Archives
Guideline: Management of age-related hearing loss – Otolaryngol Head Neck Surg
2 May, 2024 | 23:22h | UTCThis guideline by the American Academy of Otolaryngology–Head and Neck Surgery Foundation offers a comprehensive approach for the detection and management of age-related hearing loss (ARHL) in adults aged 50 and older. It stresses the importance of early identification and appropriate intervention to mitigate the effects of ARHL, which is commonly underdiagnosed despite being the most prevalent sensory deficit in the elderly. The guideline includes eleven Key Action Statements that guide clinicians in screening, diagnosis, and management strategies, emphasizing the use of audiograms, otoscopy, and hearing aids, as well as the importance of addressing sociodemographic factors affecting healthcare access. It also highlights the necessity of patient and family education on the impacts of hearing loss and communication strategies. This structured approach aims to enhance healthcare delivery and improve the quality of life for those affected by hearing loss.
Reference (link to free-full-text):
RCT: Serratus anterior plane block reduces pain and opioid use in rib fracture patients – JAMA Surgery
2 May, 2024 | 23:20h | UTCStudy Design and Population:
This study was a multicenter, open-label, pragmatic randomized clinical trial conducted across eight emergency departments in New South Wales, Australia. The trial included 210 patients aged 16 years or older who had clinically suspected or radiologically confirmed rib fractures. Patients intubated, transferred for urgent surgical intervention, or with major concomitant nonthoracic injuries were excluded.
Main Findings:
In the trial, patients were randomized to receive either a serratus anterior plane block (SAPB) along with standard rib fracture management or standard care alone. The primary outcome was a composite pain score measured 4 hours post-enrollment. The SAPB group showed a significant increase in patients achieving the desired pain score reduction (41% in SAPB group vs. 19.6% in control; RR 0.73, 95% CI 0.60-0.89, P = 0.001). Additionally, SAPB recipients had significantly lower opioid consumption at 24 hours compared to the control group.
Implications for Practice:
The trial’s results support the addition of a serratus anterior plane block (SAPB) to standard rib fracture management for providing effective early pain relief and reducing opioid use. However, it’s important to note that this study did not include a sham group, and patients were aware of whether they received the intervention. This lack of blinding could influence patient-reported outcomes due to placebo effects. Despite this limitation, the reduction in pain and opioid consumption suggests that SAPB is a beneficial component of care for patients with rib fractures.
Reference (link to abstract – $ for full-text):
USPSTF Guideline: Biennial screening mammography recommended for women aged 40-74 to reduce breast cancer morbidity and mortality
1 May, 2024 | 21:45h | UTCStudy Design and Population:
The US Preventive Services Task Force (USPSTF) performed a systematic review and collaborated on modeling studies to evaluate the effectiveness of various mammography-based breast cancer screening strategies. This assessment included factors such as age of initiation and cessation of screening, screening intervals, modalities, and the use of supplemental imaging. The population studied consisted of cisgender women and all other persons assigned female at birth who are 40 years or older and at average risk of breast cancer.
Main Findings:
The USPSTF concludes with moderate certainty that biennial screening mammography for women aged 40 to 74 years provides a moderate net benefit in reducing the incidence of and progression to advanced breast cancer, as well as in decreasing breast cancer morbidity and mortality. However, the evidence is insufficient to assess the benefits and harms of mammography screening in women aged 75 and older, as well as the use of supplemental screening with ultrasound or MRI in women with dense breasts.
Implications for Practice:
Based on these findings, the USPSTF recommends biennial screening mammography for women aged 40 to 74 years. This recommendation aims to optimize breast cancer outcomes while considering the balance of benefits and harms of screening. There is a need for further research to clarify the benefits and risks associated with mammography in women older than 75 and for those with dense breasts considering supplemental screening.
