Top medicine articles for October 2014

A collection of some interesting medical articles published recently:

Hand-grip strength is an amazingly good predictor of future rates of mortality and morbidity, or sickness -- Hand grip strength should be considered as a vital sign useful for screening middle-aged and older adults -- Measuring hand-grip strength is very simple and cheap. Every primary care doctor should have a dynamometer in their office. At every visit, the doctor could check grip strength for older patients. If someone was in the 45th percentile for their age and the measurements were stable, great. But if that person suddenly dropped to the 25th percentile, then that’s a sign that the doctor should look seriously at what might be going on.

Full fat milk (3%) cut the risk of getting diabetes type 2 by 20%

Urine Test for Diagnosis of HPV Works Well (not yet available in practice)

Weekly Injectable Drug for DM2 Approved -Trulicity (dulaglutide) a glucagon-like peptide-1 (GLP-1) receptor agonist.

FDA approved for treating fibromyalgia: pregabalin (Lyrica), duloxetine (Cymbalta), milnacipran (Savella)

Human Body, According to Venture Capitalists - which body systems stand to benefit most from their decisions - WSJ

Sodium conundrum: 9 in 10 U.S. children eat too much salt

With 23andMe, this biologist gave his parents the gift of divorce

People who spend more time preparing and cooking meals are more likely to have healthier diets

Walking is the superfood of fitness, experts say -- “Walking is a superfood. It’s the defining movement of a human". “Actively sedentary is a new category of people who are fit for one hour but sitting around the rest of the day," Bowman said. “You can’t offset 10 hours of stillness with one hour of exercise.” -- Exercise: “If you’re going to pick one thing, research says it should be walking”

Acupuncture May Not Help Chronic Knee Pain after all

Epic holds the health records of nearly half of all Americans

Gene affects your taste for bitter flavors. People who aren't as sensitive eat 200 more servings of vegetables/year

Ebola drug ZMapp is produced in the leaves of tobacco plants. 10 years from now, plants might be the dominant vaccine-production system

The articles were selected from Twitter and my RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases AT and you will receive acknowledgement in the next edition of this publication.

Multi-dose flu shot has only 25 mcg of mercury - most commercial fish contain 23 mcg of mercury per 8 ounces of fish

Multi-dose flu shot has only 25 mcg of mercury - most commercial fish contain 23 mcg of mercury per 8 ounces of fish

Are multi-dose vials less expensive?

Economics are a bit complicated due to wastage with multiple vials:

Single versus multi-dose vaccine vials: an economic computational model

Most of the Western world, apart from the US, has moved on to single vials:

Whenever possible, CDC recommends that single-use vials be used and that multi-dose vials of medication be assigned to a single patient to reduce the risk of disease transmission (

Where to get a thimerosal/mercury-free flu shot?

Many local Costco stores carry only single vials and the cost is $14.99 if no insurance is used. The availability of additional options may improve immunization rates.

Search for a Costco pharmacy near you here, and call them to verify availability: Warehouse Locations - Costco:

Personal Flu Stories - CDC:

Each year in the US, nearly 20,000 children under age 5 are hospitalized due to flu-related complications. CDC recommends that children aged six months through 18 years old get a flu vaccination. Moving personal stories help parents and caregivers learn about the dangers of influenza to children and the benefits of vaccination.

Image source: Influenza virus, Wikipedia, public domain.

How to Pick the Right Bedtime - select a wake up time, count back 7 hours and add 10 minutes to fall asleep

Given the importance of a good night's sleep, how do you pick the best possible bedtime? WSJ's Heidi Mitchell and Stanford University's Dr. Rafael Pelayo discuss with Tanya Rivero.


What Makes A Great Bedtime? | Craig Canapari, MD
Shift workers and people who get jet lag may gain weight because they dusturb their "inside garden" (gut microbes)

65-yo patient received a standard-dose flu shot already this season. Should she get the high-dose shot too? Or get a second regular flu shot?

A 65-yo female patient received a standard-dose flu shot already this season. Should he get the high-dose shot too? Or try to get a second regular flu shot?

The simple answer is no. The patients should consider herself immunized. Studies show that getting a delayed second dose doesn't necessarily increase antibody response, and there's some concern that it might actually have a negative effect on the immunity. If you've already had the regular seasonal dose, wait until next year for another dose.

Image of the H1N1 Influenza Virus, CDC.

From CDC's website:

Sometimes patients age 65 years and older who have received the standard-dose influenza vaccine hear about the high-dose product (Fluzone High-Dose, sanofi) and want to receive that, too. Is this okay to administer?

No. ACIP does not recommend that anyone receive more than one dose of influenza vaccine in a season except for certain children age 6 months through 8 years for whom two doses are recommended.

Would giving an older patient 2 doses of standard-dose influenza vaccine be the same as administering the high-dose product?

No, and this is not recommended.


New High-Dose Flu Shot for Older Americans: Answers to Flu Season Questions - AARP

Ask the Experts about Influenza Vaccines - CDC experts answer Q&As;

Fluzone High-Dose Seasonal Influenza Vaccine | Seasonal Influenza (Flu) | CDC

How to get your research published: The BMJ's tips (video)

In this video, the BMJ's research team discuss what they look for in a paper submitted for publication.

They discuss some of the pitfalls authors fall into when writing up their research, and how to present some of the information that all journals will require.

More BMJ-specific info here:
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