Latest Clinical Edge

Post date: 05/26/2020 - 12:17

Key clinical point: The increased risk of severe GI bleeding in older persons using low-dose aspirin is concentrated in individuals with a handful of risk factors.

Major finding: The risk of serious upper GI bleeding events was increased 87% in the aspirin users, while serious lower GI bleeding was increased by 36%.

Study details: ASPREE was a clinical trial of more than 19,000 apparently healthy older adults randomized to 100 mg/day of enteric-coated aspirin or placebo and followed prospectively for roughly 5 years.

Disclosures: The study’...

Post date: 05/26/2020 - 12:00

Key clinical point: Many AFib patients are already at higher risk for osteoporosis fractures.

Major finding: Direct oral anticoagulants were associated with lower risk of osteoporosis fracture than was warfarin (HR, 0.52-0.65).

Study details: This was a retrospective analysis of nearly 24,000 EHRs of AFib patients who used anticoagulants in Hong Kong.

Disclosures: The study was funded by the University of Hong Kong and University College London Strategic Partnership Fund.

Post date: 05/22/2020 - 14:32

Key clinical point: Repetitive multiple cranial nerve blocks (MCNBs) may be an effective prevention therapy in patients with chronic migraine.

Major finding: At 4 weeks, MCNBs significantly reduced headache days (mean, 5.4 days; P less than .001). The response rate was significantly (P = .009)...

Post date: 05/22/2020 - 14:31

Key clinical point: Intravenous (IV) eptinezumab (100 and 300 mg) demonstrates clinically significant migraine preventive effects over multiple efficacy measures, along with acceptable safety and tolerability in patients with chronic migraine.

Major finding: At 12 weeks, eptinezumab 100 and 300 mg demonstrated significant reductions in monthly migraine days (mean, −7.7 and −8.2 days; respectively; P less than...

Post date: 05/22/2020 - 14:30

Key clinical point: Cognitive impairment is prevalent in patients with chronic migraine (CM) even during their mildest possible headache or when headache-free.

Major finding: Patients with CM vs. those with episodic migraine had 4 times higher odds of achieving a Rey...

Post date: 05/22/2020 - 14:29

Key clinical point: Subcutaneous sumatriptan significantly reduces cilostazol-induced headache in patients with migraine without aura compared with placebo.

Major finding: Sumatriptan injection significantly reduced headache score from 0 to 2 hours (P = .0003). The difference in median headache scores was significant at 2 hours (P = .01) and 4 hours (P = .0007) after sumatriptan treatment....

Post date: 05/22/2020 - 09:37

Key clinical point: While hospitalizations for acute MI declined sharply during the COVID-19 pandemic, deaths increased.

Major finding: Mortality for ST-segment elevation MI cases more than tripled to 14% during the outbreak, compared with 4% in 2019 (P < .001), and complication rates increased by 80% to 19% (P = .025).

Study details: A multicenter, observational, nationwide survey of 319 admissions for acute MI at Italian cardiac care units for March 12-19 during the COVID-19 outbreak with an equivalent week in 2019.

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Post date: 05/22/2020 - 09:17

Key clinical point: Antenatal corticosteroids and magnesium sulfate together are associated with better outcomes in extremely preterm children.

Major finding: Children exposed to both corticosteroids and magnesium had 27% reduced risk of severe neurodevelopmental impairment or death, compared with those exposed to only corticosteroids (adjusted odds ratio, 0.73).

Study details: The findings are based on analysis of prospective observational data during 2011-2014 of 3,093 extremely preterm children (22-26 weeks).

Disclosures: The research...

Post date: 05/21/2020 - 13:37

Key clinical point: A novel penclomedine has shown promising safety and efficacy in some adolescent and young adult patients with cancers involving the central nervous system.

Major finding: Two patients who responded to the treatment, 4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN), were in their 59th month of survival at last follow-up.

Study details: A phase 1/2 study of 15 adolescents and young adults with central nervous system cancers who received DM-CHOC-PEN.

Disclosures: The study was supported by Louisiana state...

Post date: 05/21/2020 - 11:53

Key clinical point: Vaccination was effective despite the expected decrease in immunological response during MM therapy.

Major finding: The absolute risk reduction of pneumonias in patients receiving PCV13 vaccination was

33.3%.

Study details: Prospective study of 18 adult patients who were vaccinated with PCV13, compared with 18 control-matched patients from 2017 to 2020.

Disclosures: The authors reported that they had no relevant disclosures.

Post date: 05/21/2020 - 10:15

Key clinical point: Awareness of time may be disturbed in patients with dementia. Symptoms of altered temporal awareness may differ between patients with frontotemporal dementia and patients with Alzheimer’s disease.

Major finding: Patients with dementia were significantly more likely to exhibit temporal awareness symptoms, compared with healthy older individuals. Patients with typical and logopenic Alzheimer’s disease most often exhibited disturbed event ordering or interval estimation, whereas patients with semantic dementia were most prone to...

Post date: 05/21/2020 - 10:12

Key clinical point: Effective communication by nursing home staff before and during interactions with residents with advanced dementia and persistent vocalizations may provide the residents with needed personal interaction and socialization. Continued attempts to involve residents in activities and social programs may improve dementia care.

Major finding: Persistent vocalizations by people with dementia may occur in the context of a “routine of staying in bedroom” and “staff providing care without communication.” These themes indicate a lack of...

Post date: 05/21/2020 - 10:08

Key clinical point: No restriction of oral intake is deemed just as safe as traditional NPO strategy prior to nonemergent cardiac catheterization.

Major finding: In the nonfasting group, 11.3% of patients met the primary endpoint, compared with 9.8% of the patients in the standard fasting group, a nonsignificant difference.

