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Emergency Medicine

Opinion | Tocilizumab in COVID-19 therapy: who benefits, and how? – the researchers suggest that maybe IL-6 inhibitors should be given only to patients with high IL-6.

23 Jul, 2021 | 10:51h | UTC

Tocilizumab in COVID-19 therapy: who benefits, and how? – The Lancet

Related: A living WHO guideline on drugs for covid-19 – interleukin-6 receptor blockers are now recommended for patients with severe or critical covid-19. AND M-A: Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19 – “The 4% absolute risk reduction in mortality from 25% to 21% with IL-6 inhibition added to glucocorticoids may not translate to patients with a lower baseline mortality risk and likely do not justify the additional expense and risk for toxicities for patients hospitalized with modest oxygen requirements and a stable clinical course (from editorial)”. AND RECOVERY trial: In hospitalized COVID-19 patients with hypoxia and systemic inflammation (C-reactive protein ≥75 mg/L), tocilizumab improved survival and other clinical outcomes AND Secondary analysis of RCT finds Tocilizumab was beneficial to patients hospitalized with Covid-19 if CRP levels were greater than 15.0 mg/dL, but not if CRP levels were 15.0 mg/dL or less. AND M-A: Tocilizumab in COVID-19 – “For hospitalized COVID-19 patients, there is some evidence that tocilizumab use may be associated with a short-term mortality benefit, but further high-quality data are required”.


Review: Ethics in extracorporeal life support.

23 Jul, 2021 | 10:29h | UTC

Ethics in extracorporeal life support: a narrative review – Critical Care


A Narrative Review on the Role of Staphylococcus aureus Bacteriuria in S. aureus Bacteremia.

22 Jul, 2021 | 10:37h | UTC

A Narrative Review on the Role of Staphylococcus aureus Bacteriuria in S. aureus Bacteremia – Open Forum Infectious Diseases


Commentary on Twitter


RCT: Immediate oral refeeding in patients with mild and moderate acute pancreatitis.

22 Jul, 2021 | 10:32h | UTC

Immediate Oral Refeeding in Patients With Mild and Moderate Acute Pancreatitis: A Multicenter, Randomized Controlled Trial (PADI trial) – Annals of Surgery (link to abstract – $ for full-text)


Cohort study: Sickle cell disorders and severe COVID-19 outcomes – “Our analysis estimated a 4-fold increased risk for COVID-19–related hospitalization and a 2.6-fold increased risk for COVID-19–related death for sickle cell disease”.

21 Jul, 2021 | 10:44h | UTC

Sickle Cell Disorders and Severe COVID-19 Outcomes: A Cohort Study – Annals of Internal Medicine


Expert review | Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy.

21 Jul, 2021 | 10:37h | UTC

Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy – American Journal of Obstetrics & Gynecology


Commentary on Twitter


WHO Guidance for clinical case management of thrombosis with thrombocytopenia syndrome (TTS) following vaccination to prevent coronavirus disease (COVID-19).

20 Jul, 2021 | 10:29h | UTC

Guidance for clinical case management of thrombosis with thrombocytopenia syndrome (TTS) following vaccination to prevent coronavirus disease (COVID-19) – World Health Organization

Related Guidance: AHA/ASA Guidance: Diagnosis and Management of Cerebral Venous Sinus Thrombosis with Vaccine-Induced Thrombotic Thrombocytopenia – “No heparin products in any dose should be given.” AND ISTH Interim Guidance for the Diagnosis and Treatment on Vaccine Induced Immune Thrombotic Thrombocytopenia


WHO warns that HIV infection increases risk of severe and critical COVID-19.

20 Jul, 2021 | 10:24h | UTC

News release: WHO warns that HIV infection increases risk of severe and critical COVID-19 – World Health Organization

Report: WHO report on clinical features and prognostic factors of COVID-19 in people living with HIV hospitalized with SARS-CoV-2 infection

Related: M-A: Epidemiology and outcomes of COVID-19 in HIV-infected individuals – HIV is a significant risk factor for acquiring SARS-CoV-2 infection and is associated with a higher risk of mortality.


Commentary on Twitter (thread – click for more)


International Registry: Ischemic and hemorrhagic stroke among critically ill patients with Covid-19.

20 Jul, 2021 | 10:21h | UTC

Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study – Critical Care Medicine

Related: SARS-CoV-2 and Stroke Characteristics – higher rate of large vessel occlusions and stroke in young patients AND Case series of 18 male adults aged 50 years or younger with acute ischemic stroke during the convalescent phase of asymptomatic Covid-19 AND Case-control study: COVID-19-associated stroke is associated with worse outcomes and increased mortality AND Pictorial essay: Neurological emergencies associated with COVID-19: stroke and beyond AND Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke AND Risk of Ischemic Stroke in Patients with COVID-19 vs. Patients with Influenza


RCT: more data showing Azithromycin is not better than placebo in patients with Covid-19.

18 Jul, 2021 | 23:54h | UTC

Effect of Oral Azithromycin vs Placebo on COVID-19 Symptoms in Outpatients With SARS-CoV-2 Infection: A Randomized Clinical Trial – JAMA

Commentary: Common antibiotic no more effective than placebo in preventing COVID-19 symptoms among non-hospitalized – University of California – San Francisco

Related: RCT: Another study shows Azithromycin does not improve outcomes in patients with Covid-19. (several articles on the subject)


Commentary on Twitter


Position Paper: Recommendations for the use of topical inhalant budesonide in COVID-19.

18 Jul, 2021 | 23:53h | UTC

Recommendations for use of topical inhalant budesonide in COVID-19 – HNO

Related: RCT: Inhaled budesonide shortens recovery time in non-hospitalized patients with COVID-19 AND Phase 2 RCT: Inhaled budesonide shows promise for the treatment of early COVID-19


Review: Acute kidney injury.

