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Internal Medicine

A pragmatic approach to the management of menopause

25 May, 2023 | 11:30h | UTC

A pragmatic approach to the management of menopause – Canadian Medical Association Journal

News Release: Managing menopause: Hormone therapy is back – Canadian Medical Association Journal

 

Review | Skin assessments and interventions for maintaining skin integrity in nursing practice

25 May, 2023 | 11:25h | UTC

Skin assessments and interventions for maintaining skin integrity in nursing practice: An umbrella review – International Journal of Nursing Studies

 

2023 Update on sepsis and septic shock in adult patients | Management in the emergency department

25 May, 2023 | 11:26h | UTC

2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department – Journal of Clinical Medicine

 

Review | Exercise training and revascularization in the management of symptomatic peripheral artery disease

25 May, 2023 | 11:23h | UTC

Exercise Training and Revascularization in the Management of Symptomatic Peripheral Artery Disease – JACC: Basic to Translational Science

 

Commentary on Twitter

 

Consensus Statement | Pre-discharge and early post-discharge management of patients hospitalized for acute heart failure

24 May, 2023 | 13:39h | UTC

Pre-discharge and early post-discharge management of patients hospitalized for acute heart failure: a scientific statement by the Heart Failure Association (HFA) of the ESC – European Journal of Heart Failure

 

Consensus Statement | Worsening of chronic heart failure: definition, epidemiology, management and prevention

24 May, 2023 | 13:38h | UTC

Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association (HFA) of the ESC – European Journal of Heart Failure

 

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes

24 May, 2023 | 13:30h | UTC

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes – International Working Group on the Diabetic Foot

 

RCT | Spironolactone enhances acne outcomes and offers a viable alternative to oral antibiotics

24 May, 2023 | 13:27h | UTC

Summary: The SAFA (Spironolactone for Adult Female Acne) trial was a multicenter, phase 3, double-blind, randomized controlled trial in England and Wales and evaluated the efficacy of spironolactone for treating adult women with acne vulgaris. A total of 410 women, aged ≥18 years and suffering from facial acne for a minimum of six months, were randomly assigned to receive either 50 mg/day of spironolactone or a placebo, increasing to 100 mg/day until week 24.

The primary outcome was measured by the Acne-Specific Quality of Life (Acne-QoL) symptom subscale score at week 12 and 24. The trial demonstrated that spironolactone improved Acne-QoL scores more effectively than the placebo, particularly at week 24. Additionally, more participants in the spironolactone group reported acne improvement, and treatment success was significantly higher in this group at week 12. Mild side effects, notably headaches, were more common in the spironolactone group.

The findings from the SAFA trial highlight spironolactone’s effectiveness, safety, and tolerability in treating adult women with acne vulgaris, suggesting it is a viable alternative to long-term antibiotic treatments. Future research is proposed on higher initial dosages of spironolactone, and its effects on different subgroups like patients with different ages, body mass index, and ethnicity.

Article: Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial – The BMJ

Editorial: What do we know about prescribing spironolactone for acne? – The BMJ

News Release: Non-antibiotic treatment for women with persistent acne shown to be effective – University of Southhampton

 

Cohort Study | Ambulatory blood pressure more predictive of mortality than clinic blood pressure

24 May, 2023 | 13:19h | UTC

Summary: This cohort study analyzed the relationship between clinic and ambulatory blood pressure with mortality. The study utilized data from March 2004 to December 2014, sourced from the Spanish Ambulatory Blood Pressure Registry, which included 59,124 patients from 223 primary care centers across all regions of Spain. Patients were monitored until their date of death or until December 31, 2019.

During a median follow-up of 9.7 years, 7174 (12.1%) patients died, including 2361 (4.0%) due to cardiovascular causes. Findings revealed J-shaped associations for several blood pressure measures. Notably, 24-hour systolic blood pressure had a stronger association with all-cause death (HR 1.41 per 1 SD increment [95% CI 1.36–1.47]) than clinic systolic blood pressure. When adjusted for clinic blood pressure, the association between 24-hour blood pressure and all-cause death remained strong (HR 1.43 [95% CI 1.37–1.49]). Night-time systolic blood pressure was found to be the most predictive of all-cause and cardiovascular death.

The findings imply that ambulatory blood pressure, particularly night-time blood pressure, is more informative about the risk of all-cause death and cardiovascular death than clinic blood pressure. Masked hypertension and sustained hypertension were associated with increased mortality risks, but not white-coat hypertension. These results emphasize the importance of ambulatory blood pressure monitoring in hypertension management and risk prediction. Future research should focus on potential causes and strategies to control night-time blood pressure effectively, considering its substantial association with death risk.

Article: Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients – The Lancet

Commentary: Tight Link Between Ambulatory BP and Mortality Affirmed in Revamped Analysis – TCTMD

 

Guideline for the diagnosis and management of eosinophilic granulomatosis with polyangiitis

24 May, 2023 | 13:16h | UTC

Evidence-Based Guideline for the diagnosis and management of eosinophilic granulomatosis with polyangiitis – Nature Reviews Rheumatology (if the link is paywalled, try this one)

Related: 2022 ACR/EULAR Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis.

