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RCT supports the use of therapeutic heparin in moderately ill patients admitted to the hospital with Covid-19.

17 Oct, 2021 | 21:35h | UTC

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial – The BMJ

Commentary: High-dose of readily available blood thinner reduces risk of death for moderately ill COVID-19 patients – St. Michael’s Hospital

Related studies (some conflicting results)

RCT: Therapeutic-dose heparin superior to standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19.

Another meta-analysis suggests standard-dose prophylactic anticoagulation is the best option for patients hospitalized with Covid-19.

M-A: Safety and efficacy of different prophylactic anticoagulation dosing regimens in critically and non-critically ill patients with COVID-19 – According to this analysis, standard-dose prophylactic anticoagulation should be the standard of care for hospitalized patients with COVID-19 who do not have an indication for therapeutic anticoagulation, irrespective of disease severity.

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.

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

RCT: In patients hospitalized with Covid-19 with elevated D-Dimer, a full-dose anticoagulation strategy based on rivaroxaban (full-dose heparins in unstable patients) + rivaroxaban to day 30 was not better than prophylactic anticoagulation and increased bleeding risk.


Commentary on Twitter


J&J COVID-19 Vaccine: FDA recommends booster shot for all adults aged 18 and older at least two months following initial vaccination with the single-shot vaccine.

17 Oct, 2021 | 21:32h | UTC

News release: Johnson & Johnson COVID-19 Vaccine Booster Shot Unanimously Recommended for Emergency Use Authorization by U.S. FDA Advisory Committee


FDA panel endorses booster shot for J&J COVID-19 vaccine – Associated Press

The Johnson & Johnson one-dose vaccine offers good protection now. A booster shot will maximize that, experts say – CNN

FDA advisers recommend J&J Covid-19 vaccine boosters, talk mix and match boosters – CNN

Related: [Press release – not published yet] J&J says booster shot at two months provided 75% protection against moderate to severe COVID-19 globally and 94% of such cases in the U.S.


[Preprint] Breakthrough SARS-CoV-2 infections in 620,000 U.S. Veterans, February 1, 2021 to August 13, 2021 – “Vaccine protection declined by mid-August 2021, decreasing from 91.9% in March to 53.9%”.

17 Oct, 2021 | 21:29h | UTC

Breakthrough SARS-CoV-2 infections in 620,000 U.S. Veterans, February 1, 2021 to August 13, 2021 – medRxiv


Observational study in Qatar showed the effectiveness of Pfizer vaccine against any SARS-CoV-2 infection dropped to 20% in months 5 through 7 after the second dose, but effectiveness against severe Covid-19 remained high.

Cohort study: Pfizer vaccine effectiveness against any infections declined from 88% during the first month after full vaccination to 47% after 5 months. Vaccine effectiveness against hospital admissions remained high; 87% within 1 month, and 88% at 5 months after full vaccination, with no significant waning.

Editorial | Covid-19 vaccination: evidence of waning immunity is overstated.

COVID vaccine immunity is waning — how much does that matter? – “As debates about booster shots heat up, what’s known about the duration of vaccine-based immunity is still evolving”.

COVID vaccine effects wane over time but still prevent death and severe illness.

Perspective | What we actually know about waning immunity.

Another study shows Pfizer mRNA vaccine immunity is reduced over time.

[Press release – not published yet] Study shows vaccine protection wanes over time, but vaccines still offer good protection against severe disease.

Studies: COVID vaccine protection waning against infection but not hospitalization.


Commentary on Twitter


What can masks do? Part 2: What makes for a good mask study — and why most fail.

17 Oct, 2021 | 21:25h | UTC

COMMENTARY: What can masks do? Part 2: What makes for a good mask study — and why most fail – CIDRAP

See also: COMMENTARY: What can masks do? Part 1: The science behind COVID-19 protection – CIDRAP


Management of Diabetes Mellitus in patients with CKD: Core Curriculum 2022.

17 Oct, 2021 | 21:23h | UTC

Management of Diabetes Mellitus in Patients With CKD: Core Curriculum 2022 – American Journal of Kidney Diseases


Viewpoint: Surgical overtreatment and shared decision-making—the limits of choice. – “Payment models further incentivize surgical intervention. Fee-for-service payment plans reward surgeons for operating, not for ensuring that surgery is right for a patient”.

17 Oct, 2021 | 21:17h | UTC

Surgical Overtreatment and Shared Decision-making—The Limits of Choice – JAMA Surgery (free for a limited period)


Commentary on Twitter


RCT: After third molar surgery, Ibuprofen doses above 400 mg did not significantly increase the analgesic effect, and Paracetamol 1000/codeine 60 mg was not more effective than ibuprofen 400 mg.

