Internal Medicine
SR | Nonopioid pharmacological management of acute low back pain
27 Feb, 2023 | 12:42h | UTCCommentary: Which Meds are Best for Acute Low Back Pain? – RheumNow
Related:
M-A: Effectiveness of treatments for acute and subacute mechanical non-specific low back pain
Guideline Interventions for the management of acute and chronic low back pain.
M-A: Little benefit from muscle relaxants for adults with non-specific low back pain.
Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults
24 Feb, 2023 | 13:58h | UTCSummary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.
Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP
Related:
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
[Not published yet] M-A | Too little sodium can be harmful to heart failure patients
24 Feb, 2023 | 13:59h | UTCSummary: New research presented at the American College of Cardiology’s annual scientific session suggests that heart failure patients restricting their dietary sodium intake to levels below the standard recommended maximum of 2.3 grams per day do not have additional benefits and may be at increased risk of death. The study analyzed nine randomized controlled trials that assessed different levels of sodium restriction and found that patients following a diet with a sodium intake target below 2.5 grams per day were 80% more likely to die than those following a diet with a target of 2.5 grams per day or more. The researchers recommend establishing a safe level of sodium consumption instead of overly restricting sodium.
News release: Too Little Sodium Can be Harmful to Heart Failure Patients – American College of Cardiology
Guideline | Diagnosis and treatment of Helicobacter pylori
24 Feb, 2023 | 13:53h | UTCRelated:
M-A | Efficacy of elimination diets in eosinophilic esophagitis
24 Feb, 2023 | 13:47h | UTCSummary: This systematic review and meta-analysis evaluated the effectiveness of various dietary treatment regimens for eosinophilic esophagitis (EoE). After analyzing 34 studies with 1762 patients, it was concluded that dietary therapy is a viable and efficacious option for individuals with EoE of all ages, with an overall histological remission rate of 53.8% and a clinical response rate of 80.8%. The study also found that highly restrictive dietary regimes, such as a six-food elimination diet, may not be superior to less restrictive dietary regimens, such as a four-food elimination diet or one-food elimination diet, in achieving histological remission, supporting less restrictive dietary regimens as a treatment option. The study has several limitations, such as the observational nature of most studies included.
Commentary: Elimination diets effective for patients with eosinophilic esophagitis – ACP Gastroenterology
Commentary on Twitter
Efficacy of dietary therapy in eosinophilic esophagitis for (1) histologic remission & (2) clinical response
6⃣-food elimination diet: 61%, 93%
4⃣-food elimination diet: 49%, 74%
1⃣-food elimination diet: 51%, 87%
Targeted elimination diet: 46%, 69%#EoEhttps://t.co/VKXgCQO9O6 pic.twitter.com/KfpSburuwN— John Damianos, M.D. (@john_damianosMD) February 1, 2023
Article under a Creative Commons Attribution (CC BY 4.0) license
Cohort Study | Heavy coffee intake is associated with kidney disfunction in genetically predisposed individuals
24 Feb, 2023 | 13:42h | UTCSummary: The study investigated whether a person’s genetic variation in the enzyme that metabolizes caffeine, called CYP1A2, modifies the association between coffee intake and kidney dysfunction. The study was conducted on 1180 participants with stage 1 hypertension. Data were collected from April 1, 1990, to June 30, 2006, with a follow-up of approximately 10 years. The study found that consuming more than three cups of coffee per day was associated with increased risks of albuminuria, hyperfiltration, and hypertension only among slow metabolizers of caffeine. The findings suggest that caffeine may play a role in the development of kidney disease in genetically susceptible individuals, but further studies are required to confirm these findings.
Article: CYP1A2 Genetic Variation, Coffee Intake, and Kidney Dysfunction – JAMA Network Open
Commentaries:
Drinking 3 or more cups of coffee daily may increase kidney dysfunction risk – Medical News Today
Review | Young-onset dementia diagnosis, management and care
24 Feb, 2023 | 13:37h | UTC
Review | When and how to use MIC in clinical practice?
