Building a Biomarker of Aging from Frailty Measures
In this study, we tracked frailty longitudinally in a cohort of aging male mice from 21 months of age until their natural deaths and employed machine learning algorithms to build two clocks: FRIGHT (Frailty Inferred Geriatric Health Timeline) age, designed to model chronological age, and the AFRAID (Analysis of Frailty and Death) clock, which was modelled to predict life expectancy. FRIGHT age reflects apparent chronological age better than the frailty index alone, while the AFRAID clock predicts life expectancy at multiple ages. These clocks were then tested for their predicitve power on cohorts of mice treated with inter...
Source: Fight Aging! - January 3, 2020 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

Fight Aging! Newsletter, September 2nd 2019
In conclusion, in the absence of obesity, visceral adipose tissue possesses a pronounced anti-inflammatory phenotype during aging which is further enhanced by exercise. Methods of Inducing Cellular Damage are Rarely Relevant to Aging, and the Details Matter https://www.fightaging.org/archives/2019/08/methods-of-inducing-cellular-damage-are-rarely-relevant-to-aging-and-the-details-matter/ One of the major challenges in aging research is determining whether or not models of cellular or organismal damage and its consequences are in any way relevant to the natural processes of aging. One can hit a brick with...
Source: Fight Aging! - September 1, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

A Large Polypill Clinical Trial Shows a Third Reduction in Cardiovascular Events
The research and medical communities are slow to undertake work on combination therapies. Regulation makes it exceedingly expensive to assess multiple combinations, and there are numerous other perverse incentives to challenge any effort to build combination therapies with components developed and manufactured by different groups. Short of working around the existing system of regulation, and methods of doing this at scale are lacking at the present time, this is a challenging problem to solve. People follow incentives. Given this, it it is entirely plausible that there are many largely unexplored instances in which existi...
Source: Fight Aging! - August 30, 2019 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

MKSAP: 62-year-old woman with hypertension
Test your medicine knowledge with the  MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old woman is evaluated during a routine examination. She feels well and has no exercise limitations. Medical history is significant for hypertension treated with enalapril. She does not smoke. At her last examinati on 4 years ago, her blood pressure was […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 27, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > < /span > Tags: Conditions Cardiology Diabetes Endocrinology Source Type: blogs

The Doctor Who Thwarted the Charge of the General Medical Council – Part 1
By  SAURABH JHA After Dr. Hadiza Bawa-Garba was convicted for manslaughter for delayed diagnosis of fatal sepsis in Jack Adcock, a six-year-old boy who presented to Leicester Royal Infirmary with diarrhea and vomiting, she was referred to the Medical Practitioners Tribunal (MPT). The General Medical Council (GMC) is the professional regulatory body for physicians. But the MPT determines whether a physician is fit to practice. Though the tribunal is nested within the GMC and therefore within an earshot of its opinions, it is a decision-making body which is theoretically independent of the GMC. The tribunal met in 2017...
Source: The Health Care Blog - August 5, 2018 Category: Consumer Health News Authors: at RogueRad Tags: NHS #BawaGarba @roguerad Source Type: blogs

Depression: Common medication side effect?
This study is especially thought-provoking, given that more and more people are taking medications with depression or suicidal thoughts as possible side effects. The CDC just released updated data showing a troubling recent rise in suicide rates, and that 54% of those who die from suicide do not have a known mental health disorder, so this is an important public health issue. That said, it is important to note: in this study, people who used these medications were more likely to be widowed and have chronic health problems, both of which are associated with a higher risk of depression. And many (but not all) of these medica...
Source: Harvard Health Blog - July 16, 2018 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Anxiety and Depression Drugs and Supplements Health Source Type: blogs

