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SR | Drivers of emergency department use among oncology patients in the era of novel cancer therapeutics

30 Jun, 2023 | 14:35h | UTC

Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review – The Oncologist

 


Global incidence in hospital-associated infections resistant to antibiotics: an analysis of point prevalence surveys from 99 countries

30 Jun, 2023 | 14:33h | UTC

Global incidence in hospital-associated infections resistant to antibiotics: An analysis of point prevalence surveys from 99 countries – PLOS Medicine

 


Update on transfusion-related acute lung injury: an overview of its pathogenesis and management

30 Jun, 2023 | 14:31h | UTC

Update on transfusion-related acute lung injury: an overview of its pathogenesis and management – Frontiers in Immunology

 


AHA Scientific Statement | Considerations on the management of acute postoperative ischemia after cardiac surgery

29 Jun, 2023 | 14:07h | UTC

Considerations on the Management of Acute Postoperative Ischemia After Cardiac Surgery: A Scientific Statement From the American Heart Association – Circulation

 


Post hoc analysis | Low-dose aspirin linked to increased risk of anemia in older adults

29 Jun, 2023 | 14:06h | UTC

Summary: In a post hoc analysis of the ASPREE randomized controlled trial, the impact of daily low-dose aspirin on anemia, hemoglobin, and serum ferritin concentrations in elderly individuals was investigated. The study included 19,114 community-dwelling individuals aged 70 years and older (or ≥65 years for Black and Hispanic individuals) from Australia and the United States.

Findings reveal an increased incidence of anemia in the aspirin group compared to the placebo group (51.2 events versus 42.9 events per 1000 person-years, respectively). This correlates to a 20% increase in risk (hazard ratio, 1.20 [95% CI, 1.12 to 1.29]). Hemoglobin concentrations displayed a more pronounced decline in the aspirin group by 0.6 g/L per 5 years. Additionally, among participants with ferritin measures, the aspirin group exhibited a greater prevalence of ferritin levels less than 45 µg/L at year 3 and overall decline in ferritin by 11.5%. The study found similar results even in the absence of major bleeding.

This research underscores the risk of anemia and decline in ferritin in otherwise healthy older adults taking low-dose aspirin, highlighting the need for periodic monitoring of hemoglobin levels. However, the study lacked data on the causes of anemia, indicating the need for further research.

Article: Effect of Low-Dose Aspirin Versus Placebo on Incidence of Anemia in the Elderly: A Secondary Analysis of the Aspirin in Reducing Events in the Elderly Trial – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Low-dose aspirin may increase anaemia risk in healthy older adults: study – Monash University

Commentaries:

Aspirin Use Ups Risk of Anemia in Elderly Patients: ASPREE – TCTMD

Low-dose aspirin associated with 20% increase in risk of anemia among older adults – ACP Internist

Original Study: Effect of Aspirin on All-Cause Mortality in the Healthy Elderly – New England Journal of Medicine

 


Review | Breathing difficulties after covid-19: a guide for primary care

29 Jun, 2023 | 14:04h | UTC

Breathing difficulties after covid-19: a guide for primary care – The BMJ

 


M-A | Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery

29 Jun, 2023 | 14:03h | UTC

Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery: a systematic review, meta-analysis and trial sequential analysis – Anaesthesia

 


Clinical Trial Update | Equal long-term health and survival from restrictive vs. standard IV fluid therapy in septic shock patients

29 Jun, 2023 | 14:01h | UTC

Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock – Intensive Care Medicine

Original Study: RCT: A restrictive intravenous fluid strategy does not improve outcomes in ICU patients with septic shock.

 


Guidance on fecal immunochemical testing to help diagnose colorectal cancer among symptomatic patients in primary care

29 Jun, 2023 | 13:59h | UTC

Guidance on faecal immunochemical testing (FIT) to help diagnose colorectal cancer among symptomatic patients in primary care – British Journal of General Practice

Related: Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG) – Gut

 


RCT | Intravitreal therapy for uveitic macular edema—ranibizumab versus methotrexate versus the dexamethasone implant

29 Jun, 2023 | 13:57h | UTC

Intravitreal Therapy for Uveitic Macular Edema—Ranibizumab versus Methotrexate versus the Dexamethasone Implant – Ophthalmology (link to abstract – $ for full-text)

News Release: Intraocular corticosteroids best for treating complications of chronic inflammatory eye condition – National Institutes of Health

 


RCT | Acupuncture, doxylamine–pyridoxine, and their combination in nausea treatment during pregnancy

29 Jun, 2023 | 13:56h | UTC

Acupuncture and Doxylamine–Pyridoxine for Nausea and Vomiting in Pregnancy: A Randomized, Controlled, 2 × 2 Factorial Trial – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Acupuncture and doxylamine-pyridoxine beneficial for moderate to severe nausea and vomiting during pregnancy: Study – American College of Physicians

Commentary: Combo treatment eases nausea and vomiting of pregnancy – MDedge

 


