PulmCrit – Hydroxychloroquine fails first meaningful RCT

This is now the third anti-viral therapy to disappoint us within a few weeks (preliminary data on lopinavir/ritonavir and remdesivir were both unimpressive). This raises a question of whether any anti-viral therapies will be beneficial. Especially among the critically ill, patients often present relatively late (at a time-point when viral load is already falling anyway). Much of the pathogenesis of critical illness seems to result from dysregulated inflammation, rather than direct viral cytopathic effect. This raises a question of whether any antiviral treatment will be beneficial for late-presenting patients with severe illness.

PulmCrit – Hydroxychloroquine fails first meaningful RCT

Goodbye Benadryl

Link to the full article here.

Benadryl isn’t safe

Benadryl causes significant sedation. One study in a driving simulator showed an ordinary adult dose of Benadryl caused worse driving than a blood alcohol level of 0.1 percent (that’s between buzzed-drunk and frat-party drunk). Ordinary doses of Benadryl can also cause urinary retention, dizziness, trouble with coordination, dry mouth, blurry vision, and constipation. Especially in older individuals, diphenhydramine can cause delirium and contribute to long term dementia.

You be the judge.

PPI Use Linked to Elevated Mortality Risk

PPI Use Linked to Elevated Mortality Risk

During a median 10 years’ follow-up, 37% of participants died. There were 46 excess deaths per 1000 PPI users in that time. PPIs were associated with excess mortality from cardiovascular disease (CVD) and chronic kidney disease (CKD). Patients without indications for PPI use had higher mortality risk from CVD, CKD, and also upper gastrointestinal cancer. Longer duration of use was associated with greater risk.

The NEJM Journal Watch summary has a link to the full study from BMJ.

Opiods + Marijuana = Bad

Cannabis Plus Opioids in Chronic Pain: Not a Great Combo

Previous research by Humphreys and colleagues showed that people who used medical cannabis also had higher rates of opioid use and misuse. “This is one of many examples where claims about the benefits of medical cannabis are not supported by evidence,” Humphreys told MedPage Today.  The current study had several limitations: it relied on cross-sectional, self-reported data and was subject to possible selection bias and confounding. It also did not assess the frequency or quantity of cannabis or opioid use, or the type of chronic pain.

Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study

CONCLUSIONS – Metformin reduces the development of diabetes over 15 years. The subsets that benefitted the most include subjects with higher baseline fasting glucose or HbA1c and women with a history of GDM.

You can access the abstract and full study online at this link to the Diabetes Journal.

The commentary article at this link is also an interesting read.

More Evidence for a Prevention-Related Indication for Metformin: Let the Arguments Resume!

Dual Receipt of Prescription Opioids From the Department of Veterans Affairs and Medicare Part D and Prescription Opioid Overdose Death Among Veterans: A Nested Case–Control Study

Among veterans enrolled in VA and Part D, dual use of opioid prescriptions was independently associated with death from prescription opioid overdose. This risk factor for fatal overdose among veterans underscores the importance of care coordination across health care systems to improve opioid prescribing safety.

Full abstract at this link.

Does Marijuana Have Any Bad Side Effects?

Read a quick history lesson here.

Read about psychosis risk here.

Pass the doobie please.

Regardless of the century, physicians throughout the ages have known that real medicines carry risks. Any truly medicinal substance is able to give a little whack to one or more bodily processes. The goal is to whack the body back into normal functioning. That’s basically what medicine is all about – strategically whacking our physiology. But anything capable of whacking (which is to say any real medicine) is capable of harming at least a few of the many patients who would take it. This fact is so non-negotiable that we have a name for doctors who claim to have discovered effective medicines that don’t have any risks: we call them quacks.

Americans Cross Border Into Mexico To Buy Insulin At A Fraction Of U.S. Cost — Kaiser Health News

When Michelle Fenner signed up to run this year’s Los Angeles Marathon, it got her thinking: Tijuana, Mexico, is only a 2½-hour drive from L.A. Why not take a trip across the border and buy some insulin for her son? “It’s so easy to just go across the border,” mused Fenner. This idea had been…

via Americans Cross Border Into Mexico To Buy Insulin At A Fraction Of U.S. Cost — Kaiser Health News