Might Depression Be Linked to One of These Popular Medications?
If you’re taking beta blockers, certain kinds of anxiety drugs, certain types of painkillers (including ibuprofen), proton pump inhibitors (PPIs) (used to treat acid reflux), ACE inhibitors (used to treat high blood pressure), or anti-convulsant drugs, you may be at greater risk for depression. That’s according to a new, large-scale study published earlier this week in JAMA. However, this was a correlational study, so it can’t say that these medications actually cause depression or not. It may be that people with greater health problems are more likely to take one of these medications and be depressed abo...
Source: World of Psychology - June 15, 2018 Category: Psychiatry & Psychology Authors: John M. Grohol, Psy.D. Tags: Depression General Medications Psychiatry Research Drugs cause depression popular medications Source Type: blogs

Why is not neprilysin inhibitor used alone? – Discussion
Neprilysin is a neutral endopeptidase involved in the degradation of natriuretic peptides (A, B and C), bradykinin, adrenomedullin and other vasoactive peptides. Combining neprilysin inhibitor with angiotensin converting enzyme inhibitor showed superior efficacy, but was associated with serious angioedema. ARNI (Angiotensin receptor blocker neprilysin inhibitor) valsaratn/sacubitril does not inhibit angiotensin converting enzyme inhibitor or aminopeptidase P, was not associated with increased risk of angioedema in the PARADIGM-HF trial [1]. Omapatrilat, a drug which inhibits all the three enzymes involved in degradati...
Source: Cardiophile MD - June 6, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Switching from ACEI to ARNI – Cardiology MCQ – Answer
While switching over from an ACE inhibitor to ARNI, ARNI can be started — hours after ACEI: Correct answer: c) 36 hours Combination of ACEI (angiotensin converting enzyme inhibitor) and neprilysin inhibitor can lead to higher rates of angioedema as both can lead to accumulation of bradykinin [1]. Bradykinin is inactivated by angiotensin converting enzyme and neprilysin. Another drug omapatrilat which is an inhibitor of neprilysin, aminopeptidase P and ACE was tried for hypertension and heart failure. All the three enzymes are involved in inactivation of bradykinin [2]. The development of the drug was discontinue...
Source: Cardiophile MD - June 6, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Zero tolerance for low blood pressure
Just as we have zero tolerance for hypoglycemia in the Wheat Belly lifestyle, we also have zero tolerance for hypotension, or low blood pressure (BP). Follow the Wheat Belly lifestyle free of ciabattas, penne pasta, and tortellini, and blood sugars plummet. If you are injecting insulin or taking other diabetes drugs, hypoglycemia is a risk and can be dangerous, resulting in loss of consciousness and injury. We therefore urge everyone to talk to their doctor about discontinuing or reducing insulin and diabetes drugs immediately upon starting the Wheat Belly lifestyle. Unfortunately, the majority of doctors don’t under...
Source: Wheat Belly Blog - May 8, 2018 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle blood pressure blood sugar BP gluten-free grain-free grains health hypertension hypertensive Source Type: blogs

To Err is Homicide in Britain – the case of Dr. Hadiza Bawa-Garba  
By, SAURABH JHA The good that doctors do is oft interred by a single error. The case of Dr. Hadiza Bawa-Garba, a trainee pediatrician in the NHS, convicted for homicide for the death of a child from sepsis, and hounded by the General Medical Council, is every junior doctor’s primal fear.   An atypical Friday Though far from usual, Friday February 18th, 2011 was not a typically unusual day in a British hospital. Dr. Bawa-Garba had just returned from a thirteen-month maternity break. She was the on-call pediatric registrar – the second in command for the care of sick children at Leicester Royal Infirmary. A...
Source: The Health Care Blog - January 30, 2018 Category: Consumer Health News Authors: at RogueRad Tags: Patients Physicians The Business of Health Care Source Type: blogs

