Archive

Archive for November, 2013

Mortality Morbidity Meeting 27 November 2013

This is a placeholder documenting this meeting.

Advertisements
Categories: Mortality Morbidity

Journal Club 20 November 2013

Paper

Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

Presenter

MD

Summary

Background

Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or
poor neurologic function. Therapeutic hypothermia is recommended by international
guidelines, but the supporting evidence is limited, and the target temperature
associated with the best outcome is unknown. Our objective was to compare
two target temperatures, both intended to prevent fever.

Methods

In an international trial, we randomly assigned 950 unconscious adults after out-ofhospital
cardiac arrest of presumed cardiac cause to targeted temperature management
at either 33°C or 36°C. The primary outcome was all-cause mortality through
the end of the trial. Secondary outcomes included a composite of poor neurologic
function or death at 180 days, as evaluated with the Cerebral Performance Category
(CPC) scale and the modified Rankin scale.

Results

In total, 939 patients were included in the primary analysis. At the end of the trial,
50% of the patients in the 33°C group (235 of 473 patients) had died, as compared
with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with
a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P = 0.51). At
the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor
neurologic function according to the CPC, as compared with 52% of patients in the
36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P = 0.78). In the analysis using the
modified Rankin scale, the comparable rate was 52% in both groups (risk ratio,
1.01; 95% CI, 0.89 to 1.14; P = 0.87). The results of analyses adjusted for known
prognostic factors were similar.

Conclusions

In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac
cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as
compared with a targeted temperature of 36°C.

Other related material

2002 Randomized clinical trial
Editorial of presented paper
Pre-hospital cooling for cardiac arrest
Editorial: pre-hospital cooling for cardiac arrest

Guideline for the Management of Overweight and Obesity in Adults

The ACC/AHA/TOS guidelines for management of overweight and obese adults is available here.

Categories: Uncategorized Tags:

Journal Club 13 November 2013

Paper

A Randomized Trial of Colchicine for Acute Pericarditis

Presenter

SH

Summary

Background

Colchicine is effective for the treatment of recurrent pericarditis. However, conclusive
data are lacking regarding the use of colchicine during a first attack of acute
pericarditis and in the prevention of recurrent symptoms.

Methods

In a multicenter, double-blind trial, eligible adults with acute pericarditis were
randomly assigned to receive either colchicine (at a dose of 0.5 mg twice daily for
3 months for patients weighing >70 kg or 0.5 mg once daily for patients weighing
≤70 kg) or placebo in addition to conventional antiinflammatory therapy with aspirin
or ibuprofen. The primary study outcome was incessant or recurrent pericarditis.

Results

A total of 240 patients were enrolled, and 120 were randomly assigned to each of
the two study groups. The primary outcome occurred in 20 patients (16.7%) in the
colchicine group and 45 patients (37.5%) in the placebo group (relative risk reduction
in the colchicine group, 0.56; 95% confidence interval, 0.30 to 0.72; number
needed to treat, 4; P<0.001). Colchicine reduced the rate of symptom persistence at
72 hours (19.2% vs. 40.0%, P = 0.001), the number of recurrences per patient (0.21
vs. 0.52, P = 0.001), and the hospitalization rate (5.0% vs. 14.2%, P = 0.02). Colchicine
also improved the remission rate at 1 week (85.0% vs. 58.3%, P<0.001). Overall
adverse effects and rates of study-drug discontinuation were similar in the two
study groups. No serious adverse events were observed.

Conclusions

In patients with acute pericarditis, colchicine, when added to conventional antiinflammatory
therapy, significantly reduced the rate of incessant or recurrent
pericarditis.

FDA Warning: Low Molecular Weight Heparins and Epidural and Spinal Procedures.

The FDA press release is available here.

Categories: Uncategorized

Dietary Fat and Statins

Recently, ABC presented a two part special edition, Heart of the Matter. This was a controversial programme challenging the strength of the evidence of medcal advice regarding dietary fat and the value of statins. Dr. Norman (ABC) presented a response,What the research says about cholesterol and statins, which is a valuable public exposition.

The Cochrane collaborative review of the dietary fat evidence is available here.

The Cholesterol Treatment Trialists Collaboration most recent review of long term statin effects on vascula disease is here.

The journalistic critique of the Catalyst programme is here by ABC Media Watch.

Categories: Uncategorized

Journal Club 30 October 2013

Paper

Prevention of contrast-induced nephropathy with Na/K citrate

Presenter

JT

Summary

Aims

Contrast-induced nephropathy (CIN) is a frequent complication of many radiological procedures involving the application
of contrast media. It represents a significant health problem that causes the increase in mortality, morbidity,
and medical costs. For the prevention of CIN, a number of methods have been proposed to be effective. Among
them, alkalinization of urine takes an important place. Although the Na/K citrate is a well-known agent for urine alkalinization,
it has not been studied in the prevention of CIN.

Methods and results

Two hundred and two patients who underwent coronary angiography were included in the study. They were randomized
into groups receiving the drug Na/K citrate per os and to the control group. Serum creatinine and glomerular
filtration rate were determined in all patients immediately before coronary angiography, and 48 h after the
procedure. CIN criteria were a creatinine increase of .25%, reduction in the glomerular filtration rate by .25%,
or an increase in serum creatinine of .44 mmol/L. The incidence of CIN in the group receiving Na/K citrate was
significantly lower when compared with the control group (4% compared with 20%, P ¼ 0.0001). Patients who
had a urine pH ,6 had a more than ten-fold higher incidence of contrast nephropathy compared with patients
whose urine pH was .6.

Conclusion

Alkalinization of urine using the Na/K citrate may reduce the incidence of CIN.

Categories: Journal Club