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Montreal General Hospital (MGH) Internal Medicine Journal Club

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48 papers 0 to 25 followers Weekly internal medicine journal club on Thursdays at the Montreal General Hospital (MGH) - McGill University Health Centre (MUHC)
By A Raut
Anil K Pareek, Franz H Messerli, Nitin B Chandurkar, Shruti K Dharmadhikari, Anil V Godbole, Prasita P Kshirsagar, Manish A Agarwal, Kamal H Sharma, Shyam L Mathur, Mukund M Kumbla
BACKGROUND: Thiazide and thiazide-like diuretic agents are being increasingly used at lower doses. Hydrochlorothiazide (HCTZ) in the 12.5-mg dose remains the most commonly prescribed antihypertensive agent in the United States. OBJECTIVES: This study compared chlorthalidone, 6.25 mg daily, with HCTZ, 12.5 mg daily, by 24-h ambulatory blood pressure (ABP) monitoring and evaluated efficacy. Because HCTZ has been perceived as a short-acting drug, a third comparison with an extended-release formulation (HCTZ-controlled release [CR]) was added...
February 2, 2016: Journal of the American College of Cardiology
Benjamin Lazarus, Yuan Chen, Francis P Wilson, Yingying Sang, Alex R Chang, Josef Coresh, Morgan E Grams
IMPORTANCE: Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide and have been linked to acute interstitial nephritis. Less is known about the association between PPI use and chronic kidney disease (CKD). OBJECTIVE: To quantify the association between PPI use and incident CKD in a population-based cohort. DESIGN, SETTING, AND PARTICIPANTS: In total, 10,482 participants in the Atherosclerosis Risk in Communities study with an estimated glomerular filtration rate of at least 60 mL/min/1...
February 2016: JAMA Internal Medicine
Sarah B Doernberg, Lisa G Winston, Daniel H Deck, Henry F Chambers
BACKGROUND: Receipt of antibiotics is a major risk factor for Clostridium difficile infection (CDI). Doxycycline has been associated with a lower risk for CDI than other antibiotics. We investigated whether doxycycline protected against development of CDI in hospitalized patients receiving ceftriaxone, a high-risk antibiotic for CDI. METHODS: We studied adults admitted to an academic county hospital between 1 June 2005 and 31 December 2010 who received ceftriaxone to determine whether the additional receipt of doxycycline decreased the risk of CDI...
September 2012: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Dena Ettehad, Connor A Emdin, Amit Kiran, Simon G Anderson, Thomas Callender, Jonathan Emberson, John Chalmers, Anthony Rodgers, Kazem Rahimi
BACKGROUND: The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established. However, the extent to which these effects differ by baseline blood pressure, presence of comorbidities, or drug class is less clear. We therefore performed a systematic review and meta-analysis to clarify these differences. METHOD: For this systematic review and meta-analysis, we searched MEDLINE for large-scale blood pressure lowering trials, published between Jan 1, 1966, and July 7, 2015, and we searched the medical literature to identify trials up to Nov 9, 2015...
March 5, 2016: Lancet
Paul Young, Manoj Saxena, Rinaldo Bellomo, Ross Freebairn, Naomi Hammond, Frank van Haren, Mark Holliday, Seton Henderson, Diane Mackle, Colin McArthur, Shay McGuinness, John Myburgh, Mark Weatherall, Steve Webb, Richard Beasley
BACKGROUND: Acetaminophen is a common therapy for fever in patients in the intensive care unit (ICU) who have probable infection, but its effects are unknown. METHODS: We randomly assigned 700 ICU patients with fever (body temperature, ≥38°C) and known or suspected infection to receive either 1 g of intravenous acetaminophen or placebo every 6 hours until ICU discharge, resolution of fever, cessation of antimicrobial therapy, or death. The primary outcome was ICU-free days (days alive and free from the need for intensive care) from randomization to day 28...
December 3, 2015: New England Journal of Medicine
Andrew Appelboam, Adam Reuben, Clifford Mann, James Gagg, Paul Ewings, Andrew Barton, Trudie Lobban, Mark Dayer, Jane Vickery, Jonathan Benger
BACKGROUND: The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5-20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. We assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness. METHODS: We did a randomised controlled, parallel-group trial at emergency departments in England. We randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fibrillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre...
