Cardiovascular and Cerebrovascular Safety of Testosterone Replacement | RNA-binding protein HuR influences human and rodent muscle metablic flexibility | Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: Is there a correlation?
September 12, 2019
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Cardiovascular and Cerebrovascular Safety of Testosterone Replacement
Testosterone replacement therapy, used for the treatment of male testosterone deficiency, or hypogonadism, may increase the risk of cardiovascular events in aging men with low testosterone levels, particularly in the first 2 years of use. In the absence of identifiable causes of hypogonadism, this therapy should be initiated with caution among aging men with low testosterone levels.
The American Journal of Medicine (9/2019) 
Ending Soon – Hyperuricemia and Gout
In two 15-minute discussions, listen as two experts discuss case-based examples of gout, providing clinicians with knowledge and increased competence for managing patients with gout. Click here to begin this activity!
Clinical Updates
RNA-binding protein HuR influences human and rodent muscle metablic flexibility
Metabolic flexibility can be assessed by changes in respiratory exchange ratio (RER) following feeding. Though metabolic flexibility (difference in RER between fasted and fed state) is often impaired in individuals with obesity or type-2 diabetes, the cellular processes contributing to this are unclear. Male, but not female, mice exhibit metabolic inflexibility, with mild obesity, impaired glucose tolerance, impaired fat oxidation and decreased in vitro palmitate oxidation. HuR inhibition results in impaired metabolic flexibility and decreased lipid oxidation, suggesting a role for HuR as an important regulator of skeletal muscle metabolism.
Metabolism -- Clinical and Experimental (9/2019) 
Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: Is there a correlation?
We found that pelvic floor myofascial pain was common in patients seeking evaluation for pelvic floor disorder symptoms, and that the severity of pelvic floor myofascial pain was correlated with the degree of symptom bother
American Journal of Obstetrics & Gynecology (9/2019) 
Long-term e-cigarette use found to have low risk of relapse to cigarette smoking
Survey data was analyzed to identify the effects of long-term e-cigarette use and the potential risks of cigarette smoking relapse. In the 2012-2014 baseline survey, 81.4% of subjects were exclusive e-cigarette users and 14.4% were poly users. In the 2017-2018 follow up survey, of baseline e-cigarette only users, 88.3% continued using e-cigarettes exclusively, while 9.2% became poly users and one subject returned to cigarette smoking. Among baseline poly users, 60.6% became exclusive e-cigarette users at the time of the 2017-2018 follow up survey.
American Journal of Preventive Medicine (9/2019) 
Cost-Related Underuse of Medicines for Asthma
To estimate the extent of cost-related medication underuse behaviors and associated factors, an online cross-sectional survey of adults and parents of children 5-17 years with asthma in Australia was conducted. The survey was completed by 792 adults and 609 parents of children with asthma. Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with having concerns about medicines, less comfort talking to prescribers about cost, feeling less engaged with prescribers about medicine decisions, poorer asthma control, and requiring specialist or urgent healthcare visits. Urgent targeting of interventions to promote discussion of medicines and costs between doctor and patients is needed.
The Journal of Allergy and Clinical Immunology: In Practice (9/2019) 
Oral Rehydration for Orthostatic Intolerance in Children with POTS
Intravenous saline solution has been used to mitigate the effects of orthostasis in those with orthostatic intolerance; the quantitative effects of oral rehydration solution (ORS) on orthostatic tolerance have not been reported. This study examined the neurovascular response to fluid loading during orthostatic stress using lower body negative pressure in 10 subjects with POTS with orthostatic intolerance and 15 controls. In subjects with POTS, following ORS but not saline infusion, cerebral blood flow velocity was significantly higher than that with no treatment. Subjects with POTS experienced a significant improvement in orthostatic tolerance following both saline infusion and ORS.
The Journal of Pediatrics (9/2019) 
Medical News
US suicide rates on the rise, and rural areas are hit hardest
Suicide rates climbed 41% across the US from 1999 to 2016, and rural areas were hit harder than metropolitan areas, according to a study in JAMA Network Open. A county-by-county analysis showed lack of mental health professionals, lower levels of social capital, increased social fragmentation and deprivation -- which involves poverty, lack of education and low employment -- were some of the factors driving higher suicide rates in rural areas, researchers said.
HealthDay News (9/6) 
CDC: Measles cases reach 1,241 amid slowing outbreak
CDC officials reported that the number of measles cases in the US reached 1,241 across 31 states as of Sept. 5, the highest number since 1992. The seven new cases reported last week is the lowest number so far this year, indicating the outbreak has slowed, officials said.
Reuters (9/9) 
Research links napping to reduced CVD risk
Individuals who napped once or twice weekly were at a significantly reduced risk for incident cardiovascular disease events, compared with those who didn't nap, according to findings published in the journal Heart. Swiss researchers, who evaluated 3,462 people without a previous CVD history, found no association between nap duration and CVD events.
Physician's Briefing/HealthDay News (9/10) 
Business Practice News
How health care providers can prevent identity theft
Theft of physicians' National Provider Identifier is common in fraud cases, and the victims usually are unaware their NPI has been stolen, says HHS Office of Inspector General special agent Matt Charette. NPIs cannot be completely concealed, but experts say health care providers should stop using it where it is not required, share it only on a need-to-know basis, ensure former employers no longer use it, keep detailed billing records that are backed up externally, and notify the HHS OIG or the CMS Center for Program Integrity if they suspect fraud.
Medscape (free registration) (9/10) 
Hospital uses technology to improve patient experience
George Washington University Hospital CEO Kimberly Russo says the hospital has improved the patient experience through technology, such as the NicView camera system in the neonatal intensive care unit, which allows families to see infants 24/7. Russo said the hospital is working to ensure that health care is accessible and equitable and that patients get the appropriate care in the right setting at the right time.
Becker's Hospital Review (9/10) 
Patient's Perspective
Americans without medical insurance increase
The number of Americans without health insurance increased last year for the first time since 2009, according to the Census Bureau. The rate of uninsured Americans rose a half-percentage point, or 1.9 million people, compared with 2017, reaching 8.5%, or 27.5 million people.
CNN (9/10) 
The strangest, most generous, and proudest of all virtues is true courage.
Michel de Montaigne,
writer, philosopher
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