Sunday, May 20, 2018

The Winters formula and the thumb rule


The Winters formula is used to assess the appropriateness of the pCO2 response to metabolic acidosis (and thus determine whether a concomitant respiratory acid base disturbance exists). Here’s an interesting post from the archives of the Renal Fellow Network.

Saturday, May 19, 2018

Settled science: female physicians are better docs


So says one of the authors of the much talked about study in his somewhat, shall we say, promotional blog posts. [1] [2]

Thursday, May 17, 2018

Rivaroxaban versus warfarin and recurrent VTE



Methods

In this propensity-matched cohort study, we linked nationwide Danish health registries to identify all patients with a first hospital diagnosis of unprovoked VTE who were new users of rivaroxaban or warfarin. Excluded patients included those who had not been residents in Denmark for at least 1 year before VTE diagnosis, patients with outpatient VTE diagnosis only, patients with other indications for oral anticoagulation treatment, patients with previous experience of oral anticoagulation, patients who did not have a prescription for rivaroxaban or warfarin within 7 days of VTE, and patients who redeemed prescriptions for both rivaroxaban and warfarin, or other oral anticoagulants. Primary effectiveness outcome was recurrent VTE and primary safety outcome was major bleeding. We used propensity matching and Cox regression to compare rates of the outcomes with rivaroxaban versus standard treatment.

Results

From Dec 9, 2011, to Feb 28, 2016, we identified 29 963 patients with incident VTE. After exclusion, we identified 1734 propensity-matched patients given rivaroxaban (1751 before propensity matching) and 2945 propensity-matched patients given warfarin. The rate of recurrent VTE at 6 months' follow-up was 9·9 incidents per 100 person-years with rivaroxaban versus 13·1 incidents per 100 person-years with warfarin, yielding a hazard ratio (HR) of 0·74 (95% CI 0·56–0·96). The rate of major bleeding was 2·4 per 100 person-years at 6 months in rivaroxaban users versus 2·0 in warfarin users (HR 1·19, 95% CI 0·66–2·13).

Interpretation

In this clinical practice setting, rivaroxaban in patients with unprovoked VTE was associated with reduced risk of recurrent VTE compared with standard treatment, without compromising safety.

A related editorial pointed out the potential confounding effects of return visits for INR monitoring being interpreted as recurrent events.

Wednesday, May 16, 2018

Cardiac cachexia is associated with sympathetic nerve activity in skeletal muscle



Introduction: Cardiac cachexia is associated with poor prognosis in patients with heart failure (HF). Sympathetic overactivation might be implicated in the development of muscle wasting, considering the recent data that carvedilol significantly reversed body weight (BW) loss in HF patients…

Methods: We prospectively evaluated changes in BW in 108 non-edematous HFrEF patients in whom muscle sympathetic nerve activity (MSNA) was measured...

Results... One-year combined event rate was significantly higher in BW loss group...MSNA...was significantly higher in BW loss group than in non-BW loss group. Importantly, MSNA burst incidence had a moderate predictability for significant BW loss by receiver-operating characteristic analysis (area under the curve=0.794).

Conclusion: Sympathetic overactivation determined by MSNA could predict significant BW loss in HFrEF patients.

Tuesday, May 15, 2018

Herpes zoster ophthalmicus