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Urgent Updates

POSTED NOVEMBER 26, 2021

ASSOCIATIONS BETWEEN AMBIENT FINE PARTICULATE MATTER AND CHILD RESPIRATORY INFECTION: THE ROLE OF PARTICULATE MATTER SOURCE COMPOSITION IN DHAKA, BANGLADESH.
Short-term increases in ambient air pollution were associated with a rise in the incidence of pneumonia in children, according to a large, community-based study in Bangladesh.
Of 28,089 clinic visits included in this analysis, 17,219 resulted in a pneumonia diagnosis and 10,870 resulted in an upper respiratory infection diagnosis.
Full Access: EuropePMC 

EFFECT OF AMOXICILLIN DOSE AND TREATMENT DURATION ON THE NEED FOR ANTIBIOTIC RE-TREATMENT IN CHILDREN WITH COMMUNITY-ACQUIRED PNEUMONIA - THE CAP-IT RANDOMIZED CLINICAL TRIAL
In this 2 × 2 factorial randomized clinical trial of 814 children requiring amoxicillin for community-acquired pneumonia at hospital discharge, antibiotic re-treatment within 28 days occurred in 12.6% vs 12.4% of those randomized to lower vs higher doses, and in 12.5% vs 12.5% of those randomized to 3-day vs 7-day amoxicillin duration. Among children with community-acquired pneumonia, further outpatient treatment with oral amoxicillin at a dose of 35 to 50 mg/kg per day was noninferior to a dose of 70 to 90 mg/kg per day and 3 days was noninferior to 7 days with regard to the need for later antibiotic re-treatment.
Full Access: JAMA

COVID-19 TIED TO A WIDE RANGE OF ECG FINDINGS
COVID-19 infection has a number of cardiac manifestations that include myocardial infarction, myocarditis and various patterns of changes observed on electrocardiograms. In a new report in Cardiac Electrophysiology Clinics discusses some of the reported ECG changes, such as abnormal QRS axis in nearly 20% of patients, conduction abnormalities in approximately 20%, atrioventricular block in about 2.5%, and premature beats in nearly 10% of patients.
Full Access: Medscape

RISK OF SARS-COV-2 TRANSMISSION FROM ON-FIELD PLAYER CONTACTS IN AMATEUR, YOUTH AND PROFESSIONAL FOOTBALL (SOCCER)
Researchers investigated the risk of transmission among potentially infectious SARS-CoV-2-positive football players while participating in training or matches at amateur, youth and professional levels. Out of 1247 identified football matches and training sessions, 104 cases (38 training sessions, 66 matches) with 165 potentially infectious players were detected. Follow-up PCR testing at the professional level (44 cases) revealed no transmission. Study concludes that on-field transmission risk of SARS-CoV-2 in football is very low.
Full Access: British Journal of Sports Medicine


POSTED NOVEMBER 19, 2021

ASPERGILLOSIS IS COMMON AMONG COVID-19 PATIENTS IN THE ICU
A multinational study published in the CDC journal Emerging Infectious Diseases shows that as many as 15% of patients with COVID-19 who are hospitalized in an intensive care unit (ICU) develop Aspergillus infection. Damage to the lining of airways from severe SARS-CoV-2 infection allows Aspergillus fungi to invade the tissue. These secondary fungal infections can worsen patient outcomes, and they’ve raised concern about emerging evidence of Aspergillus resistance to voriconazole and isavuconazole, the first-line therapies.
Full Access: JAMA

MEDICALLY CHALLENGING CASE SHOWS NSAIDS CAN PROMPT EXERCISE-INDUCED ANAPHYLAXIS
A new medically challenging case presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting reports a situation in which a non-steroidal anti-inflammatory drug (NSAID) caused an anaphylactic reaction in a female runner.
The abstract authors note that NSAIDs are capable of both bringing on allergic responses and heightening the reaction in certain individuals.
Full Access: ACAAI

WORLD AT RISK OF MEASLES OUTBREAKS AS COVID-19 DISRUPTS INFANT SHOTS
The World Health Organization and the U.S. Centers for Disease Control and Prevention warned about the risk of measles outbreaks after more than 22 million infants missed their first vaccine doses during the COVID-19 pandemic in 2020.
Full Access:
 MDEdge

EFFECTS OF KETAMINE VERSUS MIDAZOLAM ON NEUROCOGNITION AT 24 HOURS IN DEPRESSED PATIENTS WITH SUICIDAL IDEATION
Subanesthetic ketamine rapidly reduces depressive symptoms and suicidal ideation in some depressed patients. Blinded ketamine produced rapid improvement in suicidal ideation and mood in comparison to midazolam. Ketamine, relative to midazolam, was also associated with specific improvement in reaction time and interference processing/cognitive control. Overall, ketamine was found to have a positive therapeutic effect on neurocognition 1 day after treatment on at least 1 measure associated with suicidal behavior in the context of depression. Results suggest additional independent therapeutic effects for ketamine in the treatment of depressed patients at risk for suicidal behavior.

Full Access: The Journal of Clinical Psychiatry


POSTED NOVEMBER 12, 2021

COVID VACCINE MAKERS BRACE FOR A VARIANT WORSE THAN DELTA

The possible emergence of an ‘escape variant’, a dominant strain of SARS-CoV-2 that evades the fledgling immunity established through vaccines and previous infections is driving vaccine makers to run dress rehearsals. If an escape variant emerges, RNA vaccine makers such as Pfizer and Moderna could probably design and synthesize an initial prototype jab against it in a few days.
Full Access:
Nature

 

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Heart groups release guidelines designed to help clinicians evaluate source and symptoms of chest pain while improving patient outcomes, reducing health care costs. New guidelines designed to help clinicians evaluate the source and symptoms of chest pain while improving patient outcomes and reducing health care costs.
Full Access: Journal of the American College of Cardiology

 

EFFECT OF EARLY TREATMENT WITH FLUVOXAMINE ON RISK OF EMERGENCY CARE AND HOSPITALISATION AMONG PATIENTS WITH COVID-19: THE TOGETHER RANDOMISED, PLATFORM CLINICAL TRIAL

This placebo-controlled, randomized, adaptive platform trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 showed that the proportion of patients observed in a COVID-19 emergency setting for more than 6 h or transferred to a tertiary hospital due to COVID-19 was lower for the fluvoxamine (100 mg twice daily for 10 days) group compared with placebo. No significant differences in number of treatment emergent adverse events among patients in the fluvoxamine and placebo groups.
Full Access: The Lancet

 

A PILL FOR C DIFFICILE WORKS BY INCREASING MICROBIOME DIVERSITY

An oral treatment with freeze-dried human stool can successfully treat Clostridioides difficile infections by increasing the diversity of microorganisms in the colon, hence restoring natural diversity that has been disrupted by antibiotics. Study showed that after 8 weeks, 74.5% of those given the pills had not had a recurrence, compared with 61.5% of those given the placebo. The difference was just barely statistically significant (P = .0488).
Full Access:
Medscape


POSTED NOVEMBER 5, 2021

MIXING COVID VACCINE BOOSTERS MAY BE BETTER OPTION: STUDY
The new US government preprint study was published recently in medRxiv ahead of peer review, just before a slate of meetings involving vaccine experts that advise the FDA and CDC. The study shows it isn't risky and may even be a good idea to mix, rather than match, COVID-19 vaccines when getting a booster dose. Researchers state that mixing different kinds of vaccines appears to spur the body to make higher levels of virus-blocking antibodies. The study will continue for a year, and the researchers aim to deeply characterize the breadth and depth of the immune response to all nine of the different vaccine combinations included in the study.
Full Access: Medscape

FDA APPROVES NALOXONE INJECTION TO COUNTERACT OPIOID OVERDOSES
FDA has approved ZIMHI (naloxone hydrochloride) injection as an additional option to treat opioid overdose. ZIMHI is administered using a single-dose, prefilled syringe that delivers 5 milligrams (mg) of naloxone hydrochloride solution through intramuscular (in the muscle) or subcutaneous (under the skin) injection. FDA has previously approved injectable naloxone hydrochloride products in 0.4 mg and 2 mg doses under the trade name, NARCAN.
Full Access: FDA

INTERACTIONS OF GUT BACTERIA AND ORAL DRUGS MIGHT HAVE CLINICAL IMPLICATIONS
A new study adds to the evidence that some of drug’s variability (effectiveness and adverse effects) might be due to patients' gut flora. Some bacteria store the drug without chemically modifying it, whereas other bacteria chemically modify it to make it more or less bioactive. A given drug can affect a patient's gut bacteria — their number and their function.
Full Access: NEJM

MODERNA AND J&J COVID-19 VACCINE BOOSTERS: WHAT DOCTORS MUST KNOW
Millions more people in the U.S. will soon be able to receive a booster dose of the COVID-19 vaccines from Moderna and Johnson & Johnson (J&J). This comes almost a month after a booster dose of Pfizer-BioNTech’s COVID-19 vaccine received emergency use authorization (EUA) from the Food and Drug Administration (FDA) and was recommended by Centers for Disease Control and Prevention (CDC). The moderna booster (half a dose) can be administered at least six months after the second shot of the two-dose Moderna COVID-19 vaccine series.