17 Oct, 2021 | 21:16h | UTC

Analgesic effect of oral ibuprofen 400, 600, and 800 mg; paracetamol 500 and 1000 mg; and paracetamol 1000 mg plus 60 mg codeine in acute postoperative pain: a single-dose, randomized, placebo-controlled, and double-blind study – European Journal of Clinical Pharmacology


M-A: Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis – although Etoricoxib 60 mg/day and diclofenac 150 mg/day seem to be most effective treatments, topical diclofenac 70-81 mg/day is safer and should be considered as first line treatment.

17 Oct, 2021 | 21:14h | UTC

Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis – The BMJ

News release: Topical pain-killers more effective, safer than opioids for knee osteoarthritis pain – St. Michael’s Hospital

Commentary: Network meta-analysis compares analgesic regimens for osteoarthritis – medwire News


Commentary on Twitter


Review: Management of infectious emergencies for the inpatient dermatologist.

17 Oct, 2021 | 21:06h | UTC

Management of Infectious Emergencies for the Inpatient Dermatologist – Current Dermatology Reports (if this link is paywalled, try this one)


Review: Timing of antibiotic therapy in the ICU.

17 Oct, 2021 | 21:05h | UTC

Timing of antibiotic therapy in the ICU – Critical Care


Study evaluated several heterologous SARS-CoV-2 vaccine regimens; no efficacy data but there was increased antibody production on study days 15 and 29 after booster shots from Moderna and Pfizer.

15 Oct, 2021 | 02:49h | UTC

Heterologous SARS-CoV-2 Booster Vaccinations: Preliminary Report – medRxiv

Commentary: Study: Mixing and Matching COVID-19 Booster Shots Is Effective, Safe – U.S. News


Commentary on Twitter


Statins linked to reduced risk of death from COVID-19 in major population study – “Randomized studies will be needed to ascertain whether there is a causal relationship, note the researchers”.

15 Oct, 2021 | 02:47h | UTC

News release: Statins linked to reduced risk of death from COVID-19 in major population study – Karolinska Institutet

Original study: HMG-CoA reductase inhibitors and COVID-19 mortality in Stockholm, Sweden: A registry-based cohort study – PLOS Medicine


Expert reaction to study looking at statins and risk of death from COVID-19 – Science Media Centre

People taking statins less likely to die from Covid, study suggests – The Guardian


WHO Report: Tuberculosis deaths rise for the first time in more than a decade due to the COVID-19 pandemic.

15 Oct, 2021 | 02:30h | UTC

Tuberculosis deaths rise for the first time in more than a decade due to the COVID-19 pandemic – World Health Organization

Report: Global tuberculosis report 2021

Commentary: Tuberculosis deaths rise for 1st time in years, due to COVID – Associated Press


Commentary on Twitter (thread – click for more)


FDA issues food industry guidance for reduction of sodium in processed and packaged foods.

15 Oct, 2021 | 02:29h | UTC

News Release: To Improve Nutrition and Reduce the Burden of Disease, FDA Issues Food Industry Guidance for Voluntarily Reducing Sodium in Processed and Packaged Foods – U.S. Food & Drug Administration

Guidance for Industry: Voluntary Sodium Reduction Goals – U.S. Food & Drug Administration


FDA Issues New Guidance on Sodium Targets for Food Industry – TCTMD

Reducing Sodium Intake in the US: Healthier Lives, Healthier Future – JAMA

FDA Reduces Recommended Salt Levels in Americans’ Food – HealthDay

FDA guidance to food industry aims to reduce sodium consumption – American Heart Association

New FDA guidance aims to drastically cut salt in food supply – NBC News


Former CDC director: Low sodium salt could save millions of lives.

15 Oct, 2021 | 02:27h | UTC

Former CDC director: Low sodium salt could save millions of lives – CNN


Is salt good for you after all? The evidence says no.

#ESCCongress – Cluster RCT: Among patients at increased risk for stroke, salt substitution (75% sodium chloride and 25% potassium chloride by mass) reduced the rates of stroke, major cardiovascular events, and death from any cause.

Systematic Review: Altered dietary salt intake for people with chronic kidney disease.

New WHO benchmarks help countries reduce salt intake and save lives.

RCT: Reduced-sodium added-potassium salt substitute reduces blood pressure in hypertensive patients

Potassium Enriched Salt Substitution Could Prevent a Large Number of Cardiovascular Deaths

Meta-Analysis: Effect of Reduction in Dietary Sodium on Blood Pressure Levels

Cluster Randomized Trial: Effect of Salt Substitution on Community-wide Blood Pressure and Hypertension Incidence


Meta-analysis of cohort studies: High intake of fatty acid in nuts, seeds and plant oils linked to lower risk of death.

