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2524. Association Between Socioeconomic Disadvantage and Decline in Function, Cognition, and Mental Health After Critical Illness Among Older Adults : A Cohort Study.
作者: Snigdha Jain.;Terrence E Murphy.;John R O'Leary.;Linda Leo-Summers.;Lauren E Ferrante.
来源: Ann Intern Med. 2022年175卷5期644-655页
Older adults admitted to an intensive care unit (ICU) are at risk for developing impairments in function, cognition, and mental health. It is not known whether socioeconomically disadvantaged older persons are at greater risk for these impairments than their less vulnerable counterparts.
2525. Type 1 Diabetes Mellitus.
Type 1 diabetes mellitus (T1DM) is an endocrine disorder in which pancreatic β cells stop producing insulin, typically due to autoimmune destruction. This results in hyperglycemia and ketosis; thus, insulin replacement is vital to management. Incidence peaks in puberty and early adulthood, but onset can occur at any age. However, prevalence is highest among adults because persons with T1DM live for many years. Symptoms include polyuria, polydipsia, and weight loss. Acute complications include diabetic ketoacidosis, which requires urgent management. Long-term complications include microvascular and macrovascular disease. Patients with T1DM are at higher risk for other autoimmune diseases and psychosocial issues. Management should focus on optimizing glucose control to reduce acute and long-term complications.
2527. In older adults, use of a recombinant zoster vaccine was associated with Guillain-Barré syndrome.
Goud R, Lufkin B, Duffy J, et al. Risk of Guillain-Barré syndrome following recombinant zoster vaccine in Medicare beneficiaries. JAMA Intern Med. 2021;181:1623-30. 34724025.
2528. DAPT de-escalation from ticagrelor to clopidogrel 1 mo after PCI for acute MI reduced net clinical events at 1 y.
Kim CJ, Park MW, Kim MC, et al. Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial. Lancet. 2021;398:1305-16. 34627490.
2529. In COVID-19 with hypoxemia, 12 vs. 6 mg/d of dexamethasone did not increase days alive without life support.
Munch MW, Myatra SN, Vijayaraghavan BK, et al. Effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support in adults with COVID-19 and severe hypoxemia: the COVID STEROID 2 randomized trial. JAMA. 2021;326:1807-17. 34673895.
2530. Prescribing Nirmatrelvir-Ritonavir: How to Recognize and Manage Drug-Drug Interactions.
作者: Catia Marzolini.;Daniel R Kuritzkes.;Fiona Marra.;Alison Boyle.;Sara Gibbons.;Charles Flexner.;Anton Pozniak.;Marta Boffito.;Laura Waters.;David Burger.;David Back.;Saye Khoo.
来源: Ann Intern Med. 2022年175卷5期744-746页
Nirmatrelvir–ritonavir (NMV/r) is now being used to treat high-risk patients with mild to moderate COVID-19. This article provides advice to clinicians regarding recognition of medications likely to interact with NMV/r and suggests approaches to managing such drug–drug interactions. An algorithm is provided to assist in decision making.
2531. Invitation to a single FS screening vs. usual care reduced colorectal cancer mortality and incidence at >15 y.
Senore C, Riggi E, Armaroli P, et al. Long-term follow-up of the Italian flexible sigmoidoscopy screening trial. Ann Intern Med. 2022;175:36-45. 34748376.
2532. In CV disease, GLP-1 RAs and SGLT2 inhibitors reduce CV mortality.
Kanie T, Mizuno A, Takaoka Y, et al. Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis. Cochrane Database Syst Rev. 2021;10:CD013650. 34693515.
2533. In patients with MI or high-risk coronary disease, influenza vaccination reduced CV events at 12 mo.
Fröbert O, Götberg M, Erlinge D, et al. Influenza vaccination after myocardial infarction: a randomized, double-blind, placebo-controlled, multicenter trial. Circulation. 2021;144:1476-84. 34459211.
2534. Prophylactic scopolamine butylbromide reduced death rattle in patients in the dying phase.
van Esch HJ, van Zuylen L, Geijteman ECT, et al. Effect of prophylactic subcutaneous scopolamine butylbromide on death rattle in patients at the end of life: the SILENCE randomized clinical trial. JAMA. 2021;326:1268-76. 34609452.
2535. In patients with stroke or TIA and CYP2C19 loss-of-function alleles, ticagrelor vs. clopidogrel reduced 90-d stroke.
Wang Y, Meng X, Wang A, et al. Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA. N Engl J Med. 2021;385:2520-30. 34708996.
2536. In advanced CKD with poorly controlled hypertension, chlorthalidone reduced BP at 12 wk.
Agarwal R, Sinha AD, Cramer AE, et al. Chlorthalidone for hypertension in advanced chronic kidney disease. N Engl J Med. 2021;385:2507-19. 34739197.
2537. In type 2 diabetes with increased CV risk, tirzepatide reduced HbA1c vs. glargine at 52 wk.
Del Prato S, Kahn SE, Pavo I, et al. Tirzepatide versus insulin glargine in type 2 diabetes and increased cardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial. Lancet. 2021;398:1811-24. 34672967.
2538. Major Update 2: Remdesivir for Adults With COVID-19: A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points.
作者: Anjum S Kaka.;Roderick MacDonald.;Eric J Linskens.;Lisa Langsetmo.;Kathryn Vela.;Wei Duan-Porter.;Timothy J Wilt.
来源: Ann Intern Med. 2022年175卷5期701-709页
Remdesivir is approved for the treatment of adults hospitalized with COVID-19.
2540. Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort.
作者: Marc D Ryser.;Jane Lange.;Lurdes Y T Inoue.;Ellen S O'Meara.;Charlotte Gard.;Diana L Miglioretti.;Jean-Luc Bulliard.;Andrew F Brouwer.;E Shelley Hwang.;Ruth B Etzioni.
来源: Ann Intern Med. 2022年175卷4期471-478页
Mammography screening can lead to overdiagnosis-that is, screen-detected breast cancer that would not have caused symptoms or signs in the remaining lifetime. There is no consensus about the frequency of breast cancer overdiagnosis.
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