Commentary on X (thread – click for more)
🧵 Just published: USPSTF recommends all women undergo routine #breastcancer screening every other year beginning at age 40, an update from the 2016 recommendation to start at age 50.
https://t.co/xDPK4qu7JH pic.twitter.com/3zVBMWeuKb— JAMA (@JAMA_current) April 30, 2024
Reference (link to free full-text):
RCT: Radiation therapy alone superior to chemoradiation in low-grade localized endometrial cancer recurrences
1 May, 2024 | 21:41h | UTCThis randomized clinical trial assessed the effectiveness of radiation therapy alone versus concurrent chemoradiation in treating localized recurrences of endometrial cancer. Conducted from February 2008 to August 2020, the study involved 165 patients who were randomized to receive either radiation therapy alone or chemoradiation with weekly cisplatin. Findings indicate that radiation therapy alone resulted in longer progression-free survival (PFS) compared to chemoradiation, with a median PFS not reached for radiation alone versus 73 months for chemoradiation. Additionally, radiation therapy demonstrated lower rates of acute toxicity. The study concluded that for patients with low-grade and primarily vaginal recurrences, radiation therapy alone is the preferable treatment option, offering excellent outcomes without the added toxicity of chemotherapy.
Reference (link to abstract – $ for full-text):
AUA/ASCO/SUO Updated guidelines for muscle-invasive urothelial bladder cancer
1 May, 2024 | 21:40h | UTCThe 2024 update to the muscle-invasive bladder cancer (MIBC) guidelines provides a risk-assessed framework for the treatment of this high-risk patient group, which constitutes about 25% of all bladder cancer diagnoses. These guidelines, revised through the AUA amendment process, integrate new research findings from May 2020 to November 2023, involving a rigorous review of 3739 abstracts and 46 full-text articles. Key updates include refined protocols for neoadjuvant and adjuvant chemotherapy, radical cystectomy, and multi-modal bladder-preserving therapies. Recommendations are categorized based on evidence strength, ranging from high to low, and are supplemented by clinical principles and expert opinions in areas lacking robust data. This structured approach aims to enhance clinical outcomes by updating practitioners on optimal management strategies and emphasizing the need for ongoing research to refine these recommendations.
Reference (link to free full-text):
RCT: Aspirin fails to improve invasive disease-free survival in breast cancer patients
1 May, 2024 | 21:37h | UTCThis randomized clinical trial assessed the efficacy of daily aspirin (300 mg) as adjuvant therapy in reducing breast cancer recurrence among 3020 participants with high-risk nonmetastatic breast cancer across the United States and Canada. The study, which followed participants for a median of 33.8 months, found no significant benefit of aspirin on invasive disease-free survival or overall survival, with the hazard ratio for disease-free survival being 1.27 (95% CI, 0.99-1.63; P = .06) and for overall survival 1.19 (95% CI, 0.82-1.72). Given these findings, aspirin is not recommended as an adjuvant treatment for breast cancer, challenging earlier observational data that suggested a potential survival benefit in breast cancer survivors. The trial was concluded early due to the lack of observed benefits, with adverse event rates being similar in both the aspirin and placebo groups.
Commentary on X:
Among participants with high-risk nonmetastatic breast cancer, daily aspirin therapy did not improve risk of breast cancer recurrence or survival in early follow-up. https://t.co/uPWTeaqXdJ pic.twitter.com/x6Qb4bRlqF
— JAMA (@JAMA_current) April 29, 2024
Reference (link to abstract – $ for full-text):
RCT: Beta-blockers post myocardial infarction showed no benefit in patients with preserved ejection fraction
30 Apr, 2024 | 13:40h | UTCThis randomized, open-label clinical trial conducted across 45 centers in Sweden, Estonia, and New Zealand examined the impact of long-term beta-blocker treatment in patients with acute myocardial infarction (AMI) who had undergone coronary angiography and had a preserved left ventricular ejection fraction (LVEF ≥ 50%). The study involved 5020 patients, predominantly from Sweden, with a median follow-up of 3.5 years. Participants were randomly assigned to receive either a beta-blocker (metoprolol or bisoprolol) or no beta-blocker. The primary endpoint was a composite of death from any cause or new myocardial infarction. The results showed no significant difference in the primary endpoint between the beta-blocker group (7.9%) and the no–beta-blocker group (8.3%) with a hazard ratio of 0.96 (95% CI, 0.79 to 1.16; P=0.64). Additionally, no significant differences were observed in secondary endpoints such as death from cardiovascular causes, myocardial infarction, or hospitalizations for atrial fibrillation and heart failure. Safety endpoints were also comparable between the groups. Overall, long-term beta-blocker treatment did not confer a reduction in risk for the primary composite endpoint or improve secondary outcomes in this patient population.
