Daily Archives: March 6, 2023 | LinksMedicus Free Medical News & Perspectives

Report | Economic impact of overweight and obesity to surpass $4 trillion by 2035

6 Mar, 2023 | 14:32h | UTC

Summary:

A recent report from the World Obesity Federation has issued a warning that the number of people worldwide suffering from overweight or obesity could increase significantly by 2035, surpassing the 50% mark. The report, called the World Obesity Atlas 2023, also highlights the significant economic impact of this trend, estimating that the cost of overweight and obesity could reach $4.32tn annually by 2035, equivalent to almost 3% of the global GDP.

The report also identifies two groups that are particularly at risk: children and individuals from lower-income countries. Childhood obesity is a growing concern, as the report predicts it could double by 2035. Additionally, lower-income countries face a rapid increase in obesity prevalence, with nine out of 10 countries with the greatest expected increases in obesity coming from low or lower-middle income countries.

Report: World Obesity Atlas 2023

News release: Economic impact of overweight and obesity to surpass $4 trillion by 2035

Commentary: Report: Obesity could cost the world over $4 trillion a year by 2035 – STAT

Global cost of obesity-related illness to hit $1.2tn a year from 2025

Trends and predictions of malnutrition and obesity in 204 countries and territories: an analysis of the Global Burden of Disease Study 2019 – eClinicalMedicine

Global inequalities in the double burden of malnutrition and associations with globalization: a multilevel analysis of Demographic and Healthy Surveys from 55 low-income and middle-income countries, 1992–2018.

The Lancet Series: The Double Burden of Malnutrition

BTS Clinical Guidance | Aspiration pneumonia

6 Mar, 2023 | 14:36h | UTC

BTS clinical statement on aspiration pneumonia – Thorax

BTS Clinical Guidance | Prevention and management of community-acquired pneumonia in people with learning disability

6 Mar, 2023 | 14:34h | UTC

BTS Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability – Thorax

#ACC23 – RCT | Transcatheter repair for patients with tricuspid regurgitation

6 Mar, 2023 | 14:29h | UTC

Transcatheter Repair for Patients with Tricuspid Regurgitation – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

The TRILUMINATE Transcatheter Tricuspid Repair Trial: Positive but No Benefit? – Medscape (recommended reading – free registration required)

TRILUMINATE Pivotal: TEER With the TriClip Benefits Patients With Severe TR – TCTMD

Transcatheter Repair Benefits Quality of Life in Patients with Severe Tricuspid Regurgitation – HCP Live

Commentary on Twitter

In the TRILUMINATE trial, patients with tricuspid regurgitation who were treated with transcatheter edge-to-edge repair had more favorable clinical outcomes at 1 year than did patients who received medical therapy. Full trial results: https://t.co/ZWObb9Xl6T #ACC23/#WCCardio pic.twitter.com/O2E9QSumpQ

— NEJM (@NEJM) March 4, 2023

RCT | Hydrochlorothiazide is not effective for the prevention of kidney-stone recurrence

6 Mar, 2023 | 14:26h | UTC

Summary:

This study aimed to assess the effectiveness of hydrochlorothiazide, a thiazide diuretic, in preventing the recurrence of calcium-containing kidney stones. The trial randomly assigned 416 patients with recurrent kidney stones to receive hydrochlorothiazide at a dose of 12.5 mg, 25 mg, or 50 mg once daily, or a placebo once daily, and followed them for a median of 2.9 years.

The results showed that the incidence of kidney stone recurrence did not differ significantly between the hydrochlorothiazide and placebo groups, regardless of the dose. Furthermore, patients who received hydrochlorothiazide were more likely to experience side effects such as hypokalemia, gout, new-onset diabetes mellitus, skin allergy, and a plasma creatinine level exceeding 150% of the baseline level.

Therefore, the effectiveness of hydrochlorothiazide in preventing kidney stone recurrence may be limited, and the common practice of prescribing it for these patients should be reevaluated.

Article: Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence – New England Journal of Medicine (link to abstract – $ for full-text)

Video Summary: Hydrochlorothiazide and Kidney-Stone Recurrence | NEJM

Commentary: Hydrochlorothiazide and Prevention of Kidney Stones – NEJM Resident 360

#ACC23 – RCT | Five-year follow-up after transcatheter repair of secondary mitral regurgitation

6 Mar, 2023 | 14:28h | UTC

Five-Year Follow-up after Transcatheter Repair of Secondary Mitral Regurgitation – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

COAPT at 5 Years: MitraClip Still Ahead, but Deaths and Crossovers Cast Shadows – TCTMD

Minimally Invasive Mitral Valve Repair Reduces Hospitalizations and Deaths – American College of Cardiology

Commentary on Twitter

Transcatheter repair of secondary mitral regurgitation for heart failure was associated with a lower rate of hospitalization for heart failure and lower all-cause mortality than medical therapy at 5 years of follow-up.

