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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
#ACC23 – RCT | Intravascular imaging–guided vs. angiography-guided complex PCI
7 Mar, 2023 | 13:20h | UTCIntravascular Imaging–Guided or Angiography-Guided Complex PCI – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In RENOVATE-COMPLEX-PCI, a randomized trial of imaging-guided or angiography-guided PCI for complex coronary lesion revascularization procedures, imaging-guided PCI led to a lower risk of target-vessel failure than angiography-guided PCI. https://t.co/GaE2cthB5t #ACC23/#WCCardio pic.twitter.com/EB1qb9dY21
— NEJM (@NEJM) March 5, 2023
M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia
7 Mar, 2023 | 13:18h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.
Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.
However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.
Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP
SR | Ultrasound‐guided arterial cannulation in the pediatric population
7 Mar, 2023 | 13:15h | UTCSummary:
This updated systematic review analyzed nine randomized controlled trials comparing ultrasound guidance to traditional methods of locating arteries for cannulation, such as palpation and Doppler auditory assistance.
The review found that ultrasound guidance probably improves first-attempt success rates, reduces the risk of complications such as hematoma formation, improves success rates within two attempts and the overall rate of successful cannulation, and reduces the number of attempts and duration of the cannulation procedure.
However, the review also notes that the evidence is only of moderate certainty due to the inability to mask the doctors performing the cannulation and the limited number of children studied. More research is needed to confirm the benefits of ultrasound guidance for arterial cannulation in different age groups of children.
Article: Ultrasound‐guided arterial cannulation in the paediatric population – Cochrane Library
Summary: Ultrasound use for insertion of arterial catheters in children – Cochrane Library
RCT | Study finds both one-food and six-food elimination diets are effective initial options for eosinophilic esophagitis
7 Mar, 2023 | 13:17h | UTCSummary:
The article describes a multicenter randomized trial that compared the effectiveness of a one-food elimination diet (1FED – eliminating animal milk) versus a six-food elimination diet (6FED – eliminating animal milk, wheat, egg, soy, fish and shellfish, and peanut and tree nuts) for treating eosinophilic esophagitis in adults.
The study found that both diets were equally effective at achieving histological remission, although the 6FED resulted in a higher proportion of patients achieving complete remission. Patients who did not achieve histological remission with the 1FED could proceed to the 6FED, and 43% had histological remission. For those without response to the 6FED, topical fluticasone propionate induced remission in 82%.
Overall, the study suggests that eliminating animal milk alone is an acceptable initial dietary therapy for eosinophilic esophagitis.
Article: One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial – The Lancet Gastroenterology & Hepatology (link to abstract – $ for full-text)
News Release: Forgoing one food treats eosinophilic esophagitis as well as excluding six – National Institutes of Health
Related: M-A | Efficacy of elimination diets in eosinophilic esophagitis
Commentary on Twitter
New research – Kliewer et al – One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial https://t.co/Tpm0EPPfx0#EoE #GItwitter #RareDiseaseDay #CEGIR pic.twitter.com/iUcqIt9Pg5
— The Lancet Gastroenterology & Hepatology (@LancetGastroHep) February 28, 2023
Myocarditis or pericarditis events after BNT162b2 vaccination in individuals aged 12 to 17 years in Ontario, Canada
7 Mar, 2023 | 13:13h | UTCSummary:
A population-based cohort study was conducted to estimate the incidence of reported myocarditis or pericarditis after BNT162b2 vaccination in adolescents aged 12 to 17 years in Ontario, Canada, and to describe the clinical information associated with these events. The study analyzed data from 1.65 million doses of BNT162b2 vaccinations administered between December 14, 2020, and November 21, 2021.
According to the study, 77 adolescents were reported to have developed myocarditis or pericarditis after receiving the vaccine, and there was a greater occurrence of these events among those aged 16 to 17 years compared to those aged 12 to 15 years. Additionally, adolescents with shorter intervals between vaccine doses had a higher incidence of myocarditis or pericarditis.
Most cases of myocarditis and pericarditis were mild, and the adolescents required either no treatment or were treated conservatively with nonsteroidal anti-inflammatory drugs.
Perspective | Artificial intelligence in medicine & ChatGPT: de-tether the physician
7 Mar, 2023 | 13:10h | UTCArtificial Intelligence in Medicine & ChatGPT: De-Tether the Physician – Journal of Medical Systems (if the link is paywalled, try this one)
Related:
Can artificial intelligence help for scientific writing? – Critical Care
Artificial intelligence in academic writing: a paradigm-shifting technological advance
Perspective | ChatGPT-assisted diagnosis: is the future suddenly here?