Commentary on X:
Original Article: Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction (REDUCE-AMI trial) https://t.co/z1NNeAK9Mm
Editorial: Routine Beta-Blockers in Secondary Prevention — On Injured Reserve https://t.co/NzlExH0LZm #ACC24 pic.twitter.com/8Jqpj2dM6E
— NEJM (@NEJM) April 17, 2024
Reference (link to abstract – $ for full-text):
RCT: Post-1 month ticagrelor monotherapy vs. dual antiplatelet therapy significantly reduces bleeding events in acute coronary syndromes
30 Apr, 2024 | 13:26h | UTCIn this randomized, placebo-controlled, double-blind clinical trial, 3400 patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) were assessed to compare the effects of ticagrelor alone versus ticagrelor plus aspirin from 1 to 12 months post-PCI. The study aimed to determine if ticagrelor alone could reduce bleeding without increasing major adverse cardiovascular or cerebrovascular events (MACCE). The primary findings indicated that ticagrelor alone resulted in significantly lower clinically relevant bleeding (2.1% vs. 4.6%, p<0.0001) and demonstrated non-inferiority in MACCE rates compared to the dual therapy group (3.6% vs. 3.7%, pnon-inferiority<0.0001). These outcomes suggest that ticagrelor monotherapy, starting one month post-PCI, may be an effective alternative to standard dual antiplatelet therapy in reducing bleeding risks without compromising safety.
Commentary on X:
Ticagrelor, in combination with #aspirin for 1 month, followed by ticagrelor alone,
after #PCI (GLOBAL LEADERS): a randomised superiority trial https://t.co/Bo8gfHIZLeRegister now to freely access #ESCCongress #LancetCardiology content up to Sept 10! https://t.co/6wOSrV9yXM pic.twitter.com/8EV5d8s1c8
— The Lancet (@TheLancet) August 27, 2018
Reference (link to abstract – $ for full-text):
Cluster-Randomized Trial: No reduction in hospitalization rates with EHR-based algorithm in chronic kidney disease patients
30 Apr, 2024 | 13:16h | UTCThis study evaluates the effectiveness of a personalized EHR-based algorithm combined with practice facilitators to reduce hospitalization rates among patients with chronic kidney disease, type 2 diabetes, and hypertension. Conducted as an open-label, cluster-randomized trial across 141 primary care clinics, 11,182 patients were divided into two groups: the intervention group (5,690 patients) and the usual-care group (5,492 patients). After one year, the hospitalization rate was slightly lower in the intervention group (20.7%) compared to the usual-care group (21.1%), but this difference was not statistically significant (p=0.58). Secondary outcomes, including emergency department visits, readmissions, cardiovascular events, dialysis, and death rates were similar between the groups, except for a slightly higher rate of acute kidney injury in the intervention group. The study concludes that the EHR-based intervention did not significantly decrease hospitalizations at one year.
