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Medscape
15 minutes ago
- Medscape
Cefazolin Best for Cesarean Infection Prevention
TOPLINE: In planned cesarean deliveries, cefazolin demonstrates superior infection prevention compared with clindamycin plus gentamicin, with significantly lower rates of inpatient antibiotic use (5.9% vs 15.2%) and readmissions (1.8% vs 3.8%). METHODOLOGY: Researchers conducted a retrospective cohort study at a university-affiliated tertiary medical center between 2012 and 2023, including women undergoing planned cesarean delivery. Analysis included 11,246 eligible women with 10,588 receiving cefazolin (standard regimen) and 658 receiving clindamycin plus gentamicin (alternative regimen) because of severe penicillin or cephalosporin allergies. Prophylactic antibiotics were administered within 30 minutes before incision with cefazolin dosing at 2 g (3 g for women weighing ≥ 120 kg) and the alternative regimen consisting of clindamycin 600 mg plus gentamycin 5 mg/kg. Primary outcome measures included the need for inpatient antibiotic treatment, and secondary outcomes included readmission for obstetric or gynecologic complications. TAKEAWAY: Infectious complications occurred less frequently in the cefazolin group with inpatient antibiotic treatment rates of 5.9% compared with 15.2% in the clindamycin plus gentamicin group (P < .001). Readmission rates were significantly lower in the cefazolin group at 1.8% vs 3.8% in the alternative regimen group (P = .001). Multivariate analysis revealed the alternative regimen group had higher odds of requiring inpatient antibiotics (adjusted odds ratio [aOR], 2.1; 95% CI, 1.54-2.80; P < .001) and readmission (aOR, 1.95; 95% CI, 1.19-3.18; P = .008). IN PRACTICE: 'Cefazolin may be more effective than clindamycin plus gentamicin in preventing infectious complications after planned cesarean delivery. This study emphasizes the importance of careful assessment of β-lactam allergies to guide optimal antibiotic choices. For women allergic to standard regimens, alternative strategies should be considered to reduce postoperative infections and complications,' the authors of the study wrote. SOURCE: This study was led by Daniel Gabbai, MD, MPH, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center in Tel Aviv, Israel, and published in O&G Open. LIMITATIONS: According to the authors, this study used indirect indicators of infectious complications rather than direct diagnoses of endometritis or surgical site infections. The retrospective design introduced potential selection bias, particularly due to missing data on prophylactic antibiotic use in some patients. The researchers noted that while major confounders were controlled for, unmeasured factors might have influenced the observed differences between antibiotic groups. Additionally, data on prenatal antibiotic use were not consistently available, and the 12-year study period at a single tertiary care center may limit the generalizability of findings to other institutions with different patient populations and care practices. DISCLOSURES: The authors reported no relevant conflicts of interest. This study was approved by the Tel Aviv Sourasky Medical Center Institutional Review Board (No. TLV-0284-08, July 10, 2024). This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
an hour ago
- Medscape
Study: How Do Young Adolescents Express Gender Identity?
TOPLINE: A study of just over 10,000 US kids and teens aged 11-15 years found that 1.02% of adolescents identify as transgender; approximately 8.2% who were assigned female gender at birth and 1.3% assigned male gender at birth reported sometimes feeling like the other gender. METHODOLOGY: The study included 10,089 adolescents aged 11-15 years (mean age, 12.91 years) from 21 study sites across the US, each assessed through the Adolescent Brain Cognitive Development Study Youth Gender Survey between 2019 and 2021. Statistical analysis was performed over a period beginning in June 2024 and ending in March 2025. Researchers evaluated six gender constructs: two continuous measures (felt gender, self-described placement on the gender spectrum), two ordinal measures (level of dissatisfaction with one's gender and gender expression), and two categorical measures (felt gender category and transgender identity). TAKEAWAY: A little over 1% of kids and teens identified as transgender (1.02%; 95% CI, 0.81%-1.27%), with 1.1% (95% CI, 0.9%-1.4%) responding 'maybe' to the transgender identity question. Gender diversity varied by birth assignment, with 8.2% of adolescents assigned female gender at birth expressing feelings of being a boy and 1.3% of those assigned male gender at birth expressing feelings of being a girl. Most adolescents identified with the gender they were assigned at birth, with 51.4% of those assigned male gender at birth identifying as boys and 45.7% of those assigned female gender at birth identifying as girls. IN PRACTICE: 'Our study highlights the complexity of gender within early adolescents, especially as it relates to the way early adolescents are asked about gender and their understanding of the language used,' the study authors wrote. 'The use of multidimensional measurements of gender will aid in the development of inclusive policies and public health guidance that meet the needs of gender-diverse early adolescents.' SOURCE: The study was led by Jason M. Nagata, MD, MSc, Department of Pediatrics, University of California, San Francisco. It was published online on August 11 in JAMA Pediatrics. LIMITATIONS: A cross-sectional method and self-reported data were used, which may have affected the accuracy of the results. DISCLOSURES: Various study authors reported receiving grants from National Institutes of Health during the conduct of the study. No other disclosures were reported. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
