Most doctors agree that taking a medical history from a patient not only improves rapport but is essential to accurate diagnosis.
History taking is a skill that takes time and practice. Part of this is knowing when to delve more deeply and when you can take things at face value or leave parts out. Now, AI assistants have been trained to do it too.
A randomised, controlled, double blind trial was done with actors, simulating the patients, the Articulate Medical Intelligence Explorer, and primary care physicians. To keep everyone blinded as to who was “the doctor”, text chat was used instead of face to face interviewing.
The AI machine was as good as the doctors.
My comment: I could see this being very useful in clinical practice as a way of reducing consultation times and prioritising urgency of appointments.
Around a third of US adults have impaired glucose tolerance also known as pre-diabetes. Many of the men also have low testosterone levels. This is known to cause fat accumulation, insulin resistance and type two diabetes.
Testosterone therapy is known to improve muscle mass, reduce fat mass, and improve insulin sensitivity. One would imagine that giving men who have low testosterone and pre-diabetes, hormone replacement therapy, would reduce the onset of type two diabetes.
For unknown reasons, doing this didn’t work.
In men over the age of 45 with low testosterone and pre-diabetes, testosterone gel was no more effective than placebo in reducing the onset of type two diabetes after two years. (13.5% in the active group and 15.7% in the placebo group.) Glycaemic control also failed to improve.
The trial also found out that testosterone replacement therapy also didn’t reduce fractures in hypogonadal men, even though skeletal mass is known to improve with testosterone.
My comment: I’m sure the researchers were disappointed to see this result. My practice was to treat these men with TRT and I am baffled as to these results, as treatment is usually very well tolerated.
Adapted from BMJ 17 Feb 2024Effect of exercise for depression Noetel M. Sanders et al.
We all know that exercise is beneficial in many ways. Researchers were specifically interested in what types, durations and intensity were helpful in treating major depressive disorder.
Sanders and Gallardo-Gomez performed a systematic review and network meta-analysis. The methods allowed such moderators such as intensity, dose, age, and sex to be assessed. 218 studies covering over 14 thousand people were studied.
Compared to active controls, moderate reductions in depression were found for walking or jogging, yoga, strength training, mixed aerobic exercise, and tai chi or qigong. Effects were proportional to the intensity of the exercise. Strength training, walking and yoga appeared to be the most liked and adhered to forms of exercise.
The effects seemed proportional to the intensity of the exercise, were higher when people exercised in groups. The effects were as good as psychotherapy or using drugs.
A Korean study of more than 7 million people determined at baseline if they had type two diabetes or not, and whether they had a normal liver, a mild fatty liver or severe fatty liver. They then followed them up for over 20 years to see what effects were seen on all cause mortality, or cardiovascular disease (myocardial infarction or ischaemic stroke).
In the non diabetic population 21.2% had mild fatty liver and 10.2% had severe fatty liver. In the type two diabetes population, 34% had mild fatty liver disease and 26.73% had severe fatty liver disease.
They found that even mild fatty liver disease increased cardiovascular mortality and all cause mortality in type two diabetics. As the degree of fatty liver increased, so did the rates of death for all cause and cardiovascular disease.
6.5% of the studied Korean population had type two diabetes. Weight loss through lifestyle modifications (diet and exercise) remains the cornerstone of management of type two diabetes, fatty liver and cardiovascular disease, but is difficult to achieve and even harder to maintain.
Newer weight loss drugs have shown promise in treating type two diabetes and in reducing fatty liver, but are expensive and may need to be continued for many years.
Alexei A Birkun, associate professor, Simferopol wrote a letter into BMJ:
Walker and colleagues explore whether coffee makers are a source of nosocomial pathogens (Champagne Problems Christmas 2023).
The researchers took swabs from the drip tray outlets, buttons, water tank handle, and inside the water tank of coffee makers. But what about the less accessible interior parts?
A couple of days before reading the article, I cleaned the infuser of our home coffee maker. To my surprise, a round shaped fungal colony was sitting on coffee residues left on the infuser.
While hospital fungal pathogens might invade the interior of coffee makers is unclear, but internal components are probably less commonly cleaned and could be a favourable humid environment for fungi.
Previous research has shown that coffee can be a good medium for fungal growth, and toxigenic fungal genera are well known coffee contaminants.