 

Commentary on Twitter

 

Consensus Statement | Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit

24 May, 2023 | 13:15h | UTC

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement – Journal of Anesthesia, Analgesia and Critical Care

 

Review | Update in musculoskeletal pain in older adults with a focus on osteoarthritis-related pain

24 May, 2023 | 13:09h | UTC

Clin-STAR corner: 2021 update in musculoskeletal pain in older adults with a focus on osteoarthritis-related pain – Journal of the American Geriatrics Society

 

Review | Glycemic management in people with diabetes on peritoneal dialysis

24 May, 2023 | 13:04h | UTC

Narrative Review of Glycemic Management in People With Diabetes on Peritoneal Dialysis – Kidney International Reports

 

Commentary on Twitter (thread – click for more)

 

Cluster RCT | Single-dose rifapentine reduces 4-year leprosy incidence in household contacts

23 May, 2023 | 13:09h | UTC

Single-Dose Rifapentine in Household Contacts of Patients with Leprosy – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary:

Tuberculosis drug shows protective effect against leprosy – CIDRAP

Study: Giving an antibiotic to household contacts of people with leprosy slashes chances of spread – STAT

 

Opinion Video | Questioning the reliability of nutrition science

23 May, 2023 | 13:02h | UTC

Nutrition science is entirely unreliable | Don’t trust the New York Times Well section – By Dr Vinay Prasad

 

RCT | Tonsillectomy shown to be clinically and cost-effective in adults with recurrent acute tonsillitis

23 May, 2023 | 13:06h | UTC

Summary: The NATTINA trial, a pragmatic multicentre, open-label, randomized controlled study, sought to compare the clinical and cost-effectiveness of conservative management versus tonsillectomy in adults with recurrent acute tonsillitis. Conducted across 27 UK hospitals, 453 participants aged 16 or older were randomly assigned to either undergo immediate tonsillectomy or receive standard non-surgical care.

The main finding was that participants in the immediate tonsillectomy group had fewer days of sore throat over a 24-month period than those in the conservative management group (median 23 vs. 30 days). After adjusting for site and baseline severity, the incident rate ratio of total sore throat days in the immediate tonsillectomy group was significantly lower than in the conservative management group (0.53, 95% CI 0.43 to 0.65, p < 0.0001). The most common adverse event related to tonsillectomy was bleeding, which occurred in 19% of participants.

The NATTINA trial is the largest to date assessing the clinical and cost-effectiveness of tonsillectomy in adults. The results indicate that immediate tonsillectomy is clinically effective and cost-effective for recurrent acute tonsillitis. However, patients should weigh the benefits of fewer sore throat days against the risks of surgery.

Article: Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial – The Lancet

News Release: Tonsillectomy both clinically and cost effective for adults – Newcastle University

 

Commentary on Twitter

 

Ventilator associated tracheobronchitis and pneumonia: one infection with two faces

23 May, 2023 | 12:49h | UTC

Ventilator associated tracheobronchitis and pneumonia: one infection with two faces – Intensive Care Medicine

 

M-A | Risk and benefits of wakefulness-promoting drugs in obstructive sleep apnea patients

23 May, 2023 | 12:43h | UTC

Comparative Efficacy and Safety of Wakefulness-Promoting Agents for Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea: Systematic Review and Network Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Researchers find best treatment for excessive daytime sleepiness – McMaster University

Commentary: Multiple agents effective for excessive daytime sleepiness but may be discontinued due to side effects, review finds – ACP Internist

 

USPSTF Draft Statement recommends biennial screening mammography for women ages 40 to 74 years

22 May, 2023 | 13:56h | UTC

Breast Cancer: Screening – U.S. Preventive Services Task Force

Critical perspectives on the statement:

Earlier screening for breast cancer: Benefits and harms – Lown Institute

Video: Mammography – Does it save lives? | The USPSTF is incorrect | I review ALL the data – By Dr. Vinay Prasad

Why more mammograms aren’t the solution to breast cancer – Vox

 

AGA/ACG Guideline | Pharmacological management of chronic idiopathic constipation

22 May, 2023 | 13:53h | UTC

American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation – American Journal of Gastroenterology

 

Global variations in heart failure etiology, management, and outcomes

22 May, 2023 | 13:50h | UTC

Global Variations in Heart Failure Etiology, Management, and Outcomes – JAMA (free for a limited period)

Author Interview: Global Trends in Heart Failure Etiology, Management, and Outcomes

News Release: Heart failure deadly and under-treated in most countries, says a study in 40 countries – McMaster University

 

Commentary on Twitter

 

RCT | Remote pulmonary artery monitoring may improve QoL, reduce hospitalizations in symptomatic (NYHA III) heart failure

22 May, 2023 | 13:47h | UTC

Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial – The Lancet (link to abstract – $ for full-text)

News Release: Remote monitoring reduces heart failure hospitalisations and improves quality of life – European Society of Cardiology

Commentary: CardioMEMS Beats Standard Care in First European RCT: MONITOR-HF – TCTMD

 

Commentary on Twitter

 

RCT | Apixaban fails to match warfarin in preventing valve thrombosis in On-X mechanical heart valve patients

22 May, 2023 | 13:44h | UTC

Apixaban or Warfarin in Patients with an On-X Mechanical Aortic Valve – NEJM Evidence

Commentary: Apixaban or Warfarin in Patients With On-X Mechanical Aortic Valve – American College of Cardiology

 

Commentary on Twitter

 

Underdiagnosis of primary aldosteronism: a review of screening and detection

22 May, 2023 | 13:40h | UTC

Underdiagnosis of Primary Aldosteronism: A Review of Screening and Detection – American Journal of Kidney Diseases

 

Commentary on Twitter

 

Drug-induced abnormal involuntary movements: prevalence and treatment

22 May, 2023 | 13:30h | UTC

Drug-Induced Abnormal Involuntary Movements: Prevalence and Treatment – Primary care companion to CNS disorders

 

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