Perspective | Generating scholarly content with ChatGPT: ethical challenges for medical publishing
ChatGPT: Will It Transform the World of Health Care? – UCSF Department of Medicine
ChatGPT and the future of medical writing (ChatGPT itself wrote this paper)
ChatGPT: five priorities for research – Nature
The path forward for ChatGPT in academia – Lumo’s Newsletter
ChatGPT is fun, but not an author – Science
Tools such as ChatGPT threaten transparent science; here are our ground rules for their use – Nature
ChatGPT listed as author on research papers: many scientists disapprove – Nature
Abstracts written by ChatGPT fool scientists
ChatGPT has many uses. Experts explore what this means for healthcare and medical research
7 Mar, 2023 | 13:11h | UTCRelated:
Artificial Intelligence in Medicine & ChatGPT: De-Tether the Physician – Journal of Medical Systems (if the link is paywalled, try this one)
Can artificial intelligence help for scientific writing? – Critical Care
Artificial intelligence in academic writing: a paradigm-shifting technological advance
Perspective | ChatGPT-assisted diagnosis: is the future suddenly here?
Perspective | Generating scholarly content with ChatGPT: ethical challenges for medical publishing
ChatGPT: Will It Transform the World of Health Care? – UCSF Department of Medicine
ChatGPT and the future of medical writing (ChatGPT itself wrote this paper)
ChatGPT: five priorities for research – Nature
The path forward for ChatGPT in academia – Lumo’s Newsletter
ChatGPT is fun, but not an author – Science
Tools such as ChatGPT threaten transparent science; here are our ground rules for their use – Nature
ChatGPT listed as author on research papers: many scientists disapprove – Nature
Abstracts written by ChatGPT fool scientists
Review | Acquired disorders of hypomagnesemia
7 Mar, 2023 | 13:09h | UTCAcquired Disorders of Hypomagnesemia – Mayo Clinic Proceedings
CDC Interim Guidance | Treatment considerations for severe manifestations of Mpox
7 Mar, 2023 | 13:08h | UTCCommentary: CDC recommendations and clinical considerations for the treatment of severe Mpox – News Medical
Update on current contraceptive options | A case-based discussion of efficacy, eligibility, and use
7 Mar, 2023 | 13:06h | UTC
Consensus Paper | Management of patients with advanced prostate cancer
7 Mar, 2023 | 13:02h | UTC
Position Statement | Chronic suppurative lung disease and bronchiectasis in children, adolescents and adults
7 Mar, 2023 | 13:04h | UTC
Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli
7 Mar, 2023 | 13:00h | UTCRelated:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
M-A | Long-term consumption of 10 food groups and cardiovascular mortality
7 Mar, 2023 | 12:58h | UTCSummary:
This systematic review and meta-analysis of 22 prospective cohort studies evaluated the association between the consumption of 10 food groups and cardiovascular mortality.
The researchers found that a long-term high intake of whole grains, fruits and vegetables, and nuts was associated with reduced cardiovascular mortality, while a high intake of red/processed meat was associated with increased risk. On the other hand, the consumption of dairy products and legumes did not show a significant association with cardiovascular risk.
The researchers acknowledge the limitations of observational studies and the need for further research on the long-term effects of specific food groups on cardiovascular mortality.
SR | Intermittent phototherapy versus continuous phototherapy for neonatal jaundice
7 Mar, 2023 | 12:59h | UTCSummary:
Phototherapy is a widely accepted first-line therapy for neonatal jaundice, and while continuous phototherapy is traditionally used, intermittent phototherapy has been proposed as an equally effective alternative with practical advantages such as improved maternal feeding and bonding. This systematic review compared intermittent vs. continuous phototherapy’s effectiveness and safety in treating neonatal jaundice.
The study included 12 randomized controlled trials involving 1600 infants, and found little or no difference between intermittent and continuous phototherapy in reducing bilirubin levels. Continuous phototherapy was found to be more effective in preterm infants, but the risks and potential benefits are unknown.
The review concludes that while there are theoretical benefits to intermittent regimens, large, well-designed, prospective trials are needed to determine whether intermittent and continuous phototherapy are equally effective and safe in both preterm and term infants.
Article: Intermittent phototherapy versus continuous phototherapy for neonatal jaundice – Cochrane Library
Summary: Intermittent phototherapy versus continuous phototherapy for neonatal jaundice – Cochrane Library
Podcast | Updates in chronic kidney disease
7 Mar, 2023 | 12:51h | UTC#384 Updates in Chronic Kidney Disease with Dr. Joel Topf – The Curbsiders
Cohort Study | Early pregnancy exposure to NSAIDs is associated with slightly higher risks of neonatal and maternal adverse outcomes
7 Mar, 2023 | 12:56h | UTCSummary:
A nationwide cohort study in South Korea, including 1.8 million pregnancies, investigated the association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during early pregnancy and neonatal and maternal adverse outcomes.
The study revealed that pregnant women exposed to NSAIDs during early pregnancy were at increased risk of oligohydramnios and had a slightly higher likelihood of having an infant with major congenital malformations and low birth weight. These risks remained elevated when comparing NSAIDs against acetaminophen or past users.
The study suggests that clinicians should weigh the need to prescribe NSAIDs in early pregnancy against the modest but possible risk of neonatal and maternal outcomes and consider prescribing nonselective NSAIDs for <10 days, with continued careful monitoring for any safety signals.