A one-year-old previously healthy child presented to the general practitioner (GP) with a history of fever, diarrhea, and cold for five days, and erythema at the BCG inoculation site for one-day duration. She had been initially treated as bacillary dysentery with oral cotrimoxazole. While on treatment, she developed strawberry tongue and swelling of hands and feet along with the appearance of conjunctivitis and persistent high fever. The child was admitted only on day 12 of illness with suspicion of Steven Johnson syndrome secondary to cotrimoxazole. Further, the child had poor feeding and watery discharge from her right ear. She had age-appropriate immunization and there was no history of allergy to drugs, food, and environmental allergens.  Physical examination revealed that she was ill, febrile (above 102 F), irritable, dehydrated, and had bilateral conjunctivitis without discharge. There was cervical lymphadenopathy measuring 2 cm in size. Feet and hands were swollen. Lips were cracked with beefy red tongue and a well-defined erythematous reaction was evident at the BCG inoculation site. Other systems examination was normal apart from having mild right hypochondrial tenderness. 

Investigations revealed a high white blood count (18x103 /cumm (normal range - 6x103 -17x103/cumm) with neutrophil 75%), low haemoglobin (8.9 g/dl - normal range 11.3 g/dl - 14.1 g/dl), normal platelets (350x103/cumm), high C-reactive protein (CRP-148 mg/dl - normal range - less than 5 mg/dl ), and high ESR (120 mm/hour).  

Blood picture showed evidence of either infection or inflammation with the left shift of neutrophils. Urinalysis showed microscopic haematuria (5-8/HPF) and pyuria (10-14/HPF).  

The cerebrospinal fluid analysis revealed normal findings including cultures apart from showing slightly high protein (60mg/dL). Serum sodium was 134meq/l, and potassium was 4.2meq/l. Serum total protein was 60mg/dl, and albumin was 35mg/dl. Aspartate transaminase (154 IU/l) and alanine transaminase (104 IU/L) were elevated. Alkaline phosphatase was normal (300 IU/L). Renal functions had been normal except for elevated blood urea (70mgdl). Throat swab showed no organisms, and blood and urine cultures were sterile. Rheumatoid factor was negative. Antistreptolysin O titer (ASOT) was less than 200 IU/L. antibody to leptospira, mycoplasma, Epstein Barr virus, and scrub typhus were negative. Chest X-ray was normal. Ultrasound abdomen showed hydrops of the gall bladder, and otherwise findings were normal. Echocardiogram and electrocardiogram revealed normal findings with no evidence of coronary aneurysms. The ophthalmological examination had been normal.  What do you think?

Male, 82 years old, with personal history of Hypertension, Dyslipidemia and Aortic valvuloplasty. He was admitted in our hospital for several presyncopal episodes. In the anamnesis was remarkable a several-months history of dyspepsia, weight loss of more than 10 kg and melena. What can be the differential diagnosis of his clinical presentation and how to investigate it further?

A 25-year-old, male, presented with history of abnormal behaviour, delusions, hallucinations, and aggression beginning a few hours prior to presentation. The onset was acute and progressive in nature. According to his wife, he suddenly stood up and started picking at his clothes and searching for something in a drawer; at the same time, he was not responding to her calls. He was also reported to be sniffing like a dog. When she intervened, he became aggressive and physically assaulted her. He was confused and did not seem to respond to the surroundings.No history of fever, fall, head trauma, or substance abuse was reported. On examination, patient’s vitals, and all systems including neurological system were normal. Rapport could not be established as the patient appeared confused and perplexed and was not responding to any questions. He appeared to be agitated and hallucinating as he was talking to self. He was admitted and on further evaluation it was revealed that although his speech was sparse, on many occasions he said God was talking to him and he could also see Him; hence he has the power to do anything. He only intermittently recognized family members. His orientation to time, person, and place was lost on many occasions. However, there were bouts of aggressive behaviour which was nondirected and seemed purposeless.All routine investigations were within normal limits including electrolytes, computed tomography (CT) brain, and electroencephalogram (EEG). What could this be?

