Daily Archives: February 20, 2023
AHA Scientific Statement | Anesthetic care of the pregnant patient with cardiovascular disease
20 Feb, 2023 | 12:29h | UTCSummary: The AHA emphasizes the need for specialized cardio-obstetric anesthesiology care for pregnant patients with cardiovascular disease, involving a multidisciplinary team of obstetricians, cardiologists, anesthesiologists, and other specialists as needed. The approach includes preoperative evaluation, intraoperative management, and postoperative care to maintain maternal hemodynamic stability, optimize oxygen delivery to the fetus, and avoid factors that exacerbate cardiovascular disease. Vaginal delivery with effective neuraxial analgesia is the preferred mode of delivery, with cesarean delivery used for obstetrical indications or high-risk patients. Specific recommendations are also provided for the management of patients with different types of cardiovascular disease, including congenital heart disease, valvular heart disease, pulmonary hypertension, and hypertrophic cardiomyopathy.
Top Things to Know: Statement on the anesthetic care of the pregnant patient with cardiovascular disease – American Heart Association
Study finds low rates of antipsychotic medication discontinuation in older adults following infection-related hospitalization
20 Feb, 2023 | 12:25h | UTCSummary: The study aimed to investigate discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization and infection in older adults. The cohort study involved 5,835 patients in the US, who were aged 65 years or older, without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. The study found that only 11% of new atypical APM users and 52% of new haloperidol users discontinued the medication by 30 days after initiation. The discontinuation of haloperidol and atypical APM was less likely to occur in patients with dementia and prolonged hospitalization. The findings suggest that APM discontinuation rates following infection-related hospitalization are low, especially for atypical APM, and call for effective interventions to proactively discontinue APMs when they are no longer indicated.
RCT | Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease
20 Feb, 2023 | 12:27h | UTCSummary: The article reports on a randomized trial that compared the effects of alternate-day fasting (ADF) combined with exercise, fasting alone, or exercise alone in adults with obesity and non-alcoholic fatty liver disease (NAFLD). After three months, the combination of ADF and exercise significantly reduced intrahepatic triglyceride content, body weight, fat mass, waist circumference, and alanine transaminase levels compared to the control group. The intervention seems promising for patients with fatty liver disease who want to improve their health without using medications.
Article: Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: A randomized controlled trial – Cell Metabolism (link to abstract – $ for full-text)
News Release: Alternate-day fasting could be a good option for patients with fatty liver disease – University of Illinois Chicago
Gadolinium nanoparticles detected in kidney tissue of patients after MRI with gadolinium contrast, raising safety concerns
20 Feb, 2023 | 12:24h | UTCSummary: Researchers have discovered that tiny particles of the rare earth metal gadolinium can infiltrate kidney cells, potentially causing side effects. These particles, used to enhance MRI scans, were found in human and rodent specimens in a study that used electron microscopy to detect them. Gadolinium is typically tightly bound to chelating molecules in MRI contrast agents so that it can be eliminated via the kidneys, but the researchers found that some particles can leach out and build up in tissues. This raises questions about the safety of contrast agents containing gadolinium, which are used in around 50% of MRI scans, and highlights the need for further research into the risks and potential harms associated with these agents.
Commentary: Expert left ‘astounded’ by gadolinium discovery – Health Imaging
M-A | Consumption of whole vs. refined grains and risk of cardiovascular disease and all-cause mortality
20 Feb, 2023 | 12:23h | UTCSummary: This systematic review and meta-analysis of prospective cohort studies found that consuming whole grains was associated with a reduced risk of coronary heart disease, cardiovascular disease, and all-cause mortality, while consuming refined grains had no significant influence on these outcomes. Residual confounding can’t be excluded and the association found does not necessarily imply causation.