Consensus Paper | Care for older forensic mental health patients

29 Jun, 2023 | 13:54h | UTC

Care for older forensic mental health patients: A consensus guidance document – European Psychiatry

 


FIGO staging of endometrial cancer: 2023

29 Jun, 2023 | 13:53h | UTC

FIGO staging of endometrial cancer: 2023 – Gynecology & Obstetrics

 


Review | Silent cerebral lesions following catheter ablation for atrial fibrillation

29 Jun, 2023 | 13:51h | UTC

Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review – EP Europace

 

Commentary on Twitter

 


Liver Transplantation 2023 | Status report, current and future challenges

29 Jun, 2023 | 13:50h | UTC

Liver Transplantation 2023: Status Report, Current and Future Challenges – Clinical Gastroenterology and Hepatology

 


SR | Anti‐vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy

29 Jun, 2023 | 13:49h | UTC

Anti‐vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy – Cochrane Library

 


RCT | Arthroscopic capsular shift surgery shows no significant pain or functional improvement in atraumatic shoulder instability

29 Jun, 2023 | 13:45h | UTC

Arthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomised, placebo-controlled trial – British Journal of Sports Medicine (link to abstract – $ for full-text)

 


Phase 2 RCT | Triple-hormone-receptor (GIP, GLP-1, and glucagon) agonist Retatrutide substantially reduces body weight in obesity

28 Jun, 2023 | 13:23h | UTC

Summary: This Phase 2, double-blind, randomized, placebo-controlled trial evaluated the efficacy and safety of Retatrutide, a triple-hormone-receptor agonist of GIP, GLP-1, and glucagon, for obesity treatment. The study recruited 338 adults, predominantly male, with a Body Mass Index (BMI) of 30 or higher, or 27 to 30 with at least one weight-related condition. Participants were administered subcutaneous Retatrutide at varying doses or a placebo, once weekly for 48 weeks.

The findings indicate a dose-dependent weight loss efficacy for Retatrutide. At 24 weeks, Retatrutide users exhibited a mean body weight decrease ranging from 7.2% (1 mg dose) to 17.5% (12 mg dose), compared to a 1.6% reduction in the placebo group. This effect was even more pronounced at 48 weeks, with changes ranging from 8.7% (1 mg dose) to a striking 24.2% (12 mg dose), contrasted with a 2.1% reduction in the placebo group. Adverse events, primarily gastrointestinal, were common with Retatrutide, reported by 73 to 94% of patients, and were dose-related.

Retatrutide demonstrated substantial body weight reduction in adults with obesity, with a side effects profile similar to existing GLP-1 and GIP–GLP-1 receptor agonists. These promising results warrant further investigation through a Phase 3 trial to further ascertain the safety and efficacy of Retatrutide in obesity treatment.

Article: Triple–Hormone-Receptor Agonist Retatrutide for Obesity — A Phase 2 Trial – New England Journal of Medicine (link to abstract – $ for full-text)

 

Commentary on Twitter

 


Phase 2 RCT | Triple receptor agonist (GIP, GLP-1 and glucagon) Retatrutide shows promising results in obese patients with T2DM

28 Jun, 2023 | 13:21h | UTC

Summary: A Phase 2 Randomized Clinical Trial (RCT) was conducted to investigate the efficacy and safety of Retatrutide, a glucose-dependent insulinotropic polypeptide (GIP), GLP-1, and glucagon receptor agonist, in patients with type 2 diabetes. The study involved 281 adults aged between 18 and 75 years with type 2 diabetes. These patients, with a mean HbA1c level of 8·3%, a mean BMI of 35·0 kg/m², and a mean body weight of 98·2 kg, were randomized to Retatrutide at various doses, Dulaglutide 1.5 mg, and placebo. Patients were treated with diet and exercise alone or a stable dose of metformin for at least three months prior to the study.

The primary outcomes revealed that at 24 weeks, participants who received the higher doses of Retatrutide demonstrated substantial improvements in HbA1c compared to the placebo group and those who received Dulaglutide. Specifically, for the highest-dose Retatrutide group (12 mg), HbA1c level was reduced by an average of 2.02%, which was significantly greater compared to a reduction of 0.01% in the placebo group and 1.41% in the Dulaglutide group.

Regarding body weight, at 36 weeks, participants receiving the different doses of Retatrutide showed a dose-dependent decrease: 3.19% for the 0.5 mg group, 7.92% for the 4 mg escalation group, 10.37% for the 4 mg group, 16.81% for the 8 mg slow escalation group, 16.34% for the 8 mg fast escalation group, and 16.94% for the 12 mg escalation group. This was significantly higher compared to the 3.00% weight loss in the placebo group and the 2.02% loss with 1.5 mg Dulaglutide.

Mild-to-moderate gastrointestinal adverse events were reported among 35% of the participants in the Retatrutide groups, similar to those in the Dulaglutide group, and no severe hypoglycemia or deaths were reported.