Gravida 1,31 weeks, 26 years, complaints of epigastric pain, bleeding per gum and petechiae hemorrhage for 1 day; high-grade fever for 5 days prior to admission, first seen at antenatal clinic (12 weeks pregnancy), no abnormality detected. Nothing history. 37°c, bp110/80 mmHg, pulse 80/mim and respiratory rate 20/min. Mild dehydration. Liver enlarged 1 cm below the right costal margin with mild tenderness. Fundal height - 31 weeks' gestation, fetal heart rate 144 beats/min, Petechiae1–2 mm d. found on face, forearms and both pretibial areas.

Labs: hgb 11.9 g/dl, hematocrit 35%, white blood cells 7,440/mm3 50% neutrophil, 45% lymphocytes; 3% atypical lymphocytes; platelet 10,100 /mm3. Intravenous fluid replacement, under close observation bleeding precaution. After 24h, epigastric pain disappeared, vital signs normal. Hematocrit 30% , platelet  6,320 /mm3. Day 3, gradually recovered and had an itching convalescent rash on both pretibial areas. Hematocrit 31%, platelet 15,000 /mm3. She was discharged day 4. After 1 week, she was healthy and hematocrit 32% with platelet 354,000 /mm3. After that, she had an uneventful antenatal care. At the 39 weeks' gestation, she delivered a healthy female baby weighing 2,630 grams by vaginal route with APGAR scores 9 and 10 at 1 and 5 minutes, respectively. No abnormality in newborn was detected.

Most likely diagnosis of this condition?

78% of parents rely on news reports to stay informed about bird flu, 31% turn to social media, and only 11% consult healthcare providers for guidance, according to a recent University of Michigan Health C.S. Mott Children’s Hospital National Poll. The survey included 2,021 parents of children aged 18 years or younger, with just 43% reporting confidence in their ability to access accurate information about the H5N1 virus.

These results are particularly troubling given this week's warning from the UN's Food and Agriculture Organization, which described the current bird flu threat as 'unprecedented' due to the H5N1 virus jumping to mammals. Globally, health experts have expressed concern about increasing bird flu cases, especially in the US, where an outbreak affecting poultry and dairy cows has resulted in 67 human infections and one death. Since first detected in 1997, this clade has caused 954 human cases across 24 countries, though no cases have yet been reported in Europe, according to the European Commission.

How confident do you feel in advising your patients about bird flu?

Primary care has always been the foundation of modern medicine—the first line of defense, the system that keeps patients out of hospitals, and the one place where long-term health is actually managed. Yet, quietly and steadily, it’s disappearing. Fewer doctors are choosing primary care, more patients are struggling to get appointments, and the entire healthcare system is shifting to compensate.  

The problem isn’t just that primary-care doctors are in short supply—it’s that medicine is adapting to their absence in ways that could reshape healthcare forever. Across hospitals and clinics, the workload once managed by primary-care physicians is being absorbed by a patchwork of alternatives. Nurse practitioners and physician assistants are taking on increasing responsibilities, sometimes with minimal oversight. Urgent care centers and retail clinics are filling in for long-term care, treating patients on a visit-by-visit basis. Telemedicine is expanding rapidly, but often at the cost of continuity. Artificial intelligence is being positioned as a diagnostic tool, with algorithms attempting to replicate the intuition and pattern recognition that experienced doctors develop over years of patient interactions.  

These shifts make healthcare more accessible in the short term, but they come with hidden consequences. Nurse practitioners and physician assistants, while invaluable to the system, do not undergo the same level of training as physicians. Studies have shown they refer patients to specialists more often, leading to increased healthcare costs and unnecessary procedures. Within the Veterans Health Administration, emergency departments that expanded the role of NPs saw a 7% rise in per-patient care costs due to higher rates of diagnostic testing and hospital admissions. Meanwhile, a 2024 study found that NPs referred patients to specialists 35% more often than doctors, increasing healthcare costs and unnecessary interventions.  