Full Access: AMAPOSTED OCTOBER 22, 2021

POTENTIALLY INAPPROPRIATE MEDICATION PRESCRIBING BY NURSE PRACTITIONERS AND PHYSICIANS
Potentially inappropriate medication (PIM) use is a risk factor for hospitalization and mortality. The rate of visits with a PIM prescription from the same provider was measured, the association of an NP provider with lower odds of receiving a PIM refill was more pronounced in older patients and in those with more comorbidities. NPs prescribed fewer initial PIMs and were less likely to refill a PIM after an outpatient visit than physicians. 
Full Access: Medscape

THE IMPACT OF COMMUNITY MASKING ON COVID-19: A CLUSTER-RANDOMIZED TRIAL IN BANGLADESH
Scientific evidence suggests that face masks can protect against COVID-19. In Bangladesh, researchers and IPA found that a four-part intervention (the “NORM model”) tripled mask usage (a 29- percentage-point increase), and increased physical distancing by 5 percentage points. Further, this increase in mask-wearing reduced symptomatic SARS-CoV-2 infections. This was the first large-scale randomized evaluation to demonstrate the effectiveness of masks in a real-world setting.
Full Access: IPA

NEW SAFETY DATA REGARDING COVID VACCINES
Parsonage-Turner syndrome has been highlighted as a potential adverse effect of mRNA COVID vaccines in a recent pharmacovigilance monitoring reports from the French National Agency for the Safety of Medicines and Health Products (ANSM). The rare condition is characterized by the sudden onset of severe pain in the shoulder, followed by arm paralysis. Its etiopathogenesis is not well understood, but vaccines, in particular the flu vaccine, have been implicated in some cases.
Full Access: Medscape

FDA CLEARS FIRST MOBILE RAPID TEST FOR CONCUSSION
The US Food and Drug Administration (FDA) has cleared SyncThink's Eye-Sync technology to aid in the diagnosis of mild traumatic brain injury. Eye-Sync is a virtual reality eye-tracking platform that provides objective measurements to aid in the assessment of concussion. The technology uses a series of 60-second eye tracking assessments, neurocognitive batteries, symptom inventories, and standardized patient inventories to identify the type and severity of impairment after concussion. The data study showed that Eye-Sinc had sensitivity greater than 82% and specificity greater than 93%.
Full Access: Medscape

INFECTIONS AND ANTIBIOTICS DURING FETAL LIFE AND CHILDHOOD AND THEIR RELATIONSHIP TO JUVENILE IDIOPATHIC ARTHRITIS: A PROSPECTIVE COHORT STUDY
It has been shown that use of antibiotics is associated with Juvenile Idiopathic Arthritis (JIA) and Rheumatic Arthritis.  Exposure to antibiotics during the periods 1–12 months, 1–3 years and 5–8 years was significantly associated with increased risk for JIA. The odds of developing JIA were three times higher in those exposed to antibiotics during the first 3 years of life compared with those not exposed. The cumulative number of courses of antibiotics was significantly higher during childhood for the individuals who developed JIA.
Full Access: Pediatric Rheumatology

 

POSTED OCTOBER 15, 2021

TRENDS IN OUTPATIENT ANTIBIOTIC PRESCRIPTIONS IN THE UNITED STATES DURING THE COVID-19 PANDEMIC IN 2020
Following the arrival of COVID-19 in the US, there were significant reductions in prescription fills with commonly prescribed outpatient antibiotics. In April, significant reductions in mean monthly fills of the 4 most commonly prescribed outpatient agents (ie, amoxicillin, azithromycin, amoxicillin-clavulanate, doxycycline) persisted throughout 2020. However, significantly higher-than-anticipated mean monthly ciprofloxacin fills in quarter 3 and quarter 4 reversed a 5-year trend of consistent reductions in outpatient ciprofloxacin use. Further studies of antibiotic consumption during the COVID-19 pandemic are needed, with particular attention to drivers and appropriateness of use, regional differences, and antibiotic resistance.
Full Access: JAMA

EFFECT OF A NOVEL MACROPHAGE-REGULATING DRUG ON WOUND HEALING IN PATIENTS WITH DIABETIC FOOT ULCERS. A RANDOMIZED CLINICAL TRIAL
This multicenter, evaluator-blinded, phase 3 randomized clinical trial showed that topical application of ON101 exhibited better healing efficacy than absorbent dressing alone in the treatment of Diabetic Foot Ulcers (DFUs) and showed consistent efficacy among all patients, including those with DFU-related risk factors.
Full Access:
 JAMA

THERAPEUTICS AND COVID-19: LIVING GUIDELINE
WHO updates guidance on monoclonal antibody treatment for COVID-19, recommending a combination of casirivimab and imdevimab (REGEN-COV; Regeneron) for patient with non-severe COVID-19 at high risk for hospitalization and patients with severe or critical COVID-19 who are seronegative. The new update is the fifth revision WHO has made to its guidelines.
Full Access: WHO

RETROSPECTIVE ANALYSIS OF ADULT PATIENTS PRESENTING TO THE ACUTE CARE SETTING REQUESTING PRESCRIPTIONS
In this retrospective, electronic chart review of all adult patients requesting a prescription from a two-site ED and/or an UCC., researchers found that the two most commonly requested categories of medications were opioid analgesics 21.2% and benzodiazepine anxiolytics 11.7% .
Patients who presented to the ED or UCC sought medications with and without street value in almost equal measure. Researchers conclude that a ‘one-size-fits-all’ response to these requests is inappropriate and signals some fault lines within our local healthcare system.
Full Access: Western Journal of Emergency Medicine

 

POSTED OCTOBER 8, 2021

ANTIBIOTICS FOR LOWER RESPIRATORY TRACT INFECTION IN CHILDREN PRESENTING IN PRIMARY CARE IN ENGLAND (ARTIC PC): A DOUBLE-BLIND, RANDOMISED, PLACEBO-CONTROLLED TRIAL
Antibiotics are very commonly prescribed for children presenting with uncomplicated lower respiratory tract infections (LRTIs), but there is little evidence from randomized controlled trials of the effectiveness of antibiotics. No differences were seen for the primary outcome between the treatment groups in the five prespecified clinical subgroups (patients with chest signs, fever, physician rating of unwell, sputum or chest rattle, and short of breath). Unless pneumonia is suspected, clinicians should provide safety-netting advice but not prescribe antibiotics for most children presenting with chest infections.
Full AccessThe Lancet

DRUG COCKTAIL SIGNIFICANTLY REDUCED SEVERE COVID, DEATH IN OUTPATIENTS
A monoclonal antibody combination of casirivimab and imdevimab (REGEN-COV) significantly reduced the risk of COVID-19–related hospitalizations and death from any cause in the phase 3 portion of an adaptive trial of outpatients. Additionally, the randomized trial showed that the combination resolved symptoms and reduced the SARS-CoV-2 viral load more quickly compared with placebo.
Full Access: Medscape

FDA OKAYS NEW ORAL CGRP ANTAGONIST FOR MIGRAINE PREVENTION
The US Food and Drug Administration has approved atogepant (Qulipta), a novel calcitonin gene-related peptide (CGRP) receptor antagonist, for the prevention of episodic migraines. In the ADVANCE trial, there was a reduction of 3.69 migraine days with the 10-mg dose, 3.86 days with the 30-mg dose, and 4.2 days with the 60-mg dose. The data indicated that atogepant has a favorable safety profile, with the most common adverse events associated with treatment were constipation, nausea, and upper respiratory tract infection.
Full Access: Medscape

