Daily Archives: February 23, 2023
Mpox outbreak in advanced HIV cases | Global case series reveals higher mortality and clinical complications
23 Feb, 2023 | 13:44h | UTCSummary: This article discusses a case series investigating monkeypox (mpox) in people with HIV and low CD4 cell counts. The mpox outbreak in 2022 has affected a significant percentage of people living with HIV, and data suggest worse clinical outcomes and higher mortality in those with more advanced HIV. The case series includes data from 382 confirmed mpox cases in people living with HIV from 19 countries. The individuals included were predominantly cisgender men, with a median age of 35. Most individuals were adherent to antiretroviral therapy, and the median CD4 count was 211 cells per mm3. Severe complications were more common in those with lower CD4 cell counts, including necrotizing skin lesions, lung involvement, secondary infections, and sepsis. Approximately 28% of individuals were hospitalized, and 25% of those hospitalized died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. The study reinforces the importance of HIV and CD4 testing in mpox cases, prioritization of preventive mpox vaccination in people with HIV and a CD4 cell count of less than 200 cells per mm3, and the use of potential mpox antivirals where available. The authors suggest that a severe, disseminated, and necrotizing form of mpox should be considered an AIDS-defining condition in CDC and WHO HIV disease classifications. Clinicians should also be aware that starting antiretroviral therapy in people with advanced HIV and mpox could contribute to deterioration and possible death, possibly as part of an immune reconstitution syndrome.
Article: Mpox in people with advanced HIV infection: a global case series – The Lancet (free registration required)
News Release: Clinicians identify severe form of mpox with high mortality in people with advanced HIV – Queen Mary University of London
Commentaries:
Mpox: Clinicians identify severe form with high mortality in advanced HIV patients – The BMJ
Commentary from the author on Twitter (thread – click for more)
? ? Our global case series on MPOX in people with advanced HIV infection is at #CROI2023 and in @TheLancet today: 382 cases of human MPOX infection in PLWH with CD4 counts <350 cells/mm3 in 19 countries
**We found MPOX is an opportunistic pathogen** /1https://t.co/WodDN4Ujoj pic.twitter.com/IlK7viABmy— Chloe Orkin (@profchloeorkin) February 21, 2023
WHO Report | Global trends in the 2022-23 Mpox (Monkeypox) outbreak
23 Feb, 2023 | 13:43h | UTCSummary: The report provides an overview of the 2022-23 monkeypox (mpox) outbreak worldwide as reported to WHO as of February 18, 2023. The report focuses on laboratory-confirmed cases and mentions that 86,019 cases and 1,389 probable cases, including 96 deaths, have been reported to WHO from 110 Member States across all 6 WHO regions, including some countries without previously documented mpox transmission. The outbreak primarily affects men who have sex with men, and no signal suggests sustained transmission beyond these networks. The WHO Director-General has determined that this outbreak continues to constitute a public health emergency of international concern and issued revised temporary recommendations in relation to the outbreak.
Report: 2022-23 Mpox (Monkeypox) Outbreak: Global Trends – World Health Organization
Commentary on Twitter
With over 86,000 total cases & 96 related deaths, #mpox outbreak has slowed down but is still ongoing in several countries.
Maintained surveillance & enhanced access to diagnostics, vaccines and treatments are key to stop the disease transmission globally https://t.co/mLHsVoWKBY pic.twitter.com/PcLFQjjrz7
— World Health Organization (WHO) (@WHO) February 21, 2023
M-A | Low-dose insulin infusion is safe and effective in treating diabetic ketoacidosis in children
23 Feb, 2023 | 13:40h | UTCSummary: The article discusses a systematic review and meta-analysis of randomized controlled trials comparing low-dose insulin at 0.05 units/kg/hr to standard dose at 0.1 units/kg/hr for children with diabetic ketoacidosis (DKA). The study found that low-dose insulin infusion is probably as efficacious and safer than standard-dose insulin in treating DKA in children, as it has no effect on the time to resolution of hyperglycemia or acidosis and probably reduces the risk of developing hypokalemia and hypoglycemia. However, the results are limited by imprecision and generalizability to other settings since all studies were performed in a single country. Therefore, further studies are required to identify the optimal insulin dose for children with DKA in terms of safety and effectiveness.
