Editor's Choice
Review | Glioblastoma and other primary brain malignancies in adults
24 Feb, 2023 | 13:54h | UTCArticle: Glioblastoma and Other Primary Brain Malignancies in Adults: A Review – JAMA (free for a limited period)
Audio clinical review: Glioblastoma and Other Primary Brain Malignancies in Adults – JAMA
Commentary on Twitter
Review summarizes current evidence regarding diagnosis and treatment of primary malignant brain tumors in adults. https://t.co/pNKio61bN5
— JAMA (@JAMA_current) February 21, 2023
RCT | Aspirin discontinuation at 24 to 28 weeks’ gestation in pregnancies at high risk of preterm preeclampsia
24 Feb, 2023 | 13:56h | UTCArticle: Aspirin Discontinuation at 24 to 28 Weeks’ Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Biomarkers and the Risk of Preeclampsia – JAMA (free for a limited period)
Commentary on Twitter
Aspirin discontinuation at 24 to 28 weeks of gestation was noninferior to aspirin continuation for preventing preterm preeclampsia in pregnant individuals at high risk of preeclampsia and a normal sFlt-1:PlGF ratio. https://t.co/6yIBsfxwU5 pic.twitter.com/RGqQLvb20l
— JAMA (@JAMA_current) February 21, 2023
Mpox outbreak in advanced HIV cases | Global case series reveals higher mortality and clinical complications
23 Feb, 2023 | 13:44h | UTCSummary: This article discusses a case series investigating monkeypox (mpox) in people with HIV and low CD4 cell counts. The mpox outbreak in 2022 has affected a significant percentage of people living with HIV, and data suggest worse clinical outcomes and higher mortality in those with more advanced HIV. The case series includes data from 382 confirmed mpox cases in people living with HIV from 19 countries. The individuals included were predominantly cisgender men, with a median age of 35. Most individuals were adherent to antiretroviral therapy, and the median CD4 count was 211 cells per mm3. Severe complications were more common in those with lower CD4 cell counts, including necrotizing skin lesions, lung involvement, secondary infections, and sepsis. Approximately 28% of individuals were hospitalized, and 25% of those hospitalized died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. The study reinforces the importance of HIV and CD4 testing in mpox cases, prioritization of preventive mpox vaccination in people with HIV and a CD4 cell count of less than 200 cells per mm3, and the use of potential mpox antivirals where available. The authors suggest that a severe, disseminated, and necrotizing form of mpox should be considered an AIDS-defining condition in CDC and WHO HIV disease classifications. Clinicians should also be aware that starting antiretroviral therapy in people with advanced HIV and mpox could contribute to deterioration and possible death, possibly as part of an immune reconstitution syndrome.
Article: Mpox in people with advanced HIV infection: a global case series – The Lancet (free registration required)
News Release: Clinicians identify severe form of mpox with high mortality in people with advanced HIV – Queen Mary University of London
Commentaries:
Mpox: Clinicians identify severe form with high mortality in advanced HIV patients – The BMJ
Commentary from the author on Twitter (thread – click for more)
📣 📣 Our global case series on MPOX in people with advanced HIV infection is at #CROI2023 and in @TheLancet today: 382 cases of human MPOX infection in PLWH with CD4 counts <350 cells/mm3 in 19 countries
**We found MPOX is an opportunistic pathogen** /1https://t.co/WodDN4Ujoj pic.twitter.com/IlK7viABmy— @profchloeorkin.bsky.social (@profchloeorkin) February 21, 2023
WHO Report | Global trends in the 2022-23 Mpox (Monkeypox) outbreak
23 Feb, 2023 | 13:43h | UTCSummary: The report provides an overview of the 2022-23 monkeypox (mpox) outbreak worldwide as reported to WHO as of February 18, 2023. The report focuses on laboratory-confirmed cases and mentions that 86,019 cases and 1,389 probable cases, including 96 deaths, have been reported to WHO from 110 Member States across all 6 WHO regions, including some countries without previously documented mpox transmission. The outbreak primarily affects men who have sex with men, and no signal suggests sustained transmission beyond these networks. The WHO Director-General has determined that this outbreak continues to constitute a public health emergency of international concern and issued revised temporary recommendations in relation to the outbreak.
