ALERT!
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
February 28, 2016
Submitted by: Lisa Brown
The goal of this study was to determine if there is an association between PPI use and incident chronic kidney disease (CKD) in the general population. Two cohorts were studied, the Atherosclerosis Risk in Communities (ARIC), a population based cohort (10,482 subjects followed for a median of 13.9 years) and the Geisinger Health System in Pennsylvania (248,751 subjects followed for a median of 6.2 years). In the ARIC cohort, after adjustment for confounders, the risk of incident CKD was 1.5 times greater in those taking PPIs at baseline compared to those who did not. The 10-year risk of CKD in PPI users at baseline was 11.8% whereas the expected risk (without PPI use) was 8.5%. In the Geisinger Health System cohort, the adjusted risk of incident CKD was 1.17 times greater in PPI users than in those who did not use PPIs. In addition, twice daily dosing of PPIs was associated with a greater risk of CKD than once daily dosing. This observational cohort study identified an association between PPI use and incident CKD, but does not provide evidence to prove causality.
February 28, 2016
Submitted by: Ruben Osnabrugge
In this trial 2100 undergoing coronary surgery were randomized to aspirin 100mg or placebo. The primary outcome was defined as a composite of death and thrombotic complications (myocardial infarction, stroke, pulmonary embolism, renal failure or bowel infarction) at 30 days.
There was no difference between the two treatment groups for the primary endpoint (aspirin group 19.3% versus placebo group 20.4% , p=0.55). Other endpoints included cardiac tamponade (aspirin group 1.1% versus placebo 0.4%, p=0.08) and major hemorrhage leading to reoperation (aspirin group 1.8% versus placebo 2.1%, p=0.75).
The authors conclude that preoperative aspirin did not lead to a higher risk of death, thrombotic complications or reoperation due to bleeding.
February 24, 2016
Submitted by: Marcelo Jimenez
Routine use of PET scans to follow up asymptomatic patients do not affect survival, according to this retrospective analysis of a cohort of 97,152 lung cancer and 4,446 esophageal cancer patients. They compared high and low level of use of PET centers, and found no differences in two-year survival.
February 23, 2016
Submitted by: Mark Ferguson
This consensus effort provides a new definition for septic shock, which affects a subset of patients with sepsis. The definition requires the presence of circulatory disturbances (BP unresponsive to fluids and requiring pressors), cellular and metabolic abnormalities (serum lactate level >2 mmol/L). The presence of these criteria is associated with an increased risk of mortality compared to sepsis alone.
February 20, 2016
Submitted by: Aristotle Protopapas
A succinct editorial from a British academic transplant surgeon. It discusses the need for stratifying the utilization of donor lungs based on recent and previous retrospective papers from North American and European databases. Professor Dark also briefly debates the needs for research on assessing and optimizing the organs.
February 18, 2016
Submitted by: Aristotle Protopapas
An Editorial suggesting that atheroma is here to stay...
February 18, 2016
Submitted by: Mark Ferguson
The authors studied the rate of publication of completed clinical trials performed in academic medical centers in the US. Among over 4,300 such trials, only 36% were published within 2 years of completion, and only 66% were ultimately published at any time. There was considerable variation in publication rates among institutions.
February 18, 2016
Submitted by: Mark Ferguson
The authors studied the relationship of outcomes after non-cardiac surgery to blood transfusion among over 7,300 patients. Patients with significant bleeding were excluded. Patients were stratified according to the occurence of postoperative MI and the nadir hematocrit value (20-24%, 24-27%, 27-30%). The outcome was 30-day mortality. In the no-transfusion group, mortality increased as nadir hematocrit decreased. In patients with an MI, mortality was lower in the low hematocrit patients who received a transfusion. In patients without an MI, mortality was increased for patients in the high hematocrit group who received a transfusion. In patients with stable cardiovascular status postoperatively, a restrictive transfusion policy is appropriate. Those who have cardiovascular instability or MI may require a different transfusion strategy.
February 18, 2016
Submitted by: Mark Ferguson
The authors studied outcomes after endovascular AAA aneurysm repair (EVAR) to assess whether ongoing aortic remodeling related to systemic inflammatory disease (SID) contributes to an increased incidence of endoleak. 65% of 79 treated patients had systemic inflammatory disease. Major complication rates were increased 7-fold in the group with SID. This group also experienced a 2.5-fold greater incidence of endoleaks and a 2-fold greater rate of late sac expansion. More interventions were required in the SID group.
February 18, 2016
Submitted by: Mark Ferguson
Over 1400 patients with asymptomatic severe carotid stenosis were randomized to with carotid stenting or endarterectomy. The endpoints were the composite of death, stroke, or acute MI within 30 days, or ipsilateral stroke. Stenting was non-inferior to endarterectomy. The rate of the composite endpoint was 3.8% vs 3.4% (stent vs surgery). At 30 days to 5 years, freedom from ipsilateral stroke was 97.8% vs 97.3%. Cumulative stroke-free survival rates were 93.1% and 94.7%.