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Criticality of Benzoyl Peroxide and Antibiotic Fixed Combinations in Combating Rising Resistance in Cutibacterium acnes
No full textBACKGROUND: Antibiotic resistance is growing globally, with multiple countries reporting resistance in \u3e50% of Cutibacterium acnes (C. acnes) strains. Combination formulations of an antibiotic and the antimicrobial benzoyl peroxide (BPO) may reduce this resistance risk, especially with prolonged use. This 4-part study tested susceptibility of 31 C. acnes clinical strains and development of resistance to antibiotics alone or combined with BPO.
METHODS: C. acnes susceptibility to single-drug antibiotics was assessed via minimum inhibitory concentration (MIC) values obtained from epsilometer tests, with lower MIC indicating higher susceptibility. Susceptibility to fixed-dose antibiotic/BPO combination products was determined by measuring the zone of inhibition using the agar diffusion method, with larger diameter indicating increased bacterial inhibition. The effect (synergistic, additive, antagonistic, or indifferent [no interaction]) of combining clindamycin with BPO on C. acnes inhibition was evaluated using a checkerboard assay, wherein 2 test compounds are combined in varying concentrations. Resistance development was assessed using serial passage of bacterial cultures in increasing concentrations of clindamycin alone or in combination with BPO.
RESULTS: All tested antibiotics (clindamycin, doxycycline, erythromycin, and minocycline) exhibited similar activity. C. acnes susceptibility was variable, with some strains having elevated MIC values-an indication of resistance-against different antibiotics. For 6 strains resistant to clindamycin alone (inhibitory zone=0 cm), formulations with BPO enhanced activity against the same isolates (range: 0.8-2.2 cm). Of 7 acne-associated strains, combining clindamycin and BPO had an additive effect against 4, and no interaction against 3. Bacterial cultures repeatedly exposed to the combination of clindamycin and BPO did not develop antibiotic resistance, which occurred with exposure to clindamycin alone.
CONCLUSION: Overall, antibiotic susceptibility was highly dependent on the C. acnes strain, and antibiotic formulations with BPO exhibited enhanced activity against less susceptible strains. Fixed combinations of BPO with an antibiotic may improve antimicrobial activity and protect against resistance development
Atopic dermatitis is a risk factