Annals of Internal Medicine Current Issue

Annals for Educators - 17 September 2019

Taichman DB. — Tue, 17 Sep 2019 00:00:00 GMT

Annals for Hospitalists - 17 September 2019

Wesorick DH, Chopra V. — Tue, 17 Sep 2019 00:00:00 GMT

In US veterans, PPIs were linked to increased all-cause and some cause-specific mortality compared with H 2 -blockers

Koretz RL. — Tue, 17 Sep 2019 00:00:00 GMT

The T2Bacteria Panel had 90% sensitivity for detecting targeted organisms, 43% for any bloodstream infection organism

Maki DG. — Tue, 17 Sep 2019 00:00:00 GMT

In treatment-resistant depression, adding esketamine nasal spray to an oral antidepressant improved symptoms at 28 days

Pal H. — Tue, 17 Sep 2019 00:00:00 GMT

After stroke due to ICH while on antithrombotics, starting vs avoiding antiplatelets did not differ for symptomatic ICH

Graham J. — Tue, 17 Sep 2019 00:00:00 GMT

In type 2 diabetes, intensive glucose control for 5.6 years did not differ from usual care for major CV events at 14 years

Santulli G. — Tue, 17 Sep 2019 00:00:00 GMT

In high-risk type 1 diabetes, insulin pumps with suspend-before-low technology reduced hypoglycemic events

El Kawkgi OM, Montori VM. — Tue, 17 Sep 2019 00:00:00 GMT

In poorly controlled type 2 diabetes, oral semaglutide was noninferior to liraglutide for reducing HbA 1c

Lipscombe LL. — Tue, 17 Sep 2019 00:00:00 GMT

In patients ≥ 50 years with type 2 diabetes and CV disease or risk factors, oral semaglutide did not increase CV events

Lipscombe LL. — Tue, 17 Sep 2019 00:00:00 GMT

In patients ≥ 50 years with type 2 diabetes and CV disease or risk factors, dulaglutide reduced CV outcomes

Lipscombe LL. — Tue, 17 Sep 2019 00:00:00 GMT

Guideline: EULAR provided recommendations for thrombotic and obstetric antiphospholipid syndrome

DeLoughery T. — Tue, 17 Sep 2019 00:00:00 GMT

Annals On Call - Community-Acquired Pneumonia: Diagnosis, Risk Stratification, and Treatment

Centor RM, Askin CA. — Tue, 17 Sep 2019 00:00:00 GMT

Annals for Hospitalists Inpatient Notes - Rethinking Oxygen Therapy for Hospitalized Patients

Kim LY, Chu DK, Alhazzani W. — Tue, 17 Sep 2019 00:00:00 GMT

Annals Graphic Medicine - Progress Notes: How Is Residency?

Natter M. — Tue, 17 Sep 2019 00:00:00 GMT

Annals Consult Guys - Peripheral Artery Disease Management

Merli GJ, Weitz HH. — Tue, 17 Sep 2019 00:00:00 GMT

Amnesia, Adverse Effects, and the Angel of History

Greene JA. — Tue, 17 Sep 2019 00:00:00 GMT

In this issue, Leslie and colleagues compiled a disturbing tale of historical amnesia in which the neglect of 19th- and 20th-century information led to preventable adverse events in 21st-century patients. The editorialist discusses what paths we might take in drug development to ensure that we avoid repeated rediscovery of past harms.

Of What Remains

Pyzer A. — Tue, 17 Sep 2019 00:00:00 GMT

Is it better or worse to know that something remains of our past once dementia robs us of our present?

Sodium–Glucose Cotransporter-2 Inhibitors: Lack of a Complete History Delays Diagnosis

Leslie BR, Gerwin LE, Taylor SI. — Tue, 17 Sep 2019 00:00:00 GMT

On 15 May 2015, the U.S. Food and Drug Administration (FDA) warned that administration of sodium–glucose cotransporter-2 (SGLT2) inhibitors could lead to ketoacidosis in patients with diabetes mellitus. This announcement came more than 2 years after the FDA's first approval of an SGLT2 inhibitor, although the phenomenon had been known for more than 125 years. Luminaries of diabetes research (including Josef von Mering, Frederick Allen, I. Arthur Mirsky, and George Cahill) had described ketosis and ketoacidosis induced by administration of the phytochemical phlorizin, the prototypical SGLT inhibitor, as well as in patients with familial renal glucosuria, a condition that is considered a natural model of SGLT2 inhibition. Neither government regulators nor manufacturers of SGLT2 inhibitors evinced an awareness of this extensive historical record. The absence of historical inquiry delayed notice of ketoacidosis as an adverse reaction, which could have reduced the burden of illness from these drugs.