ESPEN practical guideline | Home parenteral nutrition
20 Feb, 2023 | 12:21h | UTCSummary: Home parenteral nutrition (HPN) is a form of nutrition support where a patient receives intravenous nutrition at home. It is used for patients who cannot receive adequate nutrition through oral or enteral routes, such as those with intestinal failure, severe inflammatory bowel disease, or other gastrointestinal disorders. HPN can be a life-saving therapy, but it requires careful patient selection, as well as ongoing monitoring and management by a multidisciplinary team. The ESPEN guideline aims to provide practical guidance on the use of HPN, including the nutritional and metabolic aspects of care and the practical considerations of administering HPN at home. The guideline also emphasizes the importance of patient-centered care and shared decision-making, highlighting the need for regular assessment and monitoring of patients.
Article: ESPEN practical guideline: Home parenteral nutrition – Clinical Nutrition
RCT | Rucaparib vs. physician’s choice in metastatic prostate cancer
20 Feb, 2023 | 12:17h | UTCSummary: This phase 3 randomized trial compared Rucaparib vs. physician’s choice control (docetaxel or a second-generation ARPI) in treating metastatic, castration-resistant prostate cancer patients with a BRCA1, BRCA2, or ATM alteration who had disease progression after treatment with a second-generation androgen-receptor pathway inhibitor (ARPI). The study found that the duration of radiographic progression-free survival was significantly longer in the rucaparib group than in the control group. The most frequent adverse events with rucaparib were fatigue and nausea.
Article: Rucaparib or Physician’s Choice in Metastatic Prostate Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Rucaparib Efficacious in Metastatic Castration-Resistant Prostate Cancer – HealthDay
Commentary on Twitter
Original Article: Rucaparib or Physician’s Choice in Metastatic Prostate Cancer (TRITON3) https://t.co/vuHTxqRRyb#GU23 #oncology pic.twitter.com/UrPMOgW4Fo
— NEJM (@NEJM) February 17, 2023
M-A | General Anesthesia vs. to Non-GA in endovascular thrombectomy for ischemic stroke
20 Feb, 2023 | 12:20h | UTCSummary: The study analyzed randomized controlled trials comparing the use of general anesthesia (GA) versus non-GA techniques, such as conscious sedation or local anesthesia for endovascular thrombectomy (EVT) in patients with ischemic stroke. The meta-analysis included seven trials with a total of 980 participants, showing that GA is associated with a 9% improvement in recanalization rates and an 8.4% improvement in functional recovery compared to non-GA techniques. There was no difference in hemorrhagic complications or 3-month mortality. The study recommends that GA be the first choice for most EVT procedures in acute ischemic stroke.
Article: General Anesthesia Compared to Non-GA in Endovascular Thrombectomy for Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials – Neurology (link to abstract – $ for full-text)
Review | Neurological complications of sepsis
20 Feb, 2023 | 12:16h | UTCSummary: This article covers the latest developments in the prevention, diagnosis, and treatment of sepsis-associated encephalopathy (SAE) and ICU-acquired weakness (ICUAW). SAE diagnosis is clinical with supporting EEG and neuroimaging. Treatment involves early identification and treatment of infections and organ dysfunction. ICUAW is due to an overlap between critical illness polyneuropathy, critical illness myopathy, and muscle disuse atrophy. It affects all limbs and respiratory muscles and is associated with prolonged hospital stay, increased costs, and both short and long-term mortality. Recovery is typical in weeks or months, but severe cases may result in persistent functional impairments for ICU survivors.
Article: Neurological complications of sepsis – Current Opinion in Critical Care
M-A | Soluble fiber supplementation and serum lipid profile
20 Feb, 2023 | 12:18h | UTCSummary: The article presents the results of a systematic review and dose-response meta-analysis of randomized controlled trials (RCTs) that evaluated the effect of soluble fiber supplementation on blood lipid parameters in adults. The review included 181 RCTs with 220 treatment arms and 14,505 participants. The meta-analysis found that soluble fiber supplementation significantly reduced LDL cholesterol, total cholesterol, triglycerides, and apolipoprotein B concentrations. The article suggests that increasing fiber intake using soluble fiber supplementation could be an effective intervention in the prevention and management of dyslipidemia, and consequently may contribute to the risk reduction of cardiovascular diseases. However, the article also notes that because of the high between-study heterogeneity and publication bias, the findings should be interpreted cautiously.