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Internal Medicine

Opinion Video | Questioning the reliability of nutrition science

23 May, 2023 | 13:02h | UTC

Nutrition science is entirely unreliable | Don’t trust the New York Times Well section – By Dr Vinay Prasad

 

RCT | Tonsillectomy shown to be clinically and cost-effective in adults with recurrent acute tonsillitis

23 May, 2023 | 13:06h | UTC

Summary: The NATTINA trial, a pragmatic multicentre, open-label, randomized controlled study, sought to compare the clinical and cost-effectiveness of conservative management versus tonsillectomy in adults with recurrent acute tonsillitis. Conducted across 27 UK hospitals, 453 participants aged 16 or older were randomly assigned to either undergo immediate tonsillectomy or receive standard non-surgical care.

The main finding was that participants in the immediate tonsillectomy group had fewer days of sore throat over a 24-month period than those in the conservative management group (median 23 vs. 30 days). After adjusting for site and baseline severity, the incident rate ratio of total sore throat days in the immediate tonsillectomy group was significantly lower than in the conservative management group (0.53, 95% CI 0.43 to 0.65, p < 0.0001). The most common adverse event related to tonsillectomy was bleeding, which occurred in 19% of participants.

The NATTINA trial is the largest to date assessing the clinical and cost-effectiveness of tonsillectomy in adults. The results indicate that immediate tonsillectomy is clinically effective and cost-effective for recurrent acute tonsillitis. However, patients should weigh the benefits of fewer sore throat days against the risks of surgery.

Article: Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial – The Lancet

News Release: Tonsillectomy both clinically and cost effective for adults – Newcastle University

 

Commentary on Twitter

 

Ventilator associated tracheobronchitis and pneumonia: one infection with two faces

23 May, 2023 | 12:49h | UTC

Ventilator associated tracheobronchitis and pneumonia: one infection with two faces – Intensive Care Medicine

 

M-A | Risk and benefits of wakefulness-promoting drugs in obstructive sleep apnea patients

23 May, 2023 | 12:43h | UTC

Comparative Efficacy and Safety of Wakefulness-Promoting Agents for Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea: Systematic Review and Network Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Researchers find best treatment for excessive daytime sleepiness – McMaster University

Commentary: Multiple agents effective for excessive daytime sleepiness but may be discontinued due to side effects, review finds – ACP Internist

 

USPSTF Draft Statement recommends biennial screening mammography for women ages 40 to 74 years

22 May, 2023 | 13:56h | UTC

Breast Cancer: Screening – U.S. Preventive Services Task Force

Critical perspectives on the statement:

Earlier screening for breast cancer: Benefits and harms – Lown Institute

Video: Mammography – Does it save lives? | The USPSTF is incorrect | I review ALL the data – By Dr. Vinay Prasad

Why more mammograms aren’t the solution to breast cancer – Vox

 

AGA/ACG Guideline | Pharmacological management of chronic idiopathic constipation

22 May, 2023 | 13:53h | UTC

American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation – American Journal of Gastroenterology

 

Global variations in heart failure etiology, management, and outcomes

22 May, 2023 | 13:50h | UTC

Global Variations in Heart Failure Etiology, Management, and Outcomes – JAMA (free for a limited period)

Author Interview: Global Trends in Heart Failure Etiology, Management, and Outcomes

News Release: Heart failure deadly and under-treated in most countries, says a study in 40 countries – McMaster University

 

Commentary on Twitter

 

RCT | Remote pulmonary artery monitoring may improve QoL, reduce hospitalizations in symptomatic (NYHA III) heart failure

22 May, 2023 | 13:47h | UTC

Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial – The Lancet (link to abstract – $ for full-text)

News Release: Remote monitoring reduces heart failure hospitalisations and improves quality of life – European Society of Cardiology

Commentary: CardioMEMS Beats Standard Care in First European RCT: MONITOR-HF – TCTMD

 

Commentary on Twitter

 