Death, Taxes, and Global Warming

Bosch D. — Tue, 17 Sep 2019 00:00:00 GMT

Witness

Chen-Scarabelli C. — Tue, 17 Sep 2019 00:00:00 GMT

Reciprocal Tears

Fitzgerald FT. — Tue, 17 Sep 2019 00:00:00 GMT

This meeting was the beginning of a long-standing friendship during which I followed her in my personal clinic, without housestaff.

Screening for Breast Cancer in Average-Risk Women

Lin JS, Mustafa RA, Wilt TJ, et al. — Tue, 17 Sep 2019 00:00:00 GMT

Screening for Breast Cancer in Average-Risk Women

Lenderink-Carpenter A. — Tue, 17 Sep 2019 00:00:00 GMT

Screening for Breast Cancer in Average-Risk Women

Grimm LJ. — Tue, 17 Sep 2019 00:00:00 GMT

Screening for Breast Cancer in Average-Risk Women

Lee MV, Bennett DL, Appleton CM. — Tue, 17 Sep 2019 00:00:00 GMT

Screening for Breast Cancer in Average-Risk Women

Biggs KW. — Tue, 17 Sep 2019 00:00:00 GMT

Checklist for Initial Triage After an Anthrax Mass Exposure Event

Hupert N, Person M, Hanfling D, et al. — Tue, 17 Sep 2019 00:00:00 GMT

Checklist for Initial Triage After an Anthrax Mass Exposure Event

Zheng B. — Tue, 17 Sep 2019 00:00:00 GMT

Checklist for Initial Triage After an Anthrax Mass Exposure Event

Ertle AR. — Tue, 17 Sep 2019 00:00:00 GMT

Would You Refer This Patient With Cancer to a Palliative Care Specialist?

Reynolds EE, Buss MK, Schlechter BL. — Tue, 17 Sep 2019 00:00:00 GMT

Would You Refer This Patient With Cancer to a Palliative Care Specialist?

Di Sorbo P. — Tue, 17 Sep 2019 00:00:00 GMT

Annals Graphic Medicine - Alzheimer's Has a Funny Side Too

Mohammed D. — Tue, 17 Sep 2019 00:00:00 GMT

Menopausal Estrogen-Alone Therapy and Health Outcomes in Women With and Without Bilateral Oophorectomy

Tue, 17 Sep 2019 00:00:00 GMT

Answering the Clinical Research Challenge in a Growing Health System

Whellan DJ. — Tue, 17 Sep 2019 00:00:00 GMT

A sharp decline in clinical trials has occurred, whether measured as number of trials performed, number of participants enrolled, or number of investigators. This commentary discusses factors contributing to an environment that does not promote clinical trial research and offers suggestions for actions that academic health centers can take to counter these pressures.

Menopausal Estrogen-Alone Therapy and Health Outcomes in Women With and Without Bilateral Oophorectomy A Randomized Trial

Manson JE, Aragaki AK, Bassuk SS, et al. — Tue, 17 Sep 2019 00:00:00 GMT

Background:

Whether health outcomes of menopausal estrogen therapy differ between women with and without bilateral salpingo-oophorectomy (BSO) is unknown.

Objective:

To examine estrogen therapy outcomes by BSO status, with additional stratification by 10-year age groups.

Design:

Subgroup analyses of the randomized Women's Health Initiative Estrogen-Alone Trial. (ClinicalTrials.gov: NCT00000611)

Setting:

40 U.S. clinical centers.

Participants:

9939 women aged 50 to 79 years with prior hysterectomy and known oophorectomy status.

Intervention:

Conjugated equine estrogens (CEE) (0.625 mg/d) or placebo for a median of 7.2 years.

Measurements:

Incidence of coronary heart disease and invasive breast cancer (the trial's 2 primary end points), all-cause mortality, and a “global index” (these end points plus stroke, pulmonary embolism, colorectal cancer, and hip fracture) during the intervention phase and 18-year cumulative follow-up.

