Internal Medicine
RCT | Cannabidiol oil not effective for post-ureteroscopy pain control
10 Mar, 2023 | 14:34h | UTCSummary: The study evaluated the effect of cannabidiol oil on pain control and opioid usage in patients undergoing ureteroscopy with stent placement for urinary stone disease. Ninety patients were randomized 1:1 to receive either placebo or 20mg of cannabidiol oil daily for 3 days postoperatively.
Results showed no difference between CBD oil and placebo in reducing pain scores, opioid usage, or stent-related symptoms. The study suggests that despite the availability of numerous analgesic agents, stent symptoms continue to be bothersome for most patients, and further research is needed to find effective non-opioid alternatives for pain management in this setting.
Article: Effect of Cannabidiol Oil on Post-ureteroscopy Pain for Urinary Calculi: A Randomized, Double-blind, Placebo-controlled Trial – The Journal of Urology (free for a limited period)
Review | How to use nebulized antibiotics in severe respiratory infections
10 Mar, 2023 | 14:31h | UTCHow to Use Nebulized Antibiotics in Severe Respiratory Infections – Antibiotics
Cohort Study | Depression and poor mental health linked to premature CVD and suboptimal CVH in young adults
10 Mar, 2023 | 14:14h | UTC
Commentary on Twitter
A new analysis of #BRFSS data from >600K young adults finds double the odds of #CVD in people with depression. #AHAJournals @GarimaVSharmaMD https://t.co/ZFzTTnUs95 pic.twitter.com/gvIAqbg47H
— JAHA (@JAHA_AHA) January 31, 2023
WHO Meta-Analysis | Saturated fat and trans-fat intakes and their replacement with other macronutrients
9 Mar, 2023 | 14:24h | UTC
Commentary on Twitter
Saturated fat and trans-fat intakes
and their replacement with other
macronutrients
published on behalf @WHO https://t.co/fNXmKwWOMQ pic.twitter.com/0Qi8PNqyqq— Lukas Schwingshackl (@LSchwingshackl) March 6, 2023
Pregnancy complications linked to long-term mortality in a racially diverse cohort
10 Mar, 2023 | 14:01h | UTCPregnancy Complications and Long-Term Mortality in a Diverse Cohort – Circulation
Related:
Severity of obstructive coronary artery stenosis after pre-eclampsia – Heart
SR | Spinal cord stimulation for low back pain provides no sustained clinical benefits compared to placebo
9 Mar, 2023 | 14:12h | UTCSummary: Spinal cord stimulation (SCS) is a surgical procedure used to treat persistent low back pain by sending electrical signals via implanted electrodes into the spinal cord. The review included 13 studies (randomized controlled trials and cross‐over trials) with 699 participants.
Most of the studies were focused on short-term effects (less than one month), but the review found it is uncertain whether spinal cord stimulation can improve outcomes in the immediate term compared with placebo. At six months, SCS probably does not improve back or leg pain, function, or quality of life compared with placebo, with moderate certainty of evidence. Adverse events were also reported, including infections, neurological damage, and lead migration requiring repeated surgery.
The review concluded that the data does not support the use of SCS to manage low back pain outside a clinical trial. Current evidence suggests SCS probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.
Article: Spinal cord stimulation for low back pain – Cochrane Library
Summary: Spinal cord stimulation for low back pain – Cochrane Library
Commentary from the author on Twitter
Our Cochrane review on spinal cord stimulators for #backpain out today.
Bottom line:
-Mod certainty evidence of no benefit vs placebo in medium term
-Uncertain if benefit on pain in immediate term
-Adverse events (infection, re-operation) commonhttps://t.co/lNJQeN96Zs— Adrian Traeger (@adrian_traeger) March 7, 2023
RCT | Bempedoic acid shows modest reduction in cardiovascular events for statin-intolerant patients
8 Mar, 2023 | 14:39h | UTCSummary:
Bempedoic acid is an ATP citrate lyase inhibitor that reduces LDL cholesterol levels and is associated with a low incidence of muscle-related adverse events. The study enrolled 13,970 patients at increased cardiovascular risk, with 6,992 randomized to bempedoic acid and 6,978 randomized to placebo, with a median duration of follow-up of 40.6 months.