October 31, 2015: Lancet
Bernard Zinman, Christoph Wanner, John M Lachin, David Fitchett, Erich Bluhmki, Stefan Hantel, Michaela Mattheus, Theresa Devins, Odd Erik Johansen, Hans J Woerle, Uli C Broedl, Silvio E Inzucchi
BACKGROUND: The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known. METHODS: We randomly assigned patients to receive 10 mg or 25 mg of empagliflozin or placebo once daily. The primary composite outcome was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, as analyzed in the pooled empagliflozin group versus the placebo group...
November 26, 2015: New England Journal of Medicine
Bryan Williams, Thomas M MacDonald, Steve Morant, David J Webb, Peter Sever, Gordon McInnes, Ian Ford, J Kennedy Cruickshank, Mark J Caulfield, Jackie Salsbury, Isla Mackenzie, Sandosh Padmanabhan, Morris J Brown
BACKGROUND: Optimal drug treatment for patients with resistant hypertension is undefined. We aimed to test the hypotheses that resistant hypertension is most often caused by excessive sodium retention, and that spironolactone would therefore be superior to non-diuretic add-on drugs at lowering blood pressure. METHODS: In this double-blind, placebo-controlled, crossover trial, we enrolled patients aged 18-79 years with seated clinic systolic blood pressure 140 mm Hg or greater (or ≥135 mm Hg for patients with diabetes) and home systolic blood pressure (18 readings over 4 days) 130 mm Hg or greater, despite treatment for at least 3 months with maximally tolerated doses of three drugs, from 12 secondary and two primary care sites in the UK...
November 21, 2015: Lancet
Jackson T Wright, Jeff D Williamson, Paul K Whelton, Joni K Snyder, Kaycee M Sink, Michael V Rocco, David M Reboussin, Mahboob Rahman, Suzanne Oparil, Cora E Lewis, Paul L Kimmel, Karen C Johnson, David C Goff, Lawrence J Fine, Jeffrey A Cutler, William C Cushman, Alfred K Cheung, Walter T Ambrosius
BACKGROUND: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS: We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes...
November 26, 2015: New England Journal of Medicine
Jeffrey L Cummings, Constantine G Lyketsos, Elaine R Peskind, Anton P Porsteinsson, Jacobo E Mintzer, Douglas W Scharre, Jose E De La Gandara, Marc Agronin, Charles S Davis, Uyen Nguyen, Paul Shin, Pierre N Tariot, João Siffert
IMPORTANCE: Agitation is common among patients with Alzheimer disease; safe, effective treatments are lacking. OBJECTIVE: To assess the efficacy, safety, and tolerability of dextromethorphan hydrobromide-quinidine sulfate for Alzheimer disease-related agitation. DESIGN, SETTING, AND PARTICIPANTS: Phase 2 randomized, multicenter, double-blind, placebo-controlled trial using a sequential parallel comparison design with 2 consecutive 5-week treatment stages conducted August 2012-August 2014...
September 22, 2015: JAMA: the Journal of the American Medical Association
Justine E F Moonen, Jessica C Foster-Dingley, Wouter de Ruijter, Jeroen van der Grond, Anne Suzanne Bertens, Mark A van Buchem, Jacobijn Gussekloo, Huub A Middelkoop, Marieke J H Wermer, Rudi G J Westendorp, Anton J M de Craen, Roos C van der Mast
IMPORTANCE: Observational studies indicate that lower blood pressure (BP) increases risk for cognitive decline in elderly individuals. Older persons are at risk for impaired cerebral autoregulation; lowering their BP may compromise cerebral blood flow and cognitive function. OBJECTIVE: To assess whether discontinuation of antihypertensive treatment in older persons with mild cognitive deficits improves cognitive, psychological, and general daily functioning. DESIGN, SETTING, AND PARTICIPANTS: A community-based randomized clinical trial with a blinded outcome assessment at the 16-week follow-up was performed at 128 general practices in the Netherlands...