The implications of these findings suggest that Retatrutide provides clinically meaningful improvements in glycaemic control and bodyweight reduction with a safety profile consistent with GLP-1 receptor agonists and GIP and GLP-1 receptor agonists. Limitations of the study include limitation of this study is the relatively short duration of the trial and small sample size. Long-term effects and safety of Retatrutide remain to be evaluated in further studies.

Article: Retatrutide, a GIP, GLP-1 and glucagon receptor agonist, for people with type 2 diabetes: a randomised, double-blind, placebo and active-controlled, parallel-group, phase 2 trial conducted in the USA – The Lancet (link to abstract – $ for full-text)

 


RCT | Bulevirtide reduces HDV RNA and ALT levels in chronic hepatitis D patients

28 Jun, 2023 | 13:20h | UTC

Summary: This randomized phase 3 trial evaluated the efficacy of bulevirtide, an inhibitor of HDV entry into hepatocytes, in patients with chronic hepatitis D. Patients were randomized to receive either 2 mg or 10 mg of bulevirtide daily for 144 weeks, or no treatment for 48 weeks followed by 10 mg bulevirtide daily for 96 weeks. The study involved 150 patients, 49 in the 2-mg group, 50 in the 10-mg group, and 51 in the control group.

After 48 weeks of treatment, 45% and 48% of patients in the 2-mg and 10-mg groups respectively achieved the primary end point of undetectable HDV RNA level or a decrease of at least 2 log10 IU per milliliter from baseline, and normalization of ALT level. Only 2% in the control group reached the primary endpoint. ALT levels normalized in 51% and 56% of patients in the 2-mg and 10-mg groups respectively, a significant difference from the 12% normalization in the control group. Notably, loss of HBsAg did not occur by week 48 in the bulevirtide groups. No serious adverse events related to the treatment were reported, though side effects including headache, pruritus, and fatigue were more common in the bulevirtide groups.

These results demonstrate the effectiveness of bulevirtide in reducing HDV RNA and ALT levels in patients with chronic hepatitis D. However, the absence of HBsAg loss in bulevirtide groups raises questions about its long-term implications.

Article: A Phase 3, Randomized Trial of Bulevirtide in Chronic Hepatitis D – New England Journal of Medicine (link to abstract – $ for full-text)

 

Commentary on Twitter

 


Perspective | Psychedelic treatments for mental health conditions pose challenges for informed consent

28 Jun, 2023 | 13:17h | UTC

Psychedelic treatments for mental health conditions pose challenges for informed consent – Nature Medicine

 


Perspective | Ensuring ethical postprogression therapy for patients in randomized trial control arms

28 Jun, 2023 | 13:16h | UTC

Ensuring Ethical Postprogression Therapy for Patients in Randomized Trial Control Arms – Journal of Clinical Oncology

 

Commentary on Twitter

 


Cohort Study | Younger adults with modest kidney function reductions show increased risk of adverse outcomes

28 Jun, 2023 | 13:14h | UTC

Summary: This study was a retrospective, population-based cohort study exploring the implications of modest reductions in estimated glomerular filtration rate (eGFR) in young adults. The study was conducted on 8.7 million adult residents aged 18-65 years in Ontario, Canada, with no history of kidney disease. Data was collected from January 2008 to March 2021.

The research revealed that 18.0% of those aged 18-39, 18.8% of those aged 40-49, and 17.0% of those aged 50-65 had modestly reduced eGFR measurements specific to their age group. Adverse outcomes, including all-cause mortality, cardiovascular events, and kidney failure, were consistently higher by hazard ratio and incidence for ages 18-39 across all eGFR categories, compared to older groups. The hazard ratio for modest reductions (eGFR 70-80 mL/min/1.73m2) was found to be 1.42 for ages 18-39 years.

The findings suggest that even modest reductions in kidney function can significantly impact younger adults, necessitating frequent monitoring of kidney function in this demographic to prevent chronic kidney disease and its complications. It is noteworthy, however, that potential limitations of this study include possible misclassification of comorbidities, unmeasured confounding, and a lack of insight into the mechanism of these modest eGFR reductions.

Article: Associations between modest reductions in kidney function and adverse outcomes in young adults: retrospective, population based cohort study – The BMJ

News Release: Even a modest reduction in kidney function increases health risks in young adults – University of Ottawa

 


RCT | Total breast reconstruction with autologous fat transfer using an expansion device vs implants in patients with breast cancer

28 Jun, 2023 | 13:12h | UTC

Effect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer: A Randomized Clinical Trial – JAMA Surgery (link to abstract – $ for full-text)

See also: Visual Abstract

Author Interview: Effect of Breast Reconstruction With Autologous Fat Transfer vs Implants on Quality of Life – JAMA

 


Podcast | Antiplatelets, anticoagulation for coronary artery disease and atrial fibrillation

28 Jun, 2023 | 13:11h | UTC

#400 Antiplatelets, Anticoagulation for Coronary Artery Disease and Afib – The Curbsiders

 


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