FDA APPROVES INTRANASAL DHE (TRUDHESA) FOR ACUTE MIGRAINE
The US Food and Drug Administration (FDA) has approved an intranasal dihydroergotamine mesylate 0.725 mg per spray (DHE) for the acute treatment of migraine with or without aura in adults. Some of the most frequently reported adverse events during the study were nasal congestion, nausea, nasal discomfort, abnormal olfactory test results, and vomiting. The outcomes related to efficacy showed that 2 hours after a single dose, 38% of patients reported freedom from pain.
Full Access: Medscape

TWO MORE REPORTS OF FUNCTIONAL NEUROLOGICAL DISORDER AFTER COVID-19 VACCINE
Researchers in the United Kingdom report two cases of functional neurological disorder (FND) that occurred in women in their 30s after they received a COVID-19 vaccine. Symptoms of FND include muscle weakness, fatigue, cognitive impairment, dizziness, and impaired gait. They suggest that clinicians consider FND in the differential diagnosis when assessing post-vaccine neurologic symptoms. The researchers stress that FND is treatable, that no brain damage is involved, and that it is not caused by some toxin in the vaccine.
Full Access: Medscape

 

POSTED OCTOBER 1, 2021

INFLUENZA VACCINATION AFTER MYOCARDIAL INFARCTION: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTICENTER TRIAL
Observational and small randomized studies suggest that influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, as well as a lower risk of all-cause death and cardiovascular death at 12 months compared with placebo.
Full Access: AHA

NEW MONOCLONAL ANTIBODIES OFFER HOPE FOR PREVENTING AND TREATING CORONAVIRUS INFECTIONS
Humans face threats from coronaviruses. Two teams report identification of naturally occurring broadly neutralizing antibodies. The antibodies neutralized all tested strains of human and animal coronaviruses in laboratory cultures and offered very strong protection. Neither report describes testing of the antibodies against the Delta variant of SARS-CoV-2, presumably because the studies were conducted before the Delta variant emerged.
Full Access: NJEM

VARIATIONS IN PROCESSES OF CARE AND OUTCOMES FOR HOSPITALIZED GENERAL MEDICINE PATIENTS TREATED BY FEMALE VS MALE PHYSICIANS
Patients who were treated by female physicians had a lower in hospital rate than patients who were treated by male physicians. The in-hospital mortality rate was 4.8% among patients who were cared for by women and 5.2% among those who were cared for by men.
Full Access: JAMA

ANTIPSYCHOTICS TIED TO INCREASED BREAST CANCER RISK
Use of antipsychotics that increase prolactin levels is significantly associated with an increased risk for breast cancer in women with schizophrenia, new research suggests.
Results showed that long-term exposure to prolactin-increasing antipsychotics was associated with a 56% increased risk of developing breast cancer in comparison with exposure of short duration. Full Access: Medscape

 

POSTED SEPTEMBER 24, 2021

ANTIVAXXERS GARGLING WITH THE ANTISEPTIC BETADINE
The idea that gargling with the common antiseptic Betadine will prevent COVID-19 is finding a home in corners of social media, but there’s no evidence it works. Immediate side effects of ingesting any povidone-iodine antiseptic include nausea, vomiting, general weakness, and diarrhea. In severe cases, people can suffer acute renal failure, cardiovascular collapse, liver function impairment, shortness of breath, low blood pressure, and even death.
Full Access: Medscape

CUBA STARTS VACCINATING KIDS AS YOUNG AS 2
Cuba has begun vaccinating children as young as 2 against COVID-19 because of a sharp increase in pediatric infections and deaths caused by the virus
Cuba's regulating agency, gave an emergency use authorization last week for kids 2 to 18 years old to be given two doses of the Soberana 2 vaccine followed by one dose of Soberana Plus booster.
Full Access: Medscape

ANTIBIOTIC USE AND COLON CANCER: MORE EVIDENCE OF LINK
The latest data come from a Swedish population study shows an association between antibiotic use and an increased risk for colon cancer. They found that moderate use of antibiotics increased the risk for proximal colon cancer by 9% and that very high antibiotic use increased the risk by 17%.
Full Access: Medscape

HALLUCINOGENIC MUSHROOM TOXICITY
Hallucinogenic mushroom toxicity is not a new phenomenon. Consumption of hallucinogenic mushrooms continues to be popular today in some settings. Use of hallucinogenic mushrooms rarely results in life-threatening symptoms and symptoms typically are mild to moderate in severity and self-limited. Symptoms of poisoning typically begin 30 minutes to 1 hour after ingestion. Hallucinations may be accompanied by dysarthria, ataxia, and muscle cramps and may persist for as long as 8 hours. Benzodiazepines may be used for sedation and treatment of panic attacks, hallucinations, and seizures.

Full Access: Medscape

 

POSTED SEPTEMBER 10, 2021

THE IMPACT OF CORONAVIRUS DISEASE 2019 (COVID-19) ON HEALTHCARE-ASSOCIATED INFECTIONS IN 2020: A SUMMARY OF DATA REPORTED TO THE NATIONAL HEALTHCARE SAFETY NETWORK
Central–line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. Significant increases in the national Standardize Infection Ratios for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020.
Full Access: Cambridge University

PUBLIC PREFERENCES FOR DELAYED OR IMMEDIATE ANTIBIOTIC PRESCRIPTIONS IN UK PRIMARY CARE: A CHOICE EXPERIMENT
An online choice experiment in 2 UK general population samples: adults and parents of children under 18 years. Respondent preferences were modelled using mixed-effects logistic regression.

This study found that delayed prescription appears to be an acceptable approach to reducing antibiotic consumption. Prescribing choices for sore throat may need additional explanation to ensure patient acceptance, and parents in particular may benefit from reassurance about the usual duration of these illnesses.
Full Access:
Journal Pmed

INTRANASAL CORTICOSTEROIDS ARE ASSOCIATED WITH BETTER OUTCOMES IN CORONAVIRUS DISEASE 2019 (COVID-19)
Using the Cleveland Clinic COVID-19 Research Registry, researchers performed a propensity score matching for treatment with INCS prior to SARS-CoV-2 infection (April 1, 2020 - March 31, 2021). Intranasal Corticosteroids therapy is associated with a lower risk for COVID-19-related hospitalization, ICU admission, or death.
Full Access: The Journal of Allergy and Clinical immunology

THE OTHER EPIDEMIC: VIOLENCE AGAINST HEALTHCARE WORKERS
Violence against healthcare workers is not a new dilemma. Stories abound of patients or family members physically attacking, verbally abusing, or harassing healthcare workers the highest rates of violence are in the emergency department and against less experienced physicians. Despite the level of discord surrounding COVID-19, it is important that healthcare workers remain united.
Full Access: Medscape

 

POSTED SEPTEMBER 3, 2021

ED DOCS ARE CLEANING UP THE MESSES OF MEDICAL TOURISM

Traveling to get the lowest price for surgery procedures has been a rising phenomenon since the early 2000s. Many countries are actively fostering their medical tourism industries, as are states such as Florida. Choosing facilities based on these criteria comes with myriad problems, and the quality of medical care may be lower. Hence increasing risks of complications.
Full Access: MDedge

 

MODERNA COVID-19 VACCINE SAFE, EFFICACIOUS IN ADOLESCENTS

Phase 2/3 data now published in The New England Journal of Medicine showed that the Moderna COVID-19 vaccine was safe and generated strong activity against SARS-CoV-2 in adolescents, with an immune response similar to that of young adults. The researchers recorded no serious adverse events related to the vaccine, and no cases of COVID-19 were reported 2 weeks after participants received the second dose, compared with four cases in the placebo arm.
Full Access: 
Healio

 

AAP UPDATES GUIDANCE FOR RSV AMID OFFSEASON SPIKE IN CASES

Many regions of the country are experiencing numbers of cases of RSV that are similar to a typical winter outbreak. The interim guidance changes the timing — but not the risk categories — for the use of palivizumab prophylaxis in infants at increased risk for severe disease caused by RSV, supporting its administration outside of the typical RSV season, which generally occurs in the fall and winter, according to the AAP. The recommendations do not refer to the upcoming 2021-2022 RSV season.
Full Access:
Healio

 

