Clinical
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Deworming Is Beneficial in HIV-infected Patients
988 HIV-infected pregnant women receiving ART in sub-Saharan Africa were treated with albendazole in a targeted or non-targeted fashion. Albendazole therapy was associated with favorable changes in hemoglobin levels, CD4 counts, and viral loads, particularly in patients with helminth infections.
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Combination Therapy for Invasive Aspergillosis in Patients with Hematologic Malignancies or Hematopoeitic Cell Transplants
In an evaluation of the primary endpoint, all-cause mortality at 6 weeks, there was no statistically significant difference between treatment with voriconazole alone or in combination with anidulafungin in patients with invasive aspergillosis and hematologic malignancies or hematopoietic stem cell transplants.
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Measles in Our Not-So-Magical Kingdom
ABSTRACT & COMMENTARY: Routine vaccination would have prevented most of these recent cases in California.
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Ticagrelor Cost Effective as Well as Efficacious, According to New Analysis
The PLATO trial randomized more than 18,000 acute coronary syndrome (ACS) patients to dual anti-platelet therapy with aspirin plus either clopidogrel or the newer P2Y12 inhibitor ticagrelor. Compared with clopidogrel-treated patients, those on ticagrelor had lower rates of death and myocardial infarction at 1 year. Despite superior ischemic outcomes, both ticagrelor and the thienopyridine prasugrel have been relatively slow to be adopted in the United States. This is at least in part due to the cost differential, as the older clopidogrel is available as a generic, while the newer agents enjoy continued brand exclusivity. The National Average Drug Acquisition Cost data collected by CMS currently reports a 70-fold difference in price between clopidogrel and ticagrelor.
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Implantable Coronary Sinus Narrowing Device Shows Promise in Refractory Angina
Despite advances in medical therapy and in coronary revascularization techniques, the population of patients with chronic, stable, but debilitating angina continues to grow. The mortality of such patients is surprisingly low, such that patients with this disorder often suffer limiting symptoms for many years. Clearly more options for treatment are needed, but what?
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Surgical Management of Infective Endocarditis
SOURCES: Chu VH, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: A prospective study from the international collaboration on endocarditis. Circulation 2015;131:131-140; Erbel R. The new strategy in infective endocarditis: Early surgery based on early diagnosis: Are we too late when early surgery is best? Circulation 2015;131:121-123. -
A New Oral Treatment for Hyperkalemia: Patiromer
Patiromer (PAT) is an oral non-absorbable polymer that works by binding potassium (K+) in exchange for calcium in the distal colon. Currently available oral treatments for hyperkalemia are burdened by GI adverse effects as well as limited efficacy. Hyperkalemia is particularly problematic in chronic kidney disease (CKD), which may be compounded by the need to administer ACE inhibitors or angiotensin II receptor blockers (ARB).
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Ambulatory BP Monitoring
The benefits of hypertension treatment (HTN), often cited as a 25% reduction in myocardial infarction, 40% reduction in stroke, and 50% reduction in heart failure, have generally been demonstrated in clinical trials based on an office blood pressure measurement. Since a substantial minority of patients enrolled in HTN trials — approximately one-third according to numerous estimates — ultimately turn out to have white coat HTN (wc-HTN), we may be underestimating the actual benefits of HTN treatment. Patients with wc-HTN do not suffer the same increased risk of cardiovascular events as HTN patients; hence, their inclusion in HTN trials “dilutes” treatment effects.
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Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes
Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.1 To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.
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Intravenous Fluids in Patients With Acute Heart Failure
MONOGRAPH: Volume overload is a hallmark of acute heart failure. In hospitalized patients, intravenous loop diuretics are the most common treatment for decongestion.