Family Medicine
Cohort Study | Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years’ postpartum
24 Feb, 2023 | 13:43h | UTCSummary: Several studies show that women who develop diabetes during pregnancy are at increased risk of developing diabetes later in life. This study investigated whether giving birth to a larger-than-normal baby is associated with an increased risk of prediabetes or diabetes 10-14 years after pregnancy in individuals without gestational diabetes. The study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study, including pregnant individuals without gestational diabetes. After adjusting for various baseline maternal characteristics, the researchers found that individuals who gave birth to a large-for-gestational age (LGA) infant had a 21% higher risk of being diagnosed with prediabetes or diabetes 10-14 years after delivery compared to those who had an appropriate-for-gestational age (AGA) infant. The study concluded that having a previous LGA infant is a marker of increased risk of developing prediabetes or diabetes in individuals without gestational diabetes.
Abstract: Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years’ postpartum in the HAPO follow-up study – American Journal of Obstetrics & Gynecology (link to abstract, presented at the Society for Maternal-Fetal Medicine’s annual meeting)
Commentaries:
Delivering a Plus-Sized Baby Could Be Sign of Diabetes Risk – HealthDay
Large for Gestational Age Births Could Increase Diabetes Risk in Women – HCP Live
Cohort Study | Heavy coffee intake is associated with kidney disfunction in genetically predisposed individuals
24 Feb, 2023 | 13:42h | UTCSummary: The study investigated whether a person’s genetic variation in the enzyme that metabolizes caffeine, called CYP1A2, modifies the association between coffee intake and kidney dysfunction. The study was conducted on 1180 participants with stage 1 hypertension. Data were collected from April 1, 1990, to June 30, 2006, with a follow-up of approximately 10 years. The study found that consuming more than three cups of coffee per day was associated with increased risks of albuminuria, hyperfiltration, and hypertension only among slow metabolizers of caffeine. The findings suggest that caffeine may play a role in the development of kidney disease in genetically susceptible individuals, but further studies are required to confirm these findings.
Article: CYP1A2 Genetic Variation, Coffee Intake, and Kidney Dysfunction – JAMA Network Open
Commentaries:
Drinking 3 or more cups of coffee daily may increase kidney dysfunction risk – Medical News Today
Review | Young-onset dementia diagnosis, management and care
24 Feb, 2023 | 13:37h | UTC
Review | Contact lens–associated keratitis — An often underestimated risk
24 Feb, 2023 | 13:33h | UTCContact Lens–Associated Keratitis— an Often Underestimated Risk – Deutsches Ärzteblatt international
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
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
M-A | Disordered eating affects 1 in 5 children and adolescents
23 Feb, 2023 | 13:33h | UTCSummary: The text reports the findings of a systematic review and meta-analysis that included 32 studies on the global proportion of disordered eating in children and adolescents aged 6 to 18 years, assessed with the SCOFF questionnaire, a widely used screening measure for eating disorders. The review found that approximately 22% of children and adolescents showed disordered eating, which was higher among girls, older adolescents, and those with higher body mass index. The high figures are concerning from a public health perspective and highlight the need for prevention strategies to address disordered eating. The study has limitations, including the cross-sectional nature of most of the included studies and the use of self-report questionnaires to assess disordered eating, which may be subject to bias.
Article: Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis – JAMA Pediatrics (free for a limited period)
Commentary: What is disordered eating? And why do 20% of the world’s kids show signs of it? Experts explain – CNN
Cohort Study | Pre-pregnancy migraine linked to a higher risk of adverse pregnancy outcomes
23 Feb, 2023 | 13:31h | UTCSummary: This study investigated the relationship between migraine and adverse pregnancy outcomes. Researchers examined data from the Nurses’ Health Study II, which included 30,555 pregnancies from 19,694 women. Pre-pregnancy migraine was associated with a higher risk of preterm delivery, gestational hypertension, and preeclampsia. Migraine with aura was associated with a higher preeclampsia risk than migraine without aura. However, migraine was not associated with low birth weight or gestational diabetes mellitus. The study suggests that migraine history, and to a lesser extent, migraine phenotype, could be useful in identifying women at risk of pregnancy complications. Regular aspirin use prior to pregnancy was associated with a lower risk of preterm delivery for women with migraine, but randomized trials are needed to evaluate this hypothesis.
