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Emergency Medicine

Pre-post study: The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality.

6 Aug, 2021 | 08:55h | UTC

The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality – Journal of Trauma and Acute Care Surgery

 

Commentary on Twitter

 

RCT: In noncritically ill patients hospitalized with Covid-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge compared with usual-care thromboprophylaxis.

5 Aug, 2021 | 09:07h | UTC

Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19 – New England Journal of Medicine

Editorial: Surviving Covid-19 with Heparin?

Commentaries:

Full-dose blood thinners reduce the need for organ support in moderately ill COVID-19 patients, but not in critically ill patients – National Institutes of Health

Therapeutic-Dose Heparin in COVID-19: Who Benefits, Who Doesn’t – TCTMD

Canadian-Led International Study: Full-Dose Blood Thinners Benefit Moderately Ill COVID-19 Patients – University of Manitoba

 

Commentary on Twitter

 

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

5 Aug, 2021 | 09:04h | UTC

Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 – New England Journal of Medicine

Editorial: Surviving Covid-19 with Heparin?

Commentaries:

Full-dose blood thinners reduce the need for organ support in moderately ill COVID-19 patients, but not in critically ill patients – National Institutes of Health

Therapeutic-Dose Heparin in COVID-19: Who Benefits, Who Doesn’t – TCTMD

 

Commentary on Twitter

 

RCT: Subcutaneous REGEN-COV antibody combination prevented symptomatic Covid-19 infection in previously uninfected household contacts of infected persons.

5 Aug, 2021 | 09:01h | UTC

Subcutaneous REGEN-COV Antibody Combination to Prevent Covid-19 – New England Journal of Medicine

Related:

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).

[Preprint] RECOVERY trial finds Regeneron’s monoclonal antibody combination reduces deaths for hospitalized COVID-19 patients who have not mounted their own immune response.

 

Commentary on Twitter

 

Myocarditis and pericarditis after vaccination for COVID-19.

5 Aug, 2021 | 08:57h | UTC

Myocarditis and Pericarditis After Vaccination for COVID-19 – JAMA

Related:

Analysis finds benefits of COVID-19 vaccination outweigh risks of rare cases of myocarditis.

CDC: Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients – “Continued use of mRNA COVID-19 vaccines in all recommended age groups will prevent morbidity and mortality from COVID-19 that far exceed the number of cases of myocarditis expected”.

Case Series: Myocarditis following immunization with mRNA COVID-19 vaccines.

CDC: mRNA vaccines are likely linked to cases of myocarditis and pericarditis – 1,226 cases of myocarditis or pericarditis have been reported mostly in people under 30.

 

Position statement: Perioperative management of post-COVID-19 surgical patients.

4 Aug, 2021 | 10:00h | UTC

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement – Indian Journal of Anaesthesia

Related:

Guideline: SARS‐CoV‐2 infection, COVID‐19 and timing of elective surgery

Study from 116 countries suggests surgery should be delayed for at least seven weeks following a COVID-19 diagnosis to reduce mortality risk

Cohort study: Postoperative in-hospital mortality of patients with COVID-19 infection was more than double that in patients without COVID-19

WSES Position Paper: The management of surgical patients in the emergency setting during COVID-19 pandemic

Preparing previously COVID-19-positive patients for elective surgery: A framework for preoperative evaluation

 

Commentary on Twitter

 

M-A: Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease.

3 Aug, 2021 | 09:09h | UTC

Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis – Critical Care

 

Covid: Pulse oxygen monitors work less well on darker skin, experts say.

3 Aug, 2021 | 09:00h | UTC

Covid: Pulse oxygen monitors work less well on darker skin, experts say – BBC

Related:

FDA issues alert on ‘limitations’ of pulse oximeters, without explicit mention of racial bias

“Racial Bias in Pulse Oximetry Measurement”. In two large cohorts, Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients

 

Guideline: Clinical management of adult patients with COVID-19 Outside Intensive Care Units.

2 Aug, 2021 | 00:26h | UTC

Clinical Management of Adult Patients with COVID-19 Outside Intensive Care Units: Guidelines from the Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) – Infectious Diseases and Therapy

 

What every intensivist should know about Tocilizumab.

2 Aug, 2021 | 00:25h | UTC

What every intensivist should know about Tocilizumab – Critical Care

Related:

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

A living WHO guideline on drugs for covid-19 – interleukin-6 receptor blockers are now recommended for patients with severe or critical covid-19.

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)”.

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

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.

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”.

 

Clinical practice guidelines for the management of colonic volvulus and acute colonic pseudo-obstruction.