RCT | Apixaban fails to match warfarin in preventing valve thrombosis in On-X mechanical heart valve patients

22 May, 2023 | 13:44h | UTC

Apixaban or Warfarin in Patients with an On-X Mechanical Aortic Valve – NEJM Evidence

Commentary: Apixaban or Warfarin in Patients With On-X Mechanical Aortic Valve – American College of Cardiology

 

Commentary on Twitter

 

Underdiagnosis of primary aldosteronism: a review of screening and detection

22 May, 2023 | 13:40h | UTC

Underdiagnosis of Primary Aldosteronism: A Review of Screening and Detection – American Journal of Kidney Diseases

 

Commentary on Twitter

 

Drug-induced abnormal involuntary movements: prevalence and treatment

22 May, 2023 | 13:30h | UTC

Drug-Induced Abnormal Involuntary Movements: Prevalence and Treatment – Primary care companion to CNS disorders

 

New pharmacological agents and novel cardiovascular pharmacotherapy strategies

22 May, 2023 | 13:24h | UTC

New pharmacological agents and novel cardiovascular pharmacotherapy strategies in 2022 – European Heart Journal – Cardiovascular Pharmacotherapy

 

Commentary on Twitter

 

Review | Sarcopenia and cardiovascular diseases

22 May, 2023 | 13:22h | UTC

Sarcopenia and Cardiovascular Diseases – Circulation

 

M-A | Limited evidence for safety and effectiveness of most antidepressants in chronic pain management

18 May, 2023 | 13:50h | UTC

Antidepressants for pain management in adults with chronic pain: a network meta‐analysis – Cochrane Library

News Release: Most antidepressants prescribed for chronic pain lack reliable evidence of efficacy or safety, scientists warn – Cochrane Library

Summary: How effective are antidepressants used to treat chronic pain and do they cause unwanted effects? – Cochrane Library

Commentary: Expert reaction to Cochrane review on antidepressants for pain management in adults with chronic pain – Science Media Centre

 

RCT | Once-weekly insulin icodec shows non-inferiority to daily insulin glargine in type 2 diabetes patients

18 May, 2023 | 13:48h | UTC

Switching to once-weekly insulin icodec versus once-daily insulin glargine U100 in individuals with basal-bolus insulin-treated type 2 diabetes (ONWARDS 4): a phase 3a, randomised, open-label, multicentre, treat-to-target, non-inferiority trial – The Lancet (link to abstract – $ for full-text)

 

M-A | Timing of symptomatic venous thromboembolism after surgery

18 May, 2023 | 13:45h | UTC

Timing of symptomatic venous thromboembolism after surgery: meta-analysis – British Journal of Surgery

 

Podcast | Dysphagia pearls

18 May, 2023 | 13:42h | UTC

#395 Dysphagia with Dr. Diana Snyder – The Curbsiders

 

WHO advises not to use non-sugar sweeteners for weight control in newly released guideline

16 May, 2023 | 15:04h | UTC

News Release: WHO advises not to use non-sugar sweeteners for weight control in newly released guideline – World Health Organization

WHO Guideline: Use of non-sugar sweeteners – World Health Organization

Meta-Analysis: Health effects of the use of non-sugar sweeteners – World Health Organization

 

M-A | Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome?

16 May, 2023 | 14:44h | UTC

Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome? A meta-analysis of randomized controlled trials – Thrombosis Research

 

RCT | Colchicine ineffective for pain relief in hand osteoarthritis patients

16 May, 2023 | 14:42h | UTC

Colchicine twice a day for hand osteoarthritis (COLOR): a double-blind, randomised, placebo-controlled trial – The Lancet Rheumatology (link to abstract – $ for full-text)

Commentary: Colchicine Does Not Relieve OA-Related Hand Pain Compared With Placebo – DocWireNews

 

Commentary on Twitter

 

Practice Guidance | Differential diagnosis of suspected COPD exacerbations in the acute care setting