Commentary on X:
Original Article: Pragmatic Trial of Hospitalization Rate in Chronic Kidney Disease (ICD-Pieces trial) https://t.co/aJ0Ao0uf90 #Nephrology pic.twitter.com/l4xc54Buxy
— NEJM (@NEJM) April 8, 2024
Reference (link to abstract – $ for full-text):
Phase 2 RCT: Lixisenatide slows progression of motor disability in early Parkinson’s disease, but with notable gastrointestinal side effects
30 Apr, 2024 | 13:00h | UTCIn a phase 2, double-blind, randomized, placebo-controlled trial, the effect of lixisenatide, a glucagon-like peptide-1 receptor agonist, was evaluated for its potential to slow the progression of motor disability in patients with early Parkinson’s disease. A total of 156 patients, diagnosed within the past three years and stable on symptom-managing medications, were enrolled and equally divided into lixisenatide and placebo groups. After 12 months, the lixisenatide group showed a slight improvement in motor disability (−0.04 point change) compared to a worsening in the placebo group (3.04 point change) on the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale part III. This difference was statistically significant (p=0.007). However, after a 2-month washout period, improvements were less distinct. Notably, 46% of lixisenatide-treated patients experienced nausea, and 13% reported vomiting. These findings suggest potential benefits of lixisenatide for motor symptoms in Parkinson’s disease, though further research is necessary to fully assess its efficacy and tolerability.
Commentary on X:
Original Article: Trial of Lixisenatide in Early Parkinson’s Disease (LIXIPARK phase 2 trial) https://t.co/2ancdAqO9i
Editorial: GLP-1, Parkinson’s Disease, and Neuroprotection https://t.co/ZaFfYyvEP9 #Neurology pic.twitter.com/h6Ds5wVSHu
— NEJM (@NEJM) April 5, 2024
Reference (link to abstract – $ for full-text):
RCT: No benefit of Apolipoprotein A1 infusions in preventing cardiovascular events post-myocardial infarction
29 Apr, 2024 | 12:42h | UTCThis international, double-blind, placebo-controlled trial investigated the effect of apolipoprotein A1 (CSL112) infusions on cardiovascular outcomes in patients with recent acute myocardial infarction and multivessel coronary disease. A total of 18,219 patients were randomized to receive either four weekly 6 g infusions of CSL112 or a placebo within five days of initial medical contact. Over 90, 180, and 365 days, the trial found no significant difference in the risk of myocardial infarction, stroke, or cardiovascular death between the two groups. Additionally, adverse events were similar across groups, though hypersensitivity was more common in the CSL112 group.
Reference (link to abstract – $ for full-text):
RCT: Empagliflozin does not reduce heart failure hospitalization or death post-myocardial infarction
29 Apr, 2024 | 12:39h | UTCThis randomized, placebo-controlled trial assessed empagliflozin in preventing heart failure or death in patients recently hospitalized for acute myocardial infarction. Among 6,522 patients divided evenly into empagliflozin and placebo groups, there was no significant difference in the primary outcome—a composite of heart failure hospitalization or death—after 17.9 months. The empagliflozin group saw 8.2% experiencing the primary outcome versus 9.1% in the placebo group, yielding a non-significant hazard ratio of 0.90 (95% CI, 0.76 to 1.06; P=0.21). The results indicate that empagliflozin does not effectively reduce the risk of heart failure or mortality compared to placebo in this setting.
Reference (link to abstract – $ for full-text):
RCT: Semaglutide significantly improves symptoms and weight loss in HFpEF and type 2 diabetes patients
29 Apr, 2024 | 12:36h | UTCThis randomized clinical trial evaluated the effects of semaglutide on 616 patients with obesity-related heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes. Patients received weekly doses of 2.4 mg semaglutide or a placebo for 52 weeks. The study’s primary findings included a significant improvement in heart failure–related symptoms, as measured by the Kansas City Cardiomyopathy Questionnaire clinical summary score (average increase of 13.7 points in the semaglutide group versus 6.4 points in the placebo group). Additionally, semaglutide treatment resulted in a mean 9.8% reduction in body weight compared to 3.4% with placebo. Secondary outcomes also favored semaglutide, showing enhancements in 6-minute walk distance and reductions in C-reactive protein levels. Notably, semaglutide was associated with fewer serious adverse events compared to placebo.