2 Aug, 2021 | 00:13h | UTC

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction – Diseases of the Colon & Rectum

News release: American Society of Colon & Rectal Surgeons Publishes New Guidelines for Colonic Volvulus and Acute Colonic Pseudo-Obstruction

 

NICE COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis.

30 Jul, 2021 | 12:14h | UTC

COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis – National Institute for Health and Care Excellence

News release: NICE publishes new rapid guideline to diagnose and treat rare blood clotting condition associated with COVID-19 vaccination – National Institute for Health and Care Excellence

Related: Very rare cases of thrombosis with thrombocytopenia syndrome (TTS) after AstraZeneca vaccine: a global safety database analysis – the estimated rate of TTS after the first dose was 8.1 per million vaccinees; after the second dose, the estimated rate was 2.3 per million vaccinees. (several articles and resources on the subject)

 

Vaccine-induced immune thrombotic thrombocytopenia: what we know and do not know.

30 Jul, 2021 | 12:12h | UTC

Vaccine-induced immune thrombotic thrombocytopenia: what we know and do not know – Blood

Related: Very rare cases of thrombosis with thrombocytopenia syndrome (TTS) after AstraZeneca vaccine: a global safety database analysis – the estimated rate of TTS after the first dose was 8.1 per million vaccinees; after the second dose, the estimated rate was 2.3 per million vaccinees. (several articles and resources on the subject)

 

Observational study: Positive Fluid balance linked to worse outcomes in critically ill patients with traumatic brain injury.

1 Aug, 2021 | 23:57h | UTC

Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study – The Lancet Neurology (link to abstract – $ for full-text)

Commentary: Traumatic Brain Injury: Fluid Overload Tied to Higher Mortality in ICU Patients – Physician’s Weekly

 

Commentary on Twitter

 

Risk of acute myocardial infarction and ischemic stroke following COVID-19 in Sweden – “the true risk is increased by between three and eight times for acute myocardial infarction and by between three and seven times for ischaemic stroke following COVID-19.”

30 Jul, 2021 | 12:06h | UTC

Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study – The Lancet

Invited commentary: What is the association of COVID-19 with heart attacks and strokes? – The Lancet

 

Commentary on Twitter

 

Brazilian Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation – 2021.

30 Jul, 2021 | 11:54h | UTC

Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation – 2021 – Arquivos Brasileiros de Cardiologia (PDF)

 

Review: Changing paradigms in the management of acute uncomplicated diverticulitis.

30 Jul, 2021 | 11:37h | UTC

Changing Paradigms in the Management of Acute Uncomplicated Diverticulitis – Scandinavian Journal of Surgery

Related:

RCT: Another study shows that non-antibiotic outpatient treatment in mild acute diverticulitis is safe.

Review: Elective surgical management of diverticulitis

State of the Art Review | Management of colonic diverticulitis

Drains, germs, or steel: Multidisciplinary management of acute colonic diverticulitis

Diverticulitis: Observational study in outpatients suggests amoxicillin-clavulanate is a safe and effective option compared with metronidazole-fluoroquinolone

Randomized trial: Laparoscopic lavage vs. primary resection for perforated purulent diverticulitis; similar long-term results, but recurrence was more common after laparoscopic lavage

Randomized trial: In patients with recurrent, complicated, or persistent painful diverticulitis, sigmoid resection improved quality of life but was associated with a small but significant risk of major complications

Systematic review: Management of colonic diverticulitis

WSES Guidelines for the Management of Acute Colonic Diverticulitis

ASCRS Guidelines for the Treatment of Left-Sided Colonic Diverticulitis

 

Commentary on Twitter

https://twitter.com/ScandJSurg/status/1420655333815427084

 

Systematic review: no evidence to support the use of Ivermectin for treating or preventing COVID-19.

29 Jul, 2021 | 11:38h | UTC

Ivermectin for preventing and treating COVID‐19 – Cochrane Library

Summary: Ivermectin for preventing and treating COVID-19 – Cochrane Library

Commentary: Ivermectin treatment in humans for COVID-19 – Liverpool School of Tropical Medicine

Related:

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

RCT: Ivermectin does not prevent hospitalizations in patients with COVID-19.

Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials – “IVM did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease”.

Ivermectin is the new hydroxychloroquine, take 2 – “Ivermectin shouldn’t be used to treat COVID-19 outside of the context of a well-designed clinical trial”.

