Last Week in Medicine

Today we are joined by heavy hitter Dr. Brian Locke to talk about the new paper on 3 vs 8 days of antibiotics for pneumonia, a clever new paper looking at whether there is any association between IV contrast and kidney function, and a new retrospective study on DOAC use for valvular atrial fibrillation.  Check it out! Three Days of Antibiotics for PneumoniaIV Contrast and Kidney FunctionDOACs for Valvular Atrial FibrillationMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we are doing double duty: podcasting and parenting.  Fortunately our babies were well-behaved.  We talk about three trials for semaglutide and weight loss and a new 4 level pre-test probability rule for diagnosing PE.  We also talk about a retrospective study of cefazolin vs nafcillin for epidural abscess, a ferritin/procalcitonin ratio for differentiating bacterial from COVID pneumonia, and a new randomized controlled trial of intermediate thromboprophylaxis for ICU patients with COVID19.  Check it out! Semaglutide for Weight Loss (STEP 1)Semaglutide for Weight Loss in Diabetics (STEP 2)Semaglutide + Intensive Calorie Restriction for Weight Loss (STEP 3)4PEPS for Pulmonary EmbolismNafcillin vs Cefazolin for Epidural AbscessFerritin/Procalcitonin Ratio for COVID-19 vs Bacterial PneumoniaIntermediate Thromboprophylaxis for COVID-19 (INSPIRATION) Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/) Hall of the Mountain King Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 3.0 Licensehttp://creativecommons.org/licenses/by/3.0/Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today has a nice liver disease theme.  Does targeting a serum albumin above 3 g/dL reduce death, infections and kidney failure in patients with decompensated cirrhosis?  Does terlipressin work in hepatorenal syndrome?  Albumin Infusion for Decompensated CirrhosisTerlipressin for Type 1 Hepatorenal Syndrome Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today I am joined by Infectious Disease expert Dr. Emily Spivak to talk about the latest batch of tocilizumab trials for COVID-19 and a meta-analysis of all the convalescent plasma trials.  Check it out! Tocilizumab in Hospitalized Patients with COVID-19 (COVACTA)IL-6 Receptor Antagonists in Critically Ill Patients with COVID-19 (REMAP-CAP)RECOVERY Tocilizumab pre-printMeta-analysis of Convalescent Plasma for COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we have special guests Dr. Emily Signor and Dr. Amanda Breviu, two hospitalists, to talk about a survey published in JHM on gender-based discrimination among hospitalists.  We also discuss a survey published in JGIM on educational resources used by internal medicine residents.  Check it out! Gender Based Discrimination and Harassment Among HospitalistsEducational Resource Utilization Among Internal Medicine ResidentsLiberal vs Restrictive Transfusion Threshold for Patients with ACS and AnemiaDOACs for VTE prevention in CKDMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

In this engaging discussion, Dr. Jared Bunch, an electrophysiologist and leading expert in atrial fibrillation, dives into the latest findings from the STOP-AF and EARLY-AF trials. He reveals how early catheter ablation can significantly benefit new AF patients versus traditional medications. The conversation also touches on the safety of continuing ACE inhibitors during COVID-19, the effectiveness of oral antibiotics for uncomplicated appendicitis, and the optimal oxygen targets in respiratory failure. It's a fascinating mix of cutting-edge medical insights!

Today I am joined by pulmonary hypertension and heart failure expert, Dr. John Ryan, to talk about inhaled treprostinil for pulmonary hypertension due to ILD, and a new cardiac myosin activator, omecamtiv mecarbil, for treatment of systolic heart failure.  Check it out! Treprostinil for Pulmonary Hypertension due to ILDOmecamtiv Mecarbil for Systolic Heart FailureMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

WARNING: This episode is long on banter.  If you would like to skip the intro conversation and get right to the articles, skip ahead to 12:13.  Today we are joined by Dr. Jason Carr, pulmonary-critical care all-star, to talk about how often PE is present in patients with acute COPD exacerbations.  We also review more tocilizumab RCTs because they just keep coming. Prevalence of Pulmonary Embolism in Acute COPD ExacerbationSTOP-IT COVID trialRCT-TCZ-COVID-19 trialCORIMUNO-TOCI-1 trialREMAP-CAP trial pre-printMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

The president's supporters may have stormed the capitol and attempted a coup today, but the show must go on.  Today I'm joined by Dr. Dani Babbel to talk about treatment of hypertension in the hospital, as well as testing for primary aldosteronism in patients with resistant hypertension.  Check it out!  Treatment and Outcomes in Inpatient Hypertension Testing for Primary Aldosteronism and MRA Use Among US VeteransTocilizumab in Hospitalized Patients with COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today I do a quick review of the COVID-19 thrombosis literature from the last year to try to answer some of the following questions: Why does COVID-19 cause thrombosis?  How many patients with COVID-19 develop thrombotic complications?  Why do patients with COVID-19 on VTE prophylaxis still develop blood clots?  Should we use intermediate dosing of anticoagulation for prophylaxis?  What about full dose therapeutic anticoagulation (no!) What do the guidelines say? Lots of papers:JAMA IM Review Autopsy Findings and VTE in Patients with COVID-19Klok et al Helms et alShah et alPiazza et alPorfidia et alKunutsor et alDutt et alStessel et alParanjpe et alFraisse et alMusoke et alPatel et alISTH GuidelinesACCP GuidelinesTake home points:COVID-19 is associated with an elevated risk of thrombosis. Observational data suggests that ICU patients are likely to develop thrombotic complications even on standard VTE prophylaxis.  This number seems to be round 25%.  Ward patients are also at higher risk (around 8-9%). Critically ill patients commonly develop heparin resistance, and this may partially explain why some patients with COVID develop thrombotic complications despite prophylaxis. Some have suggested intermediate dosing of anticoagulation for prophylaxis, but there are no randomized controlled trials published at this time, and observational data are limited. Some have suggested therapeutic dosing of anticoagulation for critically ill patients, but observational data show high rates of bleeding and other complications, and the three largest randomized controlled trials have stopped enrolling critically ill patients into the therapeutic anticoagulation arm due to safety concerns and futility. Some have suggested targeting a certain anti-Xa activity level, but no one really knows what that should be, and there aren’t any guidelines recommending it. ISTH and ACCP have both put out guidelines which are overall pretty similar.Make sure your patient has VTE prophylaxis, preferably a LMWH, and keep an eye out for thrombotic complications so you can treat them in a timely manner.  Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R