24 Feb, 2023 | 13:28h | UTCWhen and How to Use MIC in Clinical Practice? – Antibiotics
Commentary on Twitter
https://twitter.com/ABsteward/status/1616852667124400129
Mpox outbreak in advanced HIV cases | Global case series reveals higher mortality and clinical complications
23 Feb, 2023 | 13:44h | UTCSummary: This article discusses a case series investigating monkeypox (mpox) in people with HIV and low CD4 cell counts. The mpox outbreak in 2022 has affected a significant percentage of people living with HIV, and data suggest worse clinical outcomes and higher mortality in those with more advanced HIV. The case series includes data from 382 confirmed mpox cases in people living with HIV from 19 countries. The individuals included were predominantly cisgender men, with a median age of 35. Most individuals were adherent to antiretroviral therapy, and the median CD4 count was 211 cells per mm3. Severe complications were more common in those with lower CD4 cell counts, including necrotizing skin lesions, lung involvement, secondary infections, and sepsis. Approximately 28% of individuals were hospitalized, and 25% of those hospitalized died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. The study reinforces the importance of HIV and CD4 testing in mpox cases, prioritization of preventive mpox vaccination in people with HIV and a CD4 cell count of less than 200 cells per mm3, and the use of potential mpox antivirals where available. The authors suggest that a severe, disseminated, and necrotizing form of mpox should be considered an AIDS-defining condition in CDC and WHO HIV disease classifications. Clinicians should also be aware that starting antiretroviral therapy in people with advanced HIV and mpox could contribute to deterioration and possible death, possibly as part of an immune reconstitution syndrome.
Article: Mpox in people with advanced HIV infection: a global case series – The Lancet (free registration required)
News Release: Clinicians identify severe form of mpox with high mortality in people with advanced HIV – Queen Mary University of London
Commentaries:
Mpox: Clinicians identify severe form with high mortality in advanced HIV patients – The BMJ
Commentary from the author on Twitter (thread – click for more)
📣 📣 Our global case series on MPOX in people with advanced HIV infection is at #CROI2023 and in @TheLancet today: 382 cases of human MPOX infection in PLWH with CD4 counts <350 cells/mm3 in 19 countries
**We found MPOX is an opportunistic pathogen** /1https://t.co/WodDN4Ujoj pic.twitter.com/IlK7viABmy— @profchloeorkin.bsky.social (@profchloeorkin) February 21, 2023
M-A | Oral manifestation of the monkeypox virus
23 Feb, 2023 | 13:42h | UTCOral manifestation of the monkeypox virus: a systematic review and meta-analysis – eClinicalMedicine
M-A | COVID-19 convalescent plasma outpatient therapy may prevent hospitalizations
23 Feb, 2023 | 13:37h | UTC
M-A | Metabolic side effects in persons with schizophrenia during mid- to long-term treatment with antipsychotics
23 Feb, 2023 | 13:26h | UTCSummary: This study aimed to evaluate the mid- to long-term metabolic side effects of 31 antipsychotics in persons with schizophrenia by analyzing 137 eligible randomized controlled trials with 35,007 participants. The primary outcome was weight gain, with secondary outcomes including fasting glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. The study found that antipsychotic drugs differ in their propensity to induce metabolic side effects. Chlorpromazine, clozapine, olanzapine, and zotepine produced the most weight gain. The confidence in the evidence ranged from low to moderate. The study suggests that differences in weight gain were more pronounced than previously published short-term data and that weight gain is most pronounced at the beginning of treatment and then remains stable.
Article: Metabolic side effects in persons with schizophrenia during mid- to long-term treatment with antipsychotics: a network meta-analysis of randomized controlled trials – World Psychiatry (free for a limited period)
Acute pain management pearls: a focused review for the hospital clinician
23 Feb, 2023 | 13:15h | UTCAcute Pain Management Pearls: A Focused Review for the Hospital Clinician – Healthcare
Antibiotic allergy de-labeling: a pathway against antibiotic resistance
23 Feb, 2023 | 13:12h | UTCAntibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance – Antibiotics
Related:
M-A: Most patients with allergy to Penicillin can be given Cefazolin
Podcast: A Clinical Pharmacologist’s Perspective on Penicillin Allergy
Study: Development and Validation of a Penicillin Allergy Clinical Decision Rule
NICE: Double Check Patients with ‘Penicillin Allergy’ to Avoid Increased MRSA Risk
RCT | An initial 8-week bedaquiline-linezolid regimen shows promise for the treatment of rifampin-susceptible tuberculosis
22 Feb, 2023 | 12:50h | UTCSummary: This randomized trial compared a standard 6-month rifampin-based tuberculosis treatment to a strategy that involved shorter initial treatment with extended therapy for persistent disease, monitoring, and retreatment for relapse. The results showed that the strategy involving an 8-week bedaquiline-linezolid regimen was noninferior to standard treatment for clinical outcomes. The experimental strategy was associated with a shorter total duration of treatment with no evident safety concerns.