Reference (link to abstract – $ for full-text):
Cohort Study: No increased risk of autism, ADHD, or intellectual disability from acetaminophen use in pregnancy
29 Apr, 2024 | 12:34h | UTCThis cohort study investigated the association between acetaminophen use during pregnancy and the risk of autism, ADHD, and intellectual disability in children. The study utilized a population-based sample of nearly 2.5 million Swedish children born between 1995 and 2019, with data analyzed up to 2021. Initial findings without sibling controls suggested a marginal increase in the risks of autism and ADHD. However, sibling control analyses, which help adjust for familial confounding, showed no significant associations (HR for autism and ADHD at 0.98, and intellectual disability at 1.01). These results imply that earlier observed risks might be due to unaccounted familial factors, not acetaminophen exposure.
Reference (link to abstract – $ for full-text):
M-A: Neoadjuvant chemoimmunotherapy enhances event-free survival in resectable NSCLC with low PD-L1 expression
28 Apr, 2024 | 20:20h | UTCThis meta-analysis evaluated the impact of neoadjuvant chemoimmunotherapy versus chemotherapy on resectable non-small cell lung cancer (NSCLC) patients, particularly focusing on those with tumor PD-L1 levels below 1%. The study synthesized data from 43 trials, encompassing 5431 patients, to assess clinical outcomes such as overall and event-free survival, alongside major and complete pathological responses. Findings highlighted that neoadjuvant chemoimmunotherapy significantly improved event-free survival (hazard ratio, 0.74; 95% CI, 0.62-0.89) compared to chemotherapy alone, particularly in patients with low PD-L1 expression, though overall survival benefits were not observed. The pooled analysis from randomized clinical trials showed favorable outcomes across all examined endpoints, supporting the superiority of neoadjuvant chemoimmunotherapy in these settings.
Reference (link to free full-text):
RCT: Efficacy and safety of microaxial flow pump in STEMI-related cardiogenic shock
28 Apr, 2024 | 20:17h | UTCThis randomized clinical trial assessed the impact of a microaxial flow pump (Impella CP) on mortality in 355 patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. Patients were randomly assigned to receive either the microaxial flow pump plus standard care or standard care alone. The primary outcome was mortality at 180 days. Results showed a significant reduction in death rates in the microaxial flow pump group (45.8%) compared to the standard care group (58.5%) with a hazard ratio of 0.74 (95% CI, 0.55 to 0.99; P=0.04). However, the incidence of severe adverse events was notably higher in the microaxial flow pump group, including severe bleeding and device-related complications.
Reference (link to abstract – $ for full-text):
RCT: No improvement in OS with atezolizumab plus cabozantinib vs. docetaxel in metastatic NSCLC post Anti-PD-L1/PD-1 therapy
28 Apr, 2024 | 20:15h | UTCIn a phase III trial, 366 patients with metastatic non-small cell lung cancer (NSCLC) were evaluated to determine the efficacy of atezolizumab combined with cabozantinib versus docetaxel following progression after anti–PD-L1/PD-1 and platinum-based chemotherapy. The study randomly assigned patients to receive either atezolizumab 1,200 mg every 3 weeks plus cabozantinib 40 mg daily or docetaxel 75 mg/m2 every 3 weeks. The results showed no significant difference in median overall survival (OS) between the two groups, with 10.7 months for the combination therapy and 10.5 months for docetaxel (HR 0.88, 95% CI, 0.68-1.16; P = .3668). The safety profiles were consistent with the known risks associated with these treatments.
Reference (link to free full-text):
Meta-Analysis: Efficacy of MRI in prostate cancer screening for reducing unnecessary biopsies
28 Apr, 2024 | 20:13h | UTCThis meta-analysis evaluated the effectiveness of incorporating magnetic resonance imaging (MRI) into prostate cancer screening pathways, compared to prostate-specific antigen (PSA)–only screening strategies. Analyzing data from 80,114 men across 12 studies, the findings demonstrate that MRI-based screening, particularly when using a sequential approach and a PI-RADS score ≥3 cutoff for biopsy, significantly increases the odds of detecting clinically significant prostate cancers (OR, 4.15) while reducing unnecessary biopsies (OR, 0.28) and detection of clinically insignificant cancers (OR, 0.34). Implementing a higher PI-RADS score of ≥4 further decreased the detection of insignificant cancers and biopsies performed, without impacting the detection rate of significant cancers. These results support the integration of MRI into screening programs to enhance diagnostic precision and reduce patient harm.
Reference (link to abstract – $ for full-text):
RCT: Reduction in cardiac events through preventive PCI in vulnerable atherosclerotic coronary plaques
28 Apr, 2024 | 17:39h | UTCThis multicenter, open-label, randomized controlled trial assessed the effectiveness of preventive percutaneous coronary intervention (PCI) versus optimal medical therapy alone in treating patients with non-flow-limiting vulnerable coronary plaques identified by intracoronary imaging. Conducted across 15 research hospitals in four countries, the trial enrolled 1,606 patients, with 803 in each treatment group. After 2 years, major adverse cardiac events were significantly lower in the PCI group (0.4%) compared to the medical therapy group (3.4%), with a p-value of 0.0003. These results suggest that preventive PCI can effectively reduce cardiac events in patients with high-risk vulnerable plaques, supporting the expansion of PCI indications to these patients.
Reference (link to abstract – $ for full-text):
RCT: Intravascular ultrasound guidance improves outcomes in percutaneous coronary intervention for acute coronary syndrome
28 Apr, 2024 | 17:22h | UTCThis randomized clinical trial evaluated 3505 acute coronary syndrome (ACS) patients across 58 centers in China, Italy, Pakistan, and the UK, comparing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI. The study’s primary endpoint was target vessel failure—comprising cardiac death, myocardial infarction, or revascularisation—after 1 year. The IVUS-guided group showed significantly lower rates of the primary endpoint (4.0%) compared to the angiography-guided group (7.3%), with a hazard ratio of 0.55. This outcome was primarily driven by reductions in myocardial infarction and revascularisation, with similar safety profiles between the two groups.
Reference (link to abstract – $ for full-text):
Systematic Review: Diagnostic accuracy of clinical examination for dislocated hips in infants
28 Apr, 2024 | 16:52h | UTCThis systematic review assesses the diagnostic accuracy of clinical examinations in identifying dislocated hips in infants, using data from nine studies that compared clinical examinations to diagnostic ultrasound as the reference. The study involved 37,859 hips with a dislocation prevalence of 0.94%. The Barlow and Ortolani maneuvers showed a sensitivity of 46% and a specificity of 99.1%, with a positive likelihood ratio of 52, highlighting their effectiveness in predicting hip dislocation. Other methods such as limited hip abduction and a clicking sound were found to have minimal diagnostic utility. This evidence supports the clinical utility of specific maneuvers in early detection to prevent long-term complications.
Reference (link to abstract – $ for full-text):
RCT: Olezarsen effectively reduces triglyceride levels and pancreatitis episodes in familial chylomicronemia Syndrome
28 Apr, 2024 | 16:47h | UTCThis phase 3, double-blind, placebo-controlled trial evaluated olezarsen in 66 patients with familial chylomicronemia syndrome. Participants received 80 mg or 50 mg of olezarsen or a placebo subcutaneously every 4 weeks for 49 weeks. The study found significant reductions in fasting triglyceride levels at the 6-month mark in the 80 mg olezarsen group compared to the placebo (-43.5 percentage points), with a similar trend observed in apolipoprotein C-III levels. Furthermore, the incidence of acute pancreatitis was significantly lower in both olezarsen groups compared to placebo by the 53-week endpoint. The findings suggest olezarsen as a potent therapy for reducing triglyceride levels and preventing pancreatitis in this population.
