Primary Care Corner with Geoffrey Modest MD: SGLT2 inhibitors for diabetes may cause ketoacidosis

By: Dr. Geoffrey Modest  The FDA just came out with a warning on the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors, including canagliflozin dapagliflozin, and empagliflozin (and the combo drugs including them) because of 20 cases of ketoacidosis. these drugs lead to increased urinary excretion of glucose, thereby lowering hemoglobin A1C. see here for the press release. findings of FDA:  –from March […]

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Primary Care Corner with Geoffrey Modest MD: Vitamin d and falls in the elderly???

By: Dr. Geoffrey Modest A recent article, which got some general press, looked at the utility of exercise and/or vitamin D in fall prevention in older women (see JAMA Intern Med. 2015;175(5):703-711). The backdrop here is that falls are common in the elderly, and 20% lead to injury requiring medical attention. A systematic review and […]

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Primary Care Corner with Geoffrey Modest MD: Celiac disease and neuropathy

By: Dr. Geoffrey Modest  Peripheral neuropathy has been associated with celiac disease in past studies, typically based in referral centers. The current population-based study in Sweden looked more systematically at the association (see doi:10.1001/jamaneurol.2015.0475​). As background, celiac disease is pretty common, with prevalence of about 1%, and peripheral neuropathy is present in 2-7% of the population. Details […]

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Primary Care Corner with Geoffrey Modest MD: Pertussis vaccine in adolescents and only transient immunity

By: Dr. Geoffrey Modest Here is a new analysis of Tdap vaccine effectiveness (VE) in the 2012 pertussis outbreak in Washington State (see DOI: 10.1542/peds.2014-3358). In a case-control study of adolescents born between 1993-2000, they correlated cases of pertussis in patients who had Tdap vaccination vs controls, matched by primary provider clinic and birth year. Those born between 1993-97 […]

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Primary Care Corner with Geoffrey Modest MD: Measles and immunosuppression

By: Dr. Geoffrey Modest  Of late, it seems that I have been mostly trashing immunization, specifically the pertussis component of Tdap. so, I thought I should highlight a really interesting (to me) article from the journal Science on the mysteries of the remarkably successful measles vaccine (see doi: 10.1126/science.aaa3662). Here is a brief review of the article. –mass measles vaccination […]

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Primary Care Corner with Geoffrey Modest MD: Cancer screening rates

By: Dr. Geoffrey Modest  MMWR just published the 2013 National Health Interview Survey (NHIS) on cancer screening rates, with targets established by Healthy People 2020 using the US Preventive Services Task Force guidelines (see here). Overall, there was not much improvement from 2010 to 2013 in breast, cervical or colorectal cancer (CRC) screening, and cervical cancer screening rates even declined. […]

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Primary Care Corner with Geoffrey Modest MD: Mammography screening, again, from another perspective

By: Dr. Geoffrey Modest This editorial is from Eric Topol, and raises concerns about the utility of mammography screening . one issue not addressed by him is primary prevention of breast cancer by decreasing environmental exposure to carcinogens: there are thousands of new chemicals developed in the US each year; historically many of them have […]

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