November 2015: Click for Credit

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Topics include: Low-risk prostate cancer • CVD and extremes of sleep • S aureus in pediatric CAP • Sunscreens with DNA repair enzymes • Breastfeeding and postpartum MS relapse • Diabetes and dementia in seniors • Arrhythmia risk in psoriasis • Hepatitis C complications and mortality


Here are 8 articles in the November issue of Clinician Reviews (accreditation valid until January 1, 2016):

1. Low-risk Prostate Cancer: Immediate Contemplation, Not Immediate Intervention
To take the posttest, go to http://bit.ly/1Vz6Cok

Key clinical point:
Men with favorable-risk prostate cancer have a low risk for progression to a lethal phenotype and should consider active surveillance.
Major finding: Of 1,298 men with favorable-risk prostate cancer who were enrolled in an active surveillance program, overall, cancer-specific, and metastasis-free survival rates were 69%, 99.9%, and 99.4%, respectively, at 15 years.
Data source: A follow-up of a cohort of men with favorable-risk prostate cancer receiving active surveillance at a single institution that used a clearly defined protocol for enrollment, monitoring, and intervention.
Disclosures: There were no outside funding sources reported. Some coauthors reported consulting or advisory roles with Metamark Genetics, MDxHealth, Dianon Systems, DAKO, Trock, SonaCare Medical, Myriad Genetics, Rochon Genova, Rothwell Figg, and Roche.

2. Diabetes in Seniors Increases Dementia Risk
To take the posttest, go to http://bit.ly/1Q1bITm

Key clinical point:
Even short-term hyperglycemia in late life can trigger or accelerate cognitive decline, and incident diabetes is a risk factor for dementia after adjustment for differences in cardiovascular disease and other common risk factors.
Major finding: Individuals diagnosed with diabetes later in life have a 16% higher risk for dementia than do those without diabetes.
Data source: A population-based matched cohort study in 225,045 seniors newly diagnosed with diabetes and 668,070 nondiabetic controls.
Disclosures: The Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario, the Canadian Institutes of Health Research, the University of Toronto, and the Ontario Ministry of Health and Long-Term Care supported the study. One author reported an unrestricted grant from Amgen, but there were no other conflicts of interest declared.

3. Extremes of Sleep Linked With Early Signs of CVD
To take the posttest, go to http://bit.ly/1FSvLmw

Key clinical point:
Individuals with very long or short sleep, or poor sleep quality, showed signs of early cardiovascular disease.
Major finding: Extremely short and extremely long sleep duration were associated with significantly increased levels of coronary artery calcification (CAC) and increased brachial-ankle pulse wave velocity (baPWV).
Data source: Cross-sectional study of more than 47,000 healthy adult men and women who reported sleep duration and quality and underwent either measurement of CAC.
Disclosures: The funding source was not reported. The authors reported no disclosures.

4. Sunscreens With DNA Repair Enzymes Might Lessen AK Progression
To take the posttest, go to http://bit.ly/1LdZWFf

Key clinical point:
Sunscreen containing DNA repair enzymes might prevent malignant progression of actinic keratosis better than sunscreen alone.
Major finding: Field cancerization and cyclobutane pyrimidine dimer levels improved significantly more with sunscreen plus enzymes than with sunscreen only (P < .0001 for each).
Data source: Six-month randomized trial of 28 patients with actinic keratosis.
Disclosures: Biodue S.p.A. provided the methyl aminolevulinate used in the study. Dr. Enzo Emanuele, the study’s senior author, is a major shareholder of Living Research S.A.S., a privately held biomedical research organization that provided funding for the work. The other researchers reported no conflicts of interest.

5. Breastfeeding Protects Against Postpartum MS Relapse
To take the posttest, go to http://bit.ly/1OSYU49

Key clinical point:
Don’t discourage new mothers with multiple sclerosis from breastfeeding.
Major finding: Among 81 women who did not breastfeed or who supplemented breastfeeding early on, 31 (38.3%) had an MS relapse within the first six postpartum months, compared with 29 women (24.2%) among the 120 who intended to breastfeed their children exclusively for at least two months (adjusted HR, 1.70).
Data source: A prospective study of 201 pregnant women with relapsing-remitting MS who were followed for one year post partum.
Disclosures: The work was funded by the German Research Foundation. The German MS and pregnancy registry was partly supported by Bayer HealthCare, Biogen Idec, Merck Serono, Novartis Pharma, and Genzyme Pharmaceuticals. Five of the researchers reported receiving speaker honoraria or other financial support from pharmaceutical companies.

6. S aureus Seen in 1% of Pediatric CAP Cases
To take the posttest, go to http://bit.ly/1FPJnQ3

Key clinical point:
About 1% of children presenting to a hospital with community-acquired pneumonia had Staphylococcus aureus infections, which do not respond to recommended firstline narrow-spectrum antibiotics for CAP.
Major finding: In a cohort of 554 children admitted with CAP, seven had S aureus infections, six classified as complicated. All received vancomycin within 24 hours of admission; anemia incidence was significantly higher in S aureus patients than for the rest of the cohort.
Data source: Retrospective cohort study of more than 3,400 children.
Disclosures: The study received no outside funding, and Dr. Hofto disclosed no conflicts of interest.

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