Report: 2022-23 Mpox (Monkeypox) Outbreak: Global Trends – World Health Organization
Commentary on Twitter
With over 86,000 total cases & 96 related deaths, #mpox outbreak has slowed down but is still ongoing in several countries.
Maintained surveillance & enhanced access to diagnostics, vaccines and treatments are key to stop the disease transmission globally https://t.co/mLHsVoWKBY pic.twitter.com/PcLFQjjrz7
— World Health Organization (WHO) (@WHO) February 21, 2023
M-A | Low-dose insulin infusion is safe and effective in treating diabetic ketoacidosis in children
23 Feb, 2023 | 13:40h | UTCSummary: The article discusses a systematic review and meta-analysis of randomized controlled trials comparing low-dose insulin at 0.05 units/kg/hr to standard dose at 0.1 units/kg/hr for children with diabetic ketoacidosis (DKA). The study found that low-dose insulin infusion is probably as efficacious and safer than standard-dose insulin in treating DKA in children, as it has no effect on the time to resolution of hyperglycemia or acidosis and probably reduces the risk of developing hypokalemia and hypoglycemia. However, the results are limited by imprecision and generalizability to other settings since all studies were performed in a single country. Therefore, further studies are required to identify the optimal insulin dose for children with DKA in terms of safety and effectiveness.
M-A | Oral manifestation of the monkeypox virus
23 Feb, 2023 | 13:42h | UTCOral manifestation of the monkeypox virus: a systematic review and meta-analysis – eClinicalMedicine
Study suggests there is little added value from follow-up pelvic CT after treatment of hepatocellular carcinoma
23 Feb, 2023 | 13:39h | UTCSummary: The study investigated the added value of pelvic coverage at follow-up liver CT in detecting pelvic metastasis or incidental tumors in patients treated for hepatocellular carcinoma (HCC). The study found that the incidence of isolated pelvic metastasis or incidental pelvic tumor was low in patients treated for HCC. The cumulative rates of isolated pelvic metastasis and incidental pelvic tumor were 1.4% and 0.5%, respectively, at 3 years. Only baseline T stage was associated with an increased risk of isolated pelvic metastasis. The study concludes that excluding the pelvic scan can reduce radiation dose and decrease the workload for radiologists. However, the study also had limitations, such as being retrospective and single-center. Therefore, more research is necessary to study the optimal scanning strategy for the pelvis and the effect of pelvic CT coverage on survival in patients with HCC.
Article: Added Value of Pelvic CT after Treatment of HCC – Radiology
M-A | COVID-19 convalescent plasma outpatient therapy may prevent hospitalizations
23 Feb, 2023 | 13:37h | UTC
RCT | An initial 8-week bedaquiline-linezolid regimen shows promise for the treatment of rifampin-susceptible tuberculosis
22 Feb, 2023 | 12:50h | UTCSummary: This randomized trial compared a standard 6-month rifampin-based tuberculosis treatment to a strategy that involved shorter initial treatment with extended therapy for persistent disease, monitoring, and retreatment for relapse. The results showed that the strategy involving an 8-week bedaquiline-linezolid regimen was noninferior to standard treatment for clinical outcomes. The experimental strategy was associated with a shorter total duration of treatment with no evident safety concerns.