an hour ago
- Medscape
FDA Warns of Future Action on Animal-Derived Thyroid Drugs
The top US regulator of medicines this week said he wants to officially approve an animal-derived thyroid drug, seemingly addressing concerns sparked by a press release from his own agency. On August 6, the FDA sent letters to manufacturers, importers, and distributors of animal-derived thyroid medications, stating that the agency 'intends to take action against marketed unapproved animal-derived thyroid (ADT) products (sometimes described as desiccated thyroid extract [DTE] products).' 'Due to their complex biological origin, these medications contain many compounds that are uncharacterized for safety and effectiveness,' the FDA said, noting that it could take as long as '12 months to safely transition patients to an FDA-approved thyroid hormone replacement product.' 'FDA is not taking immediate action against manufacturers who make unapproved animal-derived thyroid medication to give patients time to transition to an FDA-approved medication to treat their hypothyroidism,' the agency said. Following this announcement, in an August 13 post on his verified account on X, FDA Commissioner Marty Makary wrote that his agency 'is committed to pursuing the first-ever approval of desiccated thyroid extract, pending results of the ongoing clinical trials' and 'will in the meantime ensure access for all Americans,' without specifying what kind of thyroid medications would be available. The X post came after considerable social media backlash to the FDA's plans to shift patients toward synthetic thyroid medications and away from animal-derived versions. FDA-approved laboratory-made, or synthetic, thyroid medications currently dominate the US market. About 22 million people received prescriptions for levothyroxine through outpatient retail pharmacies in 2024 compared to an estimated 1.5 million patients who received prescriptions for animal-derived versions, the FDA said. Marketed under names such as Armour Thyroid, NP Thyroid, Nature-Thyroid, and Natural Thyroid, these medications are produced from dried, ground animal thyroid glands, usually those of pigs. Complex History The FDA has had a long and challenging history with regulating thyroid medicines. These drugs were first sold in the US well before federal laws gave the FDA the regulatory powers it now has, Antonio Bianco, MD, PhD, of the University of Texas Medical Branch, Galveston, Texas, and former president of the American Thyroid Association, told Medscape Medical News . 'Because they existed before the FDA, their regulatory pathway is really complicated,' Bianco said. In 1965, four of every five prescriptions for thyroid hormone were for natural thyroid preparations, as pharmacologic authorities confirmed that these were highly effective, well-absorbed, and produced clinically predictable outcomes, wrote Roselyn Cristelle Mateo-Collado, MD, of Rush University, Chicago, and James V. Hennessey, MD, of Harvard Medical School, Boston, in a 2019 review in Endocrine . But reports of patients not responding to desiccated thyroid triggered concerns about inconsistencies in the potency of these tablets, they added. Over time, a newer synthetic version, levothyroxine, became more widely used, even with concerns arising as well about inconsistent potency. Between 1987 and 1994, the FDA received 58 adverse experience reports associated with the potency of orally administered levothyroxine products. In 1997, the FDA mandated that any company wishing to market levothyroxine must first secure agency approval. In 2002, Abbott Laboratories received approval to keep selling its levothyroxine drug, Synthroid, which had been on the market for more than 40 years and was being taken by about 8 million people in the US, Abbott said at the time. In 2013, Abbott spun off its drug business as AbbVie. AbbVie now markets both Synthroid and Armour Thyroid, a desiccated thyroid drug. What's Next? In his X post, the FDA chief Makary did not mention any specific studies that he expects to lead to approval of a desiccated thyroid drug. AbbVie is sponsoring a phase 2/3 study examining the safety of its Armour Thyroid against the synthetic thyroid medicine, according to the website. AbbVie declined to comment on this story. Other companies also are working on research studies for their animal-derived thyroid drugs, so the FDA's August 7 announcement came as an unwelcome surprise for many people, Bianco said. Makary's X post this week likely was meant to respond to pushback from supporters of the animal-derived drugs, he added, noting that the commissioner's tone may signal that the agency is 'correcting course' and minimizing the impact of the agency's announcement. 'The manufacturers are working very hard' on large-scale trials, Bianco said. 'They require money and time to be done properly, and I think that's what the FDA should be stimulating.' Bianco reported being a consultant for AbbVie, Acella, Aligos, and Synthonics.
