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2023 ACC/AHA/SCAI Advanced training statement on interventional cardiology
21 Feb, 2023 | 11:52h | UTCSummary: The American College of Cardiology (ACC), the American Heart Association (AHA), and the Society for Cardiovascular Angiography and Interventions (SCAI) have issued a clinical document that outlines competency-based training requirements for interventional cardiology trainees. The report emphasizes the importance of a comprehensive training program that includes both didactic and hands-on training. The competencies required for interventional cardiologists include the ability to perform complex coronary, peripheral vascular, and structural heart interventions and manage and treat complications that may arise during these procedures.
Commentaries:
Interventional Cardiology Training Needs Defined for the First Time – TCTMD
Trends and predictions of malnutrition and obesity in 204 countries and territories: an analysis of the Global Burden of Disease Study 2019
22 Feb, 2023 | 12:17h | UTC
Sleep irregularity linked to subclinical markers of cardiovascular disease
21 Feb, 2023 | 11:51h | UTCSummary: The study examined the association between sleep irregularity and subclinical markers of cardiovascular disease in a population of over 2000 participants with a mean age of 68. The participants completed 7-day wrist actigraphy that detected when they were asleep and awake. The results showed that sleep irregularity, particularly sleep duration irregularity, was associated with subclinical atherosclerosis, including high coronary artery calcium burden and abnormal ankle-brachial index. These associations persisted even after adjusting for cardiovascular disease risk factors and other sleep characteristics such as obstructive sleep apnea, sleep duration, and sleep fragmentation. While it is important to note that observational studies like this one cannot establish causation and may be subject to residual confounding, the findings suggest that promoting regular sleep schedules could be an essential aspect of lifestyle recommendations for preventing cardiovascular disease.
News Release: Irregular sleeping habits may increase risk of atherosclerosis in older adults – American Heart Association
Commentaries:
Sleep Irregularity Linked to Measures of Subclinical Atherosclerosis – HealthDay
Irregular sleep may be harmful to your heart, study finds – CNN
Guideline Synopsis | Management of thoracic aortic dissection
21 Feb, 2023 | 11:48h | UTCManagement of Thoracic Aortic Dissection – JAMA (free for a limited period)
Original Guidelines:
Consensus Statement | Renal denervation in the management of hypertension in adults
21 Feb, 2023 | 11:45h | UTC
Instant noodle burns common in pediatric scald injuries: Study highlights need for prevention efforts
21 Feb, 2023 | 11:50h | UTCSummary: The study examined pediatric scald burns at the University of Chicago Burn Center between 2010 and 2020 and found that 31% of burns were attributed to instant noodles. Children with instant noodle burns were typically older, more likely to be Black/African American, and from lower socio-economic backgrounds. They were also more likely to be unsupervised at the time of the injury. While instant noodle burns were smaller and required less operative intervention than other scald burns, some still required hospitalization and were associated with complications. The study highlights the need for targeted burn prevention efforts to reduce the incidence of these common but serious injuries.
Article: Pediatric instant noodle burns: A ten-year single center retrospective study – Burns (link to abstract – $ for full-text)
Commentary: Why Instant Noodles Are a Danger to Your Kids – HealthDay
M-A | Drugs to reduce bleeding in major open vascular or endovascular surgery – not enough evidence to guide treatment
21 Feb, 2023 | 11:44h | UTCSummary: The article is a systematic review and network meta-analysis of randomized controlled trials (RCTs) on the effectiveness and safety of anti-fibrinolytic and hemostatic drugs and agents to reduce bleeding and the need for blood transfusion in people undergoing major vascular surgery or endovascular procedures. The authors searched multiple databases and trial registries and included 22 RCTs with 3,393 participants analyzed. Due to a lack of data, the authors are uncertain whether any systemic or topical treatments may improve outcomes, emphasizing that larger trials with clinically relevant outcomes are needed.
Cohort Study | One third of patients hospitalized with Covid-19 persist with lung abnormalities after 2 years
21 Feb, 2023 | 11:47h | UTCSummary: The study aimed to assess changes in chest CT abnormalities and pulmonary function in patients two years after recovery from SARS-CoV-2 infection. The prospective study followed 144 participants discharged from the hospital after SARS-CoV-2 infection between January 15 and March 10, 2020. The participants underwent serial chest CT scans and pulmonary function tests at 6 months, 12 months, and 2 years after symptom onset. The study found that 39% of participants had persistent interstitial lung abnormalities at 2 years, and this was associated with respiratory symptoms and decreased diffusion pulmonary function.
