Weekly General News

e-cigarettes’ effects need further research, but while they may increase transition to smoking in youths, they may also aid smoking cessation in adults. Either way, nicotine is addictive. link

Anti thyroid medications in the first trimester may increase congenital birth defects link

Interest in ketogenic diet for sustained weight loss link

Triple antiplatelet therapy in acute stroke doesn’t help and increases bleeding. Choose aspirin with dipyridamole, or clopidogrel alone.link

Seafood may help Alzheimer’s, despite the mercury concern link

Worsening anxiety-depressive symptoms a marker for preclinical Alzheimer’s link

Paintball, BB and pellet guns pose eye injury danger to kids. Who’d have guessed? NYtimes link

Extended release Naltrexone and Suboxone equally effective in preventing opioid relapse (but 28% of Nal group relapsed waiting to detox until Naltrexone could be started) jama link

A troubling 1 in 3 women don’t have their Cervical smear test because of embarrassment link

Gynecological but not medical complications increased over 1 and 3 year after hysteroscopic vs laparoscopic sterilization. Hysteroscopic seems to have too many gyn complications to replace lap yet, including higher pregnancy link

Influenza associated with a sixfold greater risk of myocardial infarction acutely nejm

For stroke, Endovascular Thrombectomy (plus medical Rx) for internal carotid or proximal middle cerebral artery occlusion with favourable perfusion findings benefits up to 16 hours and AHA extends time window to 24 hours  nejm

Much hype about ‘liquid biopsy’  blood test “CancerSEEK” detecting multiple cancers using cfDNA and protein biomarkers, specific but not always sensitive (many false negatives) and yet to show value in Stage I cancer, where we really need it for early detection  Hopkins link

Parents who supply alcohol to their teenagers just increase their risk of alcohol-related harm lancet link

Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital mortality in intracerebral hemorrhage  Jama

Use paracetamol (acetaminophen) for most sore throats, says NICE NICE guidelines

 

 

Sepsis

The quick SOFA should alert us to increased mortality risk. qSOFA: altered mental status, respiratory rate >22 and systolic BP <100. Adding Lactate can increase sensitivity. qSOFA doesn’t define sepsis, but should prompt a thorough evaluation and full SOFA score ( sofa calc ).

“Sepsis 3 Consensus”:   Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection; septic shock requires vasopressors to maintain MAP 65mm, lactate>2 in the absence of hypovolemia.

The SIRS term is gone from sepsis in favour of qSOFA and severe sepsis is now just sepsis.

A clear summary qsofa link

But (and there always is a but) many dispute the accuracy of qSOFA. As in this study Anaesthesia article where SOFA and NEWS ( news score ) outperformed.

So don’t abandon the full SOFA yet sofa jama

Enhanced Recovery after Surgery (ERAS)

An interesting view of different institutions’ protocols on enhanced recovery. Common elements are pre-op education, exercise and respiratory training, clear fluid carbohydrate loading with 2 hour clear fluid fast, no bowel prep in some cases, no premedication, Alvimopan for bowel motility unless contraindicated, multimodal analgesia with frequent use of epidural or spinal morphine, lidocaine infusion where no epidural,  two antiemetics, restrictive or goal directed fluids, normothermia, normoglycemia, early fluids advancing to diet one day post-op with ambulation amd continued antiemetics, early discontinuation of fluids, early removal of catheters and drains.

ASER protocols

But if it’s hard to implement, you’re probably not alone JAMA link