Article: Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes – Neurology (link to abstract – $ for full-text)
News Release: Migraine associated with increased risk for pregnancy complications – Brigham and Women’s Hospital
Commentary: Prepregnancy Migraine Tied to Adverse Pregnancy Outcomes – HealthDay
M-A | Metabolic side effects in persons with schizophrenia during mid- to long-term treatment with antipsychotics
23 Feb, 2023 | 13:26h | UTCSummary: This study aimed to evaluate the mid- to long-term metabolic side effects of 31 antipsychotics in persons with schizophrenia by analyzing 137 eligible randomized controlled trials with 35,007 participants. The primary outcome was weight gain, with secondary outcomes including fasting glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. The study found that antipsychotic drugs differ in their propensity to induce metabolic side effects. Chlorpromazine, clozapine, olanzapine, and zotepine produced the most weight gain. The confidence in the evidence ranged from low to moderate. The study suggests that differences in weight gain were more pronounced than previously published short-term data and that weight gain is most pronounced at the beginning of treatment and then remains stable.
Article: Metabolic side effects in persons with schizophrenia during mid- to long-term treatment with antipsychotics: a network meta-analysis of randomized controlled trials – World Psychiatry (free for a limited period)
SR | Glucocorticoids for croup in children
23 Feb, 2023 | 13:17h | UTCGlucocorticoids for croup in children – Cochrane Library
Antibiotic allergy de-labeling: a pathway against antibiotic resistance
23 Feb, 2023 | 13:12h | UTCAntibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance – Antibiotics
Related:
M-A: Most patients with allergy to Penicillin can be given Cefazolin
Podcast: A Clinical Pharmacologist’s Perspective on Penicillin Allergy
Study: Development and Validation of a Penicillin Allergy Clinical Decision Rule
NICE: Double Check Patients with ‘Penicillin Allergy’ to Avoid Increased MRSA Risk
Review | Constipation in children and adolescents
23 Feb, 2023 | 13:06h | UTCConstipation in Children and Adolescents – Deutsches Ärzteblatt international
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
M-A | Interventions for myopia control in children
22 Feb, 2023 | 12:36h | UTCRelated:
RCT | Effect of low-concentration atropine eyedrops vs. placebo on myopia incidence in children
Crossover RCT | Spectacle lenses with highly aspherical lenslets for slowing myopia.
RCT | Effect of text messaging parents of school-aged children on outdoor time to control myopia.
RCT | Myopia control effect of repeated low-level red-light therapy in children.
Health and nutrition claims for infant formula: international cross sectional survey
22 Feb, 2023 | 12:31h | UTCHealth and nutrition claims for infant formula: international cross sectional survey – The BMJ
Editorial: Poorly substantiated health claims on infant formula – The BMJ
News Release: Most health claims on infant formula products seem to have little evidence – BMJ Newsroom
Commentary: Little evidence to support health claims made on formula milk – BBC
Commentary from one of the authors on Twitter (thread – click for more)
https://twitter.com/mbrockwa/status/1626034305393893376
M-A | Sugar-sweetened beverage consumption and weight gain in children and adults
22 Feb, 2023 | 12:26h | UTC
M-A | Monoclonal antibody for the prevention of respiratory syncytial virus in infants and children
22 Feb, 2023 | 12:24h | UTCCommentary: Study Finds 3 Monoclonal Antibodies Reduce RSV Infections in High-Risk Infants, Children – HCP Live
Commentary on Twitter
Network meta-analysis of 4 monoclonal antibodies for the prevention of RSV in children finds 3 may be useful in preventing RSV; more research to confirm efficacy, safety, and cost effectiveness is needed. https://t.co/wz9yCVAFWo
— JAMA Network Open (@JAMANetworkOpen) February 17, 2023
SR | Probiotics for management of functional abdominal pain disorders in children
22 Feb, 2023 | 12:20h | UTCProbiotics for management of functional abdominal pain disorders in children – Cochrane Library
Podcast | Abnormal uterine bleeding pearls
22 Feb, 2023 | 12:19h | UTC#382 Abnormal Uterine Bleeding – The Curbsiders
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