Tuesday, March 31, 2015

NEJM - "Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Infections"

"Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Infections"

"CONCLUSIONS

We found no significant difference between clindamycin and TMP-SMX, with respect to either efficacy or side-effect profile, for the treatment of uncomplicated skin infections, including both cellulitis and abscesses. (Funded by the National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health; ClinicalTrials.gov number, NCT00730028.)" 
http://www.nejm.org/doi/full/10.1056/NEJMoa1403789 

Monday, March 30, 2015

JAMA -

"Antiplatelet Therapy Duration Following Bare Metal or Drug-Eluting Coronary Stents The Dual Antiplatelet Therapy Randomized Clinical Trial"

"Conclusions and Relevance  Among patients undergoing coronary stent placement with BMS and who tolerated 12 months of thienopyridine, continuing thienopyridine for an additional 18 months compared with placebo did not result in statistically significant differences in rates of stent thrombosis, MACCE, or moderate or severe bleeding. However, the BMS subset may have been underpowered to identify such differences, and further trials are suggested."   

https://jama.jamanetwork.com/article.aspx?articleid=2203799

Thursday, March 26, 2015

CIRC - "Antiandrogenic Therapy With Finasteride Attenuates Cardiac Hypertrophy and Left Ventricular Dysfunction"

 "Antiandrogenic Therapy With Finasteride Attenuates Cardiac Hypertrophy and Left Ventricular Dysfunction"

"Conclusions—Finasteride, which is currently used in patients to treat prostate disease, potently reverses pathological cardiac hypertrophy and dysfunction in mice and might be a therapeutic option for heart failure."

http://circ.ahajournals.org/content/131/12/1071.abstract   

Wednesday, March 25, 2015

Lancet - ENGAGE AF-TIMI 48 - Warfarin and Edoxaban

"Genetics and the clinical response to warfarin and edoxaban: findings from the randomised, double-blind ENGAGE AF-TIMI 48 trial"

"Interpretation

CYP2C9 and VKORC1 genotypes identify patients who are more likely to experience early bleeding with warfarin and who derive a greater early safety benefit from edoxaban compared with warfarin.   
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61994-2/abstract 

Tuesday, March 24, 2015

NEJM - "Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults"

"Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults"

"CONCLUSIONS

Among older adults, PCV13 was effective in preventing vaccine-type pneumococcal, bacteremic, and nonbacteremic community-acquired pneumonia and vaccine-type invasive pneumococcal disease but not in preventing community-acquired pneumonia from any cause. (Funded by Pfizer; CAPITA ClinicalTrials.gov number NCT00744263.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1408544?query=featured_home 

Monday, March 23, 2015

JAMA - "Effect of a Balloon-Expandable Intracranial Stent vs Medical Therapy on Risk of Stroke in Patients With Symptomatic Intracranial Stenosis The VISSIT Randomized Clinical Trial"

"Effect of a Balloon-Expandable Intracranial Stent vs Medical Therapy on Risk of Stroke in Patients With Symptomatic Intracranial Stenosis The VISSIT Randomized Clinical Trial"

"Conclusions and Relevance  Among patients with symptomatic intracranial arterial stenosis, the use of a balloon-expandable stent compared with medical therapy resulted in an increased 12-month risk of added stroke or TIA in the same territory, and increased 30-day risk of any stroke or TIA. These findings do not support the use of a balloon-expandable stent for patients with symptomatic intracranial arterial stenosis."


http://jama.jamanetwork.com/article.aspx?articleid=2208809

Thursday, March 19, 2015

JACC - Complete vs Lesion-Only Revascularization in STEMI

"Randomized Trial of Complete Versus Lesion-Only Revascularization in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI and Multivessel Disease The CvLPRIT Trial"

"Conclusions  
In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to confirm this result and specifically address whether this strategy is associated with improved survival. (Complete Versus Lesion-only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605)"

http://content.onlinejacc.org/article.aspx?articleID=2194892

Wednesday, March 18, 2015

BMJ - Methotrexate & Lung Disease Risks

"Methotrexate use and risk of lung disease in psoriasis, psoriatic arthritis, and inflammatory bowel disease: systematic literature review and meta-analysis of randomised controlled trials"

"Conclusions
Findings suggested that there was no increased risk of lung disease in methotrexate treated patients with non-malignant inflammatory diseases. Given the limitations of the study, however, we cannot exclude a small but clinically important risk."  


http://www.bmj.com/content/350/bmj.h1269 

Tuesday, March 17, 2015

NEJM - Transfusion After Cardiac Surgery

"Liberal or Restrictive Transfusion after Cardiac Surgery"

"CONCLUSIONS

A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. (Funded by the National Institute for Health Research Health Technology Assessment program; Current Controlled Trials number,ISRCTN70923932.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1403612?query=featured_home  

Monday, March 16, 2015

JAMA - Trancatheter AVR Outcomes

"Clinical Outcomes at 1 Year Following Transcatheter Aortic Valve Replacement"

"Conclusions and Relevance  Among patients undergoing TAVR in US clinical practice, at 1-year follow-up, overall mortality was 23.7%, the stroke rate was 4.1%, and the rate of the composite outcome of death and stroke was 26.0%. These findings should be helpful in discussions with patients undergoing TAVR."  

http://jama.jamanetwork.com/article.aspx?articleid=2190986 

Wednesday, March 11, 2015

BMJ - BNP Accuracy in HF

"The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting"

"Conclusions At the rule-out thresholds recommended in the 2012 European Society of Cardiology guidelines for heart failure, plasma B type natriuretic peptide, NTproBNP, and MRproANP have excellent ability to exclude acute heart failure. Specificity is variable, and so imaging to confirm a diagnosis of heart failure is required. There is no statistical difference between the diagnostic accuracy of plasma B type natriuretic peptide and NTproBNP. Introduction of natriuretic peptide measurement in the investigation of patients with suspected acute heart failure has the potential to allow rapid and accurate exclusion of the diagnosis."


http://www.bmj.com/content/350/bmj.h910

Tuesday, March 10, 2015

NEJM - Hepatitis E Vaccine

"Long-Term Efficacy of a Hepatitis E Vaccine"

"CONCLUSIONS
Immunization with this hepatitis E vaccine induced antibodies against HEV and provided protection against hepatitis E for up to 4.5 years. (Funded by the Chinese Ministry of Science and Technology and others; ClinicalTrials.gov number, NCT01014845.)"
http://www.nejm.org/doi/full/10.1056/NEJMoa1406011?query=featured_home

Monday, March 9, 2015

JAMA - Benign Thyroid Nodules

"The Natural History of Benign Thyroid Nodules"

"Conclusions and Relevance  Among patients with asymptomatic, sonographically or cytologically benign thyroid nodules, the majority of nodules exhibited no significant size increase during 5 years of follow-up and thyroid cancer was rare. These findings support consideration of revision of current guideline recommendations for follow-up of asymptomatic thyroid nodules."

http://jama.jamanetwork.com/article.aspx?articleid=2174027

Friday, March 6, 2015

2011 IDSA Pneumonia in Infants & Children

"The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America"

http://cid.oxfordjournals.org/content/early/2011/08/30/cid.cir531.full?sid=f62e95e9-9713-4a72-bf19-80b329afed38

Thursday, March 5, 2015

CIRC - Cardiovascular Event Risk

"Metabolite Profiling and Cardiovascular Event Risk"

"Conclusions—Metabolite profiling in large prospective cohorts identified phenylalanine, monounsaturated fatty acids, and polyunsaturated fatty acids as biomarkers for cardiovascular risk. This study substantiates the value of high-throughput metabolomics for biomarker discovery and improved risk assessment."

http://circ.ahajournals.org/content/131/9/774.abstract 

Wednesday, March 4, 2015

Lancet - Vit K Antagonist Reversal

"Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions:"

"Interpretation

4F-PCC is non-inferior and superior to plasma for rapid INR reversal and effective haemostasis in patients needing VKA reversal for urgent surgical or invasive procedures."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61685-8/abstract

Tuesday, March 3, 2015

NEJM - Peanut Allergy Challenge

"Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy"

"CONCLUSIONS
The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00329784.)"



http://www.nejm.org/doi/full/10.1056/NEJMoa1414850

Monday, March 2, 2015

JAMA - NSAID Bleeding Risk with Antithrombotics After MI


"Association of NSAID Use With Risk of Bleeding and Cardiovascular Events in Patients Receiving Antithrombotic Therapy After Myocardial Infarction"

"Conclusions and Relevance  Among patients receiving antithrombotic therapy after MI, the use of NSAIDs was associated with increased risk of bleeding and excess thrombotic events, even after short-term treatment. More research is needed to confirm these findings; however, physicians should exercise appropriate caution when prescribing NSAIDs for patients who have recently experienced MI."  


http://jama.jamanetwork.com/article.aspx?articleid=2130316