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Issues in arthroplasty care

Viernes, Julio 10, 2020

Letter from the Editor
The number of patients undergoing hip or knee arthroplasty is increasing, due in considerable part to the increasing prevalence of obesity. This rise has led to an increasing number of clinical decision points for both surgeons and primary care physicians. In the NEJM article, The HEALTH Investigators suggest that hemiarthroplasty (replacement of only the femoral head) in patients with displaced fractures of the femoral neck may be more appropriate than total arthroplasty despite expert recommendations to the contrary.



Código de aprobación:PP-PPF-PEB-0016

Associations Between Blood Pressure and Cognitive Decline

Viernes, Julio 10, 2020

Long-term elevated blood pressure was responsible for greater cognitive decline in black Americans than in white Americans.
Black people, on average, experience earlier onset of elevated blood pressure (BP) and poorer control of BP throughout life than do white people. To establish whether blood pressure is associated with the observed earlier onset of cognitive impairment and faster decline in cognition in black patients, investigators performed a pooled cohort study of almost 20,000 patients (median age at study entry, 55; 20% black [self-reported]).



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Detecting Metastatic Prostate Cancer with Prostate-Specific Membrane Antigen PET-CT

Viernes, Julio 10, 2020

PSMA PET-CT had greater sensitivity and specificity than conventional imaging for detecting pelvic nodal or distant metastases in men with high-risk prostate cancer.
The limitations in sensitivity and specificity of conventional imaging using computed tomography (CT) and bone scans in staging patients with locally advanced prostate cancer are well defined.

Aortic Stenosis and Dyslipidemia

Viernes, Julio 10, 2020

A study using a Mendelian randomization design finds causal associations between elevated total cholesterol and LDL levels and AS.
To date, aortic stenosis (AS) has no recommended prevention strategies, and statins have failed to slow disease progression in randomized trials. However, questions remain about whether dyslipidemia is associated with the condition.

Thoracic Spine Fractures Are Rarely Identified by Chest Radiographs

Viernes, Julio 10, 2020

Most of these fractures can be treated conservatively and are not associated with neurologic sequelae.
To better understand the rate and sequelae of thoracic spine fractures identified in the modern era of liberal computed tomography (CT) scanning of trauma patients, researchers performed a secondary analysis of data from the NEXUS Chest CT study. Patients were blunt trauma victims aged >14 years who received chest imaging (radiographs, CT, or both) at nine trauma centers from 2011 to 2014.



Código de aprobación:PP-PPF-PEB-0014

MRI Scores for Cerebral Small Vessel Disease and Prediction of Dementia

Viernes, Julio 10, 2020

Using MRI to score cerebral small-vessel disease may help predict dementia.
Cerebrovascular disease increases the risk for dementia. To determine whether an MRI score for cerebral small vessel disease (SVD) can assist in the prediction of dementia, investigators examined MRI scans from participants in three longitudinal cohorts. Participants’ SVD ranged from mild and asymptomatic to severe and symptomatic. Each cohort underwent cognitive testing, and conversion to dementia was determined by published criteria or screening mental status examination cutoff scores.

Accuracy of Patient-Reported Passage of Ureteral Stones

Viernes, Julio 10, 2020

Patient-reported stone passage distinguished somewhat, but not perfectly, between those who did or did not have persistent stones on computed tomography.
We generally ask patients with symptomatic ureteral stones to strain their urine to document passage of a stone. But how accurate are patients’ reports of stone passage? To find out, U.S.

Physical therapy versus meniscectomy

Lunes, Junio 22, 2020

Outcomes at 5 years were not different.

In the previously published METEOR study (NEJM JW Gen Med May 1 2013 and N Engl J Med 2013; 368:1675), researchers randomized 350 patients with meniscal tears and mild-to-moderate osteoarthritis (OA) to physical therapy (PT) alone or meniscectomy followed by PT.



Código de aprobación:PP-UPA-PEB-0004

Impact of single-pill combination therapy onadherence, blood pressure control, and clinicaloutcomes: a rapid evidence assessment ofrecent literature

Miércoles, Junio 17, 2020

Objective: The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension.



Código de aprobación:PP-CVP-PEB-0032

Ingrese aquí al documento de producto de Norvasc (amlodipino)

*NORVASC 10 MG TAB X 10: EE-08272
* NORVASC 5 MG TAB X 30: EE-08268

Topic collection: Transcatheter or surgical Aortic valve replacement

Viernes, Junio 12, 2020

Letter from the Editor
In the past decade, there has been a powerful shift toward the use of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis.

Using Routine Cardiac MRI vs. Echocardiography (with Selective MRI) in Nonischemic Heart Failure

Viernes, Junio 5, 2020

Routine MRI doesn’t improve diagnostic specificity or patient outcomes.
Cardiac magnetic resonance (CMR) imaging is increasingly used to assess structure and function. In cardiomyopathy, CMR is used to assess patients for evidence of infiltration or inflammation; late gadolinium enhancement, a common finding in cardiomyopathies, has prognostic implications. These investigators assessed routine CMR versus echocardiography with selective use of CMR in patients with newly diagnosed or worsening heart failure (HF).



Código de aprobación:PP-CVP-PEB-0026

Transcranial Magnetic Stimulation for Dementia Diagnosis

Viernes, Junio 5, 2020

Can transcranial magnetic stimulation distinguish among dementia types?
Biomarkers have been useful tools in the diagnosis and management of dementia. Researchers analyzed data from participants at four centers to determine if transcranial magnetic stimulation (TMS) can be used to identify and distinguish among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD).



Código de aprobación:PP-CNS-PEB-0027

Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes- a rapid evidence assessment of recent literature

Martes, Mayo 26, 2020

The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension. This systematic rapid evidence assessment sought to determine if initiating SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes vs. initiation of free-dose combination therapy.




Código de aprobación:PP-CVP-PEB-0024

Understanding the Complexity of the Migraine Brain

Viernes, Mayo 22, 2020

Brain regions showing consistent alterations in migraineurs converge to a common brain network, which includes areas with a pivotal role in migraine pathophysiology.
Neuroimaging studies have shown functional and structural alterations of different brain areas in migraine patients, raising new questions. How do these regions interact with each other? Does a unique network enclose all these brain areas? Are these neuroimaging findings migraine specific?



Código de aprobación:PP-CNS-PEB-0023

Prostatic Artery Embolization to Treat Complications of BPH

Viernes, Mayo 22, 2020

This procedure shows promise for selected patients with benign prostatic hyperplasia.
Prostatic artery embolization (PAE), an outpatient procedure performed by interventional radiologists, is an option for managing urinary retention and severe hematuria caused by benign prostatic hyperplasia (BPH). Patients at high risk for complications from more invasive treatments and patients with extremely large prostate volume are especially suitable for PAE.



Código de aprobación:PP-MHP-PEB-0012

Trends in Heart Failure Outcomes

Jueves, Mayo 7, 2020

Although overall mortality has changed little between 2002 and 2013, noncardiovascular mortality has increased, especially among the oldest old.
We have made substantial progress in improving outcomes for patients with ischemic heart disease, but what about for patients with heart failure? Investigators examined a clinical database of about 7% of the U.K. population to assess trends in 1-year mortality and hospital admissions among 86,833 patients with a diagnosis of incident heart failure from 2002 through 2013 (aged ≥80, 48%; ≥3 comorbidities, 79%; women, 49%).



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How Unhealthy is Pollution with Fine Particle

Jueves, Mayo 7, 2020

Researchers in China find heightened short-term risks for cardiovascular hospitalizations.
Studies are accumulating about the relationship between air quality and cardiovascular risk. Because air quality in many areas of the world is deficient, we need to quantify the health effects at levels exceeding those that have been designated as safe, particularly with respect to short-term exposure.

New Endoscopic Surgical Treatments for BPH

Miércoles, Abril 29, 2020

All eight evaluated endoscopic modalities were safer than transurethral resection of prostate in men with benign prostatic hyperplasia.
For decades, monopolar transurethral resection of prostate (TURP) has been the mainstay surgical treatment for men with benign prostatic hyperplasia (BPH). During monopolar TURP, the prostate adenoma is removed, piece by piece, with a monopolar electrode. In this network meta-analysis of 109 randomized controlled trials, researchers compared the efficacy and safety of monopolar TURP with eight newer endoscopic surgical modalities for BPH.





Does Physical Activity Affect Early Prodromal Parkinson Symptoms

Miércoles, Abril 29, 2020

A long-term study suggests so.
Researchers sought to uncover a potential relationship between physical activity and prodromal features of Parkinson disease (PD) — features that precede the clinical diagnosis — using the Nurses’ Health Study and the Health Professionals Follow-Up Study. Participants were followed from 1986 through 2012, with assessments at baseline and longitudinally at many consecutive 24-month periods thereafter.




Código de aprobación:PP-CNS-PEB-0015


Quality of Life Associated with Treatments for Prostate Cancer

Martes, Abril 14, 2020

Favorable-risk patients undergoing prostatectomy had worse sexual function at 3 years and worse urinary incontinence at 5 years than those managed with active surveillance.
Because the optimal treatment for men with localized prostate cancer remains undefined — given the great heterogeneity of the disease and a lack of prospective comparative studies — gaining a better understanding of the short- and long-term adverse effects associated with interventions is critical.





Código de aprobación:PP-MHP-PEB-0006

Percutaneous Treatment of Tricuspid Regurgitation

Martes, Abril 14, 2020

Catheter-based edge-to-edge repair may provide benefit, according to results from a preliminary single-arm trial.
Tricuspid regurgitation (TR), a common form of valvular heart disease, frequently results from right ventricular dilatation and leaflet tethering, leading to malcoaptation of the leaflets. TR has been associated with poor long-term survival and with impaired response to correction of left-sided cardiac pathology.

Autism Spectrum Disorder and Comorbid Mood Disorders

Martes, Abril 14, 2020

1+1=3: Autism significantly increases risks for both mood and anxiety disorders.
When Kanner described autistic disturbances of affective contact in 1943, he observed that one of the hallmark clinical features was an “anxiously obsessive desire for the maintenance of sameness.” Many studies since have documented the prevalence of co-occurring psychiatric disorders in patients with autism spectrum disorder (ASD). In this population-based study, investigators leveraged a cohort of 31,220 individuals born from 1976 to 2000 in Olmsted County, Minnesota, to ascertain the prevalence of bipolar

Updated AAP Guidance on ASD Detection and Management

Viernes, Marzo 27, 2020

Primary care clinicians are encouraged to refer early, partner with families to make treatment decisions, and know their community resources.
With the prevalence of autism spectrum disorder (ASD) now estimated at 1 in 59 U.S. children, the American Academy of Pediatrics (AAP) has updated its 2007 clinical report on ASD screening and management. Important points for clinicians include the following:




Código de aprobación: PP-CNS-PEB-0011

Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. NEJM Journal Watch summary, reused with permission from NEJM Group

Jueves, Marzo 19, 2020

Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown.
Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatchbased irregular pulse notification algorithm identified possible atrial fibrillation, a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days.




Código de aprobación:

Connecting Stress Disorders with Life-Threatening Infections

Miércoles, Marzo 18, 2020

Multiple stress disorders, but most strongly post-traumatic stress disorder, increase the risk for serious infections.
The poor physical health of individuals with post-traumatic stress disorder (PTSD) is presumed to occur through the stress-related compromise of multiple physiological systems producing an excess of somatic complaints and bona fide medical illnesses.



Código de aprobación: PP-CNS-PEB-0008

An instrumental treatment for negative symptoms in schizophrenia

Miércoles, Marzo 18, 2020

Improvement with 1 week of treatment with transcranial direct current stimulation is sustained for 12 weeks.
Because negative symptoms of schizophrenia have been associated with low activity in the prefrontal cortex (PFC), researchers in a sham-controlled, Brazilian study examined the effects of transcranial direct current stimulation (tDCS) in 95 schizophrenia patients with prominent negative symptoms. The device is commercially available but does not have FDA approval.




Código de aprobación: PP-MHP-PEB-0009

Does Testosterone Therapy Confer Risk for Venous Thromboembolism?

Miércoles, Marzo 4, 2020

In a case-crossover study, testosterone therapy was associated with excess risk.

Testosterone therapy can induce hematologic abnormalities associated with hypercoagulability, but whether it actually confers excess risk for venous thromboembolism (VTE; i.e., deep venous thrombosis or pulmonary embolism) is controversial. In this study, researchers used U.S. national pharmacy and medical claims databases to identify about 40,000 men (mean age, 57) with incident VTE and at least 12 months of data before VTE.



Código de aprobación: PP-MHP-PEB-0002

Light, Dark, and Bipolar Disorder: Some Practical Guidance

Martes, Febrero 11, 2020

Interventions affecting circadian rhythm can be therapeutic, with some approaches more effective than others.

Chronotherapies, interventions that affect the circadian rhythm, have been studied in both the depressive and the manic stages of bipolar disorder through the years (e.g., NEJM JW Psychiatry Nov 2017 and Am J Psychiatry 2017; 175:131; NEJM JW Psychiatry Nov 2009 and Biol Psychiatry 2009; 66:298). In this review, the authors have compiled the evidence and recommendations from an International Society of Bipolar Disorders task force. The major treatments include:


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