Internal Medicine
More people are getting COVID-19 twice, suggesting immunity wanes quickly in some
19 Nov, 2020 | 09:29h | UTCMore people are getting COVID-19 twice, suggesting immunity wanes quickly in some – Science
Hospital-acquired SARS-CoV-2 infection: Lessons for public health
19 Nov, 2020 | 09:27h | UTCHospital-Acquired SARS-CoV-2 Infection: Lessons for Public Health – JAMA
Opinion: “Proposed British guidelines reject useless chronic fatigue syndrome treatments”
19 Nov, 2020 | 09:22h | UTCProposed British guidelines reject useless chronic fatigue syndrome treatments – STAT
NICE Draft Guideline: Myalgic encephalomyelitis (or 6 encephalopathy)/chronic fatigue syndrome: diagnosis and management
#AHA20 [not published yet] Randomized trial: After drug-eluting stent implantation, one-month dual antiplatelet therapy (DAPT) followed by aspirin monotherapy was noninferior to 6-12 months of DAPT
19 Nov, 2020 | 09:21h | UTCCommentary: Latest Post-DES Drug Trial Tests Aspirin Monotherapy After 1 Month of DAPT – TCTMD
NICE Guideline: Acute coronary syndromes
19 Nov, 2020 | 09:24h | UTCAcute coronary syndromes – National Institute for Health and Care Excellence
Visual summary: STEMI
Visual summary: NSTEMI/unstable angina
Visual summary: Cardiac rehabilitation and secondary prevention
#AHA20 – Two studies show lower rate of atrial fibrillation recurrence with catheter cryoballoon ablation than with antiarrhythmic drug therapy
18 Nov, 2020 | 09:11h | UTCStudy 1: Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation – New England Journal of Medicine
Commentaries: EARLY AF and STOP AF Put Electrophysiology at a Crossroads – Medscape (free registration required) AND EARLY-AF: First-line Ablation Beats Meds for Recent Paroxysmal A-fib – TCTMD
Commentary on Twitter (thread – click for more)
NEJM published 2 RCTs of #AFib ablation vs AF drugs.
The rub was that the ablation was done EARLY in the course.
Practice had been to try drugs first then do ablation.
EARLY AF and STOP AF studied the procedure early. #AHA20 Thread and my column >>— John Mandrola, MD (@drjohnm) November 18, 2020
[Preprint] Study suggests immunity to the Coronavirus may last years
18 Nov, 2020 | 09:20h | UTCImmunological memory to SARS-CoV-2 assessed for greater than six months after infection – bioRxiv
Commentaries: Immunity to the Coronavirus May Last Years, New Data Hint – New York Times AND Could coronavirus immunity last YEARS? Study finds even survivors who had mild COVID-19 are protected for at least 8 months and their immune ‘memory’ may last MUCH longer – Daily Mail AND COVID-19: Study Suggests Durable Immune Response After SARS-CoV-2 Infection – NEJM Journal Watch
Commentary from the author on Twitter (thread – click for more)
1/ Our pre-print on immune memory to SARS-CoV-2 is out today. To our knowledge, this is the largest such study for any acute infection.
The upshot is that there is substantial immune memory after COVID-19.
Lots of stuff in this manuscript.https://t.co/lSAyZp0XiK@SetteLab
— Prof. Shane Crotty (@profshanecrotty) November 17, 2020
ATS Guideline: Home oxygen therapy for adults with chronic lung disease
18 Nov, 2020 | 09:13h | UTC
#AHA20 – Randomized trial: Among patients with recurrent pericarditis, Rilonacept was associated with lower risk of pericarditis recurrence than placebo
18 Nov, 2020 | 09:04h | UTCPhase 3 Trial of Interleukin-1 Trap Rilonacept in Recurrent Pericarditis – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: Rilonacept Prevents Recurrent Pericarditis: RHAPSODY – TCTMD AND Rilonacept inHibition of interleukin-1 Alpha and beta for recurrent Pericarditis: a pivotal Symptomatology and Outcomes stuDY – RHAPSODY – American College of Cardiology AND Trial shows drug effective in 96% of patients with recurrent pericarditis – Cleveland Clinic
Commentary on Twitter
Patients with recurrent pericarditis were treated with the interleukin-1 trap rilonacept. Those who had a response were randomly assigned to receive continued rilonacept or placebo. Rilonacept led to a significantly lower risk of pericarditis recurrence than placebo. #AHA20
— NEJM (@NEJM) November 17, 2020
#AHA20 – RCT: Sotagliflozin improved cardiovascular outcomes in patients with Diabetes and CKD. Diarrhea, genital mycotic infections, volume depletion, and diabetic ketoacidosis were more common with sotagliflozin than with placebo
18 Nov, 2020 | 09:08h | UTCSotagliflozin in Patients with Diabetes and Chronic Kidney Disease – New England Journal of Medicine (link to abstract – $ for full-text)
