Daily Medical News

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: 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. 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. 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. 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 podcasts@mdedge.com or by following us on Twitter @MDedgeTweets.

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: podcasts@mdedge.com Interact with us on Twitter: @mdedgehemonc David Henry on Twitter: @DavidHenryMD     Relevant links: Big Data Abstract LBA1 Abstract LBA5563 Abstract 110 CancerLinQ Database Colorectal Cancer Abstract 3500 Abstract 3501 Pancreatic Cancer Abstract 4000 Abstract LBA4 Prostate Cancer Abstract LBA2 Lung Cancer Abstract 8504 Breast Cancer Abstract 500 Abstract 502 TAILORx Abstract 503 Health Informatics Abstract 6509 Abstract 6510 Multiple Myeloma Multiple Myeloma Abstracts Smoldering Myeloma Abstract 8000 Myeloma Abstract 8002 Abstract 8007

Today's top stories in clinical medicine.  Medical cannabis laws appear no longer tied to drop in opioid overdose mortality EULAR revises its RA management recommendations Aggressive lowering of LDL cholesterol: Is it a good thing? Residents are drowning in job offers -- and debt You can contact the MDedge Daily Medical News by emailing us at podcasts@mdedge.com or following us on Twitter at @MDedgeTweets

Today's top stories in clinical medicine.  Treat insomnia as a full-fledged disorder. Illinois law expands abortion rights. Consider iatrogenesis in patients with new psychiatric symptoms. Foot osteoarthritis: forgotten no longer. You can contact the MDedge Daily Medical News by emailing us at podcasts@mdedge.com or following us on Twitter at @MDedgeTweets.

Today's top stories in clinical medicine: Modest changes deemed inherent in 'normal' aging COPD exacerbations associated with poor sleep quality Genetic analysis links PCSK9 inhibition and CV mortality Obesity and overweight declined among lower-income kids You can contact the MDedge Daily Medical News by emailing us at podcasts@mdedge.com or following us on Twitter at @MDedgeTweets.  

Today's top stories: Chronic opioid use may be common in patients with ankylosing spondylitis Reducing pediatric RSV burden is top priority Less reactogenic acellular pertusses vaccine has waning immunity Nearly two-thirds of gynecologic oncology respondents experienced sexual harassment You can contact the MDedge Daily Medical News by emailing us at podcasts@mdedge.com or following us on Twitter at @MDedgeTweets.  

You can find more of our podcasts at http://www.mdedge.com/podcasts. Today's top stories in clinical medicine: Updated systematic review of aspirin for primary prevention shows benefits, risks. Estimated prevalence of OSA in the Americas stands at 170 million. How to reverse type 2 diabetes with a crash diet the DiRECT approach. Zeroing in on a key issue: SGLT2s or GLP-1s for elderly T2D? You can contact the MDedge Daily Medical News by emailing us at podcasts@mdedge.com or following us on Twitter at @MDedgeTweets.

You can find more of our podcasts on our website: http://www.mdedge.com/podcasts Today's top stories in clinical medicine: Coffee, tea, and soda all up GERD risk Warfarin boosts OS risk in Rotterdam Study mTORC1 inhibitor protects elderly asthmatics from viral respiratory infections NJ law, EMR alerts appear effective at reducing opioid prescriptions You can contact the MDedge Daily Medical News by emailing us at podcasts@mdedge.com or following us on Twitter at @MDedgeTweets.

Today in clinical medicine: Most measles cases in 25 years prompts government pleas to vaccinate Positive psoriatic arthritis screens occur often in psoriasis patients Sleep apnea is linked with tau accumulation in the brain Patients say primary care video visits are convenient, high quality You can contact the MDedge Daily News by emailing us at podcasts@mdedge.com or following us on Twitter at @MDedgeTweets.  