The crisis isn’t limited to the US—it’s a growing problem worldwide. The World Health Organization estimates a global deficit of 4.3 million physicians, nurses, and other health professionals, with Europe facing its own primary-care crisis. Despite a slight increase in the number of general practitioners per capita in recent years, many countries still have severe shortages, leading to delayed care and overburdened emergency rooms. In England, the NHS is approaching a tipping point where more patient appointments will be handled by non-physicians than by GPs, fundamentally changing the way care is delivered. In the US, the Association of American Medical Colleges predicts a shortage of up to 124,000 physicians by 2034, with primary care being one of the hardest-hit areas. The impact is already being felt— in 2021 alone, an estimated 117,000 physicians left the workforce, citing burnout, retirement, and stress from the pandemic.  

The loss of primary-care physicians is not just a workforce issue—it is fundamentally changing healthcare delivery. Where once primary care was about prevention, continuity, and relationships, it is now becoming a system of quick consultations, reactive treatments, and fragmented care. Patients are spending more time managing their own referrals, navigating a system that no longer prioritizes coordination. What does a world without primary care look like? Rising healthcare costs, overwhelmed emergency rooms, and worsening health outcomes as chronic diseases are caught too late. The real question is: are we truly prepared for the price of letting primary care disappear?

Aspirin has long been known for its anti-inflammatory and blood-thinning properties, but new research suggests it may also play a crucial role in preventing cancer from metastasizing. A study conducted by scientists from the University of Cambridge, published in Nature, has revealed how aspirin may boost the immune system’s ability to fight off cancer cells that attempt to spread beyond their original tumor site.

In their mouse model of melanoma, researchers found that aspirin reduces the production of thromboxane A2 (TXA2)—a molecule produced by platelets that suppresses immune T cells. By inhibiting TXA2, aspirin allows T cells to remain active, enabling them to target and destroy metastatic cancer cells before they form secondary tumors. This discovery is significant, as over 90% of cancer deaths occur due to metastasis, making prevention a critical goal in oncology.

One of the most striking aspects of this research is the identification of a "window of vulnerability" in cancer progression. Lead author Rahul Roychoudhuri, PhD, explains that when cancer cells first begin spreading, they may be uniquely susceptible to immune attack. This suggests that intervening early with aspirin or similar drugs could help eliminate these migrating cells before they establish secondary tumors. Further supporting this concept, previous studies identified 15 genes in mice that influence cancer metastasis, including ARHGEF1, which plays a role in suppressing immune function. The researchers discovered that this gene is activated by TXA2, linking platelet activity with immune suppression—a key pathway that aspirin disrupts.

With clinical trials in humans now underway, scientists hope to determine whether aspirin could be a low-cost, globally accessible treatment for preventing cancer recurrence. Dr. Ruth Langley, a professor of oncology at University College London, is leading the Add-Aspirin clinical trial to investigate whether aspirin can stop or delay the return of early-stage cancers...Read More

Medpage Today

Despite DS patients facing a 90% lifetime risk of developing Alzheimer’s-related dementia, researchers at the University of Pittsburgh uncovered a case in which a woman with DS remained cognitively stable for over a decade, even though her brain showed clear neuropathological signs of AD. This paradoxical finding suggests that genetic factors or lifestyle influences might confer a protective effect against the cognitive decline typically seen in Alzheimer’s.

The participant’s involvement in the Alzheimer Biomarker Consortium–Down Syndrome (ABC-DS) study allowed researchers to gather extensive longitudinal data. Upon her passing, her family generously donated her brain for further analysis. Using a state-of-the-art 7 Tesla MRI scanner, the research team obtained high-resolution neuroimages that revealed Alzheimer's pathology. Yet, all the clinical assessments conducted during her life indicated she maintained normal cognitive function. Researchers, including Dr. Jr-Jiun Liou and Dr. Elizabeth Head, speculate that her high level of education or unique genetic makeup might have contributed to her resilience.