MKSAP: 68-year-old man with a right intertrochanteric fracture
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated in the hospital for a right intertrochanteric fracture sustained in a mechanical fall. He reports right hip pain but no other symptoms. He has hypertension and type 2 diabetes mellitus and was in his usual state of health prior to the fall. He checks his blood glucose level several times daily; his average blood glucose level is 150 mg/dL (8.3 mmol/L), with a low of 92 mg/dL (5.1 mmol/L) and a high of 208 mg/dL (11.5 mmol/L). Surgical repair is scheduled for tomorrow at 7 a...
Source: Kevin, M.D. - Medical Weblog - January 28, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Orthopedics Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 7
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 7. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 23, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 6
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 6. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Alzheimer’s disease and macular degeneration concerns with Entresto
Three academic physicians, writing in an editorial in the Journal of the American Medical Association, raised serious (but theoretical) concerns about the risk of Alzheimer’s disease and macular degeneration with long-term use of the new heart failure drug, valsartan/sacubitril (Entresto, Novartis). Here is the translation: Sacubitril is a drug that inhibits neprilysin, which is an enzyme (protein) responsible for breaking down things called natriuretic peptides (other proteins). This is good for heart failure patients because having more natriuretic peptides may prevent worsening heart muscle weakness. The problem i...
Source: Dr John M - January 7, 2016 Category: Cardiology Authors: Dr John Source Type: blogs

Entresto: Blockbuster, or Just Over Hyped? - Whatever, It Will Cost $4500 a Year
The newest drug for congestive heart failure, Entresto, a fixed combination of valsartan and sacubitril, has just hit the market at an elevated price.  Like other drugs recently introduced as blockbusters, the high price does not seem clearly justified by clinical evidence about the drug's benefits and harms.   Questions Raised by the One Big Published Controlled Trial Last year, we discussed the hoopla around a study of a new drug for congestive heart failure (CHF),(1) a fixed combination of valsartan and sacubitril. Also, on the now defunct CardioExchange blog, Dr Vinay Prasad discussed the same study (look her...
Source: Health Care Renewal - July 30, 2015 Category: Health Management Tags: CHF clinical trials Entresto evidence-based medicine manipulating clinical research Novartis sacubitril Source Type: blogs

Antihypertensives in heart failure – Cardiology MCQ
Antihypertensives to be avoided in heart failure include all of the following except: a) Verapamil b) Moxonidine c) Diltiazem d) Enalapril Correct answer: d) Enalapril Enalapril is one of the recommended drugs for hypertension in heart failure. All the other drugs have been shown to produce worsening of heart failure. The post Antihypertensives in heart failure – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 11, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Medications After a Heart Attack
From: www.secondscount.orgYour heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.Medications you are likely to be prescribed after a heart attack fall int...
Source: Dr Portnay - January 23, 2015 Category: Cardiology Authors: Dr Portnay Source Type: blogs

Cardiology MCQ: Omapatrilat
Omapatrilat inhibits: a) Angiotensin converting enzyme b) Neprilysin c) Aminopeptidase P d) All of the above Correct answer: d) All of the above Omapatrilat inhibits angiotensin converting enzyme, neprilysin, and aminopeptidase P [McMurray JJ et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 Sep 11;371(11):993-1004]. This would finally cause vasodilation, natriuresis and diuresis. Hence omapatrilat can have potential use in hypertension and heart failure. Since its actions are not confined to the renin-angiotensin system, its antihypertensive effect occurs in both high renin and...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ 326: Omapatrilat
Omapatrilat inhibits: a) Angiotensin converting enzyme b) Neprilysin c) Aminopeptidase P d) All of the above ["Click here for the answer with explanation", "Correct Answer:"] d) All of the above Omapatrilat inhibits angiotensin converting enzyme, neprilysin, and aminopeptidase P [McMurray JJ et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 Sep 11;371(11):993-1004]. Neprilysin is a neutral endopeptidase which degrades vasoactive peptides like natriuretic peptides, bradykinin and adrenomedullin. The post Cardiology MCQ 326: Omapatrilat appeared first on...
Source: Cardiophile MD - September 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Intravenous Nitroglycerine in STEMI, with data: Avoid its use if giving tPA
If you are giving tPA to patients with STEMI, it is wise to avoid IV nitroglycerine.  I am revisiting this topic because of a recent case I posted in which a patient who was on IV nitro received tPA.  This patient was very hypertensive, and thus needed something to control BP. But I would advise against nitroglycerine.This is data that very few cardiologists are aware ofBackground: First, know that, in the reperfusion era, there is absolutely no data to support the use of nitroglycerine in STEMI.  See the ACC/AHA recommendation below that puts the level of evidence at “C”.  I have paste...
Source: Dr. Smith's ECG Blog - September 11, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Drug Innovation and Government-Operated Health Systems
On August 30, 2014, cardiovascular drug researchers managing the PARADIGM-HF Study and its Committees announced that they were terminating their Phase III trial of LCZ696 because of observed “overwhelming benefit.” As reported in The Daily Mail: “Thousands of lives could be saved by a new drug for heart failure that researchers claim outperforms the current best treatments. … Research on more than 8,000 patients found that it saved 20 per cent more lives than the current ‘gold standard’ treatment – the ACE inhibitor enalapril.” The findings were announced at the an...
Source: blog.bioethics.net - September 9, 2014 Category: Medical Ethics Authors: Hayley Dittus-Doria Tags: Health Care Pharmaceuticals Distributive Justice drug safety syndicated Source Type: blogs

