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Aug 5, 2016


medicinescope.com

Stand tall

The story

Too much of your day is spent a tongue's length away from your computer screen, so make sure to run to codes. Moderate physical activity can help correct the ills associated with excess sitting.

The background

Prior to the 2012 London Olympics, researchers took a comprehensive look at physical activity in the information age. They estimated that sedentary lifestyle was responsible for 9% of premature mortality, or 5.3 million out of 57 million worldwide deaths in 2008. The effect size of inactivity was similar to the other behemoths of modifiable risk factors: tobacco and obesity. 

The news

In time for the start of the games in Rio, The Lancet is back with a second look at physical activity. A meta-analysis of 16 studies with over 1 million participants found that those with high sitting times due to sedentary habits – you know, like watching Netflix, or writing progress notes – faced higher mortality rates than their more active counterparts. Yet 60 - 75 minutes of physical activity a day eliminated this excess mortality risk.
Lancet

The cost

An evaluation of the cost of physical inactivity, as measured by money spent on healthcare and money lost due to early deaths of productive workers, estimated a price tag of roughly $70 billion across the globe in 2013. The investigators say the figure from less conservative estimates is much higher.

Say it on rounds

When your pants don't fit as well after a month in the ICU

Childhood asthma is growing faster than your belt size. Researchers compared the Amish community with the Hutterite community, who share a similar genetic ancestry but have higher asthma rates. They found that the Amish, who live at close proximity to livestock, had a microbial load nearly 6 times higher than that of the Hutterites in their home environment. When Amish dust extracts were instilled in mice, they inhibited airway hyperreactivity and promoted immune tolerance. Watch this video for more details on an innovative but complex study.
NEJM

When you show up late to conference, and the food's already gone

You'll find closure, even if it takes a day or two. But patients with refractory perianal fistulas in Crohn's disease often have to undergo proctectomy when conventional treatments can't close their fistulas. A European RCT of 200 patients found that injection with adipose-tissue-derived stem cells led to significantly greater fistula closure vs. placebo, with a trend towards fewer adverse events. The mechanism behind the stem cell therapeutic effect remains unclear.
Lancet 

When you still can't believe JoJo picked Jordan

Time to get off the couch (as if you need to hear this from us again). As part of a large, 19-year Japanese prospective cohort study, investigators looked at TV watching and the risk for fatal PE. Risk of death increased with daily hours of TV watched, with each additional hour of TV associated with a roughly 40% increase in risk. 
Circulation

Brush up

Acute pancreatitis

Diagnose pancreatitis in those with epigastric or left upper quadrant abdominal pain, serum amylase or lipase > 3 times the upper limit of normal, or characteristic findings on imaging. Gallstones and alcohol cause about 80% of cases. Adequate fluid resuscitation is critical to intial management.

What's the evidence

For prediction models in acute pancreatitis? Models are used to predict which patients are sickest so that they can be treated aggressively. A systemic review found that among 18 prediction models, the Ranson Criteria and APACHE scores performed best at predicting mortality, though both had limited accuracy. Routine tests such as hematocrit and BUN elevation may be similarly accurate markers of disease severity.

What your dentist friends are talking about

Don't mess with the peer-review research process. Former tech darling Theranos took a spectacular fall earlier this year, and now the benefits of daily flossing have come under the gun.

Spread the word

Send your interns something to look forward to. 
It's a long commute at 6 am

  

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