Internal Medicine
EULAR recommendations for the management of ANCA-associated vasculitis
20 Mar, 2023 | 13:47h | UTC
Review | Diseases affecting middle-aged and elderly individuals with trisomy 21
20 Mar, 2023 | 13:44h | UTC
SR | Oral Class I and III antiarrhythmic drugs for maintaining sinus rhythm after catheter ablation of atrial fibrillation
20 Mar, 2023 | 13:41h | UTCSummary: This systematic review and meta-analysis assessed the efficacy of Class I and III antiarrhythmic drugs for maintaining sinus rhythm after catheter ablation of atrial fibrillation (AF). The review included nine randomized controlled trials involving 3,269 participants.
The analysis found that Class I and/or III antiarrhythmic drugs may reduce the recurrence of atrial tachyarrhythmias at 0 to 3 months and likely reduce recurrence at > 3 to 6 months. However, beyond six months, the evidence is uncertain, and the benefit of antiarrhythmic drugs may not persist. Additionally, the use of these drugs post-ablation likely reduces hospitalizations for atrial tachyarrhythmias by approximately 57% at 0 to 3 months.
The use of Class I and/or III antiarrhythmic drugs did not increase the risk of thromboembolic events, myocardial infarction, all-cause mortality, or the need for repeat ablation.
M-A | Primary prevention of cardiovascular disease in women with a Mediterranean diet
20 Mar, 2023 | 13:20h | UTCNews Release: Mediterranean diet may cut women’s CVD and death risk by nearly 25% – BMJ Newsroom
Commentary:
Expert reaction to study looking at Mediterranean diet and women’s cardiovascular disease and death risk – Science Media Centre (Recommended reading – “Observational studies of nutrition have been notoriously misleading… Nutritional measures are strongly patterned by social factors and behavioral dispositions, leading to very substantial confounding”)
Review | Surviving sepsis campaign
20 Mar, 2023 | 13:17h | UTCSurviving Sepsis Campaign – Critical Care Medicine
Cross-sectional study | Impact of different alcoholic beverages on serum urate levels
20 Mar, 2023 | 13:16h | UTC
Commentary on Twitter
Beer and wine was associated with high and moderate increases in serum urate levels, respectively; sake was associated with a modest increase in serum urate levels, in patients getting routine checkups in Japan. https://t.co/J8OqKJI9fQ
— JAMA Network Open (@JAMANetworkOpen) March 17, 2023
Cohort Study | COVID-19 outpatients mostly at low risk for VTE, but age, being male, and obesity are risk factors
17 Mar, 2023 | 13:11h | UTCSummary: The article discusses a cohort study that aimed to assess the risk of venous thromboembolism (VTE) among outpatients with COVID-19 and identify independent predictors of VTE.
The study used data from two integrated healthcare delivery systems in California and included 398.530 nonhospitalized adults aged 18 years or older with COVID-19 diagnosed between January 1, 2020, and January 31, 2021, with follow-up through February 28, 2021.
The results showed that the overall risk of VTE among outpatients with COVID-19 is low, but higher in the first 30 days after diagnosis. Factors associated with a higher risk of VTE in COVID-19 outpatients included:
- Age 55 years or older.
- Being male.
- history of VTE or thrombophilia.
- Body mass index greater than or equal to 30.0.
The study’s results could inform future randomized trials to explore targeted VTE preventive strategies and more intensive short-term surveillance for patients with COVID-19 who are at a higher risk of developing VTE.
Commentary: Venous blood clots rare among COVID-19 outpatients, study finds – CIDRAP
Commentary on Twitter
The rate of VTE was low in outpatients with #COVID19 in the first 30 days, and even lower >30 days. Factors associated with a higher risk of VTE in included age ≥55, male, prior VTE/thrombophilia, and BMI ≥30. https://t.co/3hwfDW88k4
— JAMA Network Open (@JAMANetworkOpen) March 13, 2023
Guidelines for the management of patients with substance intoxication presenting to the ED
17 Mar, 2023 | 13:09h | UTC
Post-hoc analysis | Could SGLT2 inhibitors have a beneficial effect on gout symptoms?
17 Mar, 2023 | 13:02h | UTCRelated: Post-hoc analysis | Can SGLT2 inhibitors reduce the risk of hyperuricemia and gout?
Associations of relative fat mass, a new index of adiposity, with type-2 diabetes in the general population
17 Mar, 2023 | 13:04h | UTC
FDA issues new information on cases of squamous cell carcinoma and lymphomas around breast implants
16 Mar, 2023 | 13:28h | UTCSummary: The US Food and Drug Administration (FDA) has provided an update on reports of squamous cell carcinoma (SCC) in the scar tissue (capsule) that forms around breast implants. The FDA is aware of 19 cases of SCC in the capsule around the breast implant from published literature, including 3 reports of deaths from the disease.
While the FDA continues to believe that occurrences of SCC in the capsule around the breast implant may be rare, the cause, incidence, and risk factors remain unknown. Health care providers and people who have or are considering breast implants should be aware that cases of SCC and various lymphomas in the capsule around the breast implant have been reported to the FDA and in the literature.
The FDA continues to ask health care providers and people with breast implants to report cases of SCC, lymphomas, or any other cancers around breast implants.
FDA Safety Communication: Reports of Squamous Cell Carcinoma (SCC) in the Capsule Around Breast Implants – FDA Safety Communication – U.S. Food & Drug Administration
Related:
FDA Report: 660 Cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma
Study: Long-term Outcomes of Silicone Breast Implants
RCT | Pre-hospital rule-out of NSTE-ACS by ambulance paramedics with point-of-care troponin is feasible and cost-saving
16 Mar, 2023 | 13:27h | UTCSummary: Using a point-of-care (POC) troponin measurement, this randomized trial in the Netherlands assessed the safety and healthcare costs of a pre-hospital rule-out strategy for patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
The study included only patients considered at low risk with a HEAR (History, ECG, Age, Risk factors) score ≤3. A total of 863 low-risk participants were randomized to direct transfer to the ED or a pre-hospital rule-out strategy with POC troponin measurement.