US PEDIATRIC HOSPITALS IN PERIL AS DELTA HITS CHILDREN

Emerging data from a large study in Canada suggest that children who test positive for COVID-19 during the Delta wave may be more than twice as likely to be hospitalized as they were when previous variants were dominating transmission. The new data support what many pediatric infectious disease experts say they've been seeing: younger kids with more serious symptoms.
Full Access:
Medscape

 

MEDICAL GROUP RELEASES GUIDANCE ON POST-COVID-19 FATIGUE

The American Academy of Physical Medicine and Rehabilitation has released the first clinical guidance on the treatment of post-COVID-19-related fatigue. The fatigue guidance statement includes clinician recommendations on assessing and treating the condition among COVID-19 long-haulers.
Full Access: 
Becker’s Hospital Review

 

POSTED AUGUST 27, 2021

RANDOMISED TRIAL OF IV METOCLOPRAMIDE VS IV KETOROLAC IN TREATMENT OF ACUTE PRIMARY HEADACHES
A large variety of treatment options are available for acute primary headaches. This double-blind, randomized clinical trial study, we demonstrated that IV metoclopramide provided more headache relief but not statistically significant than IV ketorolac in adults patients presented to an ED with acute primary headache.
Full Access: Journal of Emergency Medicine

USE OF INVOLUNTARY EMERGENCY TREATMENT BY PHYSICIANS AND LAW ENFORCEMENT FOR PERSONS WITH HIGH-RISK DRUG USE OR ALCOHOL DEPENDENCE
In this cohort study, we compared the number of public court records of 213 that underwent temporary involuntary commitment secondary to substance use under Section 35 of the Massachusetts General Law. The high proportion of individuals with comorbid mental health diagnoses seen in this cohort suggests that optimal treatment should involve immersive, dual-diagnosis treatment. the findings suggest the need to further explore a multidisciplinary approach to caring for individuals with substance use disorders.
Full Access: JAMA

CONVALESCENT PLASMA DIDN'T HELP HIGH-RISK COVID PATIENTS: NIH
NIH new release that a clinical showed convalescent plasma did not stop the progression of COVID-19 in high-risk patients when given during the first few weeks of their symptoms. Of the 511 people in the study, the disease progressed in 77 (30%) in the COVID-19 plasma group compared with 81 patients (31.9%) in the placebo group. This finding suggests that more effective treatments against this devastating disease should be explored.
Full Access: Medscape

HOW TO PICK THE BEST FACE MASKS FOR KIDS, ACCORDING TO THE EXPERTS
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics recommend masks for kids going back to school. This article provides guidance on selecting masks for kids including 1) N95s are not made to fit kids. They do not come in kid sizes 2) Any masks that gapes around the edges isn't going to work well, no matter how well it filters. Parents need to consider the attributes masks in this order of priority: Comfort: "If your kid won't wear it, it's not helping at all". Fit: "Leaks around the sides are like having a hole in your mask and aerosols carrying the virus can get right through". Filtration: How well the mask blocks small particles. KF94 or KN95 masks, which are being manufactured in China and Korea, are good choices. They offer nearly the same degree of filtration as an N95, and they fit closely to the face, to minimize leaks.
Full AccessMedscape

JOINT STATEMENT FROM HHS PUBLIC HEALTH AND MEDICAL EXPERTS ON COVID-19 BOOSTER SHOTS
Based on latest assessments, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout. For that reason, experts suggest that a booster shot will be needed for American people to maximize vaccine-induced protection and prolong its durability.

Full Access: CDC


POSTED AUGUST 20, 2021

HEART FAILURE DIAGNOSES OFTEN MISSED IN PRIMARY CARE SETTING

Researchers examined commercial insurance claims data and Medicare Advantage data. They found that many patients with heart failure are not diagnosed until they seek care in an acute setting; suggesting that clinicians may need a lower threshold for evaluating patients for heart failure. This may be increasing the use of natriuretic peptide testing among patients with unexplained symptoms given its high sensitivity for identifying heart failure, or arranging for faster follow-up for symptomatic patients diagnosed with alternate conditions to ensure they improve with initial treatment.
Full Access: Medscape

VARIATION OF NATIONAL AND INTERNATIONAL GUIDELINES ON RESPIRATORY PROTECTION FOR HEALTH CARE PROFESSIONALS DURING THE COVID-19 PANDEMIC
Conflicting evidence surrounding SARS-CoV-2 transmission, particularly airborne transmission, may have contributed to heterogeneous recommendations for respiratory protection across countries and organizations. This systematic review discusses 4 strategies regarding the use of respirators: (1) systematic: recommended for care of COVID-19 patients, as in German guidelines; (2) flexible: recommended with use of medical face masks in the absence of available respirators, as in US and ECDC guidelines; (3) unit based, as in UK guidelines; and (4) recommended exclusively during aerosol-generating procedures (AGPs), as in French and WHO guidelines. More evidence is still needed to clearly define what AGPs are and the level of risk associated with different procedures.
Full Access: JAMA

LAMBDA VARIANT SHOWS VACCINE RESISTANCE
The Lambda variant of the coronavirus is highly infectious and more resistant to vaccines (three mutations in Lambda's spike protein help it resist neutralization by vaccine-induced antibodies) than the original version of the virus the emerged from Wuhan, China, Japanese researchers have found. Lambda being labeled a "Variant of Interest" by the World Health Organization.
Full Access: Medscape

A FEW MUTATIONS AWAY': THE THREAT OF A VACCINE-PROOF VARIANT
Since the beginning of the pandemic, a few mutations already have been named, and each one of them gets a little more transmissible. Based on the amount of virus circulating in USA right now “largely among unvaccinated people”, the largest concern that public health and science are worried about is that the virus mutates to a very transmissible form that has the potential to evade our vaccines in terms of how it protects us from severe disease and death.
Full Access: Medscape

MYOCARDITIS FOLLOWING IMMUNIZATION WITH MRNA COVID-19 VACCINES IN MEMBERS OF THE US MILITARY
 In this case series of 23 male patients, including 22 previously healthy military members, myocarditis was identified within 4 days of receipt of a COVID-19 vaccine. Vigilance for rare adverse events, including myocarditis, after COVID-19 vaccination is warranted but should not diminish overall confidence in vaccination during the current pandemic.
Full Access: JAMA

 

POSTED AUGUST 13, 2021

EFFECT OF 7 VS 14 DAYS OF ANTIBIOTIC THERAPY ON RESOLUTION OF SYMPTOMS AMONG AFEBRILE MEN WITH URINARY TRACT INFECTION - A RANDOMIZED CLINICAL TRIAL
Antibiotics are frequently prescribed for UTI without clinical evidence. In this randomized clinical trial that included 272 men with presumed symptomatic UTI, resolution of initial UTI symptoms by 14 days after completion of active antibiotic therapy occurred in 93.1%participants in the 7-day group and 90.2% in the 14-day group, a difference that met the prespecified noninferiority margin of 10%. Researchers concluded that A 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole for presumed, symptomatic UTI in afebrile men was noninferior to 14 days of treatment, a randomized trial showed.

Full Access: JAMA

FLORIDA BREAKS RECORD FOR COVID-19 HOSPITALIZATIONS
According to the U.S. Department of Health & Human Services, The State of Florida had 10,207 people hospitalized with confirmed COVID-19 cases. The previous record was from July 23, 2020, more than a half-year before vaccinations started becoming widespread, when Florida had 10,170 hospitalizations. Additionally, there has been a startling rise in the number of children with the virus at hospitals in Miami, many of them requiring intensive care.

Full Access: Medscape

ISRAEL TO OFFER PFIZER BOOSTER SHOT AGAINST COVID-19 TO THE OVER-60S
Israel will begin offering a third shot of the Pfizer/BioNTech COVID-19 vaccine to people aged over 60, a world first in efforts to slow the spread of the highly contagious Delta variant.

Israel was a world leader in the vaccination rollout, but since the emergence of the Delta variant, the health ministry has twice reported a drop in the vaccine's efficacy against infection and a slight decrease in its protection against severe disease. The booster campaign, with shots administered by health maintenance organizations, will effectively turn Israel into a testing ground for a third dose before approval by the U.S. Food and Drug Administration (FDA).
Full Access: Medscape 

UNTREATABLE, DRUG-RESISTANT FUNGUS FOUND IN TEXAS AND WASHINGTON, DC
The CDC has reported two clusters of Candida auris infections resistant to all anti-fungal medications in long-term care facilities in 2021; because these pan-resistant infections occurred without any exposure to antifungal drugs, the cases are even more worrisome. Candida auris is an emerging, often multidrug-resistant yeast that is highly transmissible, resulting in health care–associated outbreaks.

These clusters are the first time such nosocomial transmission has been detected and reports that colonization of skin with C auris can lead to invasive infections in 5%-10% of affected patients are of great concern.
Full Access:
Medscape

 

FDA OKAYS REGENERON COVID-19 ANTIBODY AS PREVENTIVE IN HIGH-RISK SETTINGS
The US Food and Drug Administration has expanded the emergency use authorization of Regeneron COVID-19 antibody cocktail, enabling its use as a preventive treatment for the illness in certain people. The authorization enables the therapy to be used in people exposed to an infected individual, or who are at high risk of exposure to an infected individual in settings such as nursing homes or prisons. REGEN-COV, a combination of casirivimab and imdevimab, protected household contacts from exposure to SARS-CoV-2, with 72% protection against symptomatic infections in the first week, and 93% after that, according to trial data released by the company in April.
Full Access: Medscape

 

POSTED AUGUST 6, 2021

EFFECT OF ANTIBIOTIC-PRESCRIBING FEEDBACK TO HIGH-VOLUME PRIMARY CARE PHYSICIANS ON NUMBER OF ANTIBIOTIC PRESCRIPTIONS - A RANDOMIZED CLINICAL TRIAL
Antibiotic overuse contributes to adverse drug effects, increased costs, and antimicrobial resistance. This 3-arm randomized clinical trial of 3500 primary care physicians, receipt of a letter targeting appropriate antibiotic durations resulted in a statistically significant 4.8% relative reduction in total antibiotic use.
Full Access: JAMA

VACCINE BREAKTHROUGH CASES RISING WITH DELTA: HERE'S WHAT THAT MEANS
Fully vaccinated people continue to be well protected against severe disease and death, even with Delta, but so-called breakthrough cases, where a person gets infected despite being fully vaccinated, are on the rise. Because of that, many experts continue to advise caution, even if fully vaccinated. After two doses, vaccines prevent symptomatic infection about 79% of the time against Delta, according to data compiled by Public Health England. Vaccines are still highly effective at preventing hospitalization, 96% after two doses.
Full Access: Medscape

HOW INTRANASAL COVID VACCINES COULD BE 'HOLY GRAIL' OF VACCINATION
The seven intranasal COVID-19 vaccines in development could offer two additional layers of protection against SARS-CoV-2 infection. Intranasal vaccines could produce antibodies and attract other components of the immune system to the nose and upper respiratory tract, forming a first line of defense against infection. Additionally, a local response in the nose can be faster than a systemic one, giving SARS-CoV-2 less of a chance to replicate, shed, and be transmitted to others.
Full Access: Medscape

NEW BIOMARKERS FOR TICK-BORNE DISEASE IDENTIFIED
Lyme and other tick-borne infections are notoriously difficult to diagnose. In addition, standard blood tests miss about 40% of tick-borne infections. In research supported by the Lyme Disease Association (LDA demonstrated that the presence of a hazy, white ring of peri-papillary ischemia around the optic nerve — especially in children or adults younger than 60 years who would not be expected to have ischemic changes — is associated with tick-borne infection.  The Visual Evoked Potential (VEP) test presents another diagnostic screening opportunity. Awareness of the new biomarkers will help speed that process for early detection by the optometrist and ophthalmologist.
Full Access:
Healio

 

POSTED JULY 30, 2021

CDC - SEXUALLY TRANSMITTED INFECTIONS TREATMENT GUIDELINES, 2021
On July 23rd, CDC released new guidelines for treatment of STIs. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus.
Full Access: CDC

 

 

AAP ISSUES GUIDANCE ON EVALUATING AND MANAGING FEVER IN INFANTS
This guideline addresses the evaluation and management of well-appearing, term infants, 8 to 60 days of age, with fever ≥38.0°C but appear otherwise healthy. Three algorithms summarize the recommendations for infants 8 to 21 days of age, 22 to 28 days of age, and 29 to 60 days of age. Recommendations emerged that generally relied on clinical appearance, age, urinalysis, WBC (and/or absolute neutrophil count, band count, and/or immature to total neutrophil ratio), and cerebrospinal fluid (CSF) analysis (except for the Rochester criteria, which did not require CSF.
Full Access: AAP

 

ANTIBIOTIC USE IN UK’S COVID-19 PATIENTS OFTEN UNNECESSARY
Study showed that a large portion of patients treated in UK hospitals receive antibiotics that often aren’t necessary.  A meta-analysis had found that roughly 75% of patients hospitalized with COVID-19 received antibiotics even though only 8% actually had a bacterial coinfection.
Full Access:
JAMA

 

WHY ARE TICK-BORNE ILLNESSES INCREASING IN THE U.S.?
Reports have shown that the tick population has expanded in recent years, and the diseases they carry have become more prevalent. Tick-borne illnesses in the U.S. have more than doubled in the past two decades, due to factors such as increased awareness, a growing population, and environmental change. As there are still many unknowns about tick-borne diseases, clinicians and researchers are concerned about the increasing public health threat.
Full Access: Medpage

FDA: JOHNSON & JOHNSON COVID-19 VACCINE TIED TO GUILLAIN-BARRÉ SYNDROME
According to the FDA, in most instances, the symptoms of Guillain Barré syndrome began within 6 weeks of vaccine receipt. However, the agency also said that the chance of this occurring is “very low.” Two studies published in Annals of Neurology cited small clusters “of an unusual variant of Guillain-Barré syndrome” following receipt of a COVID-19 vaccine. The rate of Guillain-Barré syndrome in these clusters was approximately four to 10 times higher than the anticipated baseline frequency.
Full Access: Healio

 

POSTED JULY 23, 2021

ASSOCIATION BETWEEN REMOVAL OF A WARNING AGAINST CEPHALOSPORIN USE IN PATIENTS WITH PENICILLIN ALLERGY AND ANTIBIOTIC PRESCRIBING
Electronic health records often include default alerts that can influence physician selection of antibiotics, which in turn may be associated with a suboptimal choice of agents and increased antibiotic resistance. In this retrospective cohort study of 4 398 792 patients, removal of a warning in the electronic health record to avoid cephalosporin use in patients with penicillin allergies was associated with increased dispensing and administration of cephalosporin. No significant differences in anaphylaxis, new allergies, or treatment failures were found. This simple and rapidly implementable system-level intervention may be useful for improvement in antibiotic stewardship. Full Access: JAMA

TRIPLE VS DUAL INHALER THERAPY AND ASTHMA OUTCOMES IN MODERATE TO SEVERE ASTHMA. A SYSTEMATIC REVIEW AND META-ANALYSIS
In this systematic review and meta-analysis published on May 19th, 2021,  included 20 randomized clinical trials and 11 894 patients (children aged 6 to 18 and adults with moderate to severe asthma), triple therapy (ICS, LABA, and LAMA), compared with dual therapy (ICS plus LABA), was significantly associated with fewer severe asthma exacerbations and modest improvements in asthma control, but no significant difference in quality of life, most adverse events, or mortality.
Full Access: JAMA

INCIDENCE OF CUTANEOUS REACTIONS AFTER MESSENGER RNA COVID-19 VACCINES
In this prospectively study, researchers calculated the number and frequency of self-reported cutaneous reactions using symptom survey respondents by dose as the denominator. Of 49 197 employees who received the first dose of a COVID-19 vaccine, cutaneous reactions were reported by 776 respondents after dose. Rash and itching (other than at the injection site) was the most common cutaneous reaction. Cutaneous reactions were more common in women than men. Of those with self-reported cutaneous reaction to the first dose, 741 (95%) received their second dose. Among the 609 who completed a symptom survey after the second dose, 508 (83%) reported no recurrent cutaneous reactions.
Full Access: JAMA

UPDATES TO THE PEDIATRICS ASTHMA MANAGEMENT GUIDELINES.
The 2020 Focused Updates to the Asthma Management Guidelines are the first revisions since the previous guidelines were released in 2007. The panel relied on systematic reviews conducted by the Agency for Healthcare Research and Quality to address six priority topics: use of fractional exhaled nitric oxide (FeNO), mitigation of indoor allergens, intermittent medication dosing in recurrent wheezing, long-acting muscarinic-antagonists (LAMA) as step-up therapy,
immunotherapy and bronchial thermoplasty. Some of the recommendations include: for children 4 years and older with moderate to severe persistent asthma, the panel now recommends single maintenance and reliever therapy (SMART) using ICS-formoterol for both daily and rescue use instead of either daily dose ICS with reliever SABA or daily ICS-long-acting beta2-agonist (LABA) with reliever SABA. The recommended LABA for is formoterol because of its rapid onset of action and more frequently allowable dosing.
Full Access: AAP

MODERNA BEGINS FIRST STUDY OF MRNA VACCINE FOR FLU
Moderna announced the start of a phase 1/2 study that will evaluate an investigational messenger RNA vaccine for influenza. First participants have been dosed with mRNA-1010, a quadrivalent seasonal influenza vaccine candidate that targets two influenza A (H1N1 and H3N2) and two influenza B (Yamagata and Victoria) viruses. The trial will enroll approximately 180 adults aged 18 years or older. Additionally, Moderna announced earlier this year that it was expanding its mRNA program to also develop vaccines against HIV and Nipah virus.
Full AccessHealio

POSTED JULY 16, 2021

IDSA, SHEA UPDATE GUIDANCE FOR MANAGING PATIENTS WITH C. DIFFICILE
The Infectious Diseases Society of America and The Society for Healthcare Epidemiology of America, or SHEA, have released new guidelines for the management of Clostridioides difficile infection (CDI). These guidelines are intended to be complementary to the recently updated Infectious Disease Society of America (IDSA) and Society of Healthcare Epidemiologists of America (SHEA) guidelines. Some of the recommendations include: Fidaxomicin is preferred over oral vancomycin for first cases of CDI; Fidaxomicin as either continuous or pulse therapy is recommended over oral vancomycin for cases of recurrent CDI; Bezlotoxumab is recommended as additional therapy for CDI that has recurred within 6 months.
Full Access: HEALIO

TRENDS IN RESPIRATORY VIRUS INFECTIONS DURING THE COVID-19 PANDEMIC IN SINGAPORE, 2020.
In this cross-sectional study, data from respiratory virus multiplex polymerase chain reaction tests from 3 major public hospitals in Singapore for 2019 and 2020 were compiled. During reopening, low levels of all viruses were sustained for approximately 13 weeks, but a reemergence of enterovirus/rhinovirus occurred in early September and a less pronounced rebound of adenovirus in mid-October.  For enterovirus/rhinovirus and adenovirus, reductions were only seen after lockdown, and these viruses rebounded earlier than others. Most other viruses remained at historically low levels until the end of the year, despite reopening businesses and schools (with mask wearing) and gradual resumption of activities.
Full Access: JAMA

AN OMINOUS TREND FOR URGENT CARE
Urgent care industry is facing an ominous and pernicious trend. Are we excessively referring injuries, minor fractures, sprains, tendinitis, injections, basic eye injuries, long lacerations, minor head injuries, burns, fingertip injures; instead of treating them ourselves? Unnecessary referrals and overcrowding Emergency Departments will train your community not to come to your Urgent Care. Advancing the specialty is in our hands, and as clinicians, we must provide high quality of care while appropriately treating “bread and butter” Urgent Care cases.
Full Access: JUCM

PEDIATRIC LIFE SUPPORT CLINICAL PRACTICE GUIDELINES (ERC, 2021)
Pediatric Advanced Life Support (PALS) was designed for pediatric healthcare providers at all levels and taught basic approaches to pediatric cardiopulmonary arrest with a heavy emphasis on algorithms. Clinical practice guidelines on pediatric life support were published in April 2021 by the European Resuscitation Council (ERC) in resuscitation.  The ERC guidelines apply to children aged 0-18 years, with the exception of newborn infants. 
Full Access: Medscape

SPERM PARAMETERS BEFORE AND AFTER COVID-19 mRNA VACCINATION
One of the reasons for vaccine hesitancy is the potential negative effect on fertility. This single-center prospective study found that after the second vaccine dose, the median sperm concentration significantly increased to 30 million/mL (IQR, 21.5-40.5; P = .02) and the median total motile sperm count to 44 million (IQR, 27.5-98; P = .001). Semen volume and sperm motility also significantly increased. No man became azoospermic after the vaccine.

Full Access: JAMAPOSTED JULY 9, 2021

DIAGNOSIS AND MANAGEMENT OF HEADACHE - A REVIEW
Headache disorders affect approximately 90% of people during their lifetime. Among primary headache disorders, migraine is most debilitating and can be treated acutely with analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan. Diagnostic testing, including neuroimaging, should be performed for patients who present with headache with abrupt onset, neurologic signs, age ≥50 years, comorbidities including cancer or immunosuppression, or provocation by physical activities or postural changes.
Full Access: JAMA

 

A RANDOMIZED CONTROLLED TRIAL OF IBUPROFEN VERSUS KETOROLAC VERSUS DICLOFENAC FOR ACUTE, NON-RADICULAR LOW BACK PAIN
Study compared ibuprofen, ketorolac, and diclofenac for the treatment of acute, non-radicular Lower Back Pain. Improvements in Roland Morris Disability Questionnaire (RMDQ)

by day 5 were as follows: ibuprofen 9.4, ketorolac 11.9, diclofenac 10.9. There were no important differences between groups with regard to the primary outcome. These data do not rule out that possibility that ketorolac results in better pain relief and less stomach irritation than ibuprofen.
Full Access: Academic Emergency Medicine

ACUTE ISCHEMIC STROKE DURING THE CONVALESCENT PHASE OF ASYMPTOMATIC COVID-2019 INFECTION IN MEN
In this case series of 18 male adults aged 50 years or younger who presented with Acute Ischemic Syndrome during the convalescent phase of an asymptomatic COVID-19 infection confirmed by a positive SARS-CoV-2 serological (antibodies) test result, the median onset of stroke was 2 months after the diagnosis of COVID-19. Acute ischemic stroke could be part of the next wave of complications of COVID-19.
Full Access: JAMA

 

DELTA VARIANT AND COVID-19 VACCINES: WHAT TO KNOW
Health experts are reiterating the importance of getting the COVID-19 vaccine. A preprint study conducted in the United Kingdom finds that one dose of the Pfizer vaccine provided about 33% protection against the Delta variant. In Northern Ireland, the gap between the first and second doses of the AstraZeneca and Pfizer vaccines is being cut to 8 weeks from 10-12 weeks to offer more protection against the Delta variant. Stomach pain, nausea, vomiting, loss of appetite, hearing loss, and joint pain are among the symptoms now being seen in India.
Full Access: MEDSCAPE

 

 

POSTED JULY 2, 2021

PNEUMONIA RISK SOARS IN HEART FAILURE PATIENTS, ESPECIALLY HFPEF
A retrospective analysis of 13,000 patients from two landmark randomized HF trials. Patients with heart failure get pneumonia at a rate almost three times greater than expected increase risk to death to fourfold. The investigators also found that HF patients with preserved ejection fraction (HFpEF) are at the highest risk of developing pneumonia.  Study emphasizes the importance of pneumonia vaccination for patients with HF.
Full Access: MDEDGE

 

PPIS ASSOCIATED WITH GASTRIC CANCER REGARDLESS OF H. PYLORI ERADICATION STATUS
A Korean study suggest that taking proton pump inhibitors (PPIs) is associated with increased risk of developing gastric cancer regardless of Helicobacter pylori eradication status. In addition, researchers found the subset of patients with eradicated chronic H. pylori infection were significantly more likely to develop gastric cancer if they used PPIs for 180 days or more than if they didn't use the medications. Full Access: Medscape

MANAGEMENT OF POST-COVID CONDITIONS
Guidance For Evaluating and Caring for Patients with Post-Covid Conditions was published by CDC on June 12th.  The goal of medical management of post-COVID conditions is to optimize function and quality of life. Healthcare providers should develop a comprehensive management plan based on their patients’ presenting symptoms, underlying medical and psychiatric conditions, personal and social situations, and their treatment goals. Evidence indicates that holistic support for the patient throughout their illness course can be beneficial.
Full Access: CDC

 

