Internal Medicine
Podcast | Pears in primary aldosteronism, mineralocorticoid receptor antagonists, and renovascular hypertension
29 Mar, 2023 | 13:07h | UTC
Plasma D-Dimer may be useful in the diagnosis of periprosthetic joint infection
29 Mar, 2023 | 12:33h | UTCPlasma D-Dimer Is Noninferior to Serum C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
News Release: D-dimer blood test shows value in detecting prosthetic joint infections – Wolters Kluwer
AHA Scientific Statement | Interpreting incidentally identified variants in genes associated with heritable cardiovascular disease
28 Mar, 2023 | 15:12h | UTCNews Release: Genetic tests unexpectedly find genes linked to heart disease — now what? – AHA Newsroom
CDC report reveals escalating Candida auris transmission and resistance in the US
28 Mar, 2023 | 15:10h | UTCWorsening Spread of Candida auris in the United States, 2019 to 2021 – Annals of Internal Medicine
Commentaries:
CDC reports dramatic increase in US Candida auris cases – CIDRAP
An emerging fungal threat spread at an alarming rate in US health care facilities, study says – CNN
Related:
CDC Report: Transmission of pan-resistant Candida auris in health care facilities.
Case reports: Multidrug-resistant Candida auris infections in critically ill Covid-19 patients
Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings
Global Epidemiology of Emerging Candida Auris (reviews and commentaries on the subject)
The superbug Candida auris is giving rise to warnings — and big questions – STAT
Candida Auris – “A Mysterious Infection, Spanning the Globe in a Climate of Secrecy” (reviews and commentaries on the subject)
Commentary on Twitter
New Annals of Internal Medicine study finds cases of deadly fungus, Candida auris, rose drastically between 2019 and 2021. Increase included treatment resistant strains: https://t.co/J3SkmfWDr5 @CDCgov pic.twitter.com/ZJBRqMIOy1
— Annals of Int Med (@AnnalsofIM) March 21, 2023
M-A | Risk factors associated with post−COVID-19 condition
28 Mar, 2023 | 15:07h | UTCCommentary:
Meta-analysis reveals risk, protective factors for long COVID – CIDRAP
Long Covid: University of East Anglia study finds women more likely affected – BBC
People who catch Omicron are less likely to get Long Covid
28 Mar, 2023 | 15:04h | UTCPeople who catch Omicron are less likely to get Long Covid – Science
Brief Review | Antifungal stewardship in critically ill patients
28 Mar, 2023 | 14:57h | UTCAntifungal stewardship in critically ill patients – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
Antifungal stewardship in #ICU
🧪 biomarkers
⬇️ de‑escalation
🍄 other methods to improve AFs use
Empirical AFs commonly used (poor prognosis if inappropriate/delayed): AFS can ⬆️ performance measures/⬇️ AFs consumption, no negative impact on outcome
🖇️ https://t.co/eS9EJdjo2a pic.twitter.com/4FMV9NBndb— Intensive Care Medicine (@yourICM) March 24, 2023
Acute heart failure: diagnostic–therapeutic pathways and preventive strategies — a real-world clinician’s guide
28 Mar, 2023 | 14:45h | UTC
M-A | The natural history of untreated pulmonary tuberculosis in adults
28 Mar, 2023 | 14:42h | UTCThe natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis – The Lancet Respiratory Medicine (free registration required)
Commentary from the author on Twitter
https://twitter.com/bianca_sossen/status/1639143776613482497
Brief Review | Admission to intensive care unit after major surgery
28 Mar, 2023 | 14:39h | UTCAdmission to intensive care unit after major surgery – Intensive Care Medicine
Commentary on Twitter
🏥 Major surgeries common reason for #ICU admission (expected/scheduled or unplanned), with varying practices & mortality. 4 major determinants driving decision
1️⃣ intrinsic procedure risk
2️⃣ patient risk
3️⃣ crashing risk
4️⃣ support outside ICU#FOAMcc
🖇️ https://t.co/CluprKlYM9 pic.twitter.com/PZC4zmymOp— Intensive Care Medicine (@yourICM) March 23, 2023
Practical guide to glucocorticoid induced hyperglycemia and diabetes
28 Mar, 2023 | 14:35h | UTCPractical Guide to Glucocorticoid Induced Hyperglycaemia and Diabetes – Diabetes Therapy
Pulmonary hypertension | An update of Dx and Tx guidelines
28 Mar, 2023 | 14:32h | UTCPulmonary hypertension: An update of Dx and Tx guidelines – Journal of Family Practice
Coffee consumption vs. caffeine avoidance: cardiac ectopy, daily steps, and sleep impacts
27 Mar, 2023 | 13:32h | UTCSummary: A prospective, randomized, case-crossover trial studied the acute health effects of caffeinated coffee consumption in 100 ambulatory adults.