15 Oct, 2021 | 02:22h | UTC

News release: High intake of fatty acid in nuts, seeds and plant oils linked to lower risk of death – The BMJ

Original study: Dietary intake and biomarkers of alpha linolenic acid and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of cohort studies – The BMJ


Current evidence on dietary intakes of fatty acids and mortality – The BMJ

Expert reaction to systematic review and meta-analysis on consumption of dietary fatty acids (alpha linolenic acid) and risk of death – Science Media Centre

Related: Total dietary fat intake, fat quality, and health outcomes: A scoping review of systematic reviews of prospective studies.


Commentary on Twitter


Systematic Review: There is not enough evidence from randomized trials to inform about the effects of additional antihypertensive drugs in patients with hypertension‐induced left ventricular hypertrophy.

15 Oct, 2021 | 02:20h | UTC

Pharmacotherapy for hypertension‐induced left ventricular hypertrophy – Cochrane Library

Summary: What are the main benefits and risks of drugs for reducing blood pressure in the treatment of people with thickening of the heart muscle caused by high blood pressure? – Cochrane Library


Commentary on Twitter


Autoimmune encephalitis–related seizures and epilepsy: diagnostic and therapeutic approaches.

15 Oct, 2021 | 02:08h | UTC

Autoimmune Encephalitis–Related Seizures and Epilepsy: Diagnostic and Therapeutic Approaches – Mayo Clinic Proceedings


Commentary on Twitter


[Preprint] In RCT with 29,949 participants, the Novavax vaccine demonstrated high overall efficacy (>90%) for the prevention of Covid-19, and all moderate-to-severe cases occurred in placebo recipients.

14 Oct, 2021 | 10:17h | UTC

Efficacy and Safety of NVX-CoV2373 in Adults in the United States and Mexico – medRxiv

Commentary: Novel vaccine demonstrates high efficacy for prevention of COVID-19 – News Medical


RCT: Novavax vaccine conferred 89.7% protection against symptomatic SARS-CoV-2 infection and 100% protection against hospitalizations or deaths.

Opinion | The mRNA vaccines are extraordinary, but Novavax is even better.

(Press release – not published yet) Novavax COVID-19 vaccine demonstrates 90% overall efficacy and 100% protection against moderate and severe disease.

RCT: Novavax vaccine is 49.4% effective against B.1.351 SARS-CoV-2 variant.

[Press release – not published yet] Novavax reports 96% efficacy against original strain of COVID-19, 86% efficacy against B.1.1.7 variant, and 55% efficacy against B1.351 variant

New COVID-19 vaccines: here’s how the promising Novavax and Johnson & Johnson jabs work

Covid-19: Novavax vaccine efficacy is 86% against UK variant and 60% against South African variant


Commentary on Twitter


Systematic Review: Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection.

14 Oct, 2021 | 10:15h | UTC

Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review – JAMA Network Open


Most COVID-19 survivors have symptoms 6 months on, review finds – CIDRAP

Expert reaction to systematic review on rates of postacute sequelae of SARS-CoV-2 infection (PASC) – Science Media Centre

How many people get ‘long COVID’? More than half, researchers find – Penn State


WHO Consensus: A clinical case definition of post COVID-19 condition (Long Covid).

Characterizing long COVID: a living systematic review.

Long Covid – The illness narratives.

New guidelines to help doctors manage long COVID patients published.

M-A: More than 50 long-term effects of COVID-19. (several articles on the subject)


Commentary on Twitter


Home Hemodialysis: Core Curriculum 2021.

14 Oct, 2021 | 09:55h | UTC

Home Hemodialysis: Core Curriculum 2021 – American Journal of Kidney Diseases


Commentary on Twitter


Podcast with Dr Walter Willett: CardioNutrition – Why are findings from prospective, epidemiologic cohort studies important in informing dietary recommendations?

14 Oct, 2021 | 09:49h | UTC

ACC CardiaCast: CardioNutrition – Why Are Findings From Prospective, Epidemiologic Cohort Studies Important In Informing Dietary Recommendations? – American College of Cardiology


Commentary on Twitter


Podcast: Acute Pain Management for the Hospitalist.

14 Oct, 2021 | 09:47h | UTC

#299 Acute Pain Management for the Hospitalist – The Curbsiders


Survey finds patients undergoing medical imaging procedures have overall limited knowledge about medical radiation.

14 Oct, 2021 | 09:46h | UTC

Patient Perceptions and Knowledge of Ionizing Radiation From Medical Imaging – JAMA Network Open

Invited commentary: It Is Time to Inform Patients of Medical Imaging Risks – JAMA Network Open


WHO advisers recommend 3rd COVID vaccine dose for highest-risk groups.

13 Oct, 2021 | 01:48h | UTC

WHO advisers recommend 3rd COVID vaccine dose for highest-risk groups – CIDRAP

See also: WHO advises additional COVID shot for immunocompromised people – Reuters


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