Results:

The effects of CEE alone did not differ significantly according to BSO status. However, age modified the effect of CEE in women with prior BSO. During the intervention phase, CEE was significantly associated with a net adverse effect (hazard ratio for global index, 1.42 [95% CI, 1.09 to 1.86]) in older women (aged ≥70 years), but the global index was not elevated in younger women (P trend by age = 0.016). During cumulative follow-up, women aged 50 to 59 years with BSO had a treatment-associated reduction in all-cause mortality (hazard ratio, 0.68 [CI, 0.48 to 0.96]), whereas older women with BSO had no reduction (P trend by age = 0.034). There was no significant association between CEE and outcomes among women with conserved ovaries, regardless of age.

Limitations:

The timing of CEE in relation to BSO varied; several comparisons were made without adjustment for multiple testing.

Conclusion:

The effects of CEE did not differ by BSO status in the overall cohort, but some findings varied by age. Among women with prior BSO, in those aged 70 years or older, CEE led to adverse effects during the treatment period, whereas women randomly assigned to CEE before age 60 seemed to derive mortality benefit over the long term.

Primary Funding Source:

The WHI program is funded by the National Heart, Lung, and Blood Institute; National Institutes of Health; and U.S. Department of Health and Human Services. Wyeth Ayerst donated the study drugs.

Rethinking Opioid Dose Tapering, Prescription Opioid Dependence, and Indications for Buprenorphine

Chou R, Ballantyne J, Lembke A. — Tue, 17 Sep 2019 00:00:00 GMT

The expanded use of opioids for chronic pain has created a population of patients prescribed long-term opioid therapy at doses that are often above those recommended by the Centers for Disease Control and Prevention. Many patients may benefit from tapering to lower, safer doses. This commentary argues that successful tapering requires implementing and incentivizing tapering protocols, recognizing prescription opioid dependence as a distinct clinical condition necessitating treatment, and expanding the indication for buprenorphine.

Midlife Smaller and Larger Infarctions, White Matter Hyperintensities, and 20-Year Cognitive Decline A Cohort Study

Windham B, Griswold ME, Wilkening SR, et al. — Tue, 17 Sep 2019 00:00:00 GMT

Background:

Smaller (<3-mm) infarctions are associated with stroke and stroke mortality, but relationships with cognitive decline are unknown.

Objective:

To characterize the relationships of smaller, larger, and both smaller and larger infarctions in middle age with 20-year cognitive decline.

Design:

Longitudinal cohort study.

Setting:

Two ARIC (Atherosclerosis Risk in Communities) study sites with magnetic resonance imaging data (1993 to 1995) and up to 5 cognitive assessments over 20 years.

Participants:

Stroke-free participants aged 50 years or older.

Measurements:

Infarctions were categorized as none, smaller only, larger only (3 to 20 mm), or both smaller and larger. Global cognitive Z scores were derived from 3 cognitive tests administered up to 5 times. Mixed-effects models estimated adjusted associations between infarctions and cognitive decline. Results are the average difference in standardized cognitive decline associated with infarctions versus no infarctions.

Results:

Among 1884 participants (mean age, 62 years; 60% women; 50% black), 1611 (86%) had no infarctions, 50 (3%) had smaller infarctions only, 185 (10%) had larger infarctions only, and 35 (2%) had both. Participants with both smaller and larger infarctions had steeper cognitive decline by more than half an SD (difference, −0.57 SD [95% CI, −0.89 to −0.26 SD]) compared with those who had no infarctions. Amounts of cognitive decline associated with only smaller infarctions and only larger infarctions were similar and were not statistically different from that associated with no infarctions.

Limitation:

Few participants had only smaller infarctions or both smaller and larger infarctions, and the data lacked counts of smaller infarctions and volumes of white matter hyperintensities.

Conclusion:

The substantial cognitive decline from middle age associated with having both smaller and larger infarctions, but not larger infarctions alone, suggests that the combination of smaller and larger infarctions may escalate risk for cognitive decline later in life in stroke-free persons.

Primary Funding Source:

National Institutes of Health.

General and Abdominal Adiposity and Mortality in Mexico City A Prospective Study of 150 000 Adults

Gnatiuc L, Alegre-Díaz J, Wade R, et al. — Tue, 17 Sep 2019 00:00:00 GMT

Background:

Some reports suggest that body mass index (BMI) is not strongly associated with mortality in Hispanic populations.