Article: Treatment Strategy for Rifampin-Susceptible Tuberculosis – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Shorter drug regimen shows promise in TB trial – CIDRAP
M-A | Past SARS-CoV-2 infection provides long-lasting protection against severe disease caused by all variants
22 Feb, 2023 | 12:48h | UTCSummary: The article describes a systematic review and meta-analysis of studies assessing protection from past SARS-CoV-2 infection against subsequent re-infection, symptomatic COVID-19 disease, and severe disease. The researchers identified 65 studies from 19 different countries and found that protection from past infection against re-infection from pre-omicron variants was high and remained so even after 40 weeks. However, protection was substantially lower for the omicron BA.1 variant and declined more rapidly over time than protection against previous variants. Protection from severe disease was high for all variants, estimated at 90·2% for ancestral, alpha, and delta variants, and 88·9% for omicron BA.1 at 40 weeks. The study highlights the importance of considering past infection in assessing future disease burden from COVID-19, providing guidance on when individuals should be vaccinated, and designing policies that mandate vaccination for workers or restrict access. The findings also suggest that individuals with a documented infection should be treated similarly to those who have been fully vaccinated with high-quality vaccines.
Commentaries:
Previous COVID-19 may slash severe illness at reinfection by 89% – CIDRAP
M-A | Global and regional prevalence of multimorbidity in the adult population in community settings
22 Feb, 2023 | 12:47h | UTCSummary: The article presents a systematic review and meta-analysis of surveys that estimate the prevalence of multimorbidity among adults in community settings. The study analyzed data from 126 peer-reviewed studies, including nearly 15.4 million people from 54 countries worldwide. The overall global prevalence of multimorbidity was 37.2%, with South America having the highest prevalence, followed by North America, Europe, and Asia. The study also found that females have a higher prevalence of multimorbidity than males, and that more than half of the adult population worldwide above 60 years of age had multimorbid conditions.
Related:
Costs of multimorbidity: a systematic review and meta-analyses – BMC Medicine
Systematic review of high-cost patients’ characteristics and healthcare utilization – BMJ Open
Multimorbidity: a priority for global health research – The Academy of Medical Sciences
The global burden of multiple chronic conditions: a narrative review – Preventive Medicine Reports
Redesigning Care for High-Cost, High-Risk Patients – Harvard Business Review
Multimorbidity: clinical assessment and management – NICE Guideline
Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs
Better Care for People with Complex Needs – Institute for Healthcare Improvement
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
22 Feb, 2023 | 12:43h | UTCSummary: The presence of pyuria is commonly used as the cornerstone of urinary tract infection (UTI) diagnosis. However, over 90% of asymptomatic bacteriuria (ASB) patients also have pyuria, which can lead to unnecessary treatment. This is especially problematic in older women who may have pre-existing lower urinary tract symptoms, cognitive impairment, and a high prevalence of ASB. This study examined the diagnostic accuracy of different pyuria thresholds for UTI in older women. The study found that current pyuria cut-offs (10 leukocytes/µl) are too low and promote inappropriate UTI diagnosis in older women. A threshold of 300 leukocytes/µl is suggested as a considerable improvement, increasing specificity to avoid overtreatment, while still maintaining a fair sensitivity. This has implications for patient care, antimicrobial stewardship efforts, and research. The impact of higher cut-off values on prescription behavior and UTI related outcomes in older women deserves further study.
Related:
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Commentary on Twitter
Presence of pyuria remains the cornerstone of UTI diagnosis However, >90% of ASB patients have pyuria,prompt unnecessary Rx
🆕️⚡️⚡️study: current pyuria cut-off is too low promote inappropriate UTI diagnosis in older women suggesting a new higher cut offhttps://t.co/qAGdwSTiU6 pic.twitter.com/Vr63RnuMv1— Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 (@ABsteward) February 20, 2023
Article under a https://creativecommons.org/licenses/by-nc-nd/4.0/ license
RCT | Another study shows Ivermectin does not benefit patients with Covid-19
22 Feb, 2023 | 12:45h | UTCSummary: The study aimed to evaluate whether Ivermectin, at a maximum dose of 600 μg/kg daily for 6 days, shortened symptom duration or prevented hospitalization among outpatients with mild to moderate COVID-19. A total of 1206 US adults were enrolled in the double-blind, randomized, placebo-controlled platform trial, with follow-up data through November 10, 2022. The study found that the median time to sustained recovery was 11 days in both the ivermectin and placebo groups. Among those receiving Ivermectin, 5.7% were hospitalized, died, or had urgent or emergency care visits compared with 6.0% receiving placebo. These findings, along with all the previous studies to date, do not support using Ivermectin in patients with mild to moderate COVID-19.