FDA TO ADD MYOCARDITIS WARNING TO MRNA COVID-19 VACCINES
The Food and Drug Administration is adding a warning to mRNA COVID-19 vaccines’ fact sheets as medical experts continue to investigate cases of heart inflammation, which are rare but are more likely to occur in young men and teen boys. The incidents are more likely to follow the second dose of the Pfizer or Moderna vaccine, with chest pain and other symptoms occurring within several days to a week. The ACIP members delivered a strong endorsement for continuing to vaccinate 12- to 29-year-olds with the Pfizer and Moderna vaccines despite the warning. Myocarditis and pericarditis are much more common with COVID-19, and the risks to the heart from COVID-19 infection can be more severe.
Full Access: MDedge

ISRAEL REINSTATES INDOOR FACE MASK RULE AMID DELTA VARIANT
After coronavirus infections quadrupled this week, The Israeli Health Ministry stated that people should wear masks in all indoor settings except at home. Masks should also be worn in large outdoor gatherings as well. Israel is a highly vaccinated nation, with about 55% of the population having received both doses of the Pfizer/BioNTech vaccine.
Full Access: MEDSCAPE

 
POSTED JUNE 25, 2021

SOME REASSURANCE ON MACROLIDES, OPIOIDS IN PREGNANCY— BUT NOT DEVOID OF FETAL RISK.
Observational studies demonstrated that mothers who used macrolides or prescription opioids in early pregnancy did not seem to have an increased risk of birth defects. The results of this study contradict those of a cohort study published last year, which found a 55% increased of major malformations for pregnant macrolide-users versus penicillin-users. In a separate BMJ study, mothers who used prescription opioids in the first trimester had no increased risk of having a child with a birth defect except oral clefts. Authors suggest that results are reassuring but they do point to this increase in risk for oral clefts, which physicians should communicate to their patients.
Full Access: MEDPAGE TODAY

DELAYED ANTIBIOTIC PRESCRIBING FOR RESPIRATORY TRACT INFECTIONS: INDIVIDUAL PATIENT DATA META-ANALYSIS
Randomized controlled trials an observational cohort studies data allowed comparison between delayed vs no antibiotic prescribing, and delayed vs immediate antibiotic prescribing. Study showed no difference was found in follow up symptom severity for delayed vs immediate antibiotic or delayed vs no antibiotics. Children younger than 5 had a slightly higher follow up symptom severity with delayed antibiotics. Researchers conclude that delayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher risk subgroups.
Full Access: TheBMJ

US FDA GIVES EMERGENCY USE APPROVAL FOR GSK-VIR COVID-19 ANTIBODY DRUG
The U.S. Food and Drug Administration gave an emergency use authorization to the antibody treatment “Sotrovimab” for treating mild-to-moderate COVID-19 in people aged 12 years and older. The European Union's drug regulator backedthe use of Sotrovimab for COVID-19 patients who were at risk of severe disease and do not need supplemental oxygen.
Full Access: Medscape

COVID-19 IMMUNITY COULD LAST FOR YEARS, STUDIES SAY.
Two recent studies indicate that most people who contracted COVID-19, recovered, and then got vaccinated later may not need a booster shot. Additionally, a study published in the journal Nature, found that certain immune cells may survive in the bone marrow of people who were infected and later vaccinated. Those immune cells may create antibodies whenever needed. In another study, published on the bioRxiv pre-print server, researchers found that these memory B cells can grow and strengthen for at least 12 months after an initial infection.
Full Access: Medscape

 
POSTED JUNE 18, 2021
EVALUATION FOR RESUMPTION OF PHYSICAL ACTIVITY/SPORTS ACTIVITY FOR CHILDREN AND ADOLESCENTS WITH COVID-19
AAP issued interim guidance to advise clinicians about the risks and benefits of children returning to athletics after COVID-19 infection. Children or adolescents with positive SARS-CoV-2 who is either asymptomatic or mildly symptomatic (<4 days of fever >100.4°F, <1 week of myalgia, chills, and lethargy) a phone or telemedicine visit is recommended, at a minimum. Clinicians should inquire about chest pain, shortness of breath out of proportion for upper respiratory tract infection, new-onset palpitations, or syncope. Severe COVID-19 symptoms or MIS-C, it is recommended they be restricted from exercise for a minimum of 3 to 6 months and obtain cardiology clearance prior to resuming training or competition. 

ACIP will hold an emergency meeting on June 18 to discuss myocarditis cases and the AAP will be monitoring the meeting closely.
Full Access: AAP

EFFECT OF CLINICAL DECISION SUPPORT ON DIAGNOSTIC IMAGING FOR PEDIATRIC APPENDICITIS A Cluster Randomized Trial
In a cluster randomized trial, researchers studied the effectiveness of an electronic health record–linked clinical decision support intervention, on diagnostic imaging, health care costs, and safety outcomes for patients with suspected appendicitis. Of 17 emergency departments caring for 5940 patients, the clinical decision support tool did not lead to an overall reduction in the use of computed tomography or ultrasonography. In 1 health care system, the clinical support tool was associated with a significant reduction in diagnostic imaging among patients at low or moderate risk of appendicitis. Authors conclude that more research is needed to determine whether clinical decision support tools promote more appropriate imaging in patients with acute abdominal.
Full Access: JAMA

INCREASED INTERSEASONAL RESPIRATORY SYNCYTIAL VIRUS (RSV) ACTIVITY IN PARTS OF THE SOUTHERN UNITED STATES
The Centers for Disease Control and Prevention (CDC) issued a health advisory to notify clinicians and caregivers about increased interseasonal respiratory syncytial virus (RSV) activity across parts of the Southern United States. CDC encourages broader testing for RSV among patients presenting with acute respiratory illness who test negative for SARS-CoV-2; and reminds healthcare personnel, childcare providers, and staff of long-term care facilities to avoid reporting to work while acutely ill – even if they test negative for SARS-CoV-2.
Full Access: CDC

EMERGENCY USE AUTHORIZATION OF REGEN-COV (CASIRIVIMAB AND IMDEVIMAB)
FDA authorizes the use of half-dose (600mg) "Regeneron cocktail" for mild to moderate Covid with high risk for progression to severe covid-19. Additionally, FDA authorized the use of subcutaneous dosing in setting where IV access is not feasible and there may be excessive delay in obtaining it.
Full Access: FDA
MORE EVIDENCE LINKS COVID VACCINES TO RARE CASES OF MYOCARDITIS IN YOUTH
CDC reports that myocarditis and pericarditis is a very rare side effect that primarily strikes young people after vaccination for COVID-19. the side effect seems to be more common in teen boys and young men than in older adults and women and may occur in 16 cases for every 1 million people who got a second dose. The number of events in this age group appears to be above the rate that would be expected for these age groups without vaccines in the picture.
Full Access: MEDSCAPEPOSTED

 

POSTED JUNE 18, 2021

EVALUATION FOR RESUMPTION OF PHYSICAL ACTIVITY/SPORTS ACTIVITY FOR CHILDREN AND ADOLESCENTS WITH COVID-19
AAP issued interim guidance to advise clinicians about the risks and benefits of children returning to athletics after COVID-19 infection. Children or adolescents with positive SARS-CoV-2 who is either asymptomatic or mildly symptomatic (<4 days of fever >100.4°F, <1 week of myalgia, chills, and lethargy) a phone or telemedicine visit is recommended, at a minimum. Clinicians should inquire about chest pain, shortness of breath out of proportion for upper respiratory tract infection, new-onset palpitations, or syncope. Severe COVID-19 symptoms or MIS-C, it is recommended they be restricted from exercise for a minimum of 3 to 6 months and obtain cardiology clearance prior to resuming training or competition.