The study found that bempedoic acid was associated with a statistically significant 13% reduction in the primary endpoint of major adverse cardiovascular events, which included death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. However, the absolute risk reduction of events was modest, at 1.6% over nearly four years.
The study also reported higher incidences of gout and cholelithiasis with bempedoic acid compared to placebo, as well as small increases in serum creatinine, uric acid, and hepatic-enzyme levels.
Article: Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
CLEAR Positives and Cautions With Bempedoic Acid for Statin Intolerance – Medscape (recommended reading – free registration required)
Cardiovascular Outcomes After “Statin-Intolerant” Patients Take Bempedoic Acid – NEJM Journal Watch (free for a limited period)
Commentary on Twitter
Bempedoic acid showed a modest absolute reduction in CV outcomes, relative to placebo, in patients “unable or unwilling” to take a statin. https://t.co/hQUfvFwz68 #ACC23 @hmkyale @NEJM #CardioTwitter pic.twitter.com/YMoNsce8MI
— NEJM Journal Watch (@JWatch) March 7, 2023
CDC Study | Estimates of serial interval and incubation period for mpox virus infection in the US
8 Mar, 2023 | 14:34h | UTCSummary:
Monkeypox cases have been reported globally since May 2022, with most transmission occurring through close physical contact associated with sexual activities among men who have sex with men.
This study presented the estimated mean serial interval and incubation period for monkeypox virus infection based on data collected from 12 US health departments. The serial interval is the time between symptom onset in a primary case-patient and symptom onset in the secondary case-patient. It is critical for estimating the effective reproduction number and forecasting incidence, both of which are important for understanding the course of an outbreak and the effect of interventions.
The results indicate that the mean estimated serial interval for symptom onset is 8.5 days, while the mean estimated incubation period is 5.6 days.
Commentary: 8.5 days elapse between successive mpox cases, study estimates – CIDRAP
RCT | Combination of intravenous doxycycline and azithromycin better than either drug alone for severe scrub typhus
8 Mar, 2023 | 14:36h | UTCSummary:
The study aimed to compare the efficacy of intravenous doxycycline, azithromycin, or a combination of both drugs in treating severe scrub typhus. The study randomized 794 patients with severe scrub typhus and at least one organ involvement to receive a 7-day course of intravenous doxycycline, azithromycin, or both.
The primary outcome was a composite of death from any cause at day 28, persistent complications at day 7, and persistent fever at day 5. The study found that combination therapy with intravenous doxycycline and azithromycin was a better therapeutic option for treating severe scrub typhus than monotherapy with either drug alone.
Article: Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: A combination therapy is found to be more effective on severe scrub typhus – University of Oxford
Commentary on Twitter
Original Article: Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus https://t.co/uZ4Y51zoZ2#InfectiousDisease pic.twitter.com/xzmeAV8Tyi
— NEJM (@NEJM) March 4, 2023
M-A | Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes
8 Mar, 2023 | 14:33h | UTCSummary:
The study aimed to determine the association between non-occupational physical activity and chronic disease and mortality outcomes in the general adult population. The systematic review and meta-analysis included 196 articles covering 94 cohorts and over 30 million participants.
The results showed that higher activity levels were associated with a lower risk of all outcomes. The strongest associations were observed for all-cause and cardiovascular disease mortality, with weaker associations for cancer incidence.
The study also found that appreciable population health benefits could be gained from increasing physical activity levels of people who are inactive to just half the current health recommendations; doing that could prevent one in 10 premature deaths.
The findings support the current physical activity recommendations and suggest that even small increases in non-occupational physical activity in inactive adults can provide substantial protection against chronic disease outcomes.
It’s worth noting, however, that this study has the usual limitations of observational studies since all the included studies are cohort studies. Therefore, the results are subject to residual confounding, meaning that other factors not measured or accounted for in the studies could influence the observed associations.
