Primary Care Corner with Geoffrey Modest MD: SSRI use in pregnancy and birth defects

By: Dr. Geoffrey Modest A recent case-control analysis from the National Center on Birth Defects compared women who had children with birth defects to those without, to assess the association of the birth defects with specific SSRIs (selective serotonin reuptake inhibitors) taken from the month before pregnancy and through the third month of pregnancy ​(see BMJ 2015;350:h3190​). Details:  –17952 mothers […]

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Primary Care Corner with Geoffrey Modest MD: Marijuana passing through the generations…

By: Dr. Geoffrey Modest A pretty striking basic science article was recently published looking at the epigenetic effects of marijuana on rats, which seems to be inherited in the next generation (see doi:10.1038/npp.2015.155​).  There have been a slew of recent articles on marijuana suggesting that its adverse effects are more profound than many of us (myself included) […]

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Primary Care Corner with Geoffrey Modest MD: Extended anticoag for PE

By: Dr. Geoffrey Modest JAMA published the PADIS-PE trial of patients having a first unprovoked pulmonary embolism (PE), randomized to stopping anticoagulation after 6 months vs continuing an additional 18 months (see JAMA. 2015;314(1):31-40​). Details:  –371 patients (mean age 58, 40% >65yo, 50% women, mean BMI 27, 45% with high bleeding risk per the Am College of Chest Physicians […]

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Primary Care Corner with Geoffrey Modest MD: Implantable defibrillators post-MI

By: Dr. Geoffrey Modest A lead article in JAMA was a study of Medicare patients who had an MI with a low ejection fraction (EF) to see what % actually had a cardioverter-defibrillator (ICD) implanted and how the patients did (see JAMA. 2015;313(24):2433-2440). This was a retrospective observational study. Details: –10,381 patients had an MI with EF<35% from 441 US hospitals, […]

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Primary Care Corner with Geoffrey Modest MD: Metformin, CKD, and death

By: Dr. Geoffrey Modest  A rather unusual quick-and-dirty study was just published looking at the relationship between metformin use and mortality, as well as lactic acidosis, in those with severe chronic kidney disease, CKD. This study was based on a window of time until 2009, when metformin was used in Taiwan without restriction in those with renal disease (See doi.org/10.1016/S2213-8587(15)00123-0). The […]

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