Morning Medtalks With Dr KK

1. AS per a British study a high-sensitivity cardiac troponin 1 (hs-cTnI) assay to diagnose myocardial infarction (MI) may lead to overdiagnosis with resulting inappropriate therapies. [UNIVERSITY HOSPITAL SOUTHAMPTON]
2. US FDA is proposing a rule for breast cancer screenings that would require doctors to give women more information about the risks associated with dense breasts. FDA wants doctors to ensure patients understand how dense breasts, which dont have a lot of fatty tissue, can skew the accuracy of mammograms and present a higher risk of developing breast cancer later in life. About 12 percent of all women are diagnosed with breast cancer at some point in their life.
3. Given that more than half of women over the age of 40 in the U.S. have dense breasts, helping to ensure patient access to information about the impact that breast density and other factors can have on the risk for developing breast cancer is an important part of a comprehensive breast health strategy
4. Mammograms are considered the best way to detect breast cancer. However, theyre not as reliable in dense breasts, characterized as those with not as much fat and more fibrous or glandular tissue, according to the American Cancer Society. Dense tissue makes it harder for doctors to see cancer, meaning the tests can be less accurate.
5. Mammograms of dense breasts ... can be difficult to interpret because the dense tissue can obscure signs of breast cancer and lower the sensitivity of the image
6. Dense breasts have also been identified as a risk factor for developing breast cancer.
7. There are 314 confirmed cases of measles in 15 states, with six states reporting measles outbreaks as per US CDC. The situation is severe enough in New Yorks Rockland County, a suburb of New York City, that an emergency was declared effective today with 155 confirmed cases. Emergency include anyone less than 18 years of age who is unvaccinated against the measles barred from public places until this declaration expires in 30 days or until they receive the measles-mumps-rubella vaccination.
8. The US FDA has approved oral testosterone undecanoate to treat men with hypogonadism resulting from Klinefelter syndrome or tumors that have damaged the pituitary gland.
9. ARBs are recommended for the treatment of hypertension, heart failure, and chronic kidney disease, with more than 61 million prescriptions written for valsartan, losartan, and irbesartan in the United States in 2016.
10. Ongoing US FDA recalls — all in generic ARB-containing products — began last July when the probable carcinogen N-nitrosodimethylamine (NDMA) was detected in the valsartan active pharmaceutical ingredient (API) supplied by Zhejiang Huahai Pharmaceuticals (ZHP), Linhai, China. Within months, the rolling recalls had extended to irbesartan- and losartan-containing products. A second probable carcinogen, N-nitrosodiethylamine (NDEA), was identified last fall and a third, N-nitroso-N-methyl-4-aminobutyric acid (NMBA), only last month.
11. Statin muscle-related adverse events are relatively uncommon. Myalgias and myopathy occur with a frequency of 2 to 11 percent. However, severe myonecrosis and clinical rhabdomyolysis are much rarer (0.5 percent and less than 0.1 percent, respectively). Patients can experience statin-induced myalgias without an elevation in serum creatine kinase (CK) concentration.
12. The risk of muscle injury is substantially higher when taking a statin that is extensively metabolized by cytochrome P450 3A4 (CYP3A4; lovastatin, simvastatin, atorvastatin) together with a drug that interferes with CYP3A4.

13. Pravastatin, fluvastatin, rosuvastatin, and pitavastatin are preferred when given to a patient receiving another drug that is a strong inhibitor of CYP3A4.
14. Grapefruit juice inhibits CYP3A4; however, daily consumption of 8 oz or less of grapefruit juice or one-half of a grapefruit or less is unlikely to increase the risk of an adverse interaction or muscle injury.
15. Enhanced susceptibility to statin-associated myopathy occurs in patients with acute or chronic renal failure, obstructive liver disease, and hypothyroidism.
16. Muscle symptoms and/or signs usually begin within weeks to months after starting statins. Myalgias, weakness, and serum CK concentrations usually return to normal over days to weeks after drug discontinuation.