M-A | Oral manifestation of the monkeypox virus
23 Feb, 2023 | 13:42h | UTCOral manifestation of the monkeypox virus: a systematic review and meta-analysis – eClinicalMedicine
Study suggests there is little added value from follow-up pelvic CT after treatment of hepatocellular carcinoma
23 Feb, 2023 | 13:39h | UTCSummary: The study investigated the added value of pelvic coverage at follow-up liver CT in detecting pelvic metastasis or incidental tumors in patients treated for hepatocellular carcinoma (HCC). The study found that the incidence of isolated pelvic metastasis or incidental pelvic tumor was low in patients treated for HCC. The cumulative rates of isolated pelvic metastasis and incidental pelvic tumor were 1.4% and 0.5%, respectively, at 3 years. Only baseline T stage was associated with an increased risk of isolated pelvic metastasis. The study concludes that excluding the pelvic scan can reduce radiation dose and decrease the workload for radiologists. However, the study also had limitations, such as being retrospective and single-center. Therefore, more research is necessary to study the optimal scanning strategy for the pelvis and the effect of pelvic CT coverage on survival in patients with HCC.
Article: Added Value of Pelvic CT after Treatment of HCC – Radiology
ISUOG Practice Guidelines | Performance of 11–14-week ultrasound scan
23 Feb, 2023 | 13:35h | UTC
M-A | COVID-19 convalescent plasma outpatient therapy may prevent hospitalizations
23 Feb, 2023 | 13:37h | UTC
Consensus Paper | Acute lower extremity fracture management in chronic spinal cord injury
23 Feb, 2023 | 13:36h | UTCCommentary: Updated spine fracture practice guidelines released – Orthopedics This Week
Consensus Statement | Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation
23 Feb, 2023 | 13:33h | UTC
M-A | Disordered eating affects 1 in 5 children and adolescents
23 Feb, 2023 | 13:33h | UTCSummary: The text reports the findings of a systematic review and meta-analysis that included 32 studies on the global proportion of disordered eating in children and adolescents aged 6 to 18 years, assessed with the SCOFF questionnaire, a widely used screening measure for eating disorders. The review found that approximately 22% of children and adolescents showed disordered eating, which was higher among girls, older adolescents, and those with higher body mass index. The high figures are concerning from a public health perspective and highlight the need for prevention strategies to address disordered eating. The study has limitations, including the cross-sectional nature of most of the included studies and the use of self-report questionnaires to assess disordered eating, which may be subject to bias.
Article: Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis – JAMA Pediatrics (free for a limited period)
Commentary: What is disordered eating? And why do 20% of the world’s kids show signs of it? Experts explain – CNN
Cohort Study | Pre-pregnancy migraine linked to a higher risk of adverse pregnancy outcomes
23 Feb, 2023 | 13:31h | UTCSummary: This study investigated the relationship between migraine and adverse pregnancy outcomes. Researchers examined data from the Nurses’ Health Study II, which included 30,555 pregnancies from 19,694 women. Pre-pregnancy migraine was associated with a higher risk of preterm delivery, gestational hypertension, and preeclampsia. Migraine with aura was associated with a higher preeclampsia risk than migraine without aura. However, migraine was not associated with low birth weight or gestational diabetes mellitus. The study suggests that migraine history, and to a lesser extent, migraine phenotype, could be useful in identifying women at risk of pregnancy complications. Regular aspirin use prior to pregnancy was associated with a lower risk of preterm delivery for women with migraine, but randomized trials are needed to evaluate this hypothesis.
Article: Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes – Neurology (link to abstract – $ for full-text)
News Release: Migraine associated with increased risk for pregnancy complications – Brigham and Women’s Hospital
Commentary: Prepregnancy Migraine Tied to Adverse Pregnancy Outcomes – HealthDay
RCT | Laparoscopic proximal gastrectomy with double-tract reconstruction vs. total gastrectomy in upper-third early gastric cancer
23 Feb, 2023 | 13:29h | UTCSummary: This randomized trial examined whether laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) is a superior surgical treatment compared to laparoscopic total gastrectomy (LTG) for patients with early gastric cancer (GC) in the upper third of the stomach. The study found that LPG-DTR resulted in significantly decreased amounts of vitamin B12 supplementation, but no significant difference in hemoglobin change compared to LTG. The study also found no difference in complication rates or overall and disease-free survival rates between the two groups. The study suggests that LPG-DTR may be a function-preserving procedure for the treatment of patients with upper-third early GC.
Commentary on Twitter
RCT: Proximal gastrectomy with double tract reconstruction had an advantage of less vitamin B12 supplementation than total gastrectomy similar complication rates and survival in patients with upper third early gastric cancer. https://t.co/tdAktJxkpL pic.twitter.com/5miUbb9Ia6
— JAMA Network Open (@JAMANetworkOpen) February 15, 2023
Diagnosis and management of myositis-associated lung disease
23 Feb, 2023 | 13:25h | UTCDiagnosis and Management of Myositis-associated Lung Disease – CHEST
M-A | Metabolic side effects in persons with schizophrenia during mid- to long-term treatment with antipsychotics
23 Feb, 2023 | 13:26h | UTCSummary: This study aimed to evaluate the mid- to long-term metabolic side effects of 31 antipsychotics in persons with schizophrenia by analyzing 137 eligible randomized controlled trials with 35,007 participants. The primary outcome was weight gain, with secondary outcomes including fasting glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. The study found that antipsychotic drugs differ in their propensity to induce metabolic side effects. Chlorpromazine, clozapine, olanzapine, and zotepine produced the most weight gain. The confidence in the evidence ranged from low to moderate. The study suggests that differences in weight gain were more pronounced than previously published short-term data and that weight gain is most pronounced at the beginning of treatment and then remains stable.
Article: Metabolic side effects in persons with schizophrenia during mid- to long-term treatment with antipsychotics: a network meta-analysis of randomized controlled trials – World Psychiatry (free for a limited period)
Review | Brain monitoring after cardiac arrest
23 Feb, 2023 | 13:23h | UTCBrain monitoring after cardiac arrest – Current Opinion in Critical Care
SR | Psychological interventions for women with non‐metastatic breast cancer
23 Feb, 2023 | 13:19h | UTCPsychological interventions for women with non‐metastatic breast cancer – Cochrane Library
SR | Totally percutaneous vs. surgical cut‐down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair
23 Feb, 2023 | 13:21h | UTC
SR | Glucocorticoids for croup in children
23 Feb, 2023 | 13:17h | UTCGlucocorticoids for croup in children – Cochrane Library
Acute pain management pearls: a focused review for the hospital clinician
23 Feb, 2023 | 13:15h | UTCAcute Pain Management Pearls: A Focused Review for the Hospital Clinician – Healthcare
152-week results of a RCT | Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection
23 Feb, 2023 | 13:16h | UTC
Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment
23 Feb, 2023 | 13:13h | UTC
Regional anesthesia for thoracic surgery: a narrative review of indications and clinical considerations
23 Feb, 2023 | 13:11h | UTC
Antibiotic allergy de-labeling: a pathway against antibiotic resistance
23 Feb, 2023 | 13:12h | UTCAntibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance – Antibiotics
Related:
M-A: Most patients with allergy to Penicillin can be given Cefazolin
Podcast: A Clinical Pharmacologist’s Perspective on Penicillin Allergy
Study: Development and Validation of a Penicillin Allergy Clinical Decision Rule
NICE: Double Check Patients with ‘Penicillin Allergy’ to Avoid Increased MRSA Risk
Robotic lung resection: a narrative review of the current role on primary lung cancer treatment
23 Feb, 2023 | 13:10h | UTC
Cohort Study | Risk and timing of venous thromboembolism in patients with gastrointestinal cancer
23 Feb, 2023 | 13:08h | UTC