18 Jul, 2021 | 23:18h | UTC

Acute kidney injury – Nature Reviews Disease Primers (free for a limited period)


Commentary on Twitter


Why was a major study on ivermectin for covid-19 just retracted?

16 Jul, 2021 | 11:11h | UTC

Why Was a Major Study on Ivermectin for COVID-19 Just Retracted? – Grifter Analysis and Review

See also: Huge study supporting ivermectin as Covid treatment withdrawn over ethical concerns – The Guardian AND Some problems in the dataset of a large study of Ivermectin for the treatment of Covid-19 – Nick Brown’s Blog AND Is Ivermectin for Covid-19 Based on Fraudulent Research? – Gideon M-K; Health Nerd


Commentary on Twitter (thread – click for more)


Short review: The gut in COVID-19.

16 Jul, 2021 | 10:54h | UTC

The gut in COVID-19 – Intensive Care Medicine


Commentary on Twitter


AAFP Guideline: Pharmacologic Management of COPD Exacerbations.

16 Jul, 2021 | 10:51h | UTC

Pharmacologic Management of COPD Exacerbations: A Clinical Practice Guideline from the AAFP – American Family Physician


RCT: Bamlanivimab plus Etesevimab reduce mortality and hospitalization in ambulatory patients with early Covid-19 (within 3 days of a positive test) who are at risk for clinical deterioration (i.e., older people, obese, diabetics, immunocompromised, with CV disease).

15 Jul, 2021 | 09:26h | UTC

Bamlanivimab plus Etesevimab in Mild or Moderate Covid-19 – New England Journal of Medicine


Tramadol: Where do we go from here? – “Tramadol’s unpredictability, unique potential harms, and lack of advantage over other opioids or NSAIDs are now well recognized”.

15 Jul, 2021 | 09:14h | UTC

[131] Tramadol: Where do we go from here? – Therapeutic Initiative


M-A: Utility of intravenous Alteplase prior to endovascular stroke treatment.

15 Jul, 2021 | 09:03h | UTC

Utility of Intravenous Alteplase Prior to Endovascular Stroke Treatment: A Systematic Review and Meta-analysis of RCTs – Neurology (link to abstract – $ for full-text)

Commentary: Direct thrombectomy, bridging therapy confer similar functional outcomes in stroke – Healio (free registration required)


Commentary on Twitter


RCT: Lopinavir-ritonavir and hydroxychloroquine worsened outcomes in critically ill patients with COVID-19.

14 Jul, 2021 | 11:25h | UTC

Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial – Intensive Care Medicine


Commentary on Twitter (thread – click for more)


RCT: Neither Remdesivir nor Hydroxychloroquine affect viral clearance in hospitalized patients with COVID-19.

14 Jul, 2021 | 11:23h | UTC

News release: Neither remdesivir nor HCQ affect viral clearance in hospitalized patients with COVID-19 – American College of Physicians

Original Study: Evaluation of the Effects of Remdesivir and Hydroxychloroquine on Viral Clearance in COVID-19 – Annals of Internal Medicine


Commentary on Twitter


FDA Safety Alert: hydroxyethyl starch products should not be used unless adequate alternative treatment is unavailable.

14 Jul, 2021 | 10:48h | UTC

Labeling Changes on mortality, kidney injury, and excess bleeding with hydroxyethyl starch products – U.S. Food and Drug Administration

Commentary: FDA Piles on New Warnings for Blood Volume Expanders – MedPage Today (free registration required)

Related: Hydroxyethyl-starch Solutions (HES) Should no Longer be Used – European Medicines Agency AND Randomized Trial: Hydroxyethyl Starch vs. Saline for Volume Replacement Therapy in High-Risk Patients Undergoing Major Abdominal Surgery AND Systematic Review: Colloids vs Crystalloids for Fluid Resuscitation in Critically Ill People


German national treatment guidance for hospitalized COVID-19 patients.

13 Jul, 2021 | 10:02h | UTC

Key summary of German national treatment guidance for hospitalized COVID-19 patients Key pharmacologic recommendations from a national German living guideline using an Evidence to Decision Framework (last updated 17.05.2021) – Infection


Extremely rare cases of Guillain-Barré reported with Johnson & Johnson vaccine for Covid-19.

13 Jul, 2021 | 09:48h | UTC

J&J’s Covid-19 vaccine may trigger neurological condition in rare cases, FDA says – STAT

See also: Johnson & Johnson Vaccine Is Linked To Neurological Disorder In Extremely Rare Cases – NPR AND F.D.A. Attaches Warning of Rare Nerve Syndrome to Johnson & Johnson Vaccine – The New York Times


Podcast | An Antibiotics Primer.

13 Jul, 2021 | 09:35h | UTC

#284 An Antibiotics Primer, with @IDdocAdi – The Curbsiders


Another RCT evaluating the efficacy and quality of life of antibiotic-only treatment of acute uncomplicated appendicitis.

13 Jul, 2021 | 09:33h | UTC

A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial – Annals of Surgery (link to abstract – $ for full-text)

Related: A Randomized trial comparing antibiotics with appendectomy for appendicitis AND Antibiotics alone for uncomplicated appendicitis: Oral Moxifloxacin almost as good as intravenous Ertapenem + oral Levofloxacin AND Observational study: 67.1% success rate with nonoperative management of children with uncomplicated appendicitis AND Randomized Trial: Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs. Appendectomy for Uncomplicated Acute Appendicitis AND Meta-Analysis: Antibiotic Treatment vs. Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children AND Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis – Pediatric Surgery International


Commentary on Twitter


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