Objective:

To assess the causal relevance of adiposity to mortality in Mexican adults, avoiding reverse causality biases.

Design:

Prospective study.

Setting:

2 Mexico City districts.

Participants:

159 755 adults aged 35 years and older at recruitment, followed for up to 14 years. Participants with a hemoglobin A_1c level of 7% or greater, diabetes, or other chronic diseases were excluded.

Measurements:

BMI, waist-to-hip ratio, waist circumference, and cause-specific mortality. Cox regression, adjusted for confounders, yielded mortality hazard ratios (HRs) after at least 5 years of follow-up and before age 75 years.

Results:

Among 115 400 participants aged 35 to <75 years at recruitment, mean BMI was 28.0 kg/m² (SD, 4.1 kg/m²) in men and 29.6 kg/m² (SD, 5.1 kg/m²) in women. The association of BMI at recruitment with all-cause mortality was J-shaped, with the minimum at 25 to <27.5 kg/m². Above 25 kg/m², each 5-kg/m² increase in BMI was associated with a 30% increase in all-cause mortality (HR, 1.30 [95% CI, 1.24 to 1.36]). This association was stronger at ages 40 to <60 years (HR, 1.40 [CI, 1.30 to 1.49]) than at ages 60 to <75 years (HR, 1.24 [CI, 1.17 to 1.31]) but was not materially affected by sex, smoking, or other confounders. The associations of mortality with BMI and waist-to-hip ratio were similarly strong, and each was weakened only slightly by adjustment for the other. Waist circumference was strongly related to mortality and remained so even after adjustment for BMI and hip circumference.

Limitation:

Analyses were limited to mortality.

Conclusion:

General, and particularly abdominal, adiposity were strongly associated with mortality in this Mexican population.

Primary Funding Source:

Mexican Health Ministry, Mexican National Council of Science and Technology, Wellcome Trust, Medical Research Council, and Kidney Research UK.

Diabetes Technology: Review of the 2019 American Diabetes Association Standards of Medical Care in Diabetes

Chamberlain JJ, Doyle-Delgado K, Peterson L, et al. — Tue, 17 Sep 2019 00:00:00 GMT

Description:

The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes.

Methods:

The ADA Professional Practice Committee comprises physicians, adult and pediatric endocrinologists, diabetes educators, registered dietitians, epidemiologists, pharmacists, and public health experts. To develop the 2019 standards, the committee continuously searched MEDLINE through November 2018 to consider and review studies, particularly high-quality trials including persons with diabetes, for potential incorporation into recommendations. It also solicited feedback from the larger clinical community.

Recommendations:

This synopsis focuses on selected guidance relating to use of diabetes technology in adults with diabetes. Recommendations address self-monitoring of blood glucose, continuous glucose monitors, and automated insulin delivery systems.

Candida auris : An Emerging Antimicrobial Resistance Threat

Vallabhaneni S, Jackson BR, Chiller TM. — Tue, 17 Sep 2019 00:00:00 GMT

Candida auris is an emerging, multidrug-resistant yeast that is now known to have caused invasive infections in more than 30 countries spanning every inhabited continent. It is an urgent antimicrobial resistance threat because many strains are resistant to at least 2 of 3 major classes of antifungal drugs and because it causes outbreaks in health care settings to an extent not seen with other Candida species.

High-Dose Spironolactone When Patients With Acute Decompensated Heart Failure Are Resistant to Loop Diuretics: A Pilot Study

Bansal S, Munoz K, Brune S, et al. — Tue, 17 Sep 2019 00:00:00 GMT

Rate of Opioid Prescriptions for Patients With Acute Ankle Sprain

Finney FT, Gossett TD, Hu H, et al. — Tue, 17 Sep 2019 00:00:00 GMT

Radiotherapy and Small Cell Carcinoma With Paraneoplastic Polyneuropathy: A Case Report

Natarajan BD, Jacobs CD, Salama JK. — Tue, 17 Sep 2019 00:00:00 GMT

Caffeine and the Dyskinesia Related to Mutations in the ADCY5 Gene

Méneret A, Gras D, McGovern E, et al. — Tue, 17 Sep 2019 00:00:00 GMT