October 2015: JAMA Internal Medicine
Francis Couturaud, Olivier Sanchez, Gilles Pernod, Patrick Mismetti, Patrick Jego, Elisabeth Duhamel, Karine Provost, Claire Bal dit Sollier, Emilie Presles, Philippe Castellant, Florence Parent, Pierre-Yves Salaun, Luc Bressollette, Michel Nonent, Philippe Lorillon, Philippe Girard, Karine Lacut, Marie Guégan, Jean-Luc Bosson, Silvy Laporte, Christophe Leroyer, Hervé Décousus, Guy Meyer, Dominique Mottier
IMPORTANCE: The optimal duration of anticoagulation after a first episode of unprovoked pulmonary embolism is uncertain. OBJECTIVES: To determine the benefits and harms of an additional 18-month treatment with warfarin vs placebo, after an initial 6-month nonrandomized treatment period on a vitamin K antagonist. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind trial (treatment period, 18 months; median follow-up, 24 months); 371 adult patients who had experienced a first episode of symptomatic unprovoked pulmonary embolism (ie, with no major risk factor for thrombosis) and had been treated initially for 6 uninterrupted months with a vitamin K antagonist were randomized and followed up between July 2007 and September 2014 in 14 French centers...
July 7, 2015: JAMA: the Journal of the American Medical Association
James D Douketis, Alex C Spyropoulos, Scott Kaatz, Richard C Becker, Joseph A Caprini, Andrew S Dunn, David A Garcia, Alan Jacobson, Amir K Jaffer, David F Kong, Sam Schulman, Alexander G G Turpie, Vic Hasselblad, Thomas L Ortel
BACKGROUND: It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS: We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure...
August 27, 2015: New England Journal of Medicine
Charles V Pollack, Paul A Reilly, John Eikelboom, Stephan Glund, Peter Verhamme, Richard A Bernstein, Robert Dubiel, Menno V Huisman, Elaine M Hylek, Pieter W Kamphuisen, Jörg Kreuzer, Jerrold H Levy, Frank W Sellke, Joachim Stangier, Thorsten Steiner, Bushi Wang, Chak-Wah Kam, Jeffrey I Weitz
BACKGROUND: Specific reversal agents for non-vitamin K antagonist oral anticoagulants are lacking. Idarucizumab, an antibody fragment, was developed to reverse the anticoagulant effects of dabigatran. METHODS: We undertook this prospective cohort study to determine the safety of 5 g of intravenous idarucizumab and its capacity to reverse the anticoagulant effects of dabigatran in patients who had serious bleeding (group A) or required an urgent procedure (group B)...
August 6, 2015: New England Journal of Medicine
Marc Carrier, Alejandro Lazo-Langner, Sudeep Shivakumar, Vicky Tagalakis, Ryan Zarychanski, Susan Solymoss, Nathalie Routhier, James Douketis, Kim Danovitch, Agnes Y Lee, Gregoire Le Gal, Philip S Wells, Daniel J Corsi, Timothy Ramsay, Doug Coyle, Isabelle Chagnon, Zahra Kassam, Hardy Tao, Marc A Rodger
BACKGROUND: Venous thromboembolism may be the earliest sign of cancer. Currently, there is a great diversity in practices regarding screening for occult cancer in a person who has an unprovoked venous thromboembolism. We sought to assess the efficacy of a screening strategy for occult cancer that included comprehensive computed tomography (CT) of the abdomen and pelvis in patients who had a first unprovoked venous thromboembolism. METHODS: We conducted a multicenter, open-label, randomized, controlled trial in Canada...
August 20, 2015: New England Journal of Medicine
Jean-Pierre Frat, Arnaud W Thille, Alain Mercat, Christophe Girault, Stéphanie Ragot, Sébastien Perbet, Gwénael Prat, Thierry Boulain, Elise Morawiec, Alice Cottereau, Jérôme Devaquet, Saad Nseir, Keyvan Razazi, Jean-Paul Mira, Laurent Argaud, Jean-Charles Chakarian, Jean-Damien Ricard, Xavier Wittebole, Stéphanie Chevalier, Alexandre Herbland, Muriel Fartoukh, Jean-Michel Constantin, Jean-Marie Tonnelier, Marc Pierrot, Armelle Mathonnet, Gaëtan Béduneau, Céline Delétage-Métreau, Jean-Christophe M Richard, Laurent Brochard, René Robert
BACKGROUND: Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia. METHODS: We performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation...