Editorial: Radiologic Findings after COVID-19 and the Correlation with Lung Function – Radiology
Commentaries:
Post-COVID-19 CT scans show lung abnormalities persist two years later – News Medical
COVID’s aftermath: Persistent organ damage at 1 year, lung abnormalities at 2 – CIDRAP
Review | How to manage coagulopathies in critically ill patients
21 Feb, 2023 | 11:43h | UTCHow to manage coagulopathies in critically ill patients – Intensive Care Medicine
Commentary on Twitter
Coagulopathies severe/frequent complication in #ICU: how to manage??
🩸 hemorrhagic coagulopathies: non‑malignant & malignant
🩸 thrombotic c.: sepsis‑induced & solid cancer‑associated
🩸 managing hemorrhagic c.
🩸(preventing &) managing thrombotic c.
🖇️ https://t.co/CKqzT7dcoH pic.twitter.com/SvpPNf0oGO— Intensive Care Medicine (@yourICM) February 18, 2023
Analysis | High drug prices are not justified by industry’s spending on research and development
21 Feb, 2023 | 11:41h | UTCHigh drug prices are not justified by industry’s spending on research and development – The BMJ
News Release: Drug prices not justified by industry’s research and development spending – BMJ Newsroom
Commentary from the author on Twitter (thread – click for more)
New @bmj_latest paper📭
High drug prices do not seem justified by pharma industry’s R&D spending & new drugs' added benefits 💊💰
How can companies develop more innovative & affordable medicines?Read the thread 🧵https://t.co/YYznD4Tvwq@ojwouters @ElsTorreele @martinmckee
— Aris Angelis – Άρης Αγγελής (@aris_angelis) February 16, 2023
AHA Scientific Statement | Anesthetic care of the pregnant patient with cardiovascular disease
20 Feb, 2023 | 12:29h | UTCSummary: The AHA emphasizes the need for specialized cardio-obstetric anesthesiology care for pregnant patients with cardiovascular disease, involving a multidisciplinary team of obstetricians, cardiologists, anesthesiologists, and other specialists as needed. The approach includes preoperative evaluation, intraoperative management, and postoperative care to maintain maternal hemodynamic stability, optimize oxygen delivery to the fetus, and avoid factors that exacerbate cardiovascular disease. Vaginal delivery with effective neuraxial analgesia is the preferred mode of delivery, with cesarean delivery used for obstetrical indications or high-risk patients. Specific recommendations are also provided for the management of patients with different types of cardiovascular disease, including congenital heart disease, valvular heart disease, pulmonary hypertension, and hypertrophic cardiomyopathy.
Top Things to Know: Statement on the anesthetic care of the pregnant patient with cardiovascular disease – American Heart Association
Review | Diagnosis and management of patients with polyneuropathy
21 Feb, 2023 | 11:40h | UTCDiagnosis and management of patients with polyneuropathy – Canadian Medical Association Journal
Study finds low rates of antipsychotic medication discontinuation in older adults following infection-related hospitalization
20 Feb, 2023 | 12:25h | UTCSummary: The study aimed to investigate discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization and infection in older adults. The cohort study involved 5,835 patients in the US, who were aged 65 years or older, without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. The study found that only 11% of new atypical APM users and 52% of new haloperidol users discontinued the medication by 30 days after initiation. The discontinuation of haloperidol and atypical APM was less likely to occur in patients with dementia and prolonged hospitalization. The findings suggest that APM discontinuation rates following infection-related hospitalization are low, especially for atypical APM, and call for effective interventions to proactively discontinue APMs when they are no longer indicated.
RCT | Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease
20 Feb, 2023 | 12:27h | UTCSummary: The article reports on a randomized trial that compared the effects of alternate-day fasting (ADF) combined with exercise, fasting alone, or exercise alone in adults with obesity and non-alcoholic fatty liver disease (NAFLD). After three months, the combination of ADF and exercise significantly reduced intrahepatic triglyceride content, body weight, fat mass, waist circumference, and alanine transaminase levels compared to the control group. The intervention seems promising for patients with fatty liver disease who want to improve their health without using medications.
Article: Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: A randomized controlled trial – Cell Metabolism (link to abstract – $ for full-text)
News Release: Alternate-day fasting could be a good option for patients with fatty liver disease – University of Illinois Chicago
Gadolinium nanoparticles detected in kidney tissue of patients after MRI with gadolinium contrast, raising safety concerns
20 Feb, 2023 | 12:24h | UTCSummary: Researchers have discovered that tiny particles of the rare earth metal gadolinium can infiltrate kidney cells, potentially causing side effects. These particles, used to enhance MRI scans, were found in human and rodent specimens in a study that used electron microscopy to detect them. Gadolinium is typically tightly bound to chelating molecules in MRI contrast agents so that it can be eliminated via the kidneys, but the researchers found that some particles can leach out and build up in tissues. This raises questions about the safety of contrast agents containing gadolinium, which are used in around 50% of MRI scans, and highlights the need for further research into the risks and potential harms associated with these agents.