Participants were monitored using continuous electrocardiogram devices, wrist-mounted accelerometers, and ongoing glucose monitoring systems for 14 days. They received daily text messages instructing them to either consume caffeinated coffee or abstain from caffeine.
The primary outcome was the mean number of daily premature atrial contractions. Results indicated that caffeinated coffee consumption didn’t lead to significantly more daily premature atrial contractions compared to caffeine avoidance. However, it was associated with a higher number of daily premature ventricular contractions, increased daily steps, and reduced nightly sleep.
Article: Acute Effects of Coffee Consumption on Health among Ambulatory Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
What to know about new research on coffee and heart risks – Associated Press
CRAVE Trials Offers Most Comprehensive Overview Yet of Impact of Coffee, Caffeine Intake – HCP Live
Acute Effects of Coffee Consumption on Health – American College of Cardiology
M-A | Examining shorter antibiotic treatment durations for community acquired pneumonia in adults
27 Mar, 2023 | 13:29h | UTCSummary: The systematic review and duration-effect meta-analysis included nine randomized trials with a total of 2,399 patients, analyzing antibiotic treatment durations for community-acquired pneumonia (CAP) in adults. The primary outcome was clinical improvement on day 15, with secondary outcomes including all-cause mortality, serious adverse events, and clinical improvement on day 30.
The study found that shorter treatment durations (3–9 days) were likely to be non-inferior to the standard 10-day treatment, and no significant difference in all-cause mortality or serious adverse events was observed. The study suggests that a 3–5 day treatment duration likely offers the optimal balance between efficacy and treatment burden if patients are clinically stable. However, the results are limited by the small number of included studies, the overall moderate-to-high risk of bias, and the varying severity of CAP among patients in the studies. Therefore, further research focusing on the shorter duration range is required.
Related:
Top POEMs (Patient-Oriented Evidence that Matters) of 2022 for choosing wisely in practice
27 Mar, 2023 | 13:30h | UTCSummary: Top POEMs of 2022 for choosing wisely in practice are based on Canadian Medical Association member ratings. These recommendations promote evidence-based and cost-effective clinical practices while reducing unnecessary treatments and diagnostic procedures.
Key recommendations from the article:
- Hypnotic agents are effective for insomnia but have adverse effects; avoid benzodiazepines as the first choice for older adults.
- For type 2 diabetes in older adults, avoid medications causing hypoglycemia to achieve A1c <7.5%; moderate control is better.
- Postoperative opioids provide no better pain relief than nonopioids; avoid prolonged use beyond the immediate postoperative period.
- Arthroscopic debridement is not recommended as the primary treatment for knee osteoarthritis.
- Proton pump inhibitor (PPI) use is associated with an increased risk of gastric cancer, although the association is observational and does not imply causation. Use the lowest dose and duration possible.
- For children with community-acquired pneumonia, low-dose amoxicillin for 3 days is noninferior to high-dose for 7 days.
- White blood cells in urine do not equate to bacterial cells; avoid urine dip tests or cultures unless urinary tract symptoms are present.
- Avoid measuring vitamin D in low-risk adults as a routine test.
- Antidepressants should not be routinely used as first-line treatment for mild or subsyndromal depressive symptoms in adults.
- ACG guideline for GERD management: try discontinuing PPIs after an 8-week trial in patients with classic GERD symptoms & no alarming symptoms.
- British Society of Gastroenterology guidelines for IBS management: colonoscopy only for alarming signs or microscopic colitis risk.
- USPSTF advises against ASA initiation for primary prevention of cardiovascular disease in adults >60.
Top POEMs of 2022 for choosing wisely in practice – Canadian Family Physician
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Dissecting coffee’s impact: high consumption lowers blood pressure, raises LDL-cholesterol
27 Mar, 2023 | 13:25h | UTC
SR | Interventions to reduce repetitive ordering of low-value inpatient laboratory tests
27 Mar, 2023 | 13:22h | UTC
Indian consensus statements on irritable bowel syndrome in adults
27 Mar, 2023 | 13:18h | UTCRelated:
Diet and irritable bowel syndrome: an update from a UK consensus meeting – BMC Medicine
M-A | Efficacy of a restrictive diet in irritable bowel syndrome.
10 mistakes in dietary management of irritable bowel syndrome and how to avoid them.
Supplement: Irritable bowel syndrome and related conditions.
RCT: FODMAPs, but not gluten, elicit modest symptoms of irritable bowel syndrome.
