Internal Medicine | Page 38 of 487 | Links Medicus Content Curation & Alerts in Medicine

Pharmacotherapy of obesity: an update on the available medications and drugs under investigation

5 Apr, 2023 | 12:50h | UTC

Pharmacotherapy of obesity: an update on the available medications and drugs under investigation – eClinicalMedicine

M-A | Efficacy of flash glucose monitoring in type 1 and type 2 diabetes

5 Apr, 2023 | 12:46h | UTC

Efficacy of Flash Glucose Monitoring in Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials – Frontiers in Clinical Diabetes and Healthcare

RCT | Mindfulness therapy proves more effective and affordable than cognitive behavioral therapy for depression

4 Apr, 2023 | 14:04h | UTC

Summary: The LIGHTMind Randomized Clinical Trial studied 410 adults with mild to moderate depression, comparing the clinical effectiveness and cost-effectiveness of practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) to practitioner-supported cognitive behavioral therapy self-help (CBT-SH). The trial provided participants with either an MBCT-SH or CBT-SH workbook and six support sessions with a trained practitioner. Depressive symptom severity was measured using the Patient Health Questionnaire (PHQ-9) score at 16 weeks after randomization.

Results showed that MBCT-SH led to significantly greater reductions in depressive symptoms and was more cost-effective than CBT-SH. The between-group difference was 1.5 PHQ-9 points, and MBCT-SH cost health services £526 ($631) less per participant over a 42-week follow-up period. A substantial portion of this cost difference was due to additional face-to-face individual psychological therapy accessed by CBT-SH participants outside of the study intervention.

The trial concluded that offering practitioner-supported MBCT-SH for mild to moderate depression could improve outcomes and save money compared to CBT-SH. To translate these findings into practice, proper training and supervision for practitioners delivering MBCT-SH are necessary. Future research should focus on corroborating and extending these findings, exploring factors contributing to MBCT-SH’s relative effectiveness, and examining potential barriers and facilitators for successful implementation in routine clinical practice.

Article: Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression: The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial – JAMA Psychiatry

Commentary:

Mindfulness better than CBT for treating depression, study finds – The Guardian

Practitioner-Supported Mindfulness-Based Cognitive Therapy Aids Depression – HealthDay

Commentary on Twitter

Practitioner-supported mindfulness-based cognitive therapy self-help for mild-moderate depression is clinically- and cost-effective compared to currently recommended practitioner-support CBT self-help. https://t.co/H23AfwiO7X pic.twitter.com/xTHzYG4oqg

— JAMA Psychiatry (@JAMAPsych) March 22, 2023

What is acute kidney injury? A visual guide

4 Apr, 2023 | 14:02h | UTC

What is acute kidney injury? A visual guide – Nature

RCT | No significant fracture reduction from monthly 60,000 IU vitamin D3 supplementation

4 Apr, 2023 | 13:58h | UTC

The effect of monthly vitamin D supplementation on fractures: a tertiary outcome from the population-based, double-blind, randomised, placebo-controlled D-Health trial – The Lancet Diabetes & Endocrinology (link to abstract – $ for full-text)

RCT | Supplemental Vitamin D does not reduce incident fractures in midlife and older adults.

Comparison of fracture risk using different supplemental doses of vitamin D, calcium or their combination: a network meta-analysis of randomised controlled trials – BMJ Open

Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis – JAMA

Contrary to prior studies, new research finds no heightened postoperative risk after a recent covid-19 infection

4 Apr, 2023 | 13:54h | UTC

Estimated Risk of Adverse Surgical Outcomes Among Patients With Recent COVID-19 Infection Using Target Trial Emulation Methods – JAMA Network Open

Commentaries:

COVID infection within 60 days not tied to adverse postsurgical outcomes – CIDRAP

Adverse Postoperative Outcomes Not Increased With Recent COVID-19 – HealthDay

ASA and APSF statement on perioperative testing for the COVID-19 virus.

Surgical Triage and Timing for Patients with COVID: A Guidance Statement from the Society of Thoracic Surgeons – Annals of Thoracic Surgery

When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA – Langenbeck’s Archives of Surgery

Guideline Update: Timing of elective surgery and risk assessment after SARS-CoV-2 infection – “The guidance remains that patients should avoid elective surgery within 7 weeks of infection, unless the benefits of doing so exceed the risk of waiting”.

Perioperative cardiovascular considerations prior to elective noncardiac surgery in patients with a history of Covid-19.

Guideline: SARS‐CoV‐2 infection, COVID‐19 and timing of elective surgery

Study from 116 countries suggests surgery should be delayed for at least seven weeks following a COVID-19 diagnosis to reduce mortality risk

BJS commission on surgery and perioperative care post-COVID-19.

The risk of postoperative complications following major elective surgery in active or resolved COVID-19 in the United States – Major, elective surgery 0–4 weeks after Covid-19 is associated with greatly increased risk of postoperative complications; surgery performed 4–8 weeks after infection is still associated with an increased risk of pneumonia.

ASA Guidance: Preoperative testing for COVID-19 is essential, regardless of vaccination.

Position statement: Perioperative management of post-COVID-19 surgical patients.

Cohort study: Postoperative in-hospital mortality of patients with COVID-19 infection was more than double that in patients without COVID-19

Bivalent Booster | Observational data suggests no increased cardiovascular risks compared to monovalent vaccine

4 Apr, 2023 | 13:55h | UTC

Stroke, Myocardial Infarction, and Pulmonary Embolism after Bivalent Booster – New England Journal of Medicine

Commentary: Similarly Low Risk of CV Events With Bivalent and Monovalent mRNA Boosters – TCTMD

Commentary on Twitter

In this French study, the risk of cardiovascular events was similar among recipients of the bivalent Pfizer–BioNTech vaccine and the original monovalent vaccine 21 days after the booster dose. https://t.co/FUZbbsn82I pic.twitter.com/ki0FPeutNm

— NEJM (@NEJM) March 29, 2023

M-A | Rapid antigen-based and rapid molecular tests for the detection of SARS-CoV-2

4 Apr, 2023 | 13:52h | UTC

Rapid antigen-based and rapid molecular tests for the detection of SARS-CoV-2: a rapid review with network meta-analysis of diagnostic test accuracy studies – BMC Medicine

Accuracy of rapid point-of-care antigen-based diagnostics for SARS-CoV-2: An updated systematic review and meta-analysis with meta-regression analyzing influencing factors – PLOS Medicine

Interpreting a lateral flow SARS-CoV-2 antigen test – The BMJ

Rapid, point‐of‐care antigen and molecular‐based tests for diagnosis of SARS‐CoV‐2 infection – Cochrane Library

RCT | Vitamin D supplementation shows no significant impact on psoriasis severity

4 Apr, 2023 | 13:51h | UTC

Summary: In a randomized, double-blind, placebo-controlled clinical trial involving 122 participants with plaque psoriasis, researchers investigated the effects of vitamin D supplementation on psoriasis severity during winter. Participants received either vitamin D (cholecalciferol, 100,000 IU loading dose followed by 20,000 IU/week) or a placebo for four months. The primary outcome was Psoriasis Area Severity Index (PASI) scores, with secondary outcomes including Physician Global Assessment, self-administered PASI, and Dermatology Life Quality Index scores.

The study found no significant difference in PASI scores or secondary outcomes between the two groups. The results suggest that vitamin D supplementation does not affect psoriasis severity. However, low baseline severity scores and a lower than expected increase in 25-hydroxyvitamin D levels in the intervention group may have influenced the findings, indicating that further research may be needed to account for these factors.

Article: Effect of Vitamin D Supplementation on Psoriasis Severity in Patients With Lower-Range Serum 25-Hydroxyvitamin D Levels: A Randomized Clinical Trial – JAMA Dermatology (free for a limited period)

Commentary: Vitamin D Ineffective for Psoriasis Patients with Lower Serum 25-Hydroxyvitamin D Levels in Winter – HCP Live

Commentary on Twitter

This RCT, performed in North-Norway, found no measurable effect of vitamin D supplementation on psoriasis severity during winter. Low baseline severity, & lower-than-expected rise in 25(OH)D levels in intervention group, may have affected the results. https://t.co/ip17uFQsgM

— JAMA Dermatology (@JAMADerm) March 29, 2023

M-A | No significant health benefits found for low-volume alcohol intake

4 Apr, 2023 | 13:48h | UTC

Summary: This systematic review and meta-analysis aimed to investigate the association between alcohol use and all-cause mortality, taking into account potential sources of bias. The study analyzed data from 107 cohort studies published between January 1980 and July 2021, which included 4,838,825 participants and 425,564 deaths.

