Internal Medicine
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
Scanxiety among adults with cancer: a scoping review to guide research and interventions
14 Mar, 2023 | 13:55h | UTCSummary: The article presents a scoping review of existing literature on scanxiety, which refers to the anxiety and distress experienced by cancer patients before and after medical imaging scans. The authors identified and synthesized findings from 36 articles on scanxiety among adults diagnosed with current or prior cancer.
The authors observed that scanxiety is a prevalent issue throughout the cancer continuum and may be linked to various factors related to the procedure itself or the uncertainty surrounding the possible outcomes of the scans.
The waiting period between the scan procedure and receipt of the results was described as particularly stressful, with participants reporting feeling overwhelmed by negative thoughts and fears about the potential outcomes of the scan. Some participants even found it difficult to focus on daily activities or responsibilities during this time.
The authors suggest that implementing supportive measures during scan experiences, including examining the waiting period between scans and scan results, could enhance the well-being for individuals with cancer who are going through different stages of treatment.
Article: Scanxiety among Adults with Cancer: A Scoping Review to Guide Research and Interventions – Cancers
SR | Environmental interventions can reduce falls in high-risk older adults
14 Mar, 2023 | 13:58h | UTCSummary: Falls and fall-related injuries are common among older adults and can have serious consequences, such as restricting activity or institutionalization. The Cochrane review aimed to assess the effects of environmental interventions, such as fall-hazard reduction, assistive technology, home modifications, and education, on preventing falls in older adults living in the community.
The review included 22 randomized controlled trials from 10 countries involving 8,463 community-residing older people. The study found that home fall-hazard interventions, which involve evaluating potential fall hazards and implementing safety adaptations or behavioral strategies, can reduce the rate of falls by 26% and the number of people who experience one or more falls by 11% in people at a higher risk of falling.
On the other hand, the study did not find any evidence of a decrease in the rate of falls when the interventions were not targeted toward individuals at higher risk. Additionally, the study suggests that these interventions are unlikely to have a significant impact on health-related quality of life, and there may be little or no difference in the risk of fall-related fractures, hospitalizations due to falls, or the rate of falls that require medical attention.
Summary: Reducing fall hazards within the environment – Cochrane Library
Commentary: Preventing falls in older people: new evidence on what helps – Evidently Cochrane
M-A | Ionizing radiation and cardiovascular disease
14 Mar, 2023 | 13:49h | UTCIonising radiation and cardiovascular disease: systematic review and meta-analysis – The BMJ
News Release: Low dose radiation linked to increased lifetime risk of heart disease – BMJ Newsroom
Review | Orthostatic tachycardia after covid-19
14 Mar, 2023 | 13:48h | UTCOrthostatic tachycardia after covid-19 – The BMJ
Commentary: Key steps for diagnosis and management of orthostatic tachycardia after COVID-19 – News Medical
Mortality rates and clinical manifestations of severe hypothyroidism in the ICU: a French multicenter cohort study
14 Mar, 2023 | 13:44h | UTCSummary: This article presents the findings of a retrospective multicenter cohort study conducted over 18 years in 32 French ICUs to investigate severe hypothyroidism (SH) requiring ICU admission.
The study included 82 patients with SH, with thyroiditis and thyroidectomy being the primary causes, and levothyroxine discontinuation, sepsis, and amiodarone-related hypothyroidism being the most frequent triggers.
Patients with SH presented with various clinical symptoms, including hypothermia, hemodynamic failure, and coma, with in-ICU and 6-month mortality rates being 26% and 39%, respectively. The study also found that patients with hemodynamic and respiratory failure on admission to the ICU had a higher likelihood of mortality.
Levothyroxine replacement was provided to all patients, but the administration route and loading dose varied. The authors recommend early diagnosis, prompt levothyroxine administration, and close monitoring of cardiac and hemodynamic parameters for SH patients admitted to the ICU.
SR | Myocardial revascularization in patients with ischemic cardiomyopathy: for whom and how
14 Mar, 2023 | 13:46h | UTC
Risk factors for Carbapenem-Resistant Enterobacterales infections: a matched case-control study
14 Mar, 2023 | 13:43h | UTCSummary: The study aimed to investigate risk factors for infections caused by carbapenem-resistant Enterobacterales (CRE) and identify variables that increase the probability of CRE infection among admitted patients in hospitals with high CRE incidence.
The study was performed in 50 hospitals in Southern Europe from March 2016 to November 2018 and included patients with complicated urinary tract infection, complicated intraabdominal infection, pneumonia, or bacteremia from other sources due to CRE. Control groups were patients with infection caused by carbapenem-susceptible Enterobacterales and non-infected patients, matched according to the same criteria as the CRE group (type of infection, ward, and duration of hospital admission).
The results showed that the main risk factors for CRE infections were previous colonization with CRE, use of urinary catheters, and exposure to broad-spectrum antibiotics.
The study’s findings offer evidence to inform decisions about preventive measures and empirical treatment for patients with suspected CRE infections. Additionally, the study can guide the efficient design of future randomized trials focusing on high-risk patients.
Related:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
Review | Pathogenesis, epidemiology and control of Group A Streptococcus infection
14 Mar, 2023 | 13:38h | UTC
Commentary on Twitter
NEW??Pathogenesis, epidemiology and control of Group A Streptococcus infectionhttps://t.co/XFSKQrTe1P
Brouwer & co. summarize the epidemiological and clinical features of Group A Streptococcus infection, and the molecular mechanisms of GAS virulence and drug resistance. pic.twitter.com/qm23YgnKlg
— Nature Reviews Microbiology (@NatureRevMicro) March 10, 2023
Podcast and Brief Review | TIA/Stroke pearls for the hospitalist
14 Mar, 2023 | 13:36h | UTC#385 TIA/Stroke for the Hospitalist featuring Dr. Karima Benameur – The Curbsiders