Review of the 2014 ESC Sessions in Barcelona
Hey Everyone, Me at Park Guell It’s been a few days since I returned home from Spain. The jet leg has resolved and normal sleep patterns have returned. I’ve had time to review the entire ESC program book. What follows is a review of my work and some notes on the past week in Barcelona. The first thing to say about the European Society of Cardiology sessions is its massiveness. The convention site is huge; it’s streaming with people and technology. The press room stretched for more than a hundred meters while more than 500 journalists from all over the world jostled for desk space and power outlets, which ...
Source: Dr John M - September 7, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

Logical Fallacies in Defense of the PARADIGM - HF Trial of Valsartan - Sacubitril, Suppsedly the "Game Changer" for Heart Failure
We frequently discuss how commercial sponsors manipulate clinical research to serve their interests.  There have been many cases of commercially sponsored controlled trials ostensibly designed to assess their sponsors' products manipulated to make these products look better.Unfortunately, often such manipulation seems to escape public notice.  What skepticism they may generate often gets little notice, an example of the anechoic effect.  Very rarely do the people responsible for the trial deign to address skeptical criticism. However, we recently noted that cogent criticism of a very recently published ...
Source: Health Care Renewal - September 5, 2014 Category: Health Management Tags: anechoic effect conflicts of interest logical fallacies manipulating clinical research Novartis sacubitril Source Type: blogs

Sacubitril - Valsartan, a "New Threshold of Hope" or Hype for Heart Failure?
Summer must be over, because the next new blockbuster drug appears to be here.  At the end of August, the media heralded the results of a study of a new product for congestive heart failure (CHF) from Novartis.Novartis' New "Game Changer" The New York Times article was fairly restrained, simply saying ithas shown a striking efficacy in prolonging the lives of people with heart failureThe Reuters article's headline saidNew Novartis drug may upend heart failure treatmentIn Forbes, Matthew Herper called it aGame ChangerThe accompanying editorial in the New England Journal of Medicine (1) suggested the drugmay w...
Source: Health Care Renewal - September 3, 2014 Category: Health Management Tags: CHF clinical trials evidence-based medicine manipulating clinical research Novartis sacubitril Source Type: blogs

ACE Inhibitors and anemia
: Angiotensin converting enzyme (ACE) inhibitors have been implicated in the worsening of anemia in patients with chronic kidney disease (CKD) on dialysis and renal transplant recipients. Both ACE inhibitors and angiotensin receptor blockers (ARB) have some effect on erythropoietin synthesis and can cause suppression of erythropoiesis in those with CKD. This can sometimes be overcome by escalating the dose of exogenously administered erythropoietin. It is known that activation of renin-angiotensin system enhances the production of erythropoietin in peritubular fibroblasts of the kidney. Some studies also suggest that ACE i...
Source: Cardiophile MD - August 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

