Month: March 2019

Medical and Health News Weekly

FDA approves Sunosi™ (solriamfetol) to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea (OSA) link

FDA reviews breast implant safety link

Hundreds of lawsuits against Purdue owners, Sackler family, for creating opioid epidemic with OxyContin link

Meanwhile Purdue settles first opioid lawsuit in Oklahoma for $270M link

And yet another fraud lawsuit in New York against – yes, them again, Sackler family and Purdue Pharma link

Hype on advances in male contraceptive pill, but a long way off still link

Congo’s Ebola epidemic has now exceeded 1,000 cases link

FDA working with Medtronic to address cyber security concerns in cardiac devices link

Parent-toddler interaction better with print books compared to electronic books link

Ontario court has ordered Correctional Service Canada to pay tens of millions of dollars for placing thousands of mentally ill prisoners in solitary confinement link

A New York county has declared a state of emergency and banned unvaccinated children from public areas, as the measles returns alongside anti-vaccination quackery link

Life expectancy and being poor – poverty kills earlier, worsening in women link

Study likens a glass of wine a day to about a cigarette per day in terms of cancer risk link

FDA proposes a rule to notify women about risks of cancer and imprecise mammograms in those with dense breasts link

The woman who feels no pain due to genetics may help to develop pain and other treatments link

Corticosteroids & mortality in influenza pneumonia

Steroid use in influenza pneumonia has been debated, and this systematic review and meta-analysis concludes that they are associated with increased secondary infection, increased ICU length of stay, and mortality. Steroids did not seem to increase length of mechanical ventilation.

None of the studies reviewed were randomized trials and the association does not prove causation. Timing, doses, duration, disease severity, co-morbitities and other factors are discussed that could influence the findings.

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Emergency Dept. Visits and Edible Cannabis

A Colorado database may foretell events in Canada when legal cannabis edibles will probably hit the market more.

These products have variable constituents and concentrations and may be taken in excess or cumulate before they are absorbed fully and produce ill effects,

Significant side effects necessitating ER visits included intoxication, hyperemesis, psychiatric and cardiovascular effects including myocardial infarction and ventricular dysthymias.

Education, especially in teenagers, is needed on the nontrivial nature of cannabis adverse effects in many spheres.

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Major bleeding and coagulopathy following trauma

The full text European guidelines on assessing and managing coagulopathy after trauma provides a comprehensive evidence base to reflect current approaches in this area.

The issues include initial stabilization and hemorrhage control, damage control surgery, point of care coagulation assessment, use of fluids, blood and factor products, vasopressors, antifibrinolytics and many more concepts.

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Spinal manipulative therapy for chronic low back pain

This was a systematic review and meta-analysis of randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain. Studies that exclusively examined sciatica were excluded.

Spinal manipulation/mobilization produces similar effects to recommended therapies like NSAIDS and exercise for chronic low back pain, and seems to be better than non-recommended interventions (eg massage) for improvement in function in the short term. It is recommended to inform patients of the potential risks of adverse events, although serious side effects were rare.

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Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma has seen renewed interest recently but data is scarce on outcomes. This retrospective study casts doubt and underlines the need for more studies before employing the procedure widely.

Placement of REBOA in severely injured trauma patients was associated with a higher mortality rate compared with no REBOA. Patients in the REBOA group also had higher rates of acute kidney injury and lower leg amputations.

“There is a need for a concerted effort to clearly define when and in which patient population REBOA has benefit”.

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Delirium Management

This network meta-analysis from a psychiatry journal will stir some controversy in anesthesia and critical care settings.

If suggests Haloperidol and Lorazepam are the best treatments, and Ramelteon the best preventive treatment.

For delirium prevention, the ramelteon, olanzapine, risperidone, and dexmedetomidine hydrochloride groups had significantly lower delirium occurrence rates than placebo/control.

None of the pharmacological interventions for treatment or prophylaxis increased the all-cause mortality.

The best treatment in reality is non-pharmacological and the use of Lorazepam and other benzodiazepines is questionable. Few treatments have proven effective in preventing delirium in critical care, in contrast to these suggestions.

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Patient centred ACS NSQIP Risk

The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator is one of the major tools employed preoperatively as a risk-adjusted, outcomes-based program to measure and improve the quality of surgical care. ( link ).

This study involved patients, who commonly underestimate their risk. Nearly 90% of participants desire to review their ACS Calculator report before future surgical consents. High-risk patients were 3 times more likely to underestimate their risk of any complication, death, serious complications or discharge to a nursing/rehabilitation unit. After reviewing their calculated risks, 70% stated that they would consider participating in prehabilitation to decrease perioperative risk, and nearly 40% would delay their surgery to do so.

The practice of involving patients may not only help in providing realistic expectations but motivate them to optimize modifiable risk factors and participate in the growing field of preoperative optimization or prehabilitation.

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Awake Fiberoptic Intubation Protocols in the Operating Room

Many different protocols of topical anesthesia and sedative agents have been used for fibreoptic intubation in the anticipated difficult airway, and were reviewed in this meta-analysis.

Intubation failure occurred in 0.6%, and severe adverse events in 0.3% with no permanent sequelae or death.

There were no differences in different methods of local anesthesia, and all sedation methods were equivalent.

Desaturation was similar with Remifentanil or Propofol, amd apnea was lower with Sevoflurane vs. Propofol. Desaturation was lower with Dexmedetomidine compared to opioids and Propofol with or without Midazolam.

The authors conclude: A high degree of efficacy and safety was observed with minimal differences among different protocols; dexmedetomidine might offer a better safety profile compared to other sedatives.

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