Study details: A single-center randomized trial of 599 patients who underwent nonemergent cardiac catheterization.

Disclosures: The Donald Guthrie Research Foundation funded the study. Dr. Mishra reported having no...

Post date: 05/21/2020 - 10:05

Key clinical point: Anxiety is associated with increased risk of vascular dementia, but whether anxiety is a modifiable risk factor or an early marker of the disease remains unclear.

Major finding: Older adults with anxiety have 1.65 times higher risk of vascular dementia, compared with older adults without anxiety.

Study details: A meta-analysis of three cohort studies that included 31,948 participants in Europe and Australia.

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Post date: 05/21/2020 - 10:04

Key clinical point: In preclinical studies, components of traditional Chinese medicine reduce amyloid beta production, apoptosis, autophagy, neuroinflammation, oxidative stress, and mitochondrial dysfunction. Studying herbal medicines may help investigators identify effective treatments for Alzheimer’s disease, researchers suggest.

Major finding: Of the bioactive ingredients that have been isolated from traditional Chinese medicine, many are from the Lamiaceae family. For example, Dracoephalum moldavica L. may reduce amyloid beta production...

Post date: 05/21/2020 - 09:54

Key clinical point: Early parental death is associated with an increased risk of dementia. Interventions intended to reduce the negative health consequences of adverse childhood events, including interventions that modify biologic markers of stress, increase resilience, or promote coping strategies, have been developed.

Major finding: The crude odds ratio for dementia in individuals who experienced the death of the father or mother at age 16 years or younger was 1.83. After adjusting for age, gender, and education, the odds ratio was 1.54....

Post date: 05/21/2020 - 09:49

Key clinical point: Use of personalized feedback with step-counting technology significantly increased the mobility of women at risk for thromboembolic events after a cesarean delivery.

Major finding: Women randomized to a pedometer intervention took an average of 5,918 steps during the first 48 hours post partum, compared with 4,161 steps for controls.

Study details: The data come from a randomized, controlled trial of 215 women who underwent cesarean deliveries.

Disclosures: The researchers had no financial conflicts to disclose.

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Post date: 05/21/2020 - 09:26

Key clinical point: Bone mineral density appears not to be compromised with relugolix combination therapy.

Major finding: The mean change in lumbar spine bone mineral density was –0.36% and –0.13% from baseline to 24 weeks in two trials.

Study details: Two phase 3, randomized trials in women with uterine fibroids and heavy menstrual bleeding enrolled almost 800 women.

Disclosures: The trials were funded by Myovant Sciences. The lead author disclosed that he has served as a consultant/advisory board member and speaker for Amgen and a...

Post date: 05/21/2020 - 09:10

Key clinical point: Chilblain-like symptoms in children should be considered a sign of COVID-19 infection.

Major finding: More cases of chilblain-like lesions are described in children suspected of having COVID-19.

Study details: A case series of 4 patients age 5-11 years in Milan and a retrospective series of 22 patients age 6-17 years in Madrid.

Disclosures: Christina Colonna, MD, and colleagues have no conflicts of interest to declare. David Andina, MD, and colleagues provided no statement of disclosures.

Post date: 05/20/2020 - 14:25

Key clinical point: COVID-19 has fundamentally transformed how some institutions care for MDS and AML patients.

Major finding: Patients undergoing allogeneic transplantation spend up to 5 weeks in the hospital alone as hospitals have moved to no-visitor policies.

Study details: Description of changes in AML and MDS patient care at Columbia University-related...

Post date: 05/20/2020 - 14:23

Key clinical point: Independent of transplant method, quizartinib improved survival vs, salvage chemotherapy for patients with refractory/relapsed acute myeloid leukemia.

Major finding: Median overall survival was 6.2 vs. 4.7 months [HR, 0.76;P = .02) for quizartinib vs. salvage chemotherapy respectively.

Study details: Of 367 randomized patients, 85 in the...

Post date: 05/20/2020 - 14:21

Key clinical point: Two forms of acute leukemia (AML and ALL) could be distinguished from normal cells.

Major finding: AML and ALL could be distinguished from normal cells with 88% sensitivity and 80% specificity.

Study details: Analysis of fluorescence spectra of blood plasma and red blood cell samples from 85 patients....

Post date: 05/20/2020 - 14:20

Key clinical point: Thiotepa, busulfan, and fludarabine (TBF) showed improved survival vs. busulfan and fludarabine (BUFLU).

Major finding: The 5-year actuarial survival was 51% for BUFLU and 68% for TBF (P = .002).

Study details: Retrospective comparison of 2 myeloablative conditioning regimens in 454 acute myeloid leukemia patients in remission....

Post date: 05/20/2020 - 14:19

Key clinical point: Decitabine plus all-trans retinoic acid showed benefits in elderly acute myeloid leukemia patients and cultured cells.

Major finding: 44.4 % of patients achieved CR; 11.1 % achieved CR with incomplete peripheral count recovery; and 13.9 % achieved partial remission.

Study details: Clinical trial of 36 elderly AML patients who were judged...

Post date: 05/20/2020 - 12:55

Key clinical point: In nonazoospermic couples with prior failed in vitro fertilization (IVF) cycles using ejaculate sperm, intracytoplasmic sperm injection (ICSI) using testicular sperm may improve embryo development, clinical pregnancy rate, and live birth rate.

Major finding: Blastocyst conversion rates were 67% vs. 35%. Clinical pregnancy rate was 44% and live birth rate was 32%.

Study details: A retrospective observational study of 112 nonazoospermic couples who underwent testicular sperm extraction for IVF/ICSI at a private fertility center.

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