#AHA20 – RCT: Sotagliflozin improved cardiovascular outcomes in patients with Diabetes and Recent Worsening Heart Failure. Diarrhea and severe hypoglycemia were more common with sotagliflozin than with placebo
18 Nov, 2020 | 09:06h | UTCSotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure – New England Journal of Medicine (link to abstract – $ for full-text)
Opinion: A new important study supports wider use of the polypill
18 Nov, 2020 | 09:01h | UTCRichard Smith: A new important study supports wider use of the polypill – The Lancet
Original study and commentaries: Randomized trial: A polypill comprising statins, multiple blood pressure lowering drugs, and aspirin prevents cardiovascular events among patients at intermediate cardiovascular risk
Commentary on Twitter
"We seem now to have good evidence that the polypill can reduce cardiovascular events and deaths by at least a third and probably by half in those who take the polypill regularly" @Richard56 discusses a new study in @NEJM https://t.co/B2tkN4pkDP
— The BMJ (@bmj_latest) November 17, 2020
[Press release – not published yet] Moderna’s COVID-19 vaccine candidate shows 94.5% protection in an interim analysis of the phase 3 COVE study
17 Nov, 2020 | 09:55h | UTCPress release: Moderna’s COVID-19 Vaccine Candidate Meets its Primary Efficacy Endpoint in the First Interim Analysis of the Phase 3 COVE Study
See also: Moderna Announces Longer Shelf Life for its COVID-19 Vaccine Candidate at Refrigerated Temperatures
Commentaries: What Moderna’s Covid-19 vaccine results mean for ending the pandemic – Vox AND Moderna follows Pfizer with exciting vaccine news – how to read these dramatic developments – The Conversation AND Moderna’s COVID Vaccine Is 95% Effective – Independent NIH-Appointed Board Assessment – Higher Storage Temperature Make It Even Better News – Health Policy Watch AND Moderna’s Vaccine News “Encouraging” But Won’t Solve Immediate Problem of Virus Surge in Europe & Americas – WHO – Health Policy Watch AND COVID vaccine excitement builds as Moderna reports third positive result – Nature AND Moderna’s Covid-19 vaccine is strongly effective, early look at data show – STAT AND With strong data on two Covid-19 vaccines, we have more answers about the road ahead — and questions too – STAT AND Early data show Moderna’s COVID vaccine 94.5% effective – CIDRAP AND A Note Of Caution On Moderna’s Promising Covid-19 Vaccine News – Forbes AND Promising Interim Results from Clinical Trial of NIH-Moderna COVID-19 Vaccine – NIH News Releases AND Moderna: Covid vaccine shows nearly 95% protection – BBC AND Latest vaccine success is good news but high price may restrict access – The Guardian AND ‘Just beautiful’—Another COVID-19 vaccine, from newcomer Moderna, succeeds in large-scale trial – Science AND Moderna trial success gives world more hope in race to end pandemic – Reuters AND Expert reaction to Moderna announcement of its phase 3 vaccine interim results – Science Media Centre
Treatment of community-acquired pneumonia in immunocompromised adults: A consensus statement regarding initial strategies
17 Nov, 2020 | 09:40h | UTCEditorial: Management of Community-Acquired Pneumonia in Immunocompromised Adults – CHEST
Primary care guidance for persons with HIV: 2020 update by the HIV Medicine Association of the Infectious Diseases Society of America
17 Nov, 2020 | 09:36h | UTCNews Release: IDSA and HIVMA Release New Comprehensive Primary Care Guidance for People with HIV – Infectious Diseases Society of America
[Abstract Only] In a Phase 2 randomized trial, Semaglutide at high doses improved Nonalcoholic Steatohepatitis (NASH), but with no significant beneficial effects in liver fibrosis
17 Nov, 2020 | 09:31h | UTCA Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Semaglutide Shows Promise in NASH Phase 2 Study – Medscape (free registration required)
Commentary on Twitter
https://twitter.com/NEJM/status/1327238536001593346
Podcast on Wilderness Medicine: Pearls on altitude sickness, frostbite, animal bites, thermoregulation, and wound care
17 Nov, 2020 | 09:32h | UTC#242 Wilderness Medicine: Prepare for Disaster – The Curbsiders Internal Medicine Podcast
Worldwide measles deaths climb 50% from 2016 to 2019, claiming over 207 500 lives in 2019
17 Nov, 2020 | 09:34h | UTCSee also: Action needed now to prevent further increases in measles and measles deaths in the coming years – The Lancet AND Progress Toward Regional Measles Elimination — Worldwide, 2000–2019 – CDC Morbidity and Mortality Weekly Report
Commentary on Twitter
NEW—Action needed now to prevent further increases in #measles and measles deaths in the coming years
Kim Mulholland, Katrina Kretsinger, Liya Wondwossen & Natasha Crowcroft lay out three pillars of action needed to address this concerning situation https://t.co/m6nD6yupMp pic.twitter.com/njd5PD9K3s
— The Lancet (@TheLancet) November 13, 2020
#AHA20 – Randomized trial: A polypill comprising statins, multiple blood pressure lowering drugs, and aspirin prevents cardiovascular events among patients at intermediate cardiovascular risk
16 Nov, 2020 | 02:03h | UTCPolypill with or without Aspirin in Persons without Cardiovascular Disease – New England Journal of Medicine (link to abstract – $ for full-text)
News release: New study confirms combo pill alone and with aspirin lowers heart disease risk – American Heart Association
Commentaries: Polypill along with aspirin cuts heart attacks and strokes by up to 40%: International study – McMaster University AND Big study supports cheap combo pill to lower heart risks – Associated Press AND TIPS-3: International Study Looks at Benefits of Polypill and Polypill Plus Aspirin in Reducing CVD Risk – American College of Cardiology
Commentary on Twitter
Public health vs precision medicine. Thinking through a one size fits all drug prevention approach. "Combined Rx w/polypill+aspirin led to lower incidence of CV events than placebo among participants w/o CV disease who were at intermediate CV risk.” #AHA20https://t.co/TsbvPtA1Pl pic.twitter.com/Ylq3AKThII
— Harlan Krumholz (@hmkyale) November 14, 2020
Sleep problems in dementia: Despite many drugs being widely prescribed, systematic review finds lack of evidence and no randomized controlled trials to guide decisions about drug treatment
17 Nov, 2020 | 09:29h | UTCPharmacotherapies for sleep disturbances in dementia – Cochrane Library
#AHA20 – In patients who had discontinued statins because of side effects, a N-of-1 trial of a statin, placebo, or no treatment found that side effects often attributed to statins were the same for those taking a placebo
16 Nov, 2020 | 01:57h | UTCCommentary: ‘Nocebo effect’ cause of most statin side-effects, study suggests – The Guardian
Original study: N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects – New England Journal of Medicine ($ – no abstract available)
Commentary on Twitter
Patients who had discontinued statins because of side effects received four bottles of a statin, four bottles of placebo, and four empty bottles. Each used for 1 month, in random sequence. The symptom burden with placebo was 90% of the symptom burden with the statin. #AHA20
— NEJM (@NEJM) November 15, 2020
#AHA20 – Randomized trial: High-dose Omega-3 fatty acids did not reduce the risk of cardiac events in patients at high cardiovascular risk
16 Nov, 2020 | 01:51h | UTCEditorial 2: Do Omega-3 Fatty Acids Benefit Health?
Commentary on Twitter
In this RCT, omega-3 fatty acids (EPA/DHA) did not reduce major adverse CV events vs corn oil in statin-treated patients at high CV risk
(Compare w Vascepa in REDUCE-IT) https://t.co/7BIs1Rr8YZ#STRENGTHTrial #AHA20 #SteveNissen@ProfSNicholls @Dmozaffarian @ClevelandClinic— JAMA (@JAMA_current) November 15, 2020
[Not Published Yet] #AHA20 – Randomized trial: Fish oil and vitamin D supplements not effective for preventing atrial fibrillation
16 Nov, 2020 | 01:49h | UTCCommentary: Fish Oil, Vitamin D Don’t Prevent A-fib: VITAL Rhythm – TCTMD
#AHA20 – In patients hospitalized for heart failure with iron deficiency, intravenous Ferric carboxymaltose at discharge reduced the risk of heart failure rehospitalizations
16 Nov, 2020 | 01:53h | UTCCommentaries: Intravenous iron reduced rehospitalization risk in people with heart failure – American Heart Association AND AFFIRM-AHF: IV Iron Supplementation Linked to Fewer Repeat Hospitalizations for HF – TCTMD
Commentary on Twitter
Latebreaker at #AHA20 @AHAMeetings—Ferric carboxymaltose for iron deficiency at discharge after acute #heartfailure: AFFIRM-AHF, a multicentre, double-blind, randomised, controlled trial https://t.co/gRKtbsxfba pic.twitter.com/k67HDJMW2b
— The Lancet (@TheLancet) November 14, 2020
Practice Pointer: Using antibiotics wisely for respiratory tract infection in the era of covid-19
16 Nov, 2020 | 01:48h | UTCUsing antibiotics wisely for respiratory tract infection in the era of covid-19 – The BMJ
Commentary on Twitter
When should patients with respiratory tract infections be assessed in person and when should you prescribe antibiotics based on best available evidence? This Practice Pointer offers guidance in the era of covid-19https://t.co/k6LoYPWmsv pic.twitter.com/rtIrjplyv0
— The BMJ (@bmj_latest) November 15, 2020