This case not only spotlights a rare phenomenon but also offers valuable insights into the discrepancy between clinical presentation and biological pathology. It challenges conventional diagnostic criteria for Alzheimer's disease in individuals with DS and calls for a re-evaluation of current methods. By linking detailed neuroimaging data with neuropathological findings, researchers hope to refine diagnostic and therapeutic criteria for early detection and intervention in both DS and the broader population affected by AD.

Moreover, this study opens new avenues for investigating the factors behind cognitive resilience. If scientists can identify the genetic or lifestyle determinants that allowed her brain to function optimally despite the disease, it could lead to strategies that benefit many at risk of Alzheimer’s. As Dr. Head noted, the implications of this case extend far beyond Down syndrome, underscoring how the participation of even a single individual in research can drive profound discoveries and potentially revolutionize our approach to neurodegenerative diseases...Read More

What are your thoughts?

MedicalXpress

Aspirin has long been known for its anti-inflammatory and blood-thinning properties, but new research suggests it may also play a crucial role in preventing cancer from metastasizing. A study conducted by scientists from the University of Cambridge, published in Nature, has revealed how aspirin may boost the immune system’s ability to fight off cancer cells that attempt to spread beyond their original tumor site.

In their mouse model of melanoma, researchers found that aspirin reduces the production of thromboxane A2 (TXA2)—a molecule produced by platelets that suppresses immune T cells. By inhibiting TXA2, aspirin allows T cells to remain active, enabling them to target and destroy metastatic cancer cells before they form secondary tumors. This discovery is significant, as over 90% of cancer deaths occur due to metastasis, making prevention a critical goal in oncology.

One of the most striking aspects of this research is the identification of a "window of vulnerability" in cancer progression. Lead author Rahul Roychoudhuri, PhD, explains that when cancer cells first begin spreading, they may be uniquely susceptible to immune attack. This suggests that intervening early with aspirin or similar drugs could help eliminate these migrating cells before they establish secondary tumors. Further supporting this concept, previous studies identified 15 genes in mice that influence cancer metastasis, including ARHGEF1, which plays a role in suppressing immune function. The researchers discovered that this gene is activated by TXA2, linking platelet activity with immune suppression—a key pathway that aspirin disrupts.

With clinical trials in humans now underway, scientists hope to determine whether aspirin could be a low-cost, globally accessible treatment for preventing cancer recurrence. Dr. Ruth Langley, a professor of oncology at University College London, is leading the Add-Aspirin clinical trial to investigate whether aspirin can stop or delay the return of early-stage cancers...Read More

Medpage Today

It may be possible to predict diagnostic transition to schizophrenia and bipolar disorder from machine learning models using routine clinical data extracted from electronic health records, according to a study published online Feb. 19 in JAMA Psychiatry.

Lasse Hansen, Ph.D., from Aarhus University Hospital in Denmark, and colleagues investigated whether machine learning models using routine clinical data from electronic health records can predict diagnostic progression to schizophrenia or bipolar disorder among patients undergoing treatment in psychiatric services for other mental illness. The analysis included 24,449 patients aged 15 to 60 years with at least two contacts at least three months apart for psychiatric services.

The researchers found that transition to the first occurrence of either schizophrenia or bipolar disorder was predicted by the XGBoost model, with an area under the receiver operating characteristic curve (AUROC) of 0.70 on the training set and 0.64 on the test set. Using a predicted positive rate of 4 percent, the XGBoost model had a sensitivity of 9.3 percent, a specificity of 96.3 percent, and a positive predictive value (PPV) of 13.0 percent. Better performance was seen for predicting schizophrenia separately (AUROC, 0.80; sensitivity, 19.4 percent; specificity, 96.3 percent; PPV, 10.8 percent) than for bipolar disorder (AUROC, 0.62; sensitivity, 9.9 percent; specificity, 96.2 percent; PPV, 8.4 percent). Prediction was aided by clinical notes.