A New Novartis Heart Failure Drug Might Be A Blockbuster
I try to avoid using words like “blockbuster” and “breakthrough” when writing about new drugs and treatments. I’ve been disappointed too many times. But, though they’ve been in short supply lately in cardiovascular medicine, sometimes there really are breakthroughs and blockbusters. In my career writing about cardiovascular medicine I’ve seen the introduction of the ACE inhibitors, statins, stents, ICDs, and clopidogrel, among others. All of these became multibillion-dollar products. Now there’s a new candidate that just might join this group. I’ll tell you why, but I c...
Source: CardioBrief - April 1, 2014 Category: Cardiology Authors: Larry Husten Tags: Heart Failure People, Places & Events Policy & Ethics ACE inhibitors Angiotensin Receptor Neprilysin Inhibitor enalapril LCZ696 Novartis Source Type: blogs

Early Success For Novel Novartis Heart Failure Drug
A large clinical trial testing a novel compound from Novartis for chronic heart failure has been stopped early for efficacy. In a press release Novartis said the Data Monitoring Committee had recommended early closure of the PARADIGM-HF trial because the trial had demonstrated a significant reduction in the combined primary endpoint of cardiovascular death and heart failure hospitalization. PARADIGM-HF randomized patients with heart failure and reduced left ventricular ejection fraction to either the ACE inhibitor enalapril or LCZ696, an Angiotensin Receptor Neprilysin Inhibitor (ARNI) that is the first in its class. &hell...
Source: CardioBrief - March 31, 2014 Category: Cardiology Authors: Larry Husten Tags: Uncategorized Angiotensin Receptor Neprilysin Inhibitor clinical trials heart failure Novartis Source Type: blogs

Drug for dilutional hyponatremia
Drug useful in management of dilutional hyponatremia: a) Tolvaptan b) Enalapril c) Omapatrilat d) Ambrisentan Correct Answer: a) Tolvaptan Tolvaptan is a vasopressin antagonist useful in the management of dilutional hyponatremia. It should not be used in hypovolemic hyponatremia. It is orally active and a selective V2 antagonist. Tolvaptan is an aquaretic causing free water excretion without loss of electrolytes. Schrier RW. Tolvaptan, a Selective Oral Vasopressin V2-Receptor Antagonist, for Hyponatremia. N Engl J Med 2006; 355:2099-2112 (Source: Cardiophile MD)
Source: Cardiophile MD - July 22, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ Test 6
Cardiology MCQ Online 6 Time limit: 0 Quiz-summary 0 of 25 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions b...
Source: Cardiophile MD - July 16, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Congestive Heart Failure
Pathophysiology of Congestive Heart Failure Congestive heart failure is: 1) inability of heart to deliver sufficient cardiac output to meet physiologic needs 2) both diastolic and systolic phases are abnormal 3) initially, compensatory mechanisms occur(increased catecholamines, increased atrial natriuretic factor, myocardial hypertrophy), but eventual failure of these ensues causing congestive heart failure 4) result is increase in venous pressure with congestion of liver, spleen, and kidney (“backward failure”) and sodium retention, peripheral edema, and pulmonary sequelae (“forward” failure&rdquo...
Source: Inside Surgery - March 20, 2013 Category: Surgeons Authors: Editor Tags: Cardiology backward failure enlarged heart foward failure myocardial hypertrophy nutmeg liver peripheral edema Source Type: blogs

FDA: Enrichment Strategies to Improve Efficiency of Drug Development
Conclusion  Temple noted that there are some issues with predictive enrichment.  One is that you always believe the characteristic you use to enrich predicts the good responders; it may not do this as well as you hope.  So it’s very important to characterize the test that leads you to select those patients; then see whether it’s true that patients with the characteristic always (or most of the time) respond, and that patients without the characteristic don’t respond very much.   An issue to consider in any enrichment design is how much you need to study the people who don’...
Source: Policy and Medicine - February 12, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs