guided treatment target (in this case the DAS28-CRP [Disease Activity Score in 28 joints plus C-reactive protein]), or a treatment target that included the conventional clinical target plus treating to eliminate any bone marrow edema visualized by MRI. After 24 months of treatment, the prevalence of clinical remission and MRI remission was about the same in both arms, with no statistically significant differences. But serious adverse events in 6 patients managed by their clinical assessment compared favorably against 17 among those managed to an imaging remission endpoint, a difference that strongly hinted at dangerous overtreatment of the imaging-guided patients. 

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

Today's top story: Levothyroxine did not reduce fatigue in older patients with hypothyroidism by Jeniffer Reising.

The study was presented at the 2019 annual meeting of the Society of General Internal Medicine in Washington. In this study, researchers used subsets of data from the TRUST. You can find more about the TRUST study by clicking here.  

In this study, researchers used the Pittsburgh Fatigability Scale  abbreviated in the story as PFS. You can learn more about the PFS by clicking here.

Other top stories in medical news today:

1. Appeals court allows Title X restrictions to take effect
2. Bisphosphonates before denosumab may prevent postdenosumab BMD rebound effect
3. COPD rates reflect current smoking prevalence

Data from the top story

Physical PFS (P = 0.88)

• Levothyroxine Group:
  • Baseline = 14.7 ± 9.3
  • 12-month = 14.8 ± 9.6
• Placebo:
  • Baseline: = 11.1 ± 9.1
  • 12-month =  12.4 ± 9.3
• Difference = 0.2 (95% CI, -1.8 to 2.1)

Mental PFS (P = 0.26):

• Levothyroxine Group:
  • Baseline = 7.4 ± 8.0
  • 12-month = 6.0 ± 7.8
• Placebo:
  • Baseline = 5.1 ± 6.9
  • 12-month = 6.0 ± 8.0
• Difference = -1.0 (95% CI, -2.8 to 0.8)

SPECIAL Crossover with Blood & Cancer, the official podcast of MDedge HematologyOncology.

You can learn more about Blood & Cancer at http://www.mdedge.com/podcasts/blood-cancer

SHOW NOTES:

Alan P. Lyss, MD, a medical oncologist in community practice at Missouri Baptist Medical Center in St. Louis, joins Blood & Cancer host David H. Henry, MD, of the University of Pennsylvania, Philadelphia, to break down the most interesting and practice-changing studies at the recent 2019 annual meeting of the American Society of Clinical Oncology.

Complete show notes by Ronak H. Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia, are available online here.

For more MDedge podcasts, go to mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @mdedgehemonc

David Henry on Twitter: @DavidHenryMD

Relevant links:

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• Colorectal Cancer
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• Health Informatics
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• Multiple Myeloma
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