#36 Recap and highlights from ACP 2017 Part 1

April 24, 2017 | By Matthew Watto, MD

A recap and highlights from ACP 2017, Internal Medicine’s largest national conference, with Dr. Alan Dow MD, MSHA, FACP, Professor of Medicine from Virginia Commonwealth University. We discuss iron supplementations, shellfish allergies and IV contrast, proton pump inhibitors, and more!

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Clinical Pearls:

1. PechaKucha presentation style in which 20 slides are shown for 20 seconds each (6min40sec) keeping presentations concise and fast-paced.
2. Oral iron supplements: Increase hepcidin levels, which blocks iron absorption. Iron should be dosed every other day!
3. Oral iron challenge: Have patient hold iron supplement for one week. Then, give them an oral dose of iron and check iron level one hour later. If no increase, then they are not absorbing iron.
4. Antibiotic resistance: There will be 10 million cases of resistance to current antibiotics by 2050, analogous to predictions made about MRSA in the 1950s…which came true!
5. Fluoroquinolones: Now becoming a second tier antibiotic due to multiple risks (tendonitis, tendon rupture, muscle and joint pains, irreversible peripheral neuropathy, confusion, hallucinations). Avoid routine use in 1) acute uncomplicated cystitis 2) acute exacerbation of chronic bronchitis 3) acute bacterial sinusitis. See this warning by FDA.
6. Fasting: May be associated with a decreased cancer risk.
7. Colon cancer screening: Now there are six ways to screen for colon cancer that are noninferior to colonoscopy (fecal occult blood q1y, FIT q1y, FIT-DNA q1-3y, CT colonography q5y, Flexible sigmoidoscopy q5y, Flex sig q10y with FIT q1y). SEPT9 is a new blood test for colon cancer screening FDA approved April 2016, but not yet recommended by USPSTF.
8. Shellfish allergy: There is NO association between shellfish allergy and IV contrast allergy!
9. Prediabetes: Lifestyle changes are first line for prevention, but if under 60 years old and high risk for diabetes type 2 (DM2), then consider metformin. Combining metformin with lifestyle changes is surprisingly NOT additive in prevention of DM2.
10. Opiate support system for clinicians: Free educational resource for safe prescribing from Providers Clinical Support System for Opioid Therapies, or from Virginia Commonwealth University.

Disclosures:
Dr. Alan Dow reports no relevant financial disclosures.

Links from the show:

1. PechaKucha presentation style Wikipedia page
2. Moretti, D et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood. 2015 Oct 22;126(17):1981-9. doi: 10.1182/blood-2015-05-642223. Epub 2015 Aug 19.
3. Harris AM, Hicks LA, Qaseem A, for the High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. doi: 10.7326/M15-1840
4. Fluoroquinolones FDA Warning from July 2016
5. The Tim Ferriss Show #117 with Dom D’Agostino on Fasting
6. USPSTF Colon Cancer Screening Guidelines as of June 2016
7. SEPT9 Article: Parikh RB, Prasad V. Blood-Based Screening for Colon CancerA Disruptive Innovation or Simply a Disruption?. JAMA. 2016;315(23):2519-2520. doi:10.1001/jama.2016.7914
8. Intravenous Contrast May Pose No risk to Kidneys NEJM Journal Watch February 2017 by Daniel Pallin, MD, MPH reviewing Ann Emerg Med 2017 Jan 19
9. VCU Safe Opiate Prescribing
10. Get help prescribing opiates here: Providers Clinical Support System for Opioid Therapies