Latest Clinical Edge

Post date: 02/24/2015 - 09:52

Early stage diagnosis of breast cancer and survival after stage I diagnosis varied by race and ethnicity, and could be statistically accounted for by intrinsic biological differences, according to an observational study of 452,215 American women diagnosed with invasive breast cancer between 2004 and 2011.

The odds ratios for being diagnosed at stage 1 rather than a later stage, compared with non-Hispanic white women (OR, 1) are as follows:

• Japanese: 1.24

• Chinese: 0.97

• Other Asian: 0.80

• Other ethnicity: 0.75

• South Asian: 0.66

• Black: 0.56

Deaths from stage I...

Post date: 02/17/2015 - 12:07

Indications: The combination of empagliflozin (a sodium glucose co-transporter 2 [SGLT2] inhibitor) and linagliptin (a dipeptidyl peptidase-4 [DPP-4] inhibitor) (Glyxambi) is used to improve glycemic control in adults with type 2 diabetes.

Dosing: The recommended starting dose is 10mg empagliflozin/5 mg linagliptin once daily and can be increased to 25 mg empagliflozin/5 mg linagliptin.

Pharmacokinetics: The combination tablet is bioequivalent to coadministration of corresponding doses of empagliflozin and linagliptin. Empagliflozin is excreted through feces and urine, and linagliptin is...

Post date: 02/10/2015 - 12:17

While primary tumor resection in patients with stage IV colorectal cancer (CRC) has declined since 2001, the procedure may still be overused, according to a retrospective cohort study of 64,157 patients from the National Cancer Institutes’ Surveillance, Epidemiology, and End Results CRC registry.

Researchers compared data on patients diagnosed with stage IV colon or rectal cancer between 1998 and 2010, and found the majority of patients (67.4%) had undergone a primary tumor resection. Factors associated with primary tumor resections included:

• younger than 50 years

• female sex

• being married...

Post date: 02/10/2015 - 12:14

Atypical hyperplasia of the breast (AHB) increases a woman’s odds of developing breast cancer over the next 25 years by up to 30%, however this high cumulative incidence is not widely recognized and not included in many high-risk guidelines, according to a special report on risk assessment and management options for the condition. Highlights of the report include:

• The younger a woman is at diagnosis of AHB, the greater her risk of breast cancer.

• Atypical ductal hyperplasia is characterized by filling and distention of involved ducts with architecturally complex patterns.

• Atypical lobular...

Post date: 02/10/2015 - 12:11

Suppressing ovarian estrogen production along with tamoxifen may benefit premenopausal women at high risk of breast cancer recurrence who required adjuvant chemotherapy, however, it did not provide a significant benefit to the overall study population, according to a trial of 3,066 women with hormone-receptor-positive early breast cancer.

Researchers randomized premenopausal breast cancer survivors to receive either 5 years of tamoxifen, tamoxifen plus ovarian suppression, or exemestane plus ovarian suppression therapy. Subjects were also stratified according to whether or not they had received chemotherapy.


Post date: 02/10/2015 - 12:04

Targeted magnetic resonance (MR)/ultrasound fusion biopsy increased detection of high-risk prostate cancer, but decreased detection of low-risk prostate cancer, compared to standard extended-sextant ultrasound guided biopsy, according to a prospective cohort study of 1,003 men undergoing biopsy for suspected prostate cancer.

Subjects referred for biopsy due to elevated levels of prostate-specific antigen (PSA) or abnormal digital rectal examination results underwent multiparametric magnetic resonance imaging to identify regions of prostate cancer suspicion followed by both targeted and standard biopsies. The results...

Post date: 02/10/2015 - 11:59

An American Society of Clinical Oncology update to the Clinical Practice Guideline for the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer includes the following:

• Thromboprophylaxis is generally required during hospitalization for patients with active cancer, but it is not recommended for outpatient treatment except in selected high-risk patients.

• Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin.

• Patients who are...

Post date: 02/03/2015 - 16:16

Vitamin D supplementation does not reduce blood pressure in patients with prehypertension and low vitamin D status, according to the randomized double-blind Vitamin D Therapy in Individuals at High Risk of Hypertension Trial (DAYLIGHT).

Researchers randomized 534 subjects with prehypertension or stage I hypertension and 25 hydroxyvitamin D (25OHD) levels of 25 ng/mL or less to receive either high dose (4,000 IU/d) or low dose (400 IU/d) oral vitamin D3 for 6 months. At the end of the study, researchers found:

• no significant difference in 24-hour systolic blood pressure (-0.8 mmHg in the high-dose...

Post date: 01/20/2015 - 15:17

Bariatric surgery can cut the risk of early death by more than half in patients with severe obesity, concludes a retrospective cohort study of 2,500 patients (75% male) who underwent the surgery and 7,462 matched controls in the Veterans Affairs (VA) health system.

Researchers compared 5- and 10-year survival rates among subjects (average age, 52 years; BMI, 47) and controls (average age, 53 years; BMI, 46), and found that while initially no significant association between surgery and all-cause mortality was evident, over time the adjusted analysis showed a hazard ratio (HR) of 0.45 at 5 years and 0.47 at 10 years...

Post date: 12/09/2014 - 14:55

Sickle cell trait may be associated with an increased risk of chronic kidney disease (CKD) in African Americans, according to an evaluation of 15,975 subjects, of whom 1,248 carry the gene.

Using data from 5 prospective, population-based studies, investigators assessed African Americans with and without sickle cell trait for CKD, incident CKD, estimated glomerula filtration rate (eGFR), and albuminuria, and found higher rates of markers of kidney disease among those who carry the gene. Sickle cell trait carriers had the following increased risks:

• CKD: odds ratio (OR), 1.6

• incident CKD: OR, 1.8

Post date: 12/02/2014 - 13:45

Postmenopausal women without osteoporosis on their first bone mineral density (BMD) test are unlikely to fracture before age 65, and unlikely to benefit from repeated screening before that age. That is the key finding from an observational cohort study of 4,068 women between the ages of 50 and 64 years who did not have prior hip or vertebral fractures or receive antifracture treatment, and were recruited as part of a larger trial cohort of 161,808 postmenopausal women in the Women’s Health Initiative study.

Subjects underwent baseline BMD testing between 1993 and 2005 and were tracked through 2012 with the following...

Post date: 10/28/2014 - 16:39

Adults who are physically active at age 23 tend to experience fewer depressive symptoms as they age, while those who engage in less physical activity at that age are more likely to see their depressive symptoms increase throughout adulthood, according to a British cohort study of 11,000 adults born during the same week in 1958.

Researchers analyzed self-reported data on depressive symptoms and physical activity frequency collected at ages 23, 33, 42, or 50 years and found a bidirectional effect between exercise and depression. The more physical activity per week, the lower the mean number of depressive symptoms a...

Post date: 10/07/2014 - 16:37

Among men who are diagnosed with HIV, gay, bisexual, and other men who have sex with men (MSM) are more likely to receive treatment if they are older, while men under 25 and African American men are least likely to receive care.

Data from the National HIV Surveillance System (NHSS) and the Medical Monitoring Project (MMP) in 2010 shows 78% HIV-diagnosed MSM linked to care, but only 51% retained in care, 50% prescribed antiretroviral therapy (ART), and 42% achieved viral suppression.

Among age groups, men under age 25 had the lowest rates of medical care within 3 months following diagnosis, at 71%, while men...

Post date: 10/07/2014 - 16:32

Roughly 1 in 21 sexually active women ages 24 and under are infected with chlamydia, with rates higher among minorities, according to data from the latest National Health and Nutrition Examination Survey (NHNES). The most common notifiable disease in the United States, 1.4 million cases were reported in 2012, yet screening rates for the sexually transmitted infection remains low.

The U.S. Preventive Services Task Force recommends healthcare providers routinely screen all sexually active young women aged 24 and younger, however fewer than half of this population are tested for chlamydia each year.


Post date: 10/07/2014 - 10:37

All sexually active females ages 24 years or younger should be screened for chlamydia and gonorrhea, as should older women who are at an increased risk of sexually transmitted infections, according to an evidence-based update of the 2007 screening recommendations for chlamydia and the 2005 recommendations for gonorrhea. There is no recommendation for screening men.

Chlamydia and gonorrhea are the most common sexually transmitted infections (STIs) in the United States, with a reported 1.4 million and 330,000 cases, respectively, in 2012.

Age is a strong predictor of risk, with the highest infection rates...

Post date: 08/19/2014 - 15:54

Indications: Oritavancin (Orbactiv) for injection is used for the treatment of adults with acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible isolates of Gram-positive microorganisms including Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant isolates), Streptococcus strains including pyogenes, agalactiae, dysgalactiae, and anginosus group, and Enterococcus faecalis (vancomycin-susceptible isolates only).

Dosing: A single 1200 mg dose administered by intravenous infusion over 3 hours, using three 400...