Editorials:
At a Higher Dose and Longer Duration, Ivermectin Still Not Effective Against COVID-19 – JAMA
The Ethics of Clinical Research: Managing Persistent Uncertainty – JAMA
Related:
RCT | Ivermectin does not improve time to recovery in outpatients with mild to moderate COVID-19.
RCT | Metformin, Ivermectin, and Fluvoxamine are not beneficial for obese outpatients with Covid-19.
Ivermectin for COVID-19 Cochrane review update: 11 trials and no evidence of benefit shown.
RCT: Early treatment with ivermectin does not improve outcomes in patients with Covid-19.
Case Series: Toxic effects from ivermectin use associated with prevention and treatment of Covid-19.
Long-term consequences of the misuse of ivermectin data.
Ivermectin: How false science created a Covid ‘miracle’ drug.
Fraudulent ivermectin studies open up new battleground between science and misinformation.
The lesson of ivermectin: meta-analyses based on summary data alone are inherently unreliable.
Ivermectin: Cochrane’s most talked about review so far, ever. Why?
Flawed ivermectin preprint highlights challenges of COVID drug studies.
Systematic review: no evidence to support the use of Ivermectin for treating or preventing COVID-19.
Why was a major study on ivermectin for covid-19 just retracted?
RCT: Ivermectin does not prevent hospitalizations in patients with COVID-19.
RCT: Ivermectin does not improve time to resolution of symptoms among adults with mild COVID-19
Bacteriuria in older adults triggers confusion in healthcare providers: a mindful pause to treat the worry
22 Feb, 2023 | 12:42h | UTCRelated:
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Commentary on Twitter
FANTASTIC⚡️⚡️
The evidence base for refraining from screening for or treating ASB in elderly is strong,but both practices remain prevalent
Bacteriuria in older adults triggers confusion in healthcare providers:A mindful pause to treat the worry #IDTwitter https://t.co/7ispdtFeFB pic.twitter.com/kOB5eGKkAc— Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 (@ABsteward) January 10, 2023
Under a http://creativecommons.org/licenses/by/4.0/ license
Review | Comorbidities, multimorbidity and COVID-19
22 Feb, 2023 | 12:39h | UTCComorbidities, multimorbidity and COVID-19 – Nature Medicine
RCT | Temporary cessation vs. continuation of first-line tyrosine kinase inhibitor in advanced clear cell renal cell carcinoma
22 Feb, 2023 | 12:40h | UTCSummary: The STAR trial investigated whether a tyrosine kinase inhibitor drug-free interval strategy was non-inferior to a conventional continuation strategy for first-line treatment of advanced clear cell renal cell carcinoma. All patients received standard dosing schedules of oral sunitinib (50 mg per day) or oral pazopanib (800 mg per day) for 24 weeks before moving into their randomly allocated group. Although non-inferiority could not be concluded for the primary endpoint of overall survival, temporary treatment cessation was found to preserve quality of life and was cost-effective. Therefore, planned breaks in tyrosine kinase inhibitor treatment represent a reasonable option for selected patients with renal cell carcinoma, providing potential lifestyle and health economic benefits. The study provides a rationale for further exploration of treatment breaks in patients with other cancers.
Commentary on Twitter
NOW OF: The STAR open-label ph 2/3 RCT could not conclude that a TKI drug-free interval strategy was non-inferior to a conventional continuation strategy for first-line treatment of advanced clear cell renal cell carcinoma. #rccsmhttps://t.co/xzCU1jdLE7 pic.twitter.com/Ks1Eh0vMId
— The Lancet Oncology (@TheLancetOncol) February 14, 2023
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
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:
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
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
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
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