Temperature and COVID-19: India
India is under nationwide lockdown from 25 March 2020, in an effort to curb the spread of COVID-19, with closed borders and enforcement of quarantine/isolation. Life under lockdown witnessed a reduction in the acceleration of COVID-19 in the country, as evident by the gradual improvement in doubling rate in the total number of 'diagnosed' infected persons.1 Until 21 May 2020, more than 112 000 cases have been diagnosed in the country, with 3435 deaths.2 There is literature suggesting the possible role of temperature on the pandemic.3 4 A sound understanding would help us in deciding the strategies for mitigation of the exi...
Source: Evidence-Based Medicine - November 25, 2021 Category: Internal Medicine Authors: Roy, M. P. Tags: COVID-19 Letters Source Type: research
Criticisms of the VAPOUR trial in a recent commentary are unsubstantiated and incorrect
We are concerned by commentary1 about the VAPOUR trial2 written by authors of two previous masked vertebroplasty trials.3 4 Having participated in the larger of these trials, INVEST,3 we adopted similar trial methodology in VAPOUR but restricted patient inclusion criteria to fractures <6 weeks duration causing severe pain (table 1). The commentary speculates that trial procedures were inadequately masked because patients could not smell polymethyl methacrylate (PMMA). We replicated the placebo used in INVEST with the exception that the selected PMMA kit emitted no odour, and lidocaine was injected into the sub...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Clark, W., Bird, P., Diamond, T., Gonski, P., Barnes, E., Gebski, V. Tags: Letters Source Type: research
Urine concentration should be taken into account when interpreting pyuria in infants
Commentary on: Chaudhari PP, Monuteaux MC, Bachur RG, et al. Urine concentration and pyuria for identifying UTI in infants. Pediatrics 2016;138:e20162370. Context The relationship between pyuria and true urinary tract infection (UTI) remains controversial. Most studies have assessed pyuria using manual microscopy in centrifuged urine. However, standard practice at most centres now involves automated urinalysis of uncentrifuged urine, thus pyuria in dilute samples may have more significance than pyuria in concentrated urine samples. It may therefore be important to consider the possible impact of urine concentrati...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Alam, S., Voort, J. v. d., Butler, C. C. Tags: Diagnosis Source Type: research
In children 7 years of age, prenatal antidepressant exposure is not associated with increased risk of poor behavioural outcomes after adjusting for maternal factors including antenatal mood
This study attempts to clarify the impact of prenatal antidepressant exposure on long-term child outcomes, accounting for antenatal maternal factors, including depression. Methods This study was conducted using data from 49 178 mother–child dyads enrolled in the Danish National Birth Cohort—a nationwide longitudinal follow-up study of pregnant women and their children. The overall cohort includes more than 100 000 women who were pregnant between 1996 and 2002. Maternal depression and medication use was assessed via self-report using computer-assisted telephone interviews conducted during pregnancy. Ch...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Gentile, S., Fusco, M. L. Tags: Aetiology/Harm Source Type: research
Among opioid-naive patients receiving opioids, more intensive opioid prescribing in the first month is associated with transition to long-term opioid use
This study sought to analyse the association between prescribing patterns in the first 30 days of opioid receipt among formerly opioid-naive subjects and transitioning to long-term opioid use. Methods This retrospective cohort study used opioid... (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Larochelle, M. R. Tags: Aetiology/Harm Source Type: research
Caesarean section is associated with offspring obesity in childhood and young adulthood
Commentary on: Yuan C, Gaskins AJ, Blaine AI, et al. Association between cesarean birth and risk of obesity in offspring in childhood, adolescence, and early adulthood. JAMA Pediatr 2016;170:e162385. Context Since 2008, several observational studies have reported an association between caesarean section (CS) and offspring obesity. The underlying biological mechanism hypothesised to explain this association is that children born via CS lack exposure to the maternal vaginal flora, resulting in colonisation of the gut with flora that increase energy harvesting from food, thereby contributing to the development of obesity. Mat...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Kuhle, S., Woolcott, C. G. Tags: Aetiology/Harm Source Type: research
Stroke rates vary substantially across cohorts of patients with atrial fibrillation
Commentary on: Quinn GRSeverdija ONChang Y. Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation. Circulation 2017;135:208–19. Context Oral anticoagulants (OACs) substantially reduce stroke risk in patients with atrial fibrillation (AF); however, they remain globally underused.1 One of the main reasons is the difficulty in stratifying AF-related ischaemic stroke risk at the individual patient level.1 2 Among scores stratifying AF-related stroke risk, CHA2-DS2-Vasc prevails in most recent international AF guidelines.3 4 Still, it remains unknown whether AF-related stroke risk ...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Sposato, L. A., Saposnik, G. Tags: EBM Prognosis Source Type: research
In patients with intracerebral haemorrhage and concomitant atrial fibrillation, optimal timing of reinitiating anticoagulants may be 7-8 weeks after ICH