Reference (link to abstract – $ for full-text):
Pooled Analysis: Semaglutide improves symptoms and reduces weight in obesity-related heart failure with preserved ejection fraction
28 Apr, 2024 | 16:33h | UTCThis pooled analysis of the STEP-HFpEF and STEP-HFpEF DM randomized trials assessed the efficacy of semaglutide in 1,145 participants with obesity-related heart failure and preserved ejection fraction, across 129 research sites globally. Participants, who had a BMI of at least 30 kg/m2 and varied cardiovascular conditions, were administered 2.4 mg of semaglutide weekly for 52 weeks. Semaglutide significantly improved heart failure-related symptoms (7.5 points increase in KCCQ-CSS), reduced body weight by 8.4%, and increased the 6-min walk distance by 17.1 meters, compared to placebo. The treatment also demonstrated safety, with fewer serious adverse events than the placebo group. These benefits were consistent across various subgroups, confirming semaglutide’s potential as a treatment in this patient population.
Reference (link to abstract – $ for full-text):
Diagnostic Study: Enhanced prediction of TB progression with IGRAs compared to tuberculin skin test
27 Apr, 2024 | 18:53h | UTCStudy Design and Population:
This prospective diagnostic study analyzed the predictive accuracy of tuberculosis (TB) tests among 22,020 high-risk participants across 10 US sites from 2012 to 2020. Participants included individuals with close contacts to infectious TB cases, those born in or travelers to high-incidence countries, individuals living with HIV, or belonging to locally prevalent high-risk groups. Testing included two interferon-γ release assays (IGRAs), QuantiFERON-TB Gold In-Tube (QFT-GIT) and SPOT.TB (TSPOT), alongside the traditional tuberculin skin test (TST).
Main Findings:
The study found that both IGRAs, TSPOT and QFT-GIT, showed significantly superior positive predictive value (PPV) for predicting TB disease progression compared to the TST, with PPV ratios of 1.65 (95% CI, 1.35-2.02) and 1.47 (95% CI, 1.22-1.77) respectively. Additionally, when considering a positive TST result, further positive results from either IGRA significantly increased the PPV, emphasizing the enhanced predictive capability of IGRAs over TST alone.
Implications for Practice:
The superior predictive performance of Interferon-γ Release Assays (IGRAs) suggests they should be considered in clinical settings for high-risk populations, if available and feasible, to better identify individuals at increased risk of progressing to active tuberculosis (TB). This enhanced detection capability could guide more targeted preventive treatments, ultimately supporting global efforts toward TB elimination. Clinicians should assess the accessibility and cost-effectiveness of IGRAs to refine decision-making processes in TB prevention strategies, ensuring that the benefits of these advanced diagnostics are balanced against their costs.
Reference (free full-text):
The Lancet Commission: Global projections and recommendations for managing the increasing burden of prostate cancer
27 Apr, 2024 | 18:42h | UTCThe Lancet Commission’s report on prostate cancer highlights the expected doubling of annual cases from 1.4 million in 2020 to 2.9 million by 2040, driven by demographic changes and increased life expectancy. This comprehensive analysis divides the issue into epidemiology, diagnostics, management of localized and advanced disease, emphasizing disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). Key findings indicate that late diagnoses are common, particularly in LMICs, leading to worse outcomes. The Commission advocates for significant changes in the diagnostic pathways and increased use of current technologies tailored to available resources to improve outcomes. Education and awareness programs are recommended to facilitate early detection and shift the treatment paradigm from palliative to curative, focusing on surgery and radiotherapy. Without decisive action, the global mortality from prostate cancer is set to rise, highlighting the need for urgent interventions across all countries, with a special focus on underserved populations.
Reference: