Latest Clinical Edge

Post date: 09/29/2020 - 16:58

Key clinical point: Brachial plexus injury occurred alone and together with shoulder dystocia, but the two appear to be unrelated complications.

Major finding: 42% of brachial plexus cases were unrelated to shoulder dystocia, and there were similar rates of persistent brachial plexus injury in children who had or did not have shoulder dystocia.

Study details: A medical review of 41,525 deliveries between March 2012 and July 2019 for complications of brachial plexus injury and shoulder dystocia.

Disclosures: The authors reported no relevant...

Post date: 09/29/2020 - 15:25

Key clinical point: The COVID-19 pandemic has limited in-clinic abortions and likely increased demand for self-managed abortions in many states.

Major finding: Overall requests for self-managed abortion via a telemedicine service increased by 27% from March 20, 2020, to April 11, 2020.

Study details: The findings come from a review of 49,935 requests received by Aid Access, the sole provider of online abortion telemedicine in the United States, between January 1, 2019, and April 11, 2020.

Disclosures: Dr. Aiken disclosed serving as a...

Post date: 09/28/2020 - 12:39

Key clinical point: Targeting increased glycemic time-in-range may improve clinical outcomes in patients with type 2 diabetes.

Major finding: A 10% rise in average time in glycemic range linked with a 6% cut in major adverse cardiac events and a 10% drop in severe hypoglycemic events.

Study details: Post hoc analysis of data from 5,774 patients from the DEVOTE trial.

Disclosures: DEVOTE was funded by Novo Nordisk. Dr. Bergenstal has had financial relationships with Novo Nordisk and several other companies.

Post date: 09/28/2020 - 12:26

Key clinical point: Further evidence that exercise reduces all-cause and cardiovascular mortality in persons with type 2 diabetes.

Major finding: Compared with no exercise, those who exercised at a moderate (0-800 kcal/week) or high (800 kcal/week) level had a 25%-32% reduction in all-cause mortality. Cycling every week was also associated with a 25-31% decreased risk for all-cause death, compared with no cycling, and reduced cardiovascular mortality.

Study details: A study with 4,859 subjects with type 2 diabetes drawn from two Taiwanese databases – the National...

Post date: 09/28/2020 - 09:48

Key clinical point: Combination therapy (mifepristone followed by misoprostol) was significantly more cost effective than misoprostol alone for managing miscarriage.

Major finding: Cost differences in favor of combination therapy over monotherapy ranged from 6.3% to 19.5% among patients across several income categories.

Study details: The data come from a decision tree analysis using Monte Carlo simulations to compare combination therapy with mifepristone and misoprostol with misoprostol alone.

Disclosures: The study received no outside...

Post date: 09/25/2020 - 14:13

Key clinical point: Individuals with a high level of ADHD symptoms display a heightened neural reward response to food in their brain circuitry on functional MRI, which may explain their high prevalence of binge eating.

Major finding: A brain-imaging study suggests that an exaggerated neural reward response to food, rather than impulsivity, accounts for the strong association between ADHD and disinhibited binge eating.

Study details: This study used functional MRI brain scans in 31 young adults with high ADHD symptoms and 27 with low ADHD symptoms to understand...

Post date: 09/25/2020 - 11:51

Key clinical point: A global analysis of premature deaths from noncommunicable diseases (NCDs) has shown mixed results for gastrointestinal cancers.

Major finding: Stomach cancer was the fastest declining cause of death (out of the NCDs analyzed) in 45 countries among men and in 40 countries among women. However, the risk of premature death from colorectal, liver, breast, prostate, and other cancers declined more slowly than the risk of premature death from other NCDs.

Study details: An analysis of 2016 World Health Organization data on age-, sex-, and cause-...

Post date: 09/25/2020 - 11:45

Key clinical point: Oral beta-blockers may be helpful in treating facial erythema and flushing in rosacea, but more data are needed.

Major finding: Carvedilol and propranolol showed a large reduction of symptoms.

Study design: A systematic review of nine studies that evaluated beta-blockers for facial erythema and flushing.

Disclosures: Jade G.M. Logger, MD, disclosed financial relationships with Galderma, AbbVie, Novartis, Janssen, and LEO Pharma; one author disclosed conducting clinical trials for AbbVie and Novartis; the third author...

Post date: 09/25/2020 - 11:16

Key clinical point: Dapagliflozin was safe and effective in patients with chronic kidney disease with an estimated glomerular filtration rate as low as 25 mL/min per 1.73m2.

Major finding: Dapagliflozin safely reduced the primary endpoint with a number needed to treat of 19 during a median of 2.4 years.

Study details: DAPA-CKD, a multicenter, randomized trial with 4,304 patients with chronic kidney disease.

Disclosures: DAPA-CKD was funded by AstraZeneca, the company that markets dapagliflozin. Dr. Heerspink has been a consultant...

Post date: 09/25/2020 - 11:07

Key clinical point: Patients with higher intraoperative blood loss and those treated at lower-volume surgical centers had a greater risk of high-grade complications after undergoing cytoreductive nephrectomy for metastatic renal cell carcinoma (RCC).

Major finding: The odds ratio for high-grade postoperative complications per 200 mL of blood lost was 1.06 (P = .007). The odds ratio for high-grade complications per 25 cases treated was 0.88 (P = .04).

Methods: Analysis of registry data from 736 patients with metastatic RCC who underwent...

Post date: 09/25/2020 - 09:34

Key clinical point: Suicidality appears to have increased in Israel during the initial nationwide lockdown because of COVID-19.

Major finding: Suicide-related contacts with an Israeli national crisis hotline rose sharply during the first COVID-19 pandemic lockdown.

Study details: This was a retrospective analysis of the content of online chats fielded by an Israeli national crisis hotline during the first months of the COVID-19 pandemic, compared with a year earlier.

Disclosures: The presenter reported having no financial conflicts...

Post date: 09/24/2020 - 11:07

Key clinical point: Initial response to induction therapy with novel agents prepares patients for favorable outcomes after stem cell transplant.

Major finding: Triplet induction beat doublet with regards to early response (95.4% vs. 84.02% [doublets], P < .003), stem cell mobilization (88.6% vs. 76.8%, P < .005) and lower day-100 transplant-related mortality (P < .001).

Study details: An analysis of 326 multiple myeloma patients who received novel agents based induction prior to autologous stem cell transplant.

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Post date: 09/24/2020 - 09:21

Key clinical point: No insulin use and less than 5 years diabetes duration predicted sustained diabetes remission 10 years after bariatric surgery.

Major finding: Half of the study population were in diabetes remission at 10 years, none had used insulin and had an average diabetes duration of 2 years.

Study details: A prospective, observational study of 85 people (76% women) with type 2 diabetes who had bariatric surgery (65 had Roux-en-Y gastric bypass; 20 had sleeve gastrectomy).

Disclosures: The study had no commercial funding. The study...

Post date: 09/23/2020 - 14:48

Key clinical point: Current guideline recommendations for long-term beta-blocker therapy after an acute MI may be outdated in the contemporary reperfusion era.

Major finding: At 3 years post MI, the major adverse cardiovascular event rate was 22.9% in patients on long-term beta-blocker therapy group and not significantly different at 21.6% in those who were not.

Study details: This was an observational Danish national registry study of more than 30,000 optimally treated patients with a first MI during 2003-2018.

Disclosures: The presenter...

Post date: 09/23/2020 - 14:14

Key clinical point: Valvular atrial fibrillation raises risk of poor outcomes in transcatheter aortic valve replacement.

Major finding: 24.2% of valvular AFib patients had poor outcomes vs. 14.5% of nonvalvular AFib patients.

Study details: Retrospective analysis of 1,472 patients at the Bern University Hospital who had TAVR for aortic stenosis between August 2007 and June 2018.

Disclosures: Dr. Okuno has no relevant financial relationships to report.

Post date: 09/23/2020 - 11:44

Key clinical point: In patients with advanced or recurrent estrogen receptor–positive endometrial cancer, progression-free survival was significantly longer with palbociclib plus letrozole versus placebo plus letrozole.

Major finding: The median progression-free survival was 3.0 months in the placebo-letrozole arm and 8.3 months in the palbociclib-letrozole arm (hazard ratio, 0.56; 95% confidence interval, 0.32-0.98; P = .0376).

Study details: A phase 2 trial of 77 patients with estrogen receptor-positive advanced/recurrent endometrial cancer.

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Post date: 09/23/2020 - 10:40

Key clinical point: A 35% higher risk for vascular dementia was seen in people with type 2 diabetes versus those without; other dementia types were increased or reduced more modestly. Hyperglycemia was associated with a higher risk for vascular and nonvascular subtypes.

Major finding: Comparing diabetic and nondiabetic individuals, the hazard ratios for having vascular dementia was 1.35, nonvascular dementia was 1.08, and Alzheimer’s disease–associated dementia was 0.92.

Study details: Data on 378,299 individuals with type 2 diabetes and 1,886,022 age- and gender...

Post date: 09/23/2020 - 10:29

Key clinical point: Proteomic biomarkers were associated with event-free survival in chronic lymphocytic leukemia patients.

Major finding: Patients with high levels of sCD23 (P = .026), sCD27 (P = .04), SPINT1 (P = .001), and LY9 (P = .0003) had a shorter event-free survival.

Study details: Baseline serum samples of 51 chronic lymphocytic leukemia patients treated with chemoimmunotherapy were analyzed for 360 proteomic markers.

Disclosures: This research was supported by a grant from Gilead Sciences and...

Post date: 09/23/2020 - 10:20

Key clinical point: Survival following a kidney transplant did not improve as much during 2000-2018 for U.S. patients with diabetes as it did for normoglycemic patients.

Major finding: Adjusted, posttransplant mortality was 94% higher among type 1 diabetes patients and 64% higher in type 2 diabetes patients, compared with patients without diabetes.

Study details: Analysis of data collected by the United States Renal Data System during 2000-2018.

Disclosures: The study received no commercial funding. Dr. Harding had no disclosures.

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Post date: 09/22/2020 - 14:51

Key clinical point: Half of the patients with hidradenitis suppurativa (HS) treated with an intravenous infusion of ustekinumab achieved clinical response, without experiencing any drug-related adverse effects.

Major finding: At 12 weeks, 50% of the patients achieved Hidradenitis Suppurativa Clinical Response. There were no adverse effects reported during the follow-up period.

Study details: Prospective evaluation of outpatients with refractory HS visiting the dermatology department of a hospital...

Post date: 09/22/2020 - 14:49

Key clinical point: Maltreatment in childhood is associated with the development of hidradenitis suppurativa (HS). This association is strong for emotional traumatic events.

Major finding: The number of traumatic events (odds ratio [OR], 1.20 per trauma), as well as childhood traumatic events (yes vs no; OR, 3.59) and the number of childhood traumatic events (OR, 1.35 per trauma) correlated with an increased risk of developing HS (P less than .05 for all). Childhood emotional traumatic events were significantly associated...

Post date: 09/22/2020 - 14:48

Key clinical point: Tumor necrosis alpha (TNF-α) inhibitors (adalimumab and infliximab [Ada/Ifx]) prescribing was very low in patients with hidradenitis suppurativa (HS), including those with a dermatology relationship.

Major finding: Overall, 1.8% of patients with HS received prescription for Ada/Ifx. Only 17.8% of patients had an established dermatology relationship. Ada/Ifx prescription was highest (6%) among those with dermatology care. Patients with established dermatology had 6.93 times the odds of Ada/Ifx prescription vs....

Post date: 09/22/2020 - 14:45

Key clinical point: Lymecycline appears to be more effective in “nodule-type” hidradenitis suppurativa (HS), and clindamycin plus rifampicin combination is more effective in “abscesses-tunnel type” HS.

Major finding: Nodule count reduction was higher with lymecycline vs. clindamycin plus rifampicin (53.7% vs. 42.1%; P less than .001). Decrease in the number of abscess (68.8% vs. 47%) and draining tunnels (13.8% vs. 0%) was statistically more with clindamycin plus rifampicin combination vs. lymecycline (P = .008)....

Post date: 09/22/2020 - 14:44

Key clinical point: Hidradenitis suppurativa (HS) is significantly associated with the risk of developing nonalcoholic fatty liver disease (NALFD) regardless of the presence of classic metabolic risk factors.

Major finding: Patients with HS had a significantly higher prevalence of NAFLD vs. controls (57.6% vs. 31.7%; P less than .001). Multivariable analysis confirmed an independent association between HS and NAFLD (odds ratio, 2.79; P = .001) even after adjustment for age, body mass index, hypertension, and...

Post date: 09/22/2020 - 10:43

Key clinical point: Patients with MDD who had active suicide ideation with intent who used esketamine nasal spray (84mg) over 4 weeks had a rapid and robust reduction in depressive symptoms.

Major finding: Greater improvement in Montegomery-Asberg Depression Rating Scale (MADRS) total score was observed with esketamine (mean [SD]: –15.7 [11.56]) over placebo (-12.4 [10.43]).

Study details: This randomized, double-blind study involved 230 patients

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