Article: Treatment Strategy for Rifampin-Susceptible Tuberculosis – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Shorter drug regimen shows promise in TB trial – CIDRAP
M-A | Past SARS-CoV-2 infection provides long-lasting protection against severe disease caused by all variants
22 Feb, 2023 | 12:48h | UTCSummary: The article describes a systematic review and meta-analysis of studies assessing protection from past SARS-CoV-2 infection against subsequent re-infection, symptomatic COVID-19 disease, and severe disease. The researchers identified 65 studies from 19 different countries and found that protection from past infection against re-infection from pre-omicron variants was high and remained so even after 40 weeks. However, protection was substantially lower for the omicron BA.1 variant and declined more rapidly over time than protection against previous variants. Protection from severe disease was high for all variants, estimated at 90·2% for ancestral, alpha, and delta variants, and 88·9% for omicron BA.1 at 40 weeks. The study highlights the importance of considering past infection in assessing future disease burden from COVID-19, providing guidance on when individuals should be vaccinated, and designing policies that mandate vaccination for workers or restrict access. The findings also suggest that individuals with a documented infection should be treated similarly to those who have been fully vaccinated with high-quality vaccines.
Commentaries:
Previous COVID-19 may slash severe illness at reinfection by 89% – CIDRAP
M-A | Global and regional prevalence of multimorbidity in the adult population in community settings
22 Feb, 2023 | 12:47h | UTCSummary: The article presents a systematic review and meta-analysis of surveys that estimate the prevalence of multimorbidity among adults in community settings. The study analyzed data from 126 peer-reviewed studies, including nearly 15.4 million people from 54 countries worldwide. The overall global prevalence of multimorbidity was 37.2%, with South America having the highest prevalence, followed by North America, Europe, and Asia. The study also found that females have a higher prevalence of multimorbidity than males, and that more than half of the adult population worldwide above 60 years of age had multimorbid conditions.
Related:
Costs of multimorbidity: a systematic review and meta-analyses – BMC Medicine
Systematic review of high-cost patients’ characteristics and healthcare utilization – BMJ Open
Multimorbidity: a priority for global health research – The Academy of Medical Sciences
The global burden of multiple chronic conditions: a narrative review – Preventive Medicine Reports
Redesigning Care for High-Cost, High-Risk Patients – Harvard Business Review
Multimorbidity: clinical assessment and management – NICE Guideline
Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs
Better Care for People with Complex Needs – Institute for Healthcare Improvement
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
22 Feb, 2023 | 12:43h | UTCSummary: The presence of pyuria is commonly used as the cornerstone of urinary tract infection (UTI) diagnosis. However, over 90% of asymptomatic bacteriuria (ASB) patients also have pyuria, which can lead to unnecessary treatment. This is especially problematic in older women who may have pre-existing lower urinary tract symptoms, cognitive impairment, and a high prevalence of ASB. This study examined the diagnostic accuracy of different pyuria thresholds for UTI in older women. The study found that current pyuria cut-offs (10 leukocytes/µl) are too low and promote inappropriate UTI diagnosis in older women. A threshold of 300 leukocytes/µl is suggested as a considerable improvement, increasing specificity to avoid overtreatment, while still maintaining a fair sensitivity. This has implications for patient care, antimicrobial stewardship efforts, and research. The impact of higher cut-off values on prescription behavior and UTI related outcomes in older women deserves further study.