The 2019 annual Internal Medicine meeting of the American College of Physicians took place beginning April 10 in Philadelphia. MDedge Podcast host and producer Nick Andrews joined Internal Medicine News editor Katie Lennon to discuss a few of the biggest topics.  ACP 2019 highlights: Telemedicine update. Neuropathic pain update. Negotiating a strong contract. ACP launches quality improvement tools. You can contact the MDedge Daily news by emailing podcasts@mdedge.com or by following us on Twitter at @MDedgeTweets.  

Today, we’re bringing you a special episode featuring exclusive coverage from the annual meeting of the American Academy of Dermatology in Washington. 1. Food allergies and atopic dermatitis: What is the evidence? https://bit.ly/2CayGcp 2. Many common dermatologic drugs can be safely used during pregnancy. https://bit.ly/2HmZLfY 3. 31-GEP test predicts likelihood of metastasis for cutaneous melanoma. https://bit.ly/2NO3dkK 4. Bermekimab reduces lesions, cuts pain in patients with hidradenitis suppurativa. https://bit.ly/2H6NuNe Contact us: podcasts@mdedge.com

Contact us: podcasts@mdedge.com 1. CDC: United States has hit a plateau with HIV. https://bit.ly/2TokV3E 2. Fauci, Messonnier testify on measles outbreaks. https://bit.ly/2XqP3KO 3. Big pharma says it can’t drop drug list prices alone. https://bit.ly/2Xs92Zy 4. Barrett’s esophagus uncommon in patients with uncomplicated GERD. https://bit.ly/2VqKRJd

Contact us: podcasts@mdedge.com FDA panels back intranasal esketamine for refractory depression. http://bit.ly/2TOKrfp ONC aims to help doctors, patients with information sharing in proposed rule. http://bit.ly/2X3SVkP Survey: Health care costs unlikely to improve in 2019. http://bit.ly/2SwSIYJ Vaccination and antiviral treatment don't lower stroke risk after shingles. http://bit.ly/2tjYQVa

Contact us: podcasts@mdedge Automated office BP readings best routine measures https://www.mdedge.com/internalmedicinenews/article/193804/hypertension/automated-office-bp-readings-best-routine-measures   Positive FIT test should prompt colonoscopy https://www.mdedge.com/internalmedicinenews/article/193798/gastroenterology/positive-fit-test-should-prompt-colonoscopy   Mild aerobic exercise speeds sports concussion recovery https://www.mdedge.com/internalmedicinenews/article/193748/injuries/mild-aerobic-exercise-speeds-sports-concussion-recovery   Phase 3 studies of antiamyloid Alzheimer’s drug crenezumab stopped https://www.mdedge.com/psychiatry/article/193578/alzheimers-cognition/phase-3-studies-antiamyloid-alzheimers-drug  

Contact us: podcasts@mdedge.com Follow MDedge on Twitter: @MDedgeTweets In this special edition of the MDedge Daily News, Nick Andrews and Terry Rudd report the latest news from the 2018 annual San Antonio Breast Cancer Symposium. Stories include: using low-dose tamoxifen, the latest findings fro KATHERINE trial, results of a meta-analysis of neoadjuvant chemotherapy, and capecitabine in early stage triple negative breast cancer

Contact us: podcasts@mdedge.com The Postcall Podcast is available here: http://bit.ly/2QxXAHh Today's stories: Asking about a family's military service can improve pediatric care. http://bit.ly/2LYC91k Knee pathologies, including multiple meniscal tears, predict accelerated osteoarthritis. http://bit.ly/2TySGvt Poor-prognosis cancers linked to highest suicide risk in first year.  http://bit.ly/2CWavzh Nuedexta mainly prescribed for dementia, Parkinson's. http://bit.ly/2Rddrju  

U.S. life expectancy down; drug overdose, suicide up sharply http://bit.ly/2Sfcx2a Less-distressed patients are driving an increase in outpatient services. http://bit.ly/2QvSoYe ASH releases new VTE guidelines. http://bit.ly/2TVCy8n Commentary: NIH director expresses concern over CRISPR-cas9 baby claim. http://bit.ly/2QvSoYe

The MDedge Psychcast is new with Dr. John Rozel and a conversation on gun violence. ( TENS cuts fibromyalgia pain in large, randomized controlled trial.  Brisk walking may decrease total knee replacement risk in osteoarthritis.  Smoking neglected in patients with peripheral arterial disease. The American College of Physicians beefs up firearms policy.