Therapeutics and COVID-19 | WHO guideline update advises Ivermectin should only be used to treat COVID-19 within clinical trials

RCT: Ivermectin does not improve time to resolution of symptoms among adults with mild COVID-19

 

PRINCIPLE RCT: Doxycycline does not improve outcomes in outpatients with suspected COVID-19 at high risk for adverse outcomes.

29 Jul, 2021 | 11:36h | UTC

Doxycycline for community treatment of suspected COVID-19 in people at high risk of adverse outcomes in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial – The Lancet Respiratory Medicine

Commentary: PRINCIPLE: a community-based COVID-19 platform trial – The Lancet Respiratory Medicine

 

Commentary on Twitter

https://twitter.com/LancetRespirMed/status/1420302490864603142

 

Evidence Analysis: Is piperacillin-tazobactam safe in patients with penicillin allergy?

29 Jul, 2021 | 11:05h | UTC

Is piperacillin-tazobactam safe in patients with penicillin allergy? – PulmCrit

 

COVID-19 and mucormycosis superinfection: the perfect storm.

28 Jul, 2021 | 10:09h | UTC

COVID-19 and mucormycosis superinfection: the perfect storm – Infection

Related:

ECMM/ISHAM recommendations for clinical management of COVID -19 associated mucormycosis in low- and middle-income countries.

The “Black Fungus” in India: The Emerging Syndemic of COVID-19–Associated Mucormycosis – careful use of antibiotics and corticosteroids and closely monitoring blood glucose levels are some of the strategies suggested by the authors.

Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India – Uncontrolled diabetes mellitus was the most common underlying disease; improper glucocorticoid use was independently associated with the disease.

Opinion | “Doctors have been blamed for the rise in black fungus in India, but the COVID treatment guidelines could be contributing” – improper use of antibiotics and higher than usual doses of corticosteroids may be contributing to the emergence of mucormycosis and other fungal co-infections.

What is mucormycosis, the fungal infection affecting COVID patients in India?

[Preprint] The Emergence of COVID-19 Associated Mucormycosis: Analysis of Cases From 18 Countries.

Mucormycosis: The ‘black fungus’ maiming Covid patients in India

Global Guideline for the Diagnosis and Management of Mucormycosis

 

RCT: 7 days of antibiotic therapy as good as 14 days for afebrile men with urinary tract infection.

28 Jul, 2021 | 10:03h | UTC

Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection: A Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Shorter Courses of Antibiotics for Urinary Tract Infection in Men (free for a limited period)

Commentary: Study Supports Shorter Antibiotic Course for Afebrile Men With UTI – MPR

 

Commentary on Twitter

 

CDC Report: Transmission of pan-resistant Candida auris in health care facilities.

28 Jul, 2021 | 09:59h | UTC

Notes from the Field: Transmission of Pan-Resistant and Echinocandin-Resistant Candida auris in Health Care Facilities ― Texas and the District of Columbia, January–April 2021 – CDC Morbidity and Mortality Weekly Report

Commentaries:

CDC reports two outbreaks of pan-resistant Candida auris – CIDRAP

U.S. sees first cases of dangerous fungus resistant to all drugs in untreated people – STAT

Related:

Case reports: Multidrug-resistant Candida auris infections in critically ill Covid-19 patients

Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings

Global Epidemiology of Emerging Candida Auris (reviews and commentaries on the subject)

The superbug Candida auris is giving rise to warnings — and big questions – STAT

Candida Auris – “A Mysterious Infection, Spanning the Globe in a Climate of Secrecy” (reviews and commentaries on the subject)

 

Commentaries on Twitter

 

NICE Guideline | Clostridioides difficile infection: antimicrobial prescribing.

27 Jul, 2021 | 03:34h | UTC

Clostridioides difficile infection: antimicrobial prescribing – National Institute for Health and Care Excellence

Infographic: Clostridioides difficile infection: antimicrobial prescribing

Related:

IDSA 2021 focused update guidelines on the management of Clostridioides difficile infection in adults.

ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections.

Prevention of Clostridioides difficile in hospitals: A position paper of the International Society for Infectious Diseases

Review | My Treatment Approach to Clostridioides difficile Infection.

 

[Preprint] RCT: In patients with COVID-19 and severe hypoxia, dexamethasone 12 mg did NOT result in statistically significant improved outcomes compared to dexamethasone 6 mg – “Mortality at 28 days was 27.1% and 32.3% in patients assigned to 12 mg and 6 mg, respectively (adjusted relative risk 0.86, 99% CI, 0.68-1.08)”.

26 Jul, 2021 | 03:01h | UTC

Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxia: an international, randomized, blinded trial – medRxiv

 

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