News Releases:
1 in 10 early deaths averted if everyone met physical activity targets – BMJ Newsroom
FDA panel endorses 2 RSV vaccines for older adults, but flag at potential increased risk of Guillain-Barre
8 Mar, 2023 | 14:27h | UTCPfizer vaccine:
In close vote, FDA advisers recommend Pfizer RSV vaccine for those 60 and older – CIDRAP
GSK’s vaccine:
FDA panel recommends GSK’s RSV vaccine for ages 60 and up – CIDRAP
FDA advisors recommend GSK’s RSV vaccine for older adults, but flag potential safety risks – CNBC
See also: Rare neurological condition is ‘important potential risk’ of Pfizer’s RSV vaccine, FDA says – CNN
Early diagnostic indicators of dengue vs. other febrile illnesses in Asia and Latin America: a multicenter, prospective, observational study
8 Mar, 2023 | 14:16h | UTCSummary:
The IDAMS study is a large, prospective, observational study conducted in eight countries in Asia and Latin America to investigate early diagnostic indicators of dengue compared to other febrile illnesses. The study included 7428 patients with undifferentiated fever, of whom 2694 were diagnosed with laboratory-confirmed dengue and 2495 with other febrile illnesses.
Platelet count, white blood cell count, and their changes over time were strongly associated with dengue, while cough and rhinitis were strongly associated with other febrile illnesses. The study found that a set of 14 clinical and three laboratory predictors can distinguish between dengue and other febrile illnesses during the early phase of symptoms, with sensitivities of 80-87% and specificities of 80-91%. The study also found that models that include laboratory markers outperform those based solely on clinical variables.
The study’s results provide important information for updating guidelines on the management of febrile illnesses, particularly in resource-limited settings where distinguishing between dengue and other febrile illnesses is crucial for patient management.
Invited Commentary: Differentiating dengue from other febrile illnesses: a dilemma faced by clinicians in dengue endemic countries – The Lancet Global Health
Commentary on Twitter
From the March Issue: Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): a multicentre, prospective, observational study https://t.co/xyvYpoiyWM (1/2) pic.twitter.com/xgvkA39PV5
— The Lancet Global Health (@LancetGH) February 23, 2023
ESC 0/1-hour algorithm unable to safely exclude 30-day cardiac death or MI in patients with known coronary artery disease, study finds
8 Mar, 2023 | 14:12h | UTCSummary:
The study aimed to determine if the European Society of Cardiology (ESC) 0/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) could achieve a negative predictive value of 99% or higher for 30-day cardiac death or myocardial infarction (MI) among emergency department patients with chest pain and known coronary artery disease (CAD).
The study included 1430 adults, and the algorithm had a negative predictive value of 96.6% for 30-day cardiac death or MI among patients with known CAD, suggesting that the algorithm may not be able to safely exclude 30-day cardiac death or MI in these patients.
These findings suggest that clinicians should be cautious when using the ESC 0/1-hour hs-cTnT algorithm in patients with known CAD.
Article: Performance of the European Society of Cardiology 0/1-Hour Algorithm With High-Sensitivity Cardiac Troponin T Among Patients With Known Coronary Artery Disease – JAMA Cardiology (link to abstract – $ for full-text)
Related:
Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In this diagnostic study of 1430 adults, the high-sensitivity troponin T (hs-cTnT) ESC 0/1-hour algorithm had a negative predictive value of 96.6% for 30-day cardiac death or MI among patients with known coronary artery disease. https://t.co/FnILIazEnU
— JAMA Cardiology (@JAMACardio) March 1, 2023
Cohort Study | Endoscopic biopsy with normal mucosa associated with elevated risk of inflammatory bowel disease for at least 30 years
8 Mar, 2023 | 14:10h | UTCSummary:
This study explored the long-term risk of inflammatory bowel disease (IBD) after an endoscopic biopsy with normal mucosa. The researchers identified individuals in Sweden with a lower or upper gastrointestinal (GI) biopsy of normal mucosa, their matched population references, and unexposed full siblings.
They found that individuals with a previous lower or upper GI biopsy showing normal mucosa were at persistently higher risk of overall IBD, ulcerative colitis, and Crohn’s disease compared to their matched population references and unexposed full siblings, and the increased risk persisted at least 30 years after the biopsy with normal findings.
The findings suggest a substantial symptomatic period before IBD diagnosis, and clinicians should be aware of the long-term increased risk of IBD in those with symptoms requiring GI investigation but with a finding of histologically normal mucosa.
Commentary: Risk for IBD Remains High After Endoscopic Biopsy With Normal Mucosa – HealthDay
Review | Approach to disorders of gut-brain interaction
8 Mar, 2023 | 14:06h | UTCApproach to Disorders of Gut-Brain Interaction – Mayo Clinic Proceedings
M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia
7 Mar, 2023 | 13:18h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.
Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.