"These findings suggest that detecting progression to schizophrenia through machine learning based on routine clinical data is feasible, which may reduce diagnostic delay and duration of untreated illness," the authors write.

Several authors disclosed ties to relevant organizations.

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Eating behavior and consuming certain foods are associated with perceived pelvic floor disorders, according to a study recently published in Women's Health.

Mari A. Kuutti, from the University of Jyväskylä in Finland, and colleagues conducted a cross-sectional, observational study involving 1,098 Finnish women aged 47 to 55 years to examine the associations of eating behavior with symptoms of pelvic floor disorders.

The researchers found that middle-aged women with disordered eating style were more likely to experience the symptoms of stress urinary incontinence and constipation or defecation difficulties (odds ratios, 1.5 and 1.4, respectively) in adjusted models. The associations were abolished by the addition of body mass index to the models. Regardless of eating style, more frequent consumption of ready-made, highly processed foods and fast foods was independently associated with symptoms of stress urinary incontinence (odds ratios, 1.5 and 1.5); consumption of ready-made foods was associated with urgency urinary incontinence symptoms (odds ratio, 1.4). There was an independent association seen for daily consumption of fruits with symptoms of stress urinary incontinence (odds ratio, 0.8). Independent of eating style, daily consumption of porridge was associated with symptoms of constipation or defecation difficulties (odds ratio, 1.7). There was an inverse association for alcohol consumption with constipation and defecation difficulties (odds ratio, 0.9). Lower odds for stress urinary incontinence were seen for women with overall higher-quality diets.

"Since we found the disordered eating style and some dietary items to be associated with perceived pelvic floor disorders, our study justifies further studies with longitudinal designs to investigate causality," the authors write.

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Physicians with a disability are significantly more likely to report mistreatment from patients and co-workers, according to a study published in the October edition of Health Affairs. 

Researchers affiliated with the Association of American Medical Colleges, the University of Michigan in Ann Arbor and the University of Texas in Austin surveyed 5,851 practicing physicians from the Association of American Medical Colleges' national sample. 

Of the 3.1 percent of respondents who self-identified as disabled, 64 percent said that in the last 12 months, they had experienced at least one form of mistreatment — physical harm or threats of physical harm, unwanted sexual advances or offensive comments regarding the respondent’s gender, sexual orientation, race and ethnicity, disability or personal beliefs - from patients or co-workers...Read more

Do these statistics surprise you? Have you noticed or experienced this mistreatment?

Becker's

Boston Scientific has issued a recall of Accolade pacemaker devices, according to a safety communication from the U.S. Food and Drug Administration.

The Accolade devices under recall include the Accolade, Proponent, Essentio, and Altrua 2 Standard Life and Extended Life pacemakers and the Visionist and Valitude cardiac resynchronization therapy pacemakers.

The devices are being recalled due to an increased risk for permanently entering Safety Mode. Safety Mode has limited functionality and is associated with the pacemaker being unable to properly regulate the heart's rhythm and rate in some patients. Devices that enter Safety Mode need to be replaced.

Due to a manufacturing issue, the battery underpowers the device and causes the device to permanently enter Safety Mode. The FDA is working with the manufacturer to assess the risk for this issue in all Accolade pacemaker devices and to pinpoint additional mitigation strategies as needed.

Serious adverse health consequences, including slow heartbeats, fainting, and death, may be caused by the recalled devices. So far, 832 injuries and two deaths have been reported.