The trial found that pre-hospital rule-out of NSTE-ACS in low-risk patients using a single POC troponin measurement is feasible, significantly reduces healthcare costs, and is associated with a low incidence of major adverse cardiac events.
The HEAR score, combined with a POC troponin measurement by ambulance paramedics, accurately identifies low-risk patients for whom ED evaluation is unnecessary. Implementing this pre-hospital rule-out strategy in low-risk patients could significantly reduce healthcare costs through more efficient use of ambulance services and fewer ED visits. It is worth noting, however, that further studies in other localities are necessary before the widespread use of this strategy can be implemented.
Commentaries:
JC: Can we rule out ACS by a single prehospital troponin measurement? – St. Emyln’s
Rule-Out of NSTE-ACS by a Prehospital Troponin Measurement – American College of Cardiology
Consensus Paper | Small intestinal bacterial overgrowth in gastrointestinal disorders
16 Mar, 2023 | 13:23h | UTC
Review | Evidence-based approach to diagnosis and management of abdominal tuberculosis
16 Mar, 2023 | 13:17h | UTCEvidence-based approach to diagnosis and management of abdominal tuberculosis – Indian Journal of Gastroenterology (if the link is paywalled, try this one)
Commentary from the author on Twitter
Our review on abdominal tuberculosis, where we summarise all the evidence on gastrointestinal tuberculosis and peritoneal tuberculosis, has been published in @ijg_journal
Great effort by @JhaDayakrishna and @menon_mythilihttps://t.co/spPXILGNw2 pic.twitter.com/SxnGs0n9DE— Vishal Sharma (@drvishal82) March 11, 2023
Study identifies outpatient procedures associated with increased risk of myocardial infarction
16 Mar, 2023 | 13:11h | UTCRisk of myocardial infarction after invasive outpatient procedures – Heart
RCT | Patient-reported outcomes 12 years after different treatments for localized prostate cancer
15 Mar, 2023 | 15:24h | UTCSummary: The article reports on a study that evaluated patient-reported outcomes of 1,643 participants in the ProtecT trial over a period of 7 to 12 years to assess the long-term functional and quality-of-life impacts of prostatectomy, radiotherapy with neoadjuvant androgen deprivation, and active monitoring for localized prostate cancer detected by PSA screening.
The study found that generic quality-of-life scores were similar among the randomized groups over 7 to 12 years. However, although the prostatectomy group had a lower incidence of nocturia, they showed a higher incidence of urinary incontinence and sexual dysfunction compared to the radiotherapy and active monitoring groups. The radiotherapy group had a higher incidence of fecal leakage compared to the other groups.
The study provides evidence that helps patients and their clinicians assess the trade-offs between treatment harms and benefits and make better-informed treatment decisions.
Article: Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment – NEJM Evidence
Original Study: RCT | Localized prostate cancer treatment options have similar 15-year survival outcomes
SR | Therapeutics for treating mpox in humans – still no evidence from randomized trials
15 Mar, 2023 | 15:20h | UTCTherapeutics for treating mpox in humans – Cochrane Library
Summary: Therapeutics for treating mpox – Cochrane Library
Review | Heart failure with preserved ejection fraction
15 Mar, 2023 | 15:18h | UTCHeart Failure With Preserved Ejection Fraction: A Review – JAMA (free for a limited period)
Author Interview: Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction – JAMA
ACCP Guidelines | Respiratory management of patients with neuromuscular weakness
15 Mar, 2023 | 15:16h | UTC
SR | Yoga may improve frailty markers in older adults
15 Mar, 2023 | 15:08h | UTCEffect of Yoga on Frailty in Older Adults: A Systematic Review – Annals of Internal Medicine (link to abstract – $ for full-text)
Annals Video Summary: Effect of Yoga on Frailty in Older Adults: A Systematic Review
News Release: Yoga may help to prevent frailty in older adults – American College of Physicians
Deprescribing strategies for opioids and benzodiazepines with emphasis on concurrent use: a scoping review
15 Mar, 2023 | 15:06h | UTCRelated:
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
M-A | Pretest probability assessment and D-Dimer are preferred for the initial evaluation of suspected PE in pregnant women
15 Mar, 2023 | 14:50h | UTC
Cohort Study | Higher ultra-processed food consumption linked to increased cancer incidence and mortality
15 Mar, 2023 | 14:48h | UTCNews Release: Ultra-processed foods may be linked to increased risk of cancer – Imperial College London
Related:
AHA Scientific Statement | Atrial fibrillation occurring during acute hospitalization
14 Mar, 2023 | 14:04h | UTC
RCT | Sotatercept improves exercise capacity in patients with pulmonary arterial hypertension
14 Mar, 2023 | 14:02h | UTCSummary: This multicenter, double-blind randomized trial involved 323 adults with Pulmonary Arterial Hypertension (PAH) who were randomized to receive either subcutaneous sotatercept or placebo every three weeks for 24 weeks.
The primary endpoint was the change from baseline in the 6-minute walk distance. Sotatercept demonstrated a greater improvement in exercise capacity compared to placebo and improved secondary endpoints, including pulmonary vascular resistance and WHO functional class.
Adverse events were more common in the sotatercept group and included epistaxis, dizziness, telangiectasia, increased hemoglobin levels, thrombocytopenia, and increased blood pressure.
Article: Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
STELLAR, ‘Impressive’ Results With Novel Drug Sotatercept in PAH – TCTMD