Full COAPT trial: https://t.co/rcJ6RQEMAX #ACC23/#WCCardio pic.twitter.com/sM8R50oaBq

— NEJM (@NEJM) March 5, 2023

RCT | Antipsychotic association seems better than antidepressant switch in treatment-resistant geriatric depression

6 Mar, 2023 | 14:23h | UTC

Summary:

This open-label randomized trial compared the benefits and risks of augmenting therapy vs. switching antidepressants in older adults with treatment-resistant depression. In the first step, 619 patients were randomly assigned to augmentation of existing antidepressant medication with aripiprazole (an antipsychotic), augmentation with bupropion, or a switch from existing antidepressant medication to bupropion. In step 2, 248 patients who did not benefit from or were ineligible for step 1 were randomly assigned to augmentation with lithium or a switch to nortriptyline.

The aripiprazole-augmentation group showed significant improvement in well-being compared to the switch-to-bupropion group. Remission occurred in 28.9% of patients in the aripiprazole-augmentation group, 28.2% in the bupropion-augmentation group, and 19.3% in the switch-to-bupropion group. In step 2, similar remission rates occurred in the lithium-augmentation group (18.9%) and the switch-to-nortriptyline group (21.5%).

Article: Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Adding antipsychotic med to antidepressant may help older adults with treatment-resistant depression – Washington University School of Medicine in St. Louis

Commentary on Twitter

#AAGPAM23: In a pragmatic trial involving older persons with treatment-resistant depression, augmentation of existing antidepressants with aripiprazole was better than augmentation with bupropion or a switch to bupropion. Full results of the OPTIMUM trial: https://t.co/2OPOxH67Qx pic.twitter.com/g0AtrYGhKV

— NEJM (@NEJM) March 3, 2023

Cluster RCT | Effectiveness of a non-physician community health-care provider-led intensive BP intervention vs. usual care on CVD

6 Mar, 2023 | 14:20h | UTC

Summary:

The study evaluated the effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention on cardiovascular disease compared to usual care. The trial randomly assigned 326 villages to the intervention or usual care, and recruited individuals aged at least 40 years with hypertension. Trained non-physician community health-care providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol and delivered health coaching for patients in the intervention group during the 36-month follow-up.

The study found that the intervention effectively reduced the risk of cardiovascular disease and all-cause death. There was a significant reduction in systolic blood pressure (23.1 mm Hg) and diastolic blood pressure (9.9 mm Hg) in the intervention group compared to the usual care group, with an increased risk of hypotension in the intervention group.

Article: Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial – The Lancet (link to abstract – $ for full-text)

Cluster Randomized Trial: A Community-Based Intervention for Managing Hypertension in Rural South Asia

#ESCCongress – Randomized Trial: A Community-based Comprehensive Intervention to Reduce Cardiovascular Risk in Hypertension

Cohort Study: Impact of Community Based Screening for Hypertension in Older Adults

Randomized Trial: Community-Based Interventions to Improve Cardiovascular Risk in High-Risk Patients

Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

Research: Effect of a Community Health Worker–Led Multicomponent Intervention on Blood Pressure Control

Perspective | Why functional neurological disorder is not feigning or malingering

6 Mar, 2023 | 14:17h | UTC

Why functional neurological disorder is not feigning or malingering – Nature Reviews Neurology (free for a limited period)

Perspective | Diagnostic stewardship to prevent diagnostic error

6 Mar, 2023 | 14:18h | UTC

Diagnostic Stewardship to Prevent Diagnostic Error – JAMA (free for a limited period)

Commentary on Twitter

This #Viewpoint discusses diagnostic stewardship and its uses and challenges in preventing diagnostic error. https://t.co/VtiqHsrlwU pic.twitter.com/Q0VVOPCrF2

— JAMA (@JAMA_current) March 2, 2023

Consensus Paper | Management of respiratory distress syndrome

6 Mar, 2023 | 14:14h | UTC

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update – Neonatology

M-A | Early vs. delayed coronary angiography after out-of-hospital cardiac arrest without ST-segment elevation

6 Mar, 2023 | 14:12h | UTC

Summary:

This systematic review and meta-analysis of randomized controlled trials evaluated the efficacy and safety of early vs. delayed coronary angiography following an out-of-hospital cardiac arrest in patients without ST elevation on the ECG.