Physicians and patients should work together to monitor Accolade pacemaker devices. For patients at high risk for harm associated with interrupted pacing that may occur with Safety Mode, the device should be immediately replaced. For other patients, nonurgent replacement is recommended. Any problems encountered with Accolade pacemaker devices should be reported to the FDA.

More Information

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A listeria outbreak tied to frozen shakes served in hospitals and long-term care facilities has sickened at least 38 people and killed 12, according to the U.S. Food and Drug Administration (FDA).

The shakes, which are not sold in retail stores, were supplied to care facilities under the Lyons ReadyCare and Sysco Imperial brands. They are sold in four-ounce cartons in flavors like chocolate, vanilla and strawberry.

The FDA urges health care facilities to stop serving the shakes immediately.

The outbreak was linked to a Prairie Farms facility in Fort Wayne, Indiana, where the shakes were produced.

On Feb. 24, the FDA confirmed that the samples tested positive for listeria.

Lyons Magnus and Sysco issued product recalls and suspended sales from the Prairie Farms facility.

“Sysco expresses our most sincere condolences with those affected by this outbreak and their families,” the company said in a news release.

Listeria is a bacteria that can contaminate many foods and be especially dangerous to older adults, people with weakened immune systems and those who are pregnant, according to the U.S. Centers for Disease Control and Prevention (CDC).

The outbreak encompasses 21 states, with 37 of the 38 identified cases requiring hospitalization, according to the CDC.

This follows a deadly listeria outbreak from deli meats made by Boar's Head, which sickened as many as 59 people and killed 10 last year.

"Food safety is and will continue to be our top priority, and our focus will always be on improving these programs that protect our customers and our communities from foodborne illnesses," Sysco's recall notice said.

More information

The U.S. Centers for Disease Control and Prevention has more information on listeria.

SOURCES: U.S. Food and Drug Administration, recall notice, Feb. 24, 2025; Sysco, recall notice, Feb. 21, 2025; U.S. Centers for Disease Control and Prevention; The Washington Post, media report, Feb. 24, 2025

Health care facilities should check if they have served Lyons ReadyCare or Sysco Imperial shakes as they could be contaminated.

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Menthol cigarettes are associated with increased mortality risk, according to a study published online Feb. 13 in Tobacco Control.

Priti Bandi, Ph.D., from the American Cancer Society in Atlanta, and colleagues examined all-cause and cause-specific mortality risk according to baseline smoking status and menthol flavor status of the cigarette brand smoked for the longest period in a population-based prospective cohort study involving 969,349 persons enrolled in 1982 to 1983 with six years of mortality follow-up.

The researchers found 4,071 and 20,738 deaths among 73,486 and 281,680 persons who reported reporting menthol and nonmenthol brands, respectively. Mortality risks were highest for currently smoking cigarettes, whether menthol or nonmenthol brands (e.g., about a twofold higher risk for all-causes than never smoking), while risks were substantially reduced for both types with quitting. Among individuals who formerly smoked, menthol versus nonmenthol smoking was associated with increased mortality risks of 12, 16, 13, and 43 percent from all causes, all cardiovascular diseases, ischemic heart disease, and other heart diseases, respectively. Among current smokers, mortality risks did not differ for menthol versus nonmenthol cigarettes, apart from elevated risk among those smoking ≥40 cigarettes daily. For other heart diseases, Black persons currently smoking menthol versus nonmenthol brands had an 88 percent increased mortality risk.

"Menthol cigarettes remain unregulated despite known harms from smoking uptake and reduced cessation," the authors write. "This study provides additional evidence in support of their regulation in the USA and globally."

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There is a dose-response relationship between physical activity and rapid kidney function decline in older adults, according to a study published online Feb. 11 in the Journal of the American Society of Nephrology.

