Understanding Medical Technologies

Underlying Causes and Causal Pathways are Largely Unknown (guess the disease)

/ SupremeCmdr / 3 Comments

Using high-quality population-based cancer registry data until 2017, this study presents contemporary trends in early-onset colorectal cancer incidence across 50 countries and territories, including 12 additional countries (Argentina, Bahrain, Belarus, Chile, Columbia, Ecuador, France [Martinique], Iceland, Kuwait, the USA [Puerto Rico], Qatar, and Uganda) since the last published report on colorectal cancer incidence trends. The findings show that the rising incidence of early-onset colorectal cancer is no longer limited to high-income countries; it now extends to countries and territories in Latin America and the Caribbean (Argentina, Chile, Costa Rica, Ecuador, Martinique, and Puerto Rico), Asia (Israel, Japan, Thailand, and Türkiye), and eastern Europe (Belarus). Colorectal cancer incidence trends in younger versus older adults: an analysis of population-based cancer registry data – https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00600-4/fulltext

Yikes.

Brugada Syndrome

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A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. The patient has no significant past medical history, and reports that she was walking to the end of her driveway to retrieve her mail when she suddenly collapsed to the ground. She recalls waking up on her driveway with concerned neighbors gathered around her…

http://www.emdocs.net/em3am-brugada-syndrome/

Dear Readers – another Saturday morning and this Grandpa Underwriter is back to his old tricks of reading about things that are WAY ABOVE his pay grade. There are two clinical scenarios in the article. Enjoy!

Emphysema More Common in Marijuana Smokers Than Cigarette Smokers

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“We know what cigarettes do to the lungs,” said study author Giselle Revah, M.D., a cardiothoracic radiologist and assistant professor at the University of Ottawa in Ottawa, Canada. “There are well researched and established findings of cigarette smoking on the lungs. Marijuana we know very little about.”

To find out more, Dr. Revah and colleagues compared chest CT results from 56 marijuana smokers with those of 57 non-smoking controls and 33 tobacco-only smokers.

Three-quarters of the marijuana smokers had emphysema, a lung disease that causes difficulty with breathing, compared with 67% of the tobacco-only smokers. Only 5% of the non-smokers had emphysema. Paraseptal emphysema, which damages the tiny ducts that connect to the air sacs in the lungs, was the predominant emphysema subtype in marijuana smokers compared to the tobacco-only group.

Radiological Society of North America. “Emphysema more common in marijuana smokers than cigarette smokers.” ScienceDaily. http://www.sciencedaily.com/releases/2022/11/221115113940.htm (originally accessed November 15, 2022).

Journal Reference

Luke Murtha, Paul Sathiadoss, Jean-Paul Salameh, Matthew D. F. Mcinnes, Giselle Revah. Chest CT Findings in Marijuana Smokers. Radiology, 2022; DOI: 10.1148/radiol.212611

The mean age of the MJ smokers in the study was 49.

The mean age of the tobacco smokers in the study was 60.

Colonoscopy – Just Do It (an almost forgotten post)

/ SupremeCmdr / 8 Comments

I came across this post in my collection of unpublished drafts. I thought I posted this but obviously I didn’t. This article link was intended to be posted before Colorectal Cancer Rates Rising in Ages 50-54. Better late than never, I guess.

More than one quarter of colonoscopies carried out in Americans aged 30 to 49 years reveal some type of neoplasm, and slightly over 6% of these patients have advanced cancer, results of a nationally representative endoscopic registry show.

One Quarter of 30–49-Year-Olds Have Abnormal Colonoscopy Results – Medscape – Jun 07, 2021. — https://www.medscape.com/viewarticle/952536?src=rss#vp_1
APL = Advanced Premalignant Lesions. CRC = Colorectal cancer.

Also see Study Finds Sharp Rise in Colon Cancer and Rectal Cancer Rates Among Young Adults and Diet and Colon Cancer Risk – CBS News.

Colorectal Cancer Rates Rising in Ages 50-54

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During the period 1992–2018, there were a total of 101,609 cases of CRC among adults aged 45–59 years. Further analysis showed that the CRC incidence rates rose from 23.4 to 34.0 per 100,000 among people aged 45–49 years and from 46.4 to 63.8 per 100,000 among those aged 50–54 years. Conversely, incidence rates decreased among individuals aged 55–59 years, from 81.7 to 63.7 per 100,000 persons.

Colorectal Cancer Rates Rising in People Aged 50 to 54 Years – Medscape – Nov 11, 2021 – https://www.medscape.com/viewarticle/962769?src=rss#vp_2

I am posting a link to this article as I enjoy the effects of 238 grams of Miralax mixed with a gallon of sports beverage and/or water. It certainly takes your mind off of not eating all day.

New Blood Test Improves Prostate Cancer Screening – the Stockholm3 test

/ SupremeCmdr / 4 Comments

On July 9 2021, results from the STHLM3MRI study were presented in The New England Journal of Medicine, indicating that over-diagnosis could be reduced by substituting traditional prostate biopsies with magnetic resonance imaging (MRI) and targeted biopsies. The new results, now published in The Lancet Oncology, show that the addition of the Stockholm3 test, which was developed by researchers at Karolinska Institutet, can be an important complement. It is a blood test that uses an algorithm to analyze a combination of protein markers, genetic markers and clinical data.

Karolinska Institutet. “New blood test improves prostate cancer screening.” ScienceDaily. http://www.sciencedaily.com/releases/2021/08/210813100313.htm (accessed August 14, 2021).

Dumb and Dumber – Noncompliance with Colonoscopy Post Positive FIT

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Results Some 88 013 patients who were FIT positive complied with colonoscopy (males: 56.1%; aged 50–59 years: 49.1%) while 23 410 did not (males: 54.6%; aged 50–59 years: 44.9%).

The 10-year cumulative incidence of CRC was 44.7 per 1000 (95% CI, 43.1 to 46.3) among colonoscopy compliers and 54.3 per 1000 (95% CI, 49.9 to 58.7) in non-compliers, while the cumulative mortality for CRC was 6.8 per 1000 (95% CI, 5.9 to 7.6) and 16.0 per 1000 (95% CI, 13.1 to 18.9), respectively. The risk of dying of CRC among non-compliers was 103% higher than among compliers (adjusted HR, 2.03; 95% CI, 1.68 to 2.44).

Conclusion The excess risk of CRC death among those not completing colonoscopy after a positive faecal occult blood test should prompt screening programmes to adopt effective interventions to increase compliance in this high-risk population.

Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer — https://gut.bmj.com/content/early/2021/03/30/gutjnl-2020-322192?rss=1

Help me understand human behavior. You get a positive FOBT or Cologuard test and your doctor says you need a colonoscopy but you decide not to follow up and follow through with the scope.

SMH.