June 4, 2015: New England Journal of Medicine
Dale N Gerding, Thomas Meyer, Christine Lee, Stuart H Cohen, Uma K Murthy, Andre Poirier, Trevor C Van Schooneveld, Darrell S Pardi, Antonio Ramos, Michelle A Barron, Hongzi Chen, Stephen Villano
IMPORTANCE: Clostridium difficile is the most common cause of health care-associated infection in US hospitals. Recurrence occurs in 25% to 30% of patients. OBJECTIVE: To determine the safety, fecal colonization, recurrence rate, and optimal dosing schedule of nontoxigenic C. difficile strain M3 (VP20621; NTCD-M3) for prevention of recurrent C. difficile infection (CDI). DESIGN, SETTING, AND PARTICIPANTS: Phase 2, randomized, double-blind, placebo-controlled, dose-ranging study conducted from June 2011 to June 2013 among 173 patients aged 18 years or older who were diagnosed as having CDI (first episode or first recurrence) and had successfully completed treatment with metronidazole, oral vancomycin, or both at 44 study centers in the United States, Canada, and Europe...
May 5, 2015: JAMA: the Journal of the American Medical Association
Patrick Mismetti, Silvy Laporte, Olivier Pellerin, Pierre-Vladimir Ennezat, Francis Couturaud, Antoine Elias, Nicolas Falvo, Nicolas Meneveau, Isabelle Quere, Pierre-Marie Roy, Olivier Sanchez, Jeannot Schmidt, Christophe Seinturier, Marie-Antoinette Sevestre, Jean-Paul Beregi, Bernard Tardy, Philippe Lacroix, Emilie Presles, Alain Leizorovicz, Hervé Decousus, Fabrice-Guy Barral, Guy Meyer
IMPORTANCE: Although retrievable inferior vena cava filters are frequently used in addition to anticoagulation in patients with acute venous thromboembolism, their benefit-risk ratio is unclear. OBJECTIVE: To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label, blinded end point trial (PREPIC2) with 6-month follow-up conducted from August 2006 to January 2013...
April 28, 2015: JAMA: the Journal of the American Medical Association
Mark R Thursz, Paul Richardson, Michael Allison, Andrew Austin, Megan Bowers, Christopher P Day, Nichola Downs, Dermot Gleeson, Alastair MacGilchrist, Allister Grant, Steven Hood, Steven Masson, Anne McCune, Jane Mellor, John O'Grady, David Patch, Ian Ratcliffe, Paul Roderick, Louise Stanton, Nikhil Vergis, Mark Wright, Stephen Ryder, Ewan H Forrest
BACKGROUND: Alcoholic hepatitis is a clinical syndrome characterized by jaundice and liver impairment that occurs in patients with a history of heavy and prolonged alcohol use. The short-term mortality among patients with severe disease exceeds 30%. Prednisolone and pentoxifylline are both recommended for the treatment of severe alcoholic hepatitis, but uncertainty about their benefit persists. METHODS: We conducted a multicenter, double-blind, randomized trial with a 2-by-2 factorial design to evaluate the effect of treatment with prednisolone or pentoxifylline...
April 23, 2015: New England Journal of Medicine
Martin O'Donnell, Andrew Mente, Sumathy Rangarajan, Matthew J McQueen, Xingyu Wang, Lisheng Liu, Hou Yan, Shun Fu Lee, Prem Mony, Anitha Devanath, Annika Rosengren, Patricio Lopez-Jaramillo, Rafael Diaz, Alvaro Avezum, Fernando Lanas, Khalid Yusoff, Romaina Iqbal, Rafal Ilow, Noushin Mohammadifard, Sadi Gulec, Afzal Hussein Yusufali, Lanthe Kruger, Rita Yusuf, Jephat Chifamba, Conrad Kabali, Gilles Dagenais, Scott A Lear, Koon Teo, Salim Yusuf
BACKGROUND: The optimal range of sodium intake for cardiovascular health is controversial. METHODS: We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events. RESULTS: The mean estimated sodium and potassium excretion was 4...
August 14, 2014: New England Journal of Medicine
2015-11-22 03:48:06
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