Stein I. Hallan, M.D., Ph.D., from the Norwegian University of Science and Technology in Trondheim, and colleagues investigated the dose-response effect of physical exercise on kidney function preservation in older adults (aged 70 to 77 years). The post-hoc analysis included 1,156 participants in the Generation 100 Study, who were randomly assigned to a control (education) group (385 participants), supervised moderate-intensity continuous training (70 percent of peak heart rate) for 50 minutes twice weekly for five years (380 participants), or high-intensity interval training (90 percent of peak heart rate) for four minutes four times twice weekly for five years (391 participants). 

The researchers found that oxygen uptake increased by 1.8, 2.3, and 3.3 mL/kg/min in the control, moderate-intensity, and high-intensity groups, respectively. Rapid estimated glomerular filtration rate (eGFR) decline occurred across groups (30, 28, and 23 percent, respectively). For the moderate-intensity (relative risk [RR], 0.93; 95 percent confidence interval [CI], 0.75 to 1.16) and high-intensity (RR, 0.75; 95 percent CI, 0.59 to 0.95) groups, there was a significant dose-response relationship. Participants with decreasing moderate-to-vigorous activity over time (> −20 minutes/week) had a trend for rapid eGFR decline (RR, 1.30; 95 percent CI, 0.93 to 1.83), while those with increasing activity (> +20 minutes/week) had lower risk (RR, 0.73; 95 percent CI, 0.53 to 0.99) versus stable activity, when adjusting for baseline factors.

"Preservation of kidney function should be recognized as one of the numerous health benefits of high-intensity exercise training," the authors write.

Two authors disclosed ties to the pharmaceutical industry.

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In 2022, there were 2.3 million new breast cancer cases and 670,000 deaths from female breast cancer globally, according to a study published online Feb. 24 in Nature Medicine.

Joanne Kim, Ph.D., from the International Agency for Research on Cancer in Lyon, France, and colleagues examined the current (2022) and future (2050) global burden of female breast cancer overall and by age group in 185 countries and assessed 10-year trends in incidence and mortality rates in 50 and 46 countries, respectively.

The researchers found that in 2022, there were 2.3 million new breast cancer cases and 670,000 deaths from female breast cancer worldwide. In half of examined countries, annual rates increased by 1 to 5 percent. In 29 countries with a very high Human Development Index (HDI), mortality rates decreased, and seven countries are currently meeting the Global Breast Cancer Initiative goal of ≥2.5 percent decrease each year. New cases and deaths are projected to increase by 38 and 68 percent, respectively, by 2050, disproportionately impacting low-HDI countries.

"Sustained investment and improvement in early diagnosis and treatment are also urgently needed, particularly in low- and medium-HDI countries, to reduce growing inequities in breast cancer survival and mitigate poor outcomes for the millions of additional women who will receive a diagnosis of breast cancer in the coming years," the authors write.

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The use of multiple muscle-building supplements is associated with muscle dysmorphia symptomatology, according to a study published online Feb. 19 in PLOS Mental Health.

Kyle T. Ganson, Ph.D., M.S.W., from the University of Toronto, and colleagues investigated the association between muscle-building supplement use and muscle dysmorphia symptomatology among Canadian adolescents and young adults. The analysis included data from 2,731 participants (mean age, 22.9 years) in the Canadian Study of Adolescent Health Behaviors.

The researchers found that using all six muscle-building supplements (e.g., amino acids/branched-chain amino acids, creatine monohydrate, preworkout drinks or powders, protein bars, weight/mass gainers, and whey protein shakes or powders) and using a greater number of muscle-building supplements were associated with greater total muscle dysmorphia symptomatology. Additionally, use of more muscle-building supplements was associated with greater odds of meeting the clinical cutoff for muscle dysmorphia.

"These findings add to a growing body of literature on the association between muscle-building supplement use and muscle dysmorphia symptomatology by including multiple muscle-building supplements and utilizing a diverse, national sample of adolescents and young adults," the authors write. "Findings warrant further investigation and the development of intervention strategies to decrease the use of increasingly normalized muscle-building supplements and muscle dysmorphia symptomatology."

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