Commentary on: Pennlert J, et al. Optimal timing of anticoagulant treatment after intracerebral haemorrhage in patients with atrial fibrillation. Stroke 2017:48;314–320. Context In patients with intracerebral haemorrhage (ICH) and a concomitant diagnosis of atrial fibrillation (AF), the clinical dilemma arises whether anticoagulant treatment should be (re)started and when.1 In the absence of results from randomised controlled trials, guidelines provide no firm recommendations. Several observational studies have suggested that reintroduction of oral anticoagulants may be associated with a reduction in thrombotic ...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Klijn, C. J., Schreuder, F. H. Tags: Therapeutics/Prevention Source Type: research
Resumption of anticoagulation after major bleeding decreases the risk of stroke in patients with atrial fibrillation
This study aimed to (1) evaluate anticoagulation use after a major bleeding event on dabigatran or warfarin and (2) compare outcomes between patients discontinuing anticoagulation and those restarting dabigatran or warfarin. Methods This was... (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Smit, M. D., Van Gelder, I. C. Tags: Therapeutics/Prevention Source Type: research
Conduct and reporting of a vertebroplasty trial warrants critical examination
Commentary on: Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016;388:1408–16. Context Percutaneous vertebroplasty was widely used in patients with symptomatic acute vertebral compression fractures until two placebo randomised controlled trials (RCTs) published in 2009 questioned its efficacy and safety.1 2 Consistent results across both trials indicated vertebroplasty was no more effective than placebo, while a combined individual patient metaanalysis failed to show a...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Buchbinder, R., Kallmes, D. F., Jarvik, J. G., Deyo, R. A. Tags: Therapeutics/prevention Source Type: research
Oral antibiotics are as effective as intravenous antibiotics for postdischarge treatment of complicated pneumonia in children
Commentary on: Shah SS, Srivastava R, Wu S, et al. Intravenous versus oral antibiotics for postdischarge treatment of complicated pneumonia. Pediatrics 2016;138:e20161692. Context In children, complicated pneumonia implies pneumonia infection that is associated with pleural effusion or empyema.1 Initial management involves use of parenteral broad spectrum antibiotics to cover the most common organisms1; thoracotomy or chest tube insertion may be indicated if there is no response to antibiotic therapy, or if there is significant respiratory difficulty. Most national guidelines do not specify the preferred route of antibioti...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Onakpoya, I. Tags: Therapeutics/Prevention Source Type: research
Possible protective effect of prenatal omega-3 long-chain polyunsaturated fatty acids supplementation on persistent wheeze and asthma in early childhood
Commentary on: Bisgaard H, Stokholm J, Chawes BL, et al. Fish oil-derived fatty acids in pregnancy and wheeze and asthma in offspring. N Engl J Med 2016;375(26):2530–9. Context The incidence of asthma and wheezing disorders in developed countries has increased in recent decades.1 Profound changes in the type of fat consumed, particularly an increased intake of omega-6 (-6) relative to omega-3 (-3) fatty acids, parallel the increasing prevalence of asthma and other inflammatory diseases, leading to the hypothesis that imbalance of fats may be causally related. This randomised controlled trial (RCT) investigates the ef...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Best, K., Makrides, M. Tags: Therapeutics/Prevention Source Type: research
High-intensity exercise offers no additional benefit to moderate-intensity exercise in reducing liver fat in patients with non-alcoholic fatty liver disease
Commentary on: Zhang HJ, He J, Pan LL, et al. Effects of moderate and vigorous exercise on non-alcoholic fatty liver disease: a randomized clinical trial. JAMA Intern Med 2016;176:1074–82. Context Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of liver morbidity and mortality, type 2 diabetes mellitus and cardiovascular disease (CVD). Lifestyle modification is the mainstay of treatment, with uncertainty regarding the effectiveness of drug therapy for patients with NAFLD.1 Exercise intervention studies demonstrate that exercise effectively reduces liver fat, even in the absence of ...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Cuthbertson, D. J., Sprung, V. S. Tags: Therapeutics/Prevention Source Type: research
Intensive blood pressure lowering provides no additional benefits and results in more adverse events
Commentary on: Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med 2016;375:1033-43. Context Elevated blood pressure (BP) in acute intracerebral haemorrhage (ICH) is common and associated with poor outcome. High BP causes an expansion of the intracerebral haematoma, and the ‘Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial’ (INTERACT2) showed that moderate BP lowering <140 mm Hg is safe and likely to reduce death and major disability.1 The results of the INTERACT2 trial changed current guidelines.2...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Sandset, E. C., Fischer, U. Tags: Therapeutics/Prevention Source Type: research
Abdominal electroacupuncture demonstrates an increase in complete spontaneous bowel movements
Commentary on: Liu Z, Yan S, Wu J, et al. Acupuncture for Chronic Severe Functional Constipation: A Randomized Trial. Ann Intern Med 2016;165:761–9. Context Chronic idiopathic constipation has been reported in ~11% of south Asian populations.1 Pharmacological agents, such as the 5-HT4 receptor agonist, prucalopride, result not only in increased spontaneous bowel movements (SBMs) but also in increased adverse events in the Asian population.2 Therefore, alternative therapies are being researched. Multiple abdominal points (‘acupoints’) have been associated with stimulation of parasympathetic nerve...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Jacob, D., Vijayvargiya, P., Camilleri, M. Tags: Therapeutics/Prevention Source Type: research