15 May, 2023 | 13:26h | UTC

Differential Diagnosis of Suspected Chronic Obstructive Pulmonary Disease Exacerbations in the Acute Care Setting: Best Practice – American Journal of Respiratory and Critical Care Medicine

 

Commentary on Twitter

 

Canadian Task Force advises fragility fracture screening for women over 65, but not for men or younger women

15 May, 2023 | 13:23h | UTC

Recommendations on screening for primary prevention of fragility fractures – Canadian Medical Association Journal

Related USPSTF Statement: Screening Osteoporosis to Prevent Fractures

 

Guideline | Acute dizziness and vertigo in the emergency department

15 May, 2023 | 13:25h | UTC

Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department – Academic Emergency Medicine

News Release: New guideline for treatment of acute dizziness and vertigo in the emergency department – Society for Academic Emergency Medicine

 

RCT | Rivaroxaban doesn’t reduce thrombotic events, hospitalization, or death in outpatients with COVID-19

15 May, 2023 | 13:19h | UTC

Summary: The PREVENT-HD trial, a double-blind, placebo-controlled randomized study, was conducted to evaluate the effectiveness of prophylactic anticoagulation in reducing venous and arterial thrombosis, hospitalization, and death in nonhospitalized patients with symptomatic COVID-19 and at least one thrombosis risk factor. The trial took place between August 2020 and April 2022 across 14 US integrated healthcare delivery networks, with 1,284 patients enrolled and randomly assigned to receive either 10 mg of oral rivaroxaban or placebo daily for 35 days.

However, the study was terminated prematurely due to enrollment challenges and lower-than-expected event rates. The primary efficacy outcome, a composite of various hazardous events, occurred in 3.4% of the rivaroxaban group and 3.0% of the placebo group, with no significant difference between the two groups (hazard ratio, 1.16 [95% CI, 0.63–2.15]; P=0.63). No critical-site or fatal bleeding was observed, and only one patient in the rivaroxaban group experienced a major bleed.

In conclusion, rivaroxaban prescribed for 35 days in nonhospitalized patients with symptomatic COVID-19 at risk for thrombosis does not appear to reduce the composite end point of venous and arterial thrombotic events, hospitalization, and death. The study’s premature termination and lower-than-expected event rates may limit the generalizability of these findings.

Article: Rivaroxaban for Prevention of Thrombotic Events, Hospitalization, and Death in Outpatients With COVID-19: A Randomized Clinical Trial – Circulation

 

Commentary on Twitter

 

RCT | Prophylactic antibiotics show no statistically significant survival improvement in severe alcohol-related hepatitis

15 May, 2023 | 13:21h | UTC

Summary: This multicenter, randomized, double-blind clinical trial aimed to determine the efficacy of amoxicillin-clavulanate combined with prednisolone compared to placebo combined with prednisolone on mortality in patients hospitalized with severe alcohol-related hepatitis. The study involved 284 patients from 25 centers in France and Belgium with biopsy-proven severe alcohol-related hepatitis, who were followed up for 180 days.

The primary outcome was all-cause mortality at 60 days, while secondary outcomes included mortality at 90 and 180 days, infection rates, hepatorenal syndrome, and changes in Model for End-stage Liver Disease (MELD) and Lille scores. The results showed no statistically significant difference in 60-day mortality between the two groups, with 17.3% in the amoxicillin-clavulanate group and 21.3% in the placebo group. However, infection rates at 60 days were significantly lower in the amoxicillin-clavulanate group compared to the placebo group.

It is worth noting that the study may have been underpowered, as the absolute risk difference of 4% did not achieve statistical significance. In conclusion, the combination of amoxicillin-clavulanate and prednisolone did not show a statistically significant improvement in 2-month survival in patients hospitalized with severe alcohol-related hepatitis compared to prednisolone alone. These findings do not support the use of prophylactic antibiotics to improve survival in this patient population, but the potential underpowered nature of the study should be considered.

Article: Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

 

Commentary on Twitter

 

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