169. COVID19, Combined Oral Contraception and DVT, Colon Capsule Endoscopy

Also ask yourself, did this study compare their treatment to the 'gold standard' and if the answer is no they compared it to a straw man, then think big Pharma, or authors that needed publication for their job. We can't treat what we don't know exist and 30-50% of the time COVID19 is asymptomatic. Combined Oral Contraception DO NOT have an increase risk of DVT and long term the risk are very minimal if a DVT does develop while on COC.



Speaking of studies that should have never been done- Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study) | Gut (bmj.com)


Diagnostic Yield of Colon Capsule Endoscopy vs CT Colonography in a Screening Population | PracticeUpdate

The authors of this multicenter, prospective, randomized study compared the diagnostic yield of colon capsule endoscopy (CCE) with that of CT colonography (CTC) for colon cancer screening in an average-risk adult population.
First you had either a CCE or a CTC and then the findings were confirmed with colonoscopy.

The sensitivity and specificity of CCE for polyps ≥6 mm were 79.2% and 96.3%, respectively, compared with 26.8% and 98.9%, respectively, with CTC. The sensitivity and specificity of CCE for polyps ≥10 mm were 85.7% and 98.2%, respectively, compared with 50% and 99.1%, respectively, with CTC.

They authors say this may work for people who refuse colonoscopy. Which is true it might but we have a fit test—it cost pennies—why in the world do we need this test?!? Its more money its more invasive its not better than FIT…..

This is a study we didn’t need
till I read the 30 line conflict of interest and I knew exactly why we needed this trial—to keep big pharm in business


Colon cancer is scary cause most of the time we don’t know we have it and speaking of thigs we don’t know we have

Asymptomatic SARS-CoV-2 Infections Among Persons Entering China From April 16 to October 12, 2020 | Global Health | JAMA | JAMA Network

China controlled their cases because

Beginning April 1, 2020, persons entering China via air, sea, or land have been mandatorily tested for SARS-CoV-2 infection by PCR test at border checkpoints.
retrospective cohort study looked at All international entrants found to have SARS-CoV-2 infection via a positive PCR test result at China’s border checkpoints from April 16 to October 12 were included in this study.
3103 had confirmed COVID-19 cases, AMONG THOSE 1612 (51.9%) never developed symptoms through day 13 and were considered to have asymptomatic SARS-CoV-2 infection.




The Proportion of SARS-CoV-2 Infections That Are Asymptomatic: A Systematic Review: Annals of Internal Medicine: Vol 0, No 0 (acpjournals.org)

Purpose:
To estimate the proportion of persons infected with SARS-CoV-2 who never develop symptoms.


And results found- about 1/3 of people had no symptoms and if you test positive and have no symptoms then about 75% of the time you will never have symptoms. WE will never be able to stop what we don’t even know about. WE can never and I repeat NEVER flatten a curve on something that you may not even know you have 33% of the time.






Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis | The BMJ

Prescribe antidepressants for depression not for pain

Design Systematic review and meta-analysis.

Objective To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo.

Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability).


Results 33 trials (5318 participants) were included.

Back pain-

serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference −5.30, 95% confidence interval −7.31 to −3.30) at 3-13 weeks
SNRIs reduced sciatica at two weeks or less (−18.60, −31.87 to −5.33) but not at 3-13 weeks (−17.50, −42.90 to 7.89).
tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less but did at 3-13 weeks (−15.95, −31.52 to −0.39) and 3-12 months (−27.0, −36.11 to −17.89).
SNRIs reduced disability from back pain at 1-13 weeks around 1-3 points—TO WHAT SIGNIFCANT CLINCALY ON 100 point scale.

osteoarthritis-
SNRIs reduced osteoarthritis pain (−9.72, −12.75 to −6.69) at 3-13 weeks
TCAs and other antidepressants did not reduce pain or disability from back pain.



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8000 women from 2004-2006- to be included you could not be pregnant or postpartum and aged ≤ 50 years, without active cancer

There were 220 women had either a first distal dvt, first prox dvt, or a first PE

Of these women, 47.3% (n/N = 104/220) were on COC pills at the time of their VTE event.

Overall, 27.6% of patients developed venous thromboembolism (VTE) <12 months after starting OCPs.

BUT this article was great because it said what is the long term effect of this VTE caused by COC--- are their long term effects?

At 3‐year follow‐up, all women with COC‐associated distal DVTs were alive, and none had bled during anticoagulant treatment or had experienced a DVT or PE recurrence after stopping anticoagulants.

At 3‐year follow‐up, all women with COC‐associated PE were alive and none had bled during anticoagulant treatment or had experienced a DVT or PE recurrence after stopping anticoagulants.

At 3‐year follow‐up, all women with COC‐associated proximal DVT had a recurrence rate of 1.7% per patient‐year and there were no deaths or major bleeds

The take home is that DVTs and PE with COC are basically just as common in women . taking and not taking COC as long as they are not pregnant and not postpartum women less than 50yrs old without active cancer AND most importantly, The long term outcome or side effects are basically the same, just remember to stop the COC if they are on it and then treat with 3 months of anticoagulation..