MedPAC eyes 'incident to' billing.  (http://bit.ly/2AbQBP3) Stepdown to oral ciprofloxacin looks safe in gram-negative bloodstream infections. (http://bit.ly/2CKC0wx) Nasal cannula device may be an option for severe COPD. (http://bit.ly/2IX5aZR) Brexanolone injection quickly improves postpartum depression. (http://bit.ly/2CLuLVs)

Postcall Podcast: (http://bit.ly/2CfnY52) Suicide risk doubles in COPD patients who are taking benzodiazepines. (http://bit.ly/2yGVIVt) Feds say ACA's silver plan premiums will drop in 2019. (http://bit.ly/2ygRQLt) Bias in the clinical setting can impact patient care. (http://bit.ly/2CIqH89) Managing asthma in children: PEts don't always have to go.  (http://bit.ly/2IVYD1m)

Postcall Podcast: https://apple.co/2IeKD2y GARFIELD-AF registry: DOACs cut mortality 19% http://bit.ly/2CFwmfe Obesity paradox extends to PE patients http://bit.ly/2yvOILf Adjuvanted flu vaccine reduces hospitalizations in oldest old http://bit.ly/2ITnnHq Third trimester Tdap vaccination raises antibodies in newborns http://bit.ly/2Cb1Jx8

Guidelines outlines patient-centered approach to type 2 diabetes. (http://bit.ly/2Przga9) With more mindfulness, menopausal symptoms wane.  (http://bit.ly/2ybN2Hk) Employer health insurance: Deductibles rising faster than wages.  (http://bit.ly/2ybN2Hk) Delayed pushing during labor does not benefit mother or baby.  (http://bit.ly/2QC8sEq)

Bisphosphonate holiday may help reduce atypical femur fracture risk. (http://bit.ly/2QFvMkF) Most dermatologic drugs safe for breastfeeding mothers. (http://bit.ly/2C7VLgn) 'Twincreatin' produces 'impressive' HbA1c, weight control in T2DM. (http://bit.ly/2RBRIyp) Short-term NSAIDs appear safe for high-risk patients.(http://bit.ly/2ONpv9e)

Half of outpatient antibiotics prescribed with no infectious disease code.https://www.mdedge.com/internalmedicinenews/article/176602/practice-management/half-outpatient-antibiotics-prescribed-no How to vaccinate patients on biologics.https://www.mdedge.com/internalmedicinenews/article/176611/vaccines/how-vaccinate-patients-biologics Opiate use tied to hepatitis C risk in youth.https://www.mdedge.com/internalmedicinenews/article/176570/hepatitis/opiate-use-tied-hepatitis-c-risk-youth In rosacea, a single treatment may not be enough.https://www.mdedge.com/internalmedicinenews/article/176604/rosacea/rosacea-single-treatment-may-not-be-enough

FDA expands approval of 9-valent HPV vaccine to include men and women aged 27 - 45.  http://bit.ly/2zYfcHj Allergen of the year may be closer than you think.  http://bit.ly/2y6FllH Encourage influenza vaccination in pregnant women. http://bit.ly/2NtitBC Sunscreens: Misleading labels, poor performance, and more. http://bit.ly/2y50M6G 

Sexual assault and harassment and the impact they have on women’s health. Also today, experts recommend anti-TNFs to for severe psoriasis in pregnancy, the FDA approves first-of-its-kind lung disease treatment, and do you know what the rive ontological emergencies are?

PCV13 shows moderate overall effectiveness for preventing invasive pneumococcal disease caused by PCV13 vaccine serotypes in adults 65 years and older (http://bit.ly/2QtUXGW). Also today, ED visits that are related to psychiatric complaints are up 20 among elderly (http://bit.ly/2xVmmus), nonobstructive angina should trigger functional testing (http://bit.ly/2Nk6TJk), and antibiotics trigger proteolytic activity that leads to chronic colitis (http://bit.ly/2zP0n9P).

Around one-half of women and, one-third of men will eventually develop dementia, stroke, or parkinsonism during their lifetime (http://bit.ly/2OxI0yh0). Also today, trivalent adjuvant influenza vaccine aIIV3 is safe in elderly adults (http://bit.ly/2P6MWqY) , pill burden affects the ability to reach systolic BP control (http://bit.ly/2P5LOUy), and breast cancer risk in type 2 diabetes related to adiposity (http://bit.ly/2NiOsVf).

Using aspirin across the board is not justified based on results of the ASPREE trial as well as on the equivocal results from other recent primary prevention trials (http://bit.ly/2Ophib1). Also today, swings in four metabolic measures predicted death in healthy people (http://bit.ly/2y4StXQ), anticoagulation plus single antiplatelet fails noninferiority measure 1 year after stenting (http://bit.ly/2Iuohdm), and Behavioral checklist identifies children at risk of depressive and/or anxiety disorders (http://bit.ly/2xRdHJr).

Hayden Bosworth, PhD has advice on how to get on top of home BP monitoring and how it can be clinically relevant (http://bit.ly/2QkMllQ). Also today, opioid use in osteoarthritis may mean more activity-limiting pain (http://bit.ly/2QlQqWN), sulfasalazine is pinpointed as the reason for high triple-therapy discontinuation (http://bit.ly/2DIyqoc), and point-of-care test for respiratory viruses lowers antibiotic use (http://bit.ly/2xRiLNM).

The National Foundation for Infectious Diseases advocates for vaccination for influenza (http://bit.ly/2N8ZRXE). Also today, the U.S. House and Senate agree on a broad opioid legislation (http://bit.ly/2OQ9lsh), a computerized tool could ease decision-making for lupus (http://bit.ly/2xXRrwA), and a proposed change to Part B drug reimbursement draws more fire from physician organizations (http://bit.ly/2QgYS9T).

Signs point to growing abuse of gabapentinoids in the United States. Short sleep is linked to elevated blood pressure. Another large trial shows CT screening reduces lung cancer deaths. And atrial fibrillation guidelines may miss the mark with oral anticoagulation.

A pediatric psychiatric consult for adolescent and adult ADHD by Sarah E. Guth, MD (http://bit.ly/2IiA6Dy). Also today, prosthesis-patient mismatch post TAVR ups the risk of death by 19% (http://bit.ly/2zshtdw), residents help to curb the overuse of IV antibiotics in children (http://bit.ly/2IhySsg), and both age and other risk factors ought to guide chlamydia and gonorrhea screening for women infected with HIV (http://bit.ly/2ztaT6E).   You can subscribe to the Postcall Podcast ahead of the first episode (https://apple.co/2IeKD2y)

Ketamine may be helpful in central sensitization pain syndromes (http://bit.ly/2O5TN6F). Also today, trifarotene cream for acne meats all endpoints in twin phase 3 trials (http://bit.ly/2xJ5GGz), the pros and cons of gastric bypass surgery for patients with type 2 diabetes (http://bit.ly/2OOam4m), and it looks like obesity plays a role in sleep-disordered breathing for pregnant women (http://bit.ly/2px9yWr).

Bleeding from rivaroxaban may help diagnose some GI and GU cancers (http://bit.ly/2O6YfCf [Cardiocast: http://bit.ly/2xJNOdv]). Also today, a review by the FDA supports the safety of nuplazid (http://bit.ly/2pxT5Bw), arthritis is prevalent in older adults with any degree of depression (http://bit.ly/2xxTXug), and growth in overdose deaths is exponential (http://bit.ly/2xIHG5xf).

Dr. Joseph Murray of the Mayo Clinic points out that you might know as much about celiac as you think (http://bit.ly/2preFr4). Also today, a novel agent shows unprecedented efficacy in psoriasis (http://bit.ly/2MLLE2I), IgA vasculitis may be more common in adults than you think (http://bit.ly/2DeXTFC), and one-step gestational diabetes screening doesn’t improve outcomes (http://bit.ly/2xy7VLM).

The U.S. Preventative Services Task Force advises clinicians to refer or offer intensive behavioral weight-loss interventions to obese adults (http://bit.ly/2DbYO9F). Also today, stop treating gout and start curing it (http://bit.ly/2QIhaBO) the FDA has a new risk evaluation mitigation strategy for immediate-release opioids (http://bit.ly/2Df9AvY), and the United Nations aims to eradicate tuberculosis by the year 2030 (http://bit.ly/2DenEFN).

Researchers found evidence of impaired white matter integrity on MRI in a handful of hypertensive children similar to what is found in adults with cognitive impairment from hypertension (http://bit.ly/2NR9MWc). Also today, predictors for worse outcomes in low–disease activity RA remain tough to come by (http://bit.ly/2MMZ4M1), elevated type 2 diabetes risk seen in PsA patients (http://bit.ly/2NjOAZo), and new European hypertension guidelines target most adults to less than 130/80 mm Hg (http://bit.ly/2OAmLsv).

Most patients with type 2 diabetes stop taking their medication within a year, and nearly one-third stop within the first 3 months (http://bit.ly/2QD0U4U). Also today, the FDA approves Ajovy for migraine prevention(http://bit.ly/2Nhbxwq), some teens are using cannabis in their vapor devices (http://bit.ly/2pekqs7), and alpha-blocker use is still common and still risky (http://bit.ly/2No2QAE).

More than half of patients who were tested for prescription drug compliance last year misused their medications (http://bit.ly/2xpqou1). Also today, obesity prevalence is now at least 35% in 7 states(http://bit.ly/2NLI3WW), the FDA has a new plan to combat antibiotic resistance (http://bit.ly/2MCBykL), and what will come of all the comments about the new E/M payment proposals (http://bit.ly/2xryMZM).

Physician burnout may jeopardize patient care. The FDA cracks down on companies selling an increasingly popular, unproven alternative to opioids. Multiday seizure cycles in epilepsy may be quite common. And new stroke guidelines raise the bar on mechanical thrombectomy procedures.

One-quarter of emergency department sprained ankle diagnoses result in an opioid prescription. How secondhand smoke in childhood leads to COPD deaths in adulthood. A potential contender to treat antibiotic-resistant blood poisoning falls flat. And be on the lookout for a nasty skin souvenir on international travelers.

Tai chi tempers the risk of falls in older adults. Rosacea’s global reach may be greater than expected. How an MRI at prostate cancer diagnosis shapes disease management. And new guidelines debut for diagnosing and treating mild traumatic brain injury in children.

Why composite risk, not age, is key for timing a patient’s first colorectal cancer screening. EULAR updates its hand osteoarthritis management recommendations for the first time in more than a decade. Why the right medication starting dose shapes success in treating anxiety disorders. And how to avoid fraud and abuse hot spots in your telemedicine ventures.

Fluoroquinolones are recommended for adults with cancer-related immunosuppression. Also today, statins are not preventative in the elderly unless they have diabetes, children born from ART have risk for arterial hypertension, and Supreme Court nominee Judge Kavanaugh testifies on Roe v. Wade.

Single-dose influenza drug baloxavirhas similar efficacy to oseltamivir, according to new data in the New England Journal of Medicine. Also today, the relationship between obstructive sleep apnea and gout, community-based therapy for asthma in African American teens, and the importance of hospital settings for pneumonia.