The study found no significant reductions in all-cause mortality risk for drinkers who consumed less than 25 grams of ethanol per day compared to lifetime nondrinkers. However, there was a significantly increased risk of all-cause mortality among female drinkers who drank 25 or more grams per day and male drinkers who drank 45 or more grams per day.

The analysis highlighted the importance of controlling for former drinker bias and misclassification errors and found sex differences in the risk of all-cause mortality.

In conclusion, the updated meta-analysis found no significantly reduced risk of all-cause mortality associated with low-volume alcohol consumption after adjusting for potential confounding factors. The study recommends that future longitudinal studies in this field should attempt to minimize lifetime selection biases by not including former and occasional drinkers in the reference group and by using younger cohorts at baseline.

Article: Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses – JAMA Network Open

Commentary: Drinking Alcohol Brings No Health Benefits, Study Finds – HealthDay

National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study – The Lancet Public Health

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 – The Lancet

The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 – The Lancet Psychiatry

Prioritising action on alcohol for health and development – The BMJ

Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study – The Lancet Oncology

Cohort study | Younger stroke survivors show elevated cancer risk for up to 8 years

4 Apr, 2023 | 13:46h | UTC

Summary: In this cohort study, 390,398 patients aged 15 years or older in the Netherlands, without a history of cancer and with a first-ever ischemic stroke or intracerebral hemorrhage (ICH), were analyzed between January 1, 1998, and January 1, 2019. The primary outcome was the cumulative incidence of first-ever cancer after the index stroke, stratified by stroke subtype, age, and sex, compared with age-, sex-, and calendar year-matched peers from the general population.

The findings revealed that, in the first year after a stroke, patients aged 15 to 49 years had a 3- to 5-fold increased risk of cancer compared to individuals without a stroke. In contrast, the risk was only slightly elevated for patients aged 50 years or older. The cancer risk remained elevated for up to 8 years after an ischemic stroke and 6 years after an ICH in the younger age group, with the highest risks observed for lung cancer, gastrointestinal cancer, and hematologic cancer.

The findings may be confounded by shared risk factors, such as smoking. Alternatively, the increased cancer risk may have a causal mechanism between cancer and stroke, possibly related to the hypercoagulable state induced by cancer. However, the study design does not allow for conclusions about causal mechanisms, and the researchers called for further studies investigating the usefulness of cancer screening after a stroke.

Article: Association of Stroke at Young Age With New Cancer in the Years After Stroke Among Patients in the Netherlands – JAMA Network Open

Cross-sectional study | Association between sodium intake and coronary and carotid atherosclerosis

4 Apr, 2023 | 13:42h | UTC

The association between sodium intake and coronary and carotid atherosclerosis in the general Swedish population – European Heart Journal Open

Editorial: Dietary salt intake and atherosclerosis: an area not fully explored – European Heart Journal Open

News Release: High salt diet associated with hardened arteries even in people with normal blood pressure – European Society of Cardiology

Two FITs better than one: enhancing diagnostic performance for colorectal cancer in symptomatic populations

4 Apr, 2023 | 13:32h | UTC

Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer – British Journal of Surgery

Cohort Study | Preoperative depression has minimal impact on 5-year bariatric surgery outcomes

4 Apr, 2023 | 13:23h | UTC

Preoperative Depression Status and 5 Year Metabolic and Bariatric Surgery Outcomes in the PCORnet Bariatric Study Cohort – Annals of Surgery

Single-arm study | Transcatheter arterialization of deep veins may help avoid amputation in chronic limb-threatening ischemia

3 Apr, 2023 | 14:03h | UTC

Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

New procedure helps patients avoid leg amputation – Vanderbilt University

PROMISE II: Flow-Diverting Procedure May Save Limbs in CLTI – TCTMD

Transcatheter Arterialization Could Revolutionize Treatment of Limb-Threatening Ischemia – HCP Live

Transcatheter Arterialization for Limb Ischemia – American College of Cardiology

Commentary on Twitter

https://twitter.com/NEJM/status/1641192272539824128

RCT | Comparable efficacy of cefotaxime, ceftriaxone, and ciprofloxacin in treating spontaneous bacterial peritonitis

3 Apr, 2023 | 14:01h | UTC

Summary: This multicenter, prospective, open-label, randomized controlled trial compared the efficacy of cefotaxime, ceftriaxone, and ciprofloxacin as initial treatments for spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites. The study included 261 patients aged 16 to 75, with liver cirrhosis, ascites, and a polymorphonuclear cell count of >250/mm3. Researchers performed follow-up paracentesis at 48 hours to evaluate the assigned antibiotics, and assessed resolution rates at 120 and 168 hours of treatment.

The primary endpoint, resolution rates at 120 hours, showed no statistically significant difference between the groups: 67.8% for cefotaxime, 77.0% for ceftriaxone, and 73.6% for ciprofloxacin. One-month mortality rates were also similar. The study concluded that these antibiotics are equally effective as initial treatments for SBP, particularly for community-acquired infections, when administered based on response-guided therapy.

Article: Response-Guided Therapy With Cefotaxime, Ceftriaxone, or Ciprofloxacin for Spontaneous Bacterial Peritonitis: A Randomized Trial: A Validation Study of 2021 AASLD Practice Guidance for SBP – American Journal of Gastroenterology (free for a limited period)

M-A | Mediterranean & low-fat diets may reduce mortality and non-fatal MI in patients with high cardiovascular risk

3 Apr, 2023 | 13:59h | UTC

Summary: This systematic review and network meta-analysis aimed to determine the relative efficacy of different diets for preventing mortality and major cardiovascular events in patients at increased risk of cardiovascular disease. The study identified 40 randomized trials with 35,548 participants across seven dietary programs.

Moderate certainty evidence showed that Mediterranean and low-fat diets, with or without physical activity or other interventions, reduced all-cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean diet programs were also likely to reduce stroke risk.

Other dietary programs generally were not superior to minimal intervention. When compared with one another, no convincing evidence was found that the Mediterranean diet was superior to the low-fat diets in preventing mortality or non-fatal myocardial infarction.

Article: Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis – The BMJ

News Release: Benefits of Mediterranean and low fat diet programmes in patients at risk of cardiovascular disease – BMJ Newsroom

Commentary: Mediterranean, Low-Fat Diets Both Good for Health: Network Meta-analysis – TCTMD

SR | Adding ultrasound to mammography increases breast cancer detection, but increases false-positives and biopsies

3 Apr, 2023 | 13:55h | UTC

Summary: The systematic review examined the effectiveness and safety of combining mammography with breast ultrasonography versus mammography alone for breast cancer screening in women at average risk. The research included one randomized controlled trial, two prospective cohort studies, and five retrospective cohort studies, involving a total of 209,207 women.

High certainty evidence from one trial indicated that combining mammography with ultrasonography led to the detection of more breast cancer cases than mammography alone (5 vs. 3 per 1000 women). However, this combination also led to a higher number of false-positive results and biopsies. For every 1000 women screened with the combined approach, 37 more received a false-positive result, and 27 more women underwent a biopsy.

Secondary analysis of the trial data revealed that in women with dense breasts, the combined screening detected more cancer cases than mammography alone, while cohort studies for women with non-dense breasts showed no statistically significant difference between the two screening methods.

The included studies did not analyze whether the higher number of detected cancers with the combined screening method resulted in lower mortality rates compared to mammography alone. Further research, including randomized controlled trials or prospective cohort studies with longer observation periods, is needed to assess the impact of the two screening interventions on morbidity and mortality.

Article: Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk – Cochrane Database of Systematic Reviews

Summary: Mammography followed by ultrasonography compared to mammography alone for breast cancer screening in women at average risk of breast cancer – Cochrane Database of Systematic Reviews

Cohort Study | Infections requiring hospitalization linked to increased short- and long-term cardiovascular risks

3 Apr, 2023 | 13:57h | UTC

Summary: The study examined the association between severe infections and the risk of cardiovascular disease in people without prior cardiovascular issues. Data from 331,683 UK Biobank participants and 271,533 Finnish participants were analyzed. Cardiovascular risk factors were measured at baseline, and infectious diseases and subsequent cardiovascular events were diagnosed through the linkage of participants to hospital and mortality registers.

Results showed that hospitalization for infection was associated with an increased risk of major cardiovascular events, regardless of the type of infection. The risk was highest during the first month after infection, with hazard ratios of 7.87 and 7.64 in the UK Biobank and Finnish cohorts, respectively. However, the risk remained elevated throughout the follow-up period, with hazard ratios of 1.47 in the UK Biobank and 1.41 in the Finnish cohort.

The study suggests that severe infections requiring hospital treatment are associated with increased risks for major cardiovascular disease events both immediately after hospitalization and in the long-term. However, it is important to note that residual confounding cannot be excluded, and further research is needed to establish causality.

Article: Severe Infection and Risk of Cardiovascular Disease: A Multicohort Study – Circulation

Commentary: Severe Infections Linked to a Variety of CV Events, Both Acute and Long-term – TCTMD

Commentary on Twitter

#OriginalResearch: In this multicohort study, hospital-treated infections associated w/ significant increase in short-term risk and modest long-term risk of major CVD events. @MikaKivimaki @nellimarikki@PyrySipila #AHAJournals https://t.co/51JSJkS6l4 pic.twitter.com/U21U2IgYCO

— Circulation (@CircAHA) March 29, 2023

Lateral flow devices maintain detection sensitivity across Alpha, Delta, and Omicron waves

3 Apr, 2023 | 13:53h | UTC

Summary: The study assessed the performance of antigen lateral flow devices (LFDs) during the alpha, delta, and omicron waves of the SARS-CoV-2 pandemic in the UK. Researchers aimed to understand LFD performance concerning changes in variant infections, vaccination, viral load, and LFD use, as well as the devices’ ability to detect infectious individuals. Paired LFD and RT-PCR test results were collected from both asymptomatic and symptomatic participants between November 2020 and March 2022.

When compared to RT-PCR testing, the overall LFD sensitivity was 63.2%, and specificity was 99.71%. The sensitivity was higher in symptomatic participants (68.7%) than in asymptomatic participants (52.8%). The study found that increased viral load was independently associated with a higher likelihood of being LFD positive. There was no evidence of a significant difference in LFD sensitivity between the alpha and delta variants, but sensitivity increased during the omicron wave. Vaccination status did not show an independent association with LFD sensitivity.

The study concluded that LFDs can detect most SARS-CoV-2 infections across different viral variants and during vaccine roll-out, contributing to reduced transmission risk. However, LFD performance is lower in asymptomatic individuals, which should be taken into account when designing testing programs.

Article: Performance of antigen lateral flow devices in the UK during the alpha, delta, and omicron waves of the SARS-CoV-2 pandemic: a diagnostic and observational study – The Lancet Infectious Diseases

Invited Commentary: The performance of rapid antigen tests against SARS-CoV-2 variants – The Lancet Infectious Diseases

Accuracy of rapid point-of-care antigen-based diagnostics for SARS-CoV-2: An updated systematic review and meta-analysis with meta-regression analyzing influencing factors – PLOS Medicine

Interpreting a lateral flow SARS-CoV-2 antigen test – The BMJ

Rapid, point‐of‐care antigen and molecular‐based tests for diagnosis of SARS‐CoV‐2 infection – Cochrane Library

RCT | Sparsentan reduces proteinuria in patients with IgA nephropathy

3 Apr, 2023 | 13:35h | UTC

Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial – The Lancet (link to abstract – $ for full-text)

Commentary on Twitter

PROTECT (Interim results): Sparsentan reduces proteinuria in patients with IgA Nephropathy (IgAN)#ISNWCN 🇹🇭 #Nephpearls #VisualAbstract by @dakidneydoc https://t.co/ViW9YncwI6 pic.twitter.com/zEGRSY8N3x

— Edgar V. Lerma 🇵🇭 (@edgarvlermamd) April 1, 2023

Postoperative delirium’s linked to long-term cognitive decline in elderly patients

3 Apr, 2023 | 13:20h | UTC

Postoperative Delirium’s linked to Long-term Cognitive Decline in Elderly Patients – JAMA Internal Medicine (link to abstract – $ for full-text)

News Release: Developing postoperative delirium associated with a faster rate of cognitive decline, says study – EurekAlert

Commentary: Postoperative Delirium Associated With Accelerated Cognitive Decline, Study Finds – Psychiatric News Alert

Commentary on Twitter

Delirium associated with accelerated cognitive decline that continued for 72 months following the index delirium episode; it's uncertain if delirium causes cognitive decline or if pts with preclinical brain disease are more likely to develop delirium. https://t.co/ADz7yxEZiP

— JAMA Internal Medicine (@JAMAInternalMed) March 20, 2023