Daily Archives: March 8, 2023
RCT | Bempedoic acid shows modest reduction in cardiovascular events for statin-intolerant patients
8 Mar, 2023 | 14:39h | UTCSummary:
Bempedoic acid is an ATP citrate lyase inhibitor that reduces LDL cholesterol levels and is associated with a low incidence of muscle-related adverse events. The study enrolled 13,970 patients at increased cardiovascular risk, with 6,992 randomized to bempedoic acid and 6,978 randomized to placebo, with a median duration of follow-up of 40.6 months.
The study found that bempedoic acid was associated with a statistically significant 13% reduction in the primary endpoint of major adverse cardiovascular events, which included death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. However, the absolute risk reduction of events was modest, at 1.6% over nearly four years.
The study also reported higher incidences of gout and cholelithiasis with bempedoic acid compared to placebo, as well as small increases in serum creatinine, uric acid, and hepatic-enzyme levels.
Article: Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
CLEAR Positives and Cautions With Bempedoic Acid for Statin Intolerance – Medscape (recommended reading – free registration required)
Cardiovascular Outcomes After “Statin-Intolerant” Patients Take Bempedoic Acid – NEJM Journal Watch (free for a limited period)
Commentary on Twitter
Bempedoic acid showed a modest absolute reduction in CV outcomes, relative to placebo, in patients “unable or unwilling” to take a statin. https://t.co/hQUfvFwz68 #ACC23 @hmkyale @NEJM #CardioTwitter pic.twitter.com/YMoNsce8MI
— NEJM Journal Watch (@JWatch) March 7, 2023
CDC Study | Estimates of serial interval and incubation period for mpox virus infection in the US
8 Mar, 2023 | 14:34h | UTCSummary:
Monkeypox cases have been reported globally since May 2022, with most transmission occurring through close physical contact associated with sexual activities among men who have sex with men.
This study presented the estimated mean serial interval and incubation period for monkeypox virus infection based on data collected from 12 US health departments. The serial interval is the time between symptom onset in a primary case-patient and symptom onset in the secondary case-patient. It is critical for estimating the effective reproduction number and forecasting incidence, both of which are important for understanding the course of an outbreak and the effect of interventions.
The results indicate that the mean estimated serial interval for symptom onset is 8.5 days, while the mean estimated incubation period is 5.6 days.
Commentary: 8.5 days elapse between successive mpox cases, study estimates – CIDRAP
RCT | Combination of intravenous doxycycline and azithromycin better than either drug alone for severe scrub typhus
8 Mar, 2023 | 14:36h | UTCSummary:
The study aimed to compare the efficacy of intravenous doxycycline, azithromycin, or a combination of both drugs in treating severe scrub typhus. The study randomized 794 patients with severe scrub typhus and at least one organ involvement to receive a 7-day course of intravenous doxycycline, azithromycin, or both.
The primary outcome was a composite of death from any cause at day 28, persistent complications at day 7, and persistent fever at day 5. The study found that combination therapy with intravenous doxycycline and azithromycin was a better therapeutic option for treating severe scrub typhus than monotherapy with either drug alone.
Article: Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: A combination therapy is found to be more effective on severe scrub typhus – University of Oxford
Commentary on Twitter
Original Article: Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus https://t.co/uZ4Y51zoZ2#InfectiousDisease pic.twitter.com/xzmeAV8Tyi
— NEJM (@NEJM) March 4, 2023
M-A | Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes
8 Mar, 2023 | 14:33h | UTCSummary:
The study aimed to determine the association between non-occupational physical activity and chronic disease and mortality outcomes in the general adult population. The systematic review and meta-analysis included 196 articles covering 94 cohorts and over 30 million participants.
The results showed that higher activity levels were associated with a lower risk of all outcomes. The strongest associations were observed for all-cause and cardiovascular disease mortality, with weaker associations for cancer incidence.
The study also found that appreciable population health benefits could be gained from increasing physical activity levels of people who are inactive to just half the current health recommendations; doing that could prevent one in 10 premature deaths.
The findings support the current physical activity recommendations and suggest that even small increases in non-occupational physical activity in inactive adults can provide substantial protection against chronic disease outcomes.
It’s worth noting, however, that this study has the usual limitations of observational studies since all the included studies are cohort studies. Therefore, the results are subject to residual confounding, meaning that other factors not measured or accounted for in the studies could influence the observed associations.
News Releases:
1 in 10 early deaths averted if everyone met physical activity targets – BMJ Newsroom
Perspective | Antipsychotics are increasingly being prescribed to children – here’s why we should be concerned
8 Mar, 2023 | 14:29h | UTCOriginal study: Cohort Study | Trends in antipsychotic prescribing to children and adolescents in England
Perspective | Dangerous selfies aren’t just foolish. We need to treat them like the public health hazard they really are
8 Mar, 2023 | 14:30h | UTC
FDA panel endorses 2 RSV vaccines for older adults, but flag at potential increased risk of Guillain-Barre
8 Mar, 2023 | 14:27h | UTCPfizer vaccine:
In close vote, FDA advisers recommend Pfizer RSV vaccine for those 60 and older – CIDRAP
GSK’s vaccine:
FDA panel recommends GSK’s RSV vaccine for ages 60 and up – CIDRAP
FDA advisors recommend GSK’s RSV vaccine for older adults, but flag potential safety risks – CNBC
See also: Rare neurological condition is ‘important potential risk’ of Pfizer’s RSV vaccine, FDA says – CNN
Perspective | How to not be completely wrong about masks
8 Mar, 2023 | 14:25h | UTCHow to not be completely wrong about masks – The Munro Report
Related:
SR | Physical interventions to interrupt or reduce the spread of respiratory viruses
Hospital masking should be optional – Sensible Medicine
RCT | Medical masks vs. N95 respirators for preventing COVID-19 among health care workers.
Commentary on Twitter
Excellent and sensible interpretation of the data, on both ends of the spectrum, and everything in between.
(Will forgive the split infinitive in the title. ?)
How to not be completely wrong about masks, by @apsmunro https://t.co/85Ot6oUOZF
— Paul Sax (@PaulSaxMD) March 2, 2023
Position Statement | Telemedicine in obstetrics — quality and safety considerations
8 Mar, 2023 | 14:23h | UTC
Commentary on Twitter
Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics—quality and safety considerations https://t.co/15knjAg4tc @MySMFM @acog #telemedicine pic.twitter.com/jUL7inHuu4
— AJOG (@AJOG_thegray) March 7, 2023
Consensus Paper | Pain management and opioid stewardship in adult cardiac surgery
8 Mar, 2023 | 14:22h | UTC
Early diagnostic indicators of dengue vs. other febrile illnesses in Asia and Latin America: a multicenter, prospective, observational study
8 Mar, 2023 | 14:16h | UTCSummary:
The IDAMS study is a large, prospective, observational study conducted in eight countries in Asia and Latin America to investigate early diagnostic indicators of dengue compared to other febrile illnesses. The study included 7428 patients with undifferentiated fever, of whom 2694 were diagnosed with laboratory-confirmed dengue and 2495 with other febrile illnesses.
Platelet count, white blood cell count, and their changes over time were strongly associated with dengue, while cough and rhinitis were strongly associated with other febrile illnesses. The study found that a set of 14 clinical and three laboratory predictors can distinguish between dengue and other febrile illnesses during the early phase of symptoms, with sensitivities of 80-87% and specificities of 80-91%. The study also found that models that include laboratory markers outperform those based solely on clinical variables.
The study’s results provide important information for updating guidelines on the management of febrile illnesses, particularly in resource-limited settings where distinguishing between dengue and other febrile illnesses is crucial for patient management.
Invited Commentary: Differentiating dengue from other febrile illnesses: a dilemma faced by clinicians in dengue endemic countries – The Lancet Global Health
Commentary on Twitter
From the March Issue: Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): a multicentre, prospective, observational study https://t.co/xyvYpoiyWM (1/2) pic.twitter.com/xgvkA39PV5
— The Lancet Global Health (@LancetGH) February 23, 2023
Guideline | Management of severe peri-operative bleeding
8 Mar, 2023 | 14:18h | UTC
E-Scooter users more likely to suffer serious trauma compared to bicycle users: a nationwide study in England and Wales
8 Mar, 2023 | 14:13h | UTCSummary:
The study aimed to determine the incidence, demographics, and injury patterns involved in E-Scooter-related hospital admissions due to significant trauma compared with bicycle-related trauma within England and Wales. The retrospective cohort study was based on data submitted to the UK Trauma Audit and Research Network (TARN) registry between 1 January 2021 to 31 December 2021.
The study found that E-Scooter users were more likely to be admitted to a major trauma center or a critical care unit than bicycle users. Serious head and limb trauma occurred more frequently among E-Scooter users, while serious chest and pelvic trauma were greater among bicycle users. Over one-third of E-Scooter injuries were incurred outside the current legislation by patients who were intoxicated by alcohol and drugs or under the age of 17.
The study suggests a greater relative incidence of serious trauma and an alternative pattern of injury among E-Scooter users compared with bicycle users. The study concludes that further legislation and tighter regulation of E-Scooter rental are required to reduce the already significant burden of injury associated with this mode of transport.
Article: Major trauma among E-Scooter and bicycle users: a nationwide cohort study – Injury Prevention
News Release: Crashing an e-scooter likely to lead to more serious injuries than crashing a bike – British Medical Journal
Commentary: E-scooter riders more likely than cyclists to sustain serious injuries – BBC
ESC 0/1-hour algorithm unable to safely exclude 30-day cardiac death or MI in patients with known coronary artery disease, study finds
8 Mar, 2023 | 14:12h | UTCSummary:
The study aimed to determine if the European Society of Cardiology (ESC) 0/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) could achieve a negative predictive value of 99% or higher for 30-day cardiac death or myocardial infarction (MI) among emergency department patients with chest pain and known coronary artery disease (CAD).
The study included 1430 adults, and the algorithm had a negative predictive value of 96.6% for 30-day cardiac death or MI among patients with known CAD, suggesting that the algorithm may not be able to safely exclude 30-day cardiac death or MI in these patients.
These findings suggest that clinicians should be cautious when using the ESC 0/1-hour hs-cTnT algorithm in patients with known CAD.
Article: Performance of the European Society of Cardiology 0/1-Hour Algorithm With High-Sensitivity Cardiac Troponin T Among Patients With Known Coronary Artery Disease – JAMA Cardiology (link to abstract – $ for full-text)
Related:
Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In this diagnostic study of 1430 adults, the high-sensitivity troponin T (hs-cTnT) ESC 0/1-hour algorithm had a negative predictive value of 96.6% for 30-day cardiac death or MI among patients with known coronary artery disease. https://t.co/FnILIazEnU
— JAMA Cardiology (@JAMACardio) March 1, 2023
Cohort Study | Endoscopic biopsy with normal mucosa associated with elevated risk of inflammatory bowel disease for at least 30 years
8 Mar, 2023 | 14:10h | UTCSummary:
This study explored the long-term risk of inflammatory bowel disease (IBD) after an endoscopic biopsy with normal mucosa. The researchers identified individuals in Sweden with a lower or upper gastrointestinal (GI) biopsy of normal mucosa, their matched population references, and unexposed full siblings.
They found that individuals with a previous lower or upper GI biopsy showing normal mucosa were at persistently higher risk of overall IBD, ulcerative colitis, and Crohn’s disease compared to their matched population references and unexposed full siblings, and the increased risk persisted at least 30 years after the biopsy with normal findings.
The findings suggest a substantial symptomatic period before IBD diagnosis, and clinicians should be aware of the long-term increased risk of IBD in those with symptoms requiring GI investigation but with a finding of histologically normal mucosa.
Commentary: Risk for IBD Remains High After Endoscopic Biopsy With Normal Mucosa – HealthDay
#ACC23 – Single-arm study | Pulsed field ablation shows promise for the treatment of atrial fibrillation
8 Mar, 2023 | 14:08h | UTCCommentaries:
PULSED AF ‘Strengthens the Case’ for Pulsed-Field Ablation in AF – TCTMD
M-A | Real-time ultrasound guidance as compared to landmark technique for subclavian central venous cannulation
8 Mar, 2023 | 14:04h | UTCReal-Time Ultrasound Guidance as Compared to Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis – Critical Care Medicine (link to abstract – $ for full-text)
Review | Approach to disorders of gut-brain interaction
8 Mar, 2023 | 14:06h | UTCApproach to Disorders of Gut-Brain Interaction – Mayo Clinic Proceedings