However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.
Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP
RCT | Study finds both one-food and six-food elimination diets are effective initial options for eosinophilic esophagitis
7 Mar, 2023 | 13:17h | UTCSummary:
The article describes a multicenter randomized trial that compared the effectiveness of a one-food elimination diet (1FED – eliminating animal milk) versus a six-food elimination diet (6FED – eliminating animal milk, wheat, egg, soy, fish and shellfish, and peanut and tree nuts) for treating eosinophilic esophagitis in adults.
The study found that both diets were equally effective at achieving histological remission, although the 6FED resulted in a higher proportion of patients achieving complete remission. Patients who did not achieve histological remission with the 1FED could proceed to the 6FED, and 43% had histological remission. For those without response to the 6FED, topical fluticasone propionate induced remission in 82%.
Overall, the study suggests that eliminating animal milk alone is an acceptable initial dietary therapy for eosinophilic esophagitis.
Article: One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial – The Lancet Gastroenterology & Hepatology (link to abstract – $ for full-text)
News Release: Forgoing one food treats eosinophilic esophagitis as well as excluding six – National Institutes of Health
Related: M-A | Efficacy of elimination diets in eosinophilic esophagitis
Commentary on Twitter
New research – Kliewer et al – One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial https://t.co/Tpm0EPPfx0#EoE #GItwitter #RareDiseaseDay #CEGIR pic.twitter.com/iUcqIt9Pg5
— The Lancet Gastroenterology & Hepatology (@LancetGastroHep) February 28, 2023
Review | Acquired disorders of hypomagnesemia
7 Mar, 2023 | 13:09h | UTCAcquired Disorders of Hypomagnesemia – Mayo Clinic Proceedings
Position Statement | Chronic suppurative lung disease and bronchiectasis in children, adolescents and adults
7 Mar, 2023 | 13:04h | UTC
Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli
7 Mar, 2023 | 13:00h | UTCRelated:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
M-A | Long-term consumption of 10 food groups and cardiovascular mortality
7 Mar, 2023 | 12:58h | UTCSummary:
This systematic review and meta-analysis of 22 prospective cohort studies evaluated the association between the consumption of 10 food groups and cardiovascular mortality.
The researchers found that a long-term high intake of whole grains, fruits and vegetables, and nuts was associated with reduced cardiovascular mortality, while a high intake of red/processed meat was associated with increased risk. On the other hand, the consumption of dairy products and legumes did not show a significant association with cardiovascular risk.
The researchers acknowledge the limitations of observational studies and the need for further research on the long-term effects of specific food groups on cardiovascular mortality.
Podcast | Updates in chronic kidney disease
7 Mar, 2023 | 12:51h | UTC#384 Updates in Chronic Kidney Disease with Dr. Joel Topf – The Curbsiders
Review | Analysis of deprescription strategies of proton pump inhibitors in primary care
7 Mar, 2023 | 12:42h | UTCRelated:
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Report | Economic impact of overweight and obesity to surpass $4 trillion by 2035
6 Mar, 2023 | 14:32h | UTCSummary:
A recent report from the World Obesity Federation has issued a warning that the number of people worldwide suffering from overweight or obesity could increase significantly by 2035, surpassing the 50% mark. The report, called the World Obesity Atlas 2023, also highlights the significant economic impact of this trend, estimating that the cost of overweight and obesity could reach $4.32tn annually by 2035, equivalent to almost 3% of the global GDP.
The report also identifies two groups that are particularly at risk: children and individuals from lower-income countries. Childhood obesity is a growing concern, as the report predicts it could double by 2035. Additionally, lower-income countries face a rapid increase in obesity prevalence, with nine out of 10 countries with the greatest expected increases in obesity coming from low or lower-middle income countries.
Report: World Obesity Atlas 2023
News release: Economic impact of overweight and obesity to surpass $4 trillion by 2035
Commentary: Report: Obesity could cost the world over $4 trillion a year by 2035 – STAT
Related:
Report: Tenfold increase in childhood and adolescent obesity in four decades
Global cost of obesity-related illness to hit $1.2tn a year from 2025
The Lancet Series: The Double Burden of Malnutrition
BTS Clinical Guidance | Aspiration pneumonia
6 Mar, 2023 | 14:36h | UTCBTS clinical statement on aspiration pneumonia – Thorax