How accurate are the findings noted during a physical examination?

When I was in training, it was common knowledge that the observations we made when examining patients were important observations that enabled us to diagnose with accuracy the patient’s disease. Over the years since then, a number of physical findings have been shown to be either inaccurate or less than helpful in diagnosing disease states. For example, I was taught a number of maneuvers to determine if abdominal ascites were present. Carefully controlled studies, however, have in recent years demonstrated that the accuracy of physical exam findings predicting the presence of ascites are less accurate than I was taught.

Heart failure with preserved ejection fraction: Is ischemia due to coronary microvascular dysfunction a mechanistic factor?

Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and has no guideline recommended therapy, related in part to a lack of mechanism. Traditionally, HFpEF was thought to be secondary to afterload overload due to systemic hypertension, however, accumulating evidence suggests that HFpEF continues to worsen despite adequate blood pressure control. Emerging data support the suggestion that myocardial ischemia secondary to coronary microvascular dysfunction could be the new paradigm pathophysiology.

UNDERUTILIZATION OF ASPIRIN IN PATIENTS WITH ADVANCED COLORECTAL POLYPS

Colorectal cancer is the third most common cause of cancer deaths in the United States and advanced colorectal polyps are a major risk factor. Although there are no large-scale individual trials designed a priori to test the hypothesis, in meta-analyses of trials in primary prevention of cardiovascular disease aspirin reduces risk of colorectal cancer. The United States Preventive Services Task Force utilized a micro-simulation model including baseline risk factors and concluded that aspirin reduces risk of colorectal cancer by 40%.

Those with inadequate access to food likely to suffer from obesity

Researchers have assessed the link between food-related hardships and obesity. Using a national sample of adults across the United States, the researchers learned that individuals who are food insecure are at an increased risk of obesity. Study results also showed that the individuals who live in food deserts are at an elevated risk for obesity.

CRISPR/Cas9 used to control genetic inheritance in mice

Using active genetics technology, biologists have developed the world’s first CRISPR/Cas9-based approach to control genetic inheritance in a mammal. The achievement in mice lays the groundwork for further advances based on this technology, including biomedical research on human disease. Future animal models may be possible of complex human genetic diseases, like arthritis and cancer, which are not currently possible.