Commentary: Expert left ‘astounded’ by gadolinium discovery – Health Imaging
M-A | Consumption of whole vs. refined grains and risk of cardiovascular disease and all-cause mortality
20 Feb, 2023 | 12:23h | UTCSummary: This systematic review and meta-analysis of prospective cohort studies found that consuming whole grains was associated with a reduced risk of coronary heart disease, cardiovascular disease, and all-cause mortality, while consuming refined grains had no significant influence on these outcomes. Residual confounding can’t be excluded and the association found does not necessarily imply causation.
ESPEN practical guideline | Home parenteral nutrition
20 Feb, 2023 | 12:21h | UTCSummary: Home parenteral nutrition (HPN) is a form of nutrition support where a patient receives intravenous nutrition at home. It is used for patients who cannot receive adequate nutrition through oral or enteral routes, such as those with intestinal failure, severe inflammatory bowel disease, or other gastrointestinal disorders. HPN can be a life-saving therapy, but it requires careful patient selection, as well as ongoing monitoring and management by a multidisciplinary team. The ESPEN guideline aims to provide practical guidance on the use of HPN, including the nutritional and metabolic aspects of care and the practical considerations of administering HPN at home. The guideline also emphasizes the importance of patient-centered care and shared decision-making, highlighting the need for regular assessment and monitoring of patients.
Article: ESPEN practical guideline: Home parenteral nutrition – Clinical Nutrition
RCT | Rucaparib vs. physician’s choice in metastatic prostate cancer
20 Feb, 2023 | 12:17h | UTCSummary: This phase 3 randomized trial compared Rucaparib vs. physician’s choice control (docetaxel or a second-generation ARPI) in treating metastatic, castration-resistant prostate cancer patients with a BRCA1, BRCA2, or ATM alteration who had disease progression after treatment with a second-generation androgen-receptor pathway inhibitor (ARPI). The study found that the duration of radiographic progression-free survival was significantly longer in the rucaparib group than in the control group. The most frequent adverse events with rucaparib were fatigue and nausea.
Article: Rucaparib or Physician’s Choice in Metastatic Prostate Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Rucaparib Efficacious in Metastatic Castration-Resistant Prostate Cancer – HealthDay
Commentary on Twitter
Original Article: Rucaparib or Physician’s Choice in Metastatic Prostate Cancer (TRITON3) https://t.co/vuHTxqRRyb#GU23 #oncology pic.twitter.com/UrPMOgW4Fo
— NEJM (@NEJM) February 17, 2023
M-A | General Anesthesia vs. to Non-GA in endovascular thrombectomy for ischemic stroke
20 Feb, 2023 | 12:20h | UTCSummary: The study analyzed randomized controlled trials comparing the use of general anesthesia (GA) versus non-GA techniques, such as conscious sedation or local anesthesia for endovascular thrombectomy (EVT) in patients with ischemic stroke. The meta-analysis included seven trials with a total of 980 participants, showing that GA is associated with a 9% improvement in recanalization rates and an 8.4% improvement in functional recovery compared to non-GA techniques. There was no difference in hemorrhagic complications or 3-month mortality. The study recommends that GA be the first choice for most EVT procedures in acute ischemic stroke.
Article: General Anesthesia Compared to Non-GA in Endovascular Thrombectomy for Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials – Neurology (link to abstract – $ for full-text)
Review | Neurological complications of sepsis
20 Feb, 2023 | 12:16h | UTCSummary: This article covers the latest developments in the prevention, diagnosis, and treatment of sepsis-associated encephalopathy (SAE) and ICU-acquired weakness (ICUAW). SAE diagnosis is clinical with supporting EEG and neuroimaging. Treatment involves early identification and treatment of infections and organ dysfunction. ICUAW is due to an overlap between critical illness polyneuropathy, critical illness myopathy, and muscle disuse atrophy. It affects all limbs and respiratory muscles and is associated with prolonged hospital stay, increased costs, and both short and long-term mortality. Recovery is typical in weeks or months, but severe cases may result in persistent functional impairments for ICU survivors.