British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
Guidelines for the treatment of irritable bowel syndrome
ACG Clinical Guideline: Management of irritable bowel syndrome
M-A: Efficacy of a low-FODMAP diet in adult irritable bowel syndrome
M-A | Completion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine
27 Mar, 2023 | 13:14h | UTCCompletion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine: an individual patient data network meta-analysis – The Lancet Respiratory Medicine (free registration required)
Invited Commentary: Shorter regimens for tuberculosis preventive treatment: piecing together the global implementation jigsaw – The Lancet Respiratory Medicine (free registration required)
Commentary on Twitter
NEW Research—3HP provided an increase in treatment completion vs 4R but was associated with a higher risk of adverse events. The trade-off between completion and safety must be considered when deciding TPT
From Prof Dick Menzies & colleagues#WorldTBDayhttps://t.co/UY7l9OuI03 pic.twitter.com/GoKnu9BXoi
— The Lancet Respiratory Medicine (@LancetRespirMed) March 24, 2023
Outcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study
27 Mar, 2023 | 13:12h | UTCOutcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study – European Heart Journal – Quality of Care and Clinical Outcomes (free for a limited period)
Commentary on Twitter
Cancer and #STEMI – a worrisome combination of higher short- and long-term mortality, and bleeding risk. https://t.co/kHvhGP0PBE #EHJQCCO #cardiotwitter @cpgale3 @diogoasantosfer pic.twitter.com/SfjyizoJvQ
— European Society of Cardiology Journals (@ESC_Journals) March 26, 2023
Brief Review | Long-term outcomes of intensive care unit delirium
27 Mar, 2023 | 13:09h | UTCLong-term outcomes of intensive care unit delirium – Intensive Care Medicine
Commentary on Twitter
#ICU delirium
🏥 well described short-term effects: ⬆️ hospital mortality, MV duration, ICU/hospital LoS
📚 more recent findings related to long-term outcomes (≥ 6 months post-ICU)
How to mitigate this serious acute BI & its long-term burden? #FOAMcc
🖇️ https://t.co/kg5TIOmVHm pic.twitter.com/Hnbc1ISKnI— Intensive Care Medicine (@yourICM) March 25, 2023
Phase 2 RCT | Semaglutide did not improve fibrosis in NASH-related cirrhosis
27 Mar, 2023 | 13:01h | UTCCommentary: Semaglutide Well-Tolerated, But Shows Lack of Improvement in Liver Fibrosis – HCP Live
Commentary on Twitter
New research – Loomba et al – Semaglutide 2·4 mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trialhttps://t.co/qkydKMpVfO#NASH #NAFLD #cirrhosis #gitwitter #livertwitter #medtwitter @DrLoomba pic.twitter.com/2A1dylSiq3
— The Lancet Gastroenterology & Hepatology (@LancetGastroHep) March 17, 2023
Brief Review | Bronchodilators or inhaled corticosteroids for postinfectious cough
27 Mar, 2023 | 13:00h | UTCBronchodilators or inhaled corticosteroids for postinfectious cough – Canadian Family Physician
Study shows increased bleeding complications in ESKD patients undergoing AF ablation
24 Mar, 2023 | 13:09h | UTCSummary: The study analyzed 347 procedures in 307 patients with end-stage kidney disease (ESKD) undergoing atrial fibrillation (AF) catheter ablation in 12 referral centers in Japan.
Despite a vast majority of patients having subtherapeutic international normalized ratio (INR) values during the peri-procedural period, 35 patients (10%) experienced major complications, with the majority being major bleeding events (19 patients; 5.4%), including 11 cases of cardiac tamponade (3.2%). There were also two peri-procedural deaths (0.6%), both related to bleeding events. A pre-procedural INR value of 2.0 or higher was identified as the only independent predictor of major bleeding.
Current peri-procedural anticoagulation guidelines state that patients undergoing AF ablation should be under therapeutic anticoagulation throughout the peri-procedural period. The findings of this study suggest that these guidelines may not be appropriate for ESKD patients undergoing the procedure, and the role of peri-procedural anticoagulation in this population should be further investigated.
Commentary on Twitter
Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing #afib ablation 👉 despite undertreatment with warfarin, the rate of haemorrhagic complications is high! https://t.co/3W8gEtZYdy#kidney #afib #anticoagulation #ablation #cardiotwitter #europace pic.twitter.com/vI27UeIpRf
— European Society of Cardiology Journals (@ESC_Journals) March 16, 2023
Consensus Paper | Connective tissue disease-associated pulmonary arterial hypertension
24 Mar, 2023 | 13:06h | UTC