Physicians Academy
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Table Of Contents
Editorial :
 The Real Paradigm Shift in Management of T2DM
Article 1 :
 Introduction of DMS irrigation to heal Endo–Perio lesions and Cysts
Article 2 :
 Alagille Syndrome in a Neonate
Picture of The Month :
 POTM-April 2018
Drug Update :
 SEGLUROMET (ertugliflozin+metformin)
Abstracts from Other Journals :
 Abstracts from Other Journals-April 2018

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Dec 2017 ( Volume -11 Number -12)

Abstracts from Other Journals
Abstracts from Other Journals-December 2017
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DECEMBER 2017

Abstracts from Other Journals

Migraine Prevention: Two Calcitonin Gene-Related Peptide Treatments May Help

Two humanized monoclonal antibodies seem effective in preventing migraine, according to two industry-conducted, phase III trials in the New England Journal of Medicine. The investigational treatments target the calcitonin gene-related peptide (CGRP) or its receptor; CGRP affects neuronal modulation of pain and vascular activity.

In the first trial, researchers randomized nearly 1000 adults with episodic migraine (mean of 8 migraine days a month) to receive monthly subcutaneous injections of erenumab (70 or 140 mg) or placebo. From months 4 to 6, erenumab recipients had a greater reduction in monthly migraine days than did placebo recipients (mean reduction of 3.2–3.7 vs. 1.8 days).

In the second trial, over 1000 patients with chronic migraine (mean, 13 headache days per month) were randomized to receive injections of fremanezumab (quarterly or monthly) or placebo. At 12 weeks, fremanezumab recipients had a greater reduction in headache days per month (reduction of 4.3–4.6 vs. 2.5 days with placebo). Fremanezumab also reduced migraine days.

An editorialist concludes: "These drugs may find a specific role in the treatment of patients who have migraines that are refractory to treatment or who are severely disabled by headaches."

NEJM article on erenumab (Free abstract)

NEJM article on fremanezumab (Free abstract)

NEJM editorial (Subscription required)

Perioperative Aspirin Might Benefit Patients with Prior PCI

Perioperative aspirin seems beneficial for high-risk patients undergoing noncardiac surgery who've previously undergone percutaneous coronary intervention (PCI), according to a subanalysis from the POISE-2 trial. The findings were published in the Annals of Internal Medicine and presented at the American Heart Association conference on Monday.

In POISE-2, 10,000 adults with or at risk for atherosclerotic disease who were undergoing noncardiac surgery were randomized to receive perioperative low-dose aspirin plus clonidine; placebo plus clonidine; aspirin plus placebo; or double placebo. Among the 470 participants with prior PCI, aspirin was associated with significantly lower risk for the primary outcome — 30-day incidence of death or nonfatal myocardial infarction —- relative to placebo (6% vs. 11%). Aspirin's benefits did not extend to patients without prior PCI.

NEJM Journal Watch Cardiology summary (Your NEJM Journal Watch subscription required)

Annals of Internal Medicine article (Free abstract)

Annals of Internal Medicine editorial (Subscription required)

Heart Groups Update Guidelines on Managing Ventricular Arrhythmias and Preventing Sudden Cardiac Death

The American Heart Association, the American College of Cardiology, and the Heart Rhythm Society have released guidelines on treating patients who have ventricular arrhythmias or otherwise are at risk for sudden cardiac death. This is an update from the groups' 2006 guidance.

Among the many recommendations:

  • For patients with NYHA class IV symptoms who aren't hospitalized and are candidates for a left ventricular assist device or cardiac transplantation, an implantable cardioverter defibrillator (ICD) is an acceptable option if the patient's expected meaningful survival is at least 1 year.
  • For patients with nonischemic cardiomyopathy, ICDs are recommended in patients who survive sudden cardiac arrest due to ventricular tachycardia (VT)/ventricular fibrillation or who experience hemodynamically unstable VT or stable VT unrelated to reversible causes.
  • A subcutaneous ICD is recommended for patients who have inadequate vascular access or are at high infection risk from an ICD, and for whom pacing (for bradycardia or VT termination or as part of cardiac resynchronization) is not required.

JACC article (Free PDF)

New BP Guidelines Expand Hypertension Definition to 130 Systolic or Above

New guidelines from the American College of Cardiology and American Heart Association, among others, define substantially more U.S. adults as having hypertension than the 2003 Joint National Committee (JNC 7) report's definition.

The new ACC/AHA guidelines — unveiled on Monday at the AHA's annual meeting — define systolic blood pressure at or above 130 mm Hg as constituting hypertension, while the older definition set the threshold at 140 or above. In addition, a diastolic BP of 80 or above is now considered hypertensive, versus 90 or above with JNC 7. On the basis of nationally representative data on roughly 10,000 adults, some 46% of Americans have hypertension under the new guidelines — versus 32% under JNC 7 — according to an analysis in the Journal of the American College of Cardiology.

Despite the expanded definition, the percentage of adults recommended to take drug therapy would rise modestly under the new guidelines — by about two percentage points over the JNC 7 recommendations.

ACC/AHA 2017 guidelines (Free PDF)

Guideline executive summary (Free PDF)

JACC analysis (Free abstract)

Sodium Bicarbonate, Acetylcysteine Don't Prevent Kidney Injury After Angiography

Neither sodium bicarbonate nor acetylcysteine appears to reduce risk for acute kidney injury in high-risk patients undergoing angiography, according to a randomized trial published in the New England Journal of Medicine and presented at the American Heart Association conference.

Some 5000 patients with stage 3 or 4 chronic kidney disease who were scheduled to have angiography were randomized to receive either periprocedural intravenous sodium bicarbonate or sodium chloride, plus 5 days of either oral acetylcysteine or placebo. The primary composite outcome — death, need for dialysis, or persistent increase in serum creatinine at 90 days — did not differ significantly across the treatments, at roughly 4.5%.

NEJM Journal Watch Cardiology summary (Free)

NEJM article (Free)

 


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