Related:
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Commentary on Twitter
Presence of pyuria remains the cornerstone of UTI diagnosis However, >90% of ASB patients have pyuria,prompt unnecessary Rx
🆕️⚡️⚡️study: current pyuria cut-off is too low promote inappropriate UTI diagnosis in older women suggesting a new higher cut offhttps://t.co/qAGdwSTiU6 pic.twitter.com/Vr63RnuMv1— Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 (@ABsteward) February 20, 2023
Article under a https://creativecommons.org/licenses/by-nc-nd/4.0/ license
RCT | Another study shows Ivermectin does not benefit patients with Covid-19
22 Feb, 2023 | 12:45h | UTCSummary: The study aimed to evaluate whether Ivermectin, at a maximum dose of 600 μg/kg daily for 6 days, shortened symptom duration or prevented hospitalization among outpatients with mild to moderate COVID-19. A total of 1206 US adults were enrolled in the double-blind, randomized, placebo-controlled platform trial, with follow-up data through November 10, 2022. The study found that the median time to sustained recovery was 11 days in both the ivermectin and placebo groups. Among those receiving Ivermectin, 5.7% were hospitalized, died, or had urgent or emergency care visits compared with 6.0% receiving placebo. These findings, along with all the previous studies to date, do not support using Ivermectin in patients with mild to moderate COVID-19.
Editorials:
At a Higher Dose and Longer Duration, Ivermectin Still Not Effective Against COVID-19 – JAMA
The Ethics of Clinical Research: Managing Persistent Uncertainty – JAMA
Related:
RCT | Ivermectin does not improve time to recovery in outpatients with mild to moderate COVID-19.
RCT | Metformin, Ivermectin, and Fluvoxamine are not beneficial for obese outpatients with Covid-19.
Ivermectin for COVID-19 Cochrane review update: 11 trials and no evidence of benefit shown.
RCT: Early treatment with ivermectin does not improve outcomes in patients with Covid-19.
Case Series: Toxic effects from ivermectin use associated with prevention and treatment of Covid-19.
Long-term consequences of the misuse of ivermectin data.
Ivermectin: How false science created a Covid ‘miracle’ drug.
Fraudulent ivermectin studies open up new battleground between science and misinformation.
The lesson of ivermectin: meta-analyses based on summary data alone are inherently unreliable.
Ivermectin: Cochrane’s most talked about review so far, ever. Why?
Flawed ivermectin preprint highlights challenges of COVID drug studies.
Systematic review: no evidence to support the use of Ivermectin for treating or preventing COVID-19.
Why was a major study on ivermectin for covid-19 just retracted?
RCT: Ivermectin does not prevent hospitalizations in patients with COVID-19.
RCT: Ivermectin does not improve time to resolution of symptoms among adults with mild COVID-19
Bacteriuria in older adults triggers confusion in healthcare providers: a mindful pause to treat the worry
22 Feb, 2023 | 12:42h | UTCRelated:
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Commentary on Twitter
FANTASTIC⚡️⚡️
The evidence base for refraining from screening for or treating ASB in elderly is strong,but both practices remain prevalent
Bacteriuria in older adults triggers confusion in healthcare providers:A mindful pause to treat the worry #IDTwitter https://t.co/7ispdtFeFB pic.twitter.com/kOB5eGKkAc— Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 (@ABsteward) January 10, 2023
Under a http://creativecommons.org/licenses/by/4.0/ license
Review | Comorbidities, multimorbidity and COVID-19
22 Feb, 2023 | 12:39h | UTCComorbidities, multimorbidity and COVID-19 – Nature Medicine
M-A | Sugar-sweetened beverage consumption and weight gain in children and adults
22 Feb, 2023 | 12:26h | UTC
Bacteremia | ED presentations, evaluation, and management
22 Feb, 2023 | 12:25h | UTCBacteremia: ED Presentations, Evaluation, and Management – emDocs
M-A | Monoclonal antibody for the prevention of respiratory syncytial virus in infants and children
22 Feb, 2023 | 12:24h | UTCCommentary: Study Finds 3 Monoclonal Antibodies Reduce RSV Infections in High-Risk Infants, Children – HCP Live
Commentary on Twitter
Network meta-analysis of 4 monoclonal antibodies for the prevention of RSV in children finds 3 may be useful in preventing RSV; more research to confirm efficacy, safety, and cost effectiveness is needed. https://t.co/wz9yCVAFWo
— JAMA Network Open (@JAMANetworkOpen) February 17, 2023
Prevalence of long-term decision regret and associated risk factors in a large cohort of ICU surrogate decision makers
22 Feb, 2023 | 12:22h | UTC
Commentary on Twitter
One in five #ICU surrogate decision makers experience moderate to strong regret about life support decisions in ICU.
Read the full article: https://t.co/epCXB4QHRY@jlvincen @ISICEM #FOAMed #FOAMcc pic.twitter.com/0Q3X2uFYk0
— Critical Care (@Crit_Care) February 20, 2023