Article: Neurological complications of sepsis – Current Opinion in Critical Care
M-A | Soluble fiber supplementation and serum lipid profile
20 Feb, 2023 | 12:18h | UTCSummary: The article presents the results of a systematic review and dose-response meta-analysis of randomized controlled trials (RCTs) that evaluated the effect of soluble fiber supplementation on blood lipid parameters in adults. The review included 181 RCTs with 220 treatment arms and 14,505 participants. The meta-analysis found that soluble fiber supplementation significantly reduced LDL cholesterol, total cholesterol, triglycerides, and apolipoprotein B concentrations. The article suggests that increasing fiber intake using soluble fiber supplementation could be an effective intervention in the prevention and management of dyslipidemia, and consequently may contribute to the risk reduction of cardiovascular diseases. However, the article also notes that because of the high between-study heterogeneity and publication bias, the findings should be interpreted cautiously.
Phase 2b RCT | Ad26.RSV.preF–Respiratory Syncytial Virus preF protein vaccine is immunogenic in older adults
17 Feb, 2023 | 13:30h | UTCSummary: A phase 2b clinical trial evaluated the Ad26.RSV.preF–RSV preF protein vaccine’s efficacy, immunogenicity, and safety in preventing RSV-mediated lower respiratory tract disease in adults aged 65 years and older. The vaccine was effective in preventing the disease and immunogenic, as demonstrated by the increase in RSV A2 neutralizing antibody titers after vaccination. The vaccine was associated with higher rates of adverse events than the placebo, but most were of mild to moderate severity. The trial concluded that Ad26.RSV.preF–RSV preF protein vaccine was effective in preventing RSV-mediated lower respiratory tract disease in older adults.*
Article: Efficacy and Safety of an Ad26.RSV.preF–RSV preF Protein Vaccine in Older Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Ad26.RSV.preF-RSV preF Protein Vaccine Immunogenic in Seniors – HealthDay
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
RCT | Respiratory Syncytial Virus prefusion F protein vaccine provides protection for older adults
17 Feb, 2023 | 13:32h | UTCSummary: A phase 2b clinical trial evaluated the Ad26.RSV.preF–RSV preF protein vaccine in adults aged 65 years and older. The vaccine was effective and immunogenic, as demonstrated by the increase in RSV A2 neutralizing antibody titers after vaccination. The vaccine was associated with higher rates of adverse events than the placebo, but most were of mild to moderate severity.*
Article: Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Respiratory syncytial virus causes clinically significant illness in children and adults. In a placebo-controlled trial, a prefusion stabilized F protein vaccine led to an 83% lower risk of RSV infection. https://t.co/aU9BV0LXBU pic.twitter.com/0zy1hu0VH6
— NEJM (@NEJM) February 15, 2023
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
RCT | Evaluation of BNT162b2 Covid-19 vaccine in children younger than 5 years of age
17 Feb, 2023 | 13:27h | UTCSummary: The study was a combined phase 2-3 clinical trial that aimed to determine whether the BNT162b2 vaccine was safe, could elicit an immune response and was effective in preventing COVID-19 in healthy children. The trial was conducted on children aged 6 months to 11 years, with the findings presented for the 6 months to 4 years age group. The results indicated that the vaccine was safe, immunogenic, and effective in reducing the risk of symptomatic COVID-19 by 73.2% in children aged 6 months to 4 years. The vaccine was well-tolerated, and the side effects were mainly mild to moderate. The incidence of fever was similar among those who received the vaccine or a placebo.*
Article: Evaluation of BNT162b2 Covid-19 Vaccine in Children Younger than 5 Years of Age – New England Journal of Medicine (link to abstract – $ for full-text)
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
RCT | Breast-conserving surgery without irradiation may be an option for older patients with early breast cancer
17 Feb, 2023 | 13:25h | UTCSummary: The article reports a phase 3 randomized trial that investigated the efficacy of omitting irradiation after breast-conserving surgery in women aged 65 years or older with hormone receptor-positive, node-negative, T1 or T2 primary breast cancer, and tumors ≤3 cm in the largest dimension, who received adjuvant endocrine therapy. A total of 1326 women were enrolled, with 658 receiving whole-breast irradiation and 668 receiving no irradiation. The results showed that the omission of radiotherapy led to an increased incidence of local breast cancer recurrence but had no negative effect on distant recurrence as the first event or overall survival. The study suggests that omission of radiotherapy could be a viable treatment option for older women with low-risk, hormone receptor–positive early breast cancer who receive adjuvant endocrine therapy.*
Article: Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
For many older breast cancer patients, study finds radiation doesn’t affect survival – STAT
Do Older Patients Need Radiation Rx After Breast Cancer Surgery? – HealthDay
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.