Fungal species living in the interior of coffee makers should not be overlooked in future research.
An analysis of the medical records of 5 million adults under the age of 50 in the USA found that myocardial infarction was six times more frequent in cannabis users compared to non-users.
Ischaemic stroke was also four times more frequent.
Cannabis is also the most used illicit substance used in pregnancy. Eight new studies found that cannabis use doubled the risk of a baby being born with low birthweight.
Preterm birth and being small for gestational age was also raised.
One in four UK adults has obesity and one in three is overweight. These factors increase the rate of diabetes and cardiovascular disease. Although many people lose weight after starting various types of dietary intervention, they are often dismayed that weight is usually regained.
A systematic review and meta-analysis of 249 weight management programmes for adults worldwide was conducted. Intense weight management programmes were compared to less intense or no intervention at all. Intensive programmes included diet and exercise but not medications or surgery.
All trials ran for at least a year after the interventions were completed and some as far as four years afterwards. The average follow up period was 28 months.
Those who had little or no support had lost 2.1kg and those who had had intensive support lost 4.9kg. Those who lost the most weight gained it back the most quickly.
The researchers found that five years after the end of a weight management programme, people who had been offered support still weighed less than those who got little or no support. They also had lower blood pressure, cholesterol, and blood sugar levels despite the weight regain.
Photo by Katie Rainbow ud83cudff3ufe0fu200dud83cudf08 on Pexels.com
Adapted from BMJ 27 Jan 2024
Dissecting Health by Scarlett McNally
The body positive movement correctly states that weight based discrimination can contribute to poor health and even more weight gain. Even so, obesity causes considerable health and economic damage.
The Tony Blair Institute calculated that obesity costs the UK £98 billion a year including £19.2 billion from related illnesses.
People who have obesity have seven times the likelihood of type two diabetes and the complications such as infection, amputation and kidney failure. Obesity can cause heart disease, cancer and chronic pain.
A person under the age of 50 who is obese, is more than ten times more likely to have complex multi-morbidity than someone of healthy weight. Hip and knee joint replacements are needed earlier, need longer operating times, a 50% greater risk of infections and a higher chance of needing postoperative intensive care.
Several treatments can successfully reverse obesity and type two diabetes including bariatric surgery, low carbohydrate diets, intermittent fasting, ultra-low calorie diets, and now regular injections to suppress the appetite.
Prevention of obesity is different. Obesity is caused by the type and availability of food and a lack of physical activity. Exercise alone doesn’t reverse obesity, but it can help prevent it.
Obesity is a product of our environments. People in the most deprived areas have the fewest food and exercise options and are twice as likely to have obesity (36.8%) as those in the least deprived areas (19.2%).
We need to go back to basics: affordable fruit and vegetables, unprocessed foods, less snacking, smaller portions, and less alcohol.
Many organisations have suggested such interventions such as play parks, limits on junk food advertising, and more PE in schools. We need safe cycle lanes, green spaces, and 20 mph limits in built up areas. Despite swimming being a great all round exercise, many affordable swimming pools have closed.
The obesity epidemic matters more about health than just appearance. Poor health results in unaffordable health needs and reduced tax income from the economically inactive working age group.
We cannot afford the inevitable human and financial costs of inaction.
A randomised controlled trial by Mikko Raisanen in Finland compared treatments for Dupuytren’s contracture.
This condition is common in those of Viking ancestry. Famous afflicted people include Ronald Reagan, Margaret Thatcher and Frank Sinatra.
Thickening and tightening of the tendons in the palms of the hands occurs. Progression is usually slow, but as the pinky finger and others become unable to extend, it can cause real difficulty in dressing and holding objects.
Three treatments were compared: surgery, needle fasciotomy and collagenase injections.
At the three month point, all seemed equally successful with 70% improved considerably, but after two years, surgery was 78% effective compared to 50% and 65% respectively.
Diabetics are prone to this condition too, as tendon glycation worsens the problem.
Should women have grade 2 cervical intraepithelial cancer treated with large loop excision or should they just be kept under surveillance?
A Danish study sought to find out. Women who had CIN 2 diagnosed between the ages of 18-40 were followed up from 1998 to 2020. The study involved 27.5 thousand women.
The cumulative risk for cervical cancer was only 2.65% but women who had had the loop excision biopsy were four times less likely to get cervical cancer.
Diabetes Diet 