ACIP will hold an emergency meeting on June 18 to discuss myocarditis cases and the AAP will be monitoring the meeting closely.
Full Access: AAP

EFFECT OF CLINICAL DECISION SUPPORT ON DIAGNOSTIC IMAGING FOR PEDIATRIC APPENDICITIS A Cluster Randomized Trial
In a cluster randomized trial, researchers studied the effectiveness of an electronic health record–linked clinical decision support intervention, on diagnostic imaging, health care costs, and safety outcomes for patients with suspected appendicitis. Of 17 emergency departments caring for 5940 patients, the clinical decision support tool did not lead to an overall reduction in the use of computed tomography or ultrasonography. In 1 health care system, the clinical support tool was associated with a significant reduction in diagnostic imaging among patients at low or moderate risk of appendicitis. Authors conclude that more research is needed to determine whether clinical decision support tools promote more appropriate imaging in patients with acute abdominal.
Full AccessJAMA

INCREASED INTERSEASONAL RESPIRATORY SYNCYTIAL VIRUS (RSV) ACTIVITY IN PARTS OF THE SOUTHERN UNITED STATES
The Centers for Disease Control and Prevention (CDC) issued a health advisory to notify clinicians and caregivers about increased interseasonal respiratory syncytial virus (RSV) activity across parts of the Southern United States. CDC encourages broader testing for RSV among patients presenting with acute respiratory illness who test negative for SARS-CoV-2; and reminds healthcare personnel, childcare providers, and staff of long-term care facilities to avoid reporting to work while acutely ill – even if they test negative for SARS-CoV-2.
Full Access: CDC

EMERGENCY USE AUTHORIZATION OF REGEN-COV (CASIRIVIMAB AND IMDEVIMAB)
FDA authorizes the use of half-dose (600mg) "Regeneron cocktail" for mild to moderate Covid with high risk for progression to severe covid-19. Additionally, FDA authorized the use of subcutaneous dosing in setting where IV access is not feasible and there may be excessive delay in obtaining it.
Full Access: FDA

MORE EVIDENCE LINKS COVID VACCINES TO RARE CASES OF MYOCARDITIS IN YOUTH
CDC reports that myocarditis and pericarditis is a very rare side effect that primarily strikes young people after vaccination for COVID-19. the side effect seems to be more common in teen boys and young men than in older adults and women and may occur in 16 cases for every 1 million people who got a second dose. The number of events in this age group appears to be above the rate that would be expected for these age groups without vaccines in the picture.
Full Access: MEDSCAPE

 

POSTED JUNE 11, 2021

FOR OUTPATIENT DIVERTICULITIS, AMOXICILLIN–CLAVULANATE PREFERABLE TO METRONIDAZOLE PLUS FLUOROQUINOLONE?
In an observational study, researchers analyze the effectiveness and harms of metronidazole-with-fluoroquinolone versus amoxicillin–clavulanate for outpatient diverticulitis. There were no differences in 1-year admission risk, 1-year urgent surgery risk, 3-year elective surgery risk between groups. Authors conclude that treating diverticulitis in the outpatient setting with amoxicillin–clavulanate may reduce the risk for fluoroquinolone-related harms without adversely affecting diverticulitis-specific outcomes.
Full Access: Annals of Internal Medicine

ASSOCIATION BETWEEN THIRD-GENERATION FLUOROQUINOLONES AND ACHILLES TENDON RUPTURE: A SELF-CONTROLLED CASE SERIES ANALYSIS
Researchers used administrative claims data to identify 504 patients with Achilles tendon rupture who had received antibiotic prescriptions. Risk of rupture was not significantly elevated during exposure to third-generation fluoroquinolones (IRR = 1.05; 95% CI, 0.33-3.37) and nonfluoroquinolones. In contrast, risk was significantly elevated during exposure to first- and second-generation fluoroquinolones. Study has some limitations, including the use of an administrative claims database. Article suggests that third-generation fluoroquinolone use was not associated with an increased risk of Achilles tendon rupture. These antibiotics may be a safer option for patients in whom this risk is elevated, such as athletes.
Full Access: Annals of Family Medicine

ASSOCIATION BETWEEN VACCINATION WITH BNT162B2 AND INCIDENCE OF SYMPTOMATIC AND ASYMPTOMATIC SARS-COV-2 INFECTIONS AMONG HEALTH CARE WORKERS
In this retrospective cohort study conducted in Israel that included 6710 health care workers who underwent periodic testing for SARS-CoV-2 with potential exposure. Vaccination with the BNT162b2 vaccine was associated with an adjusted incidence rate ratio of 0.03 for symptomatic infection and 0.14 for asymptomatic infection more than 7 days after the second dose (both statistically significant). Symptomatic SARS-CoV-2 infection occurred in 8 fully vaccinated health care workers. Asymptomatic SARS-CoV-2 infection occurred in 19 fully vaccinated health care workers. Vaccination with 2 doses of the BNT162b2 messenger RNA vaccine was associated with significantly lower incidence rates for both symptomatic and asymptomatic SARS-CoV-2 infection.
Full Access: JAMA

COVID-19 VASCULITIS AND NOVEL VASCULITIS MIMICS
Patients with severe COVID-19 pneumonia can develop cutaneous vasculitis-like lesions and systemic arterial and venous thromboemboli, including cryptogenic strokes and other vasculopathy features. This article highlights how imaging and post-mortem findings from patients with COVID-19 indicate a novel thrombosis in the pulmonary venous territory distal to the alveolar capillary bed, which might represent an unappreciated nidus for systemic microembolism. Necrotic skin lesions were reported in 6% of patients with cutaneous pathology associated with COVID-19 and were associated with older age, increased disease severity, and a 10% higher risk of mortality.
Full Access: The Lancet

 

POSTED JUNE 2, 2021

EFFECT OF ORAL MOXIFLOXACIN VS INTRAVENOUS ERTAPENEM PLUS ORAL LEVOFLOXACIN FOR TREATMENT OF UNCOMPLICATED ACUTE APPENDICITIS

A multicenter randomized clinical trial analyzed the effects of moxifloxacin vs ertapenem in 583 adults with uncomplicated acute appendicitis. Patients were treated with either 7 days of oral moxifloxacin or 2 days intravenous ertapenem followed by 5 days of levofloxacin and metronidazole. Treatment success (discharge from hospital without need for surgery and no recurrent appendicitis within 1 year) occurred in 70.2% who received oral antibiotics alone vs 73.8% of patients who received intravenous followed by oral antibiotics. Patients with acute, uncomplicated appendicitis treated with oral antibiotics alone met the prespecified threshold for treatment success but failed to demonstrate noninferiority relative to systemic antibiotics followed by oral antibiotics.
Full Access: JAMA

REDUCING EXPECTATIONS FOR ANTIBIOTICS IN PATIENTS WITH UPPER RESPIRATORY TRACT INFECTIONS: A PRIMARY CARE RANDOMIZED CONTROLLED TRIAL
Overuse of antibiotics drives the emergence and spread of antimicrobial-resistant organisms, which pose a major threat to public health. A 3-arm randomized controlled trial among patients presenting with Upper Respiratory Tract Infections (URTIs) in New Zealand, compared the effects of viewing 2 brief tablet-based educational presentations, designed to reduce expectations for antibiotics in patients with URTIs. Participants who viewed either the futility or the adverse effects presentation had greater reductions in their expectations to receive antibiotics than the control group. Researchers found that results are in agreement with those of other studies that highlight the impact of patients’ beliefs and expectations on inappropriate antibiotic prescribing.
Full Access: Annals of Family Medicine

HOW TO HELP RUNNERS STEER CLEAR OF INJURY
The Journal of Family Practice published an article for healthcare workers to counsel runners and prevent injuries. More than 60% of runners report overuse injuries annually and these are commonly seeing in Urgent Care settings. Clinicians must accurately diagnose and manage such injuries and counsel patients about how to prevent them. The article includes suggestions like cross-training, replace shoes regularly, use shoes with moderate-to-high (8-12 mm) heel-to-toe drop, don’t discourage running for exercise (as long as it is tolerated) in patients who have osteoarthritis, encourage moderation in running distance and intensity, especially in novice runners, among other recommendations.
Full Access: MDedge

BNT162B2-ELICITED NEUTRALIZATION AGAINST NEW SARS-COV-2 SPIKE VARIANTS
On May 12th, 2021, JAMA reported that recombinant SARS-CoV-2 bearing S genes from the B.1.1.7 variant (South Africa), and the variant first identified in Brazil remained susceptible to BNT162b2 vaccine–elicited serum neutralization, although at a reduced level for the B.1.351 variant.  An inherent limitation of the study is that new SARS-CoV-2 variants continuously emerge, so the set of strains of current concern constantly shifts. Nevertheless, some mutations are of particular interest, because these data show that the newly emerged B.1.526, B.1.429, and B.1.1.7+E484K variants remain susceptible to an important vaccine-elicited immune effector (neutralizing antibody).  Researchers confirm the importance of mass immunization with current, highly effective, authorized vaccines as a central strategy to end the Covid-19 pandemic.
Full Access:  JAMA