The review included six trials with 1,590 patients and found that early angiography probably has no effect on mortality, survival with good neurologic outcomes, and ICU length of stay, indicating that the procedure should not be routinely recommended for these patients.

Article: Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials – Critical Care Explorations

#ESCCongress – RCT: Immediate coronary angiography after out-of-hospital cardiac arrest without ST-segment elevation did not improve outcomes compared to delayed/selective angiography – New England Journal of Medicine

Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial – JAMA Cardiology (link to abstract – $ for full-text)

Guideline | Diagnosis, management, and follow-up of the incidentally discovered adrenal mass

6 Mar, 2023 | 14:16h | UTC

Canadian Urological Association guideline: Diagnosis, management, and follow up of the incidentally discovered adrenal mass – Canadian Medical Association Journal

RCT | Perioperative vs. postoperative calcium and vitamin D supplementation to prevent symptomatic hypocalcemia after total thyroidectomy

6 Mar, 2023 | 14:09h | UTC

Summary:

This study aimed to compare the efficacy of perioperative vs. postoperative calcium and vitamin D supplementation in reducing symptomatic hypocalcemia in patients who underwent thyroidectomy.

In a randomized placebo-controlled trial involving 134 patients, one group received calcium carbonate and alfacalcidol both 3 days before surgery and for 14 days after surgery, while the other group received the same treatment only after surgery.

Results showed that the perioperative group had significantly lower rates of symptomatic and biochemical hypocalcemia compared to the postoperative group. Patients who underwent central neck dissection were at increased risk of symptomatic hypocalcemia in this study, so perioperative supplementation could be more beneficial for these patients.

Article: Perioperative versus postoperative calcium and vitamin D supplementation to prevent symptomatic hypocalcemia after total thyroidectomy: a randomized placebo controlled trial – International Journal of Surgery

Phase 2 RCT | Neoadjuvant–adjuvant pembrolizumab improves event-free survival vs. adjuvant-only therapy in advanced melanoma

6 Mar, 2023 | 14:11h | UTC

Summary:

This phase 2 clinical trial evaluated whether giving pembrolizumab before and after surgery (neoadjuvant-adjuvant therapy) would increase event-free survival in patients with resectable stage III or IV melanoma, compared to adjuvant therapy alone. The trial involved 313 patients, with 154 in the neoadjuvant-adjuvant group and 159 in the adjuvant-only group.

At a median follow-up of 14.7 months, the neoadjuvant-adjuvant group had significantly longer event-free survival than the adjuvant-only group, with similar rates of adverse events between groups, suggesting that pembrolizumab given both before and after surgery may be an effective treatment option for these patients.

Article: Neoadjuvant–Adjuvant or Adjuvant-Only Pembrolizumab in Advanced Melanoma – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Neoadjuvant immunotherapy improves outlook in high-risk melanoma – MD Anderson Cancer Center

Commentary on Twitter

Patients who received 3 doses of pembrolizumab before surgery and 15 doses after surgery had significantly longer event-free survival than those who received adjuvant-only therapy with 18 doses after surgery. https://t.co/qmMPV4gvSj #SkinCancer pic.twitter.com/69TDuyPAg7

— NEJM (@NEJM) March 4, 2023

RCT | Oral nicotinamide does not reduce skin cancer incidence in organ-transplant recipients

6 Mar, 2023 | 14:07h | UTC

Summary:

This article discusses a phase 3 clinical trial investigating whether oral nicotinamide (vitamin B3) effectively prevents skin cancer in organ transplant recipients.

The study enrolled 158 participants who had at least two keratinocyte cancers in the past five years, with 79 assigned to the nicotinamide group and 79 to the placebo group.

After 12 months, the two groups had no significant differences in the number of squamous-cell and basal-cell carcinomas, or actinic keratoses. Adverse events and changes in blood or urine laboratory variables were also similar in the two groups.

Article: Nicotinamide for Skin-Cancer Chemoprevention in Transplant Recipients – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Oral Nicotinamide Not Beneficial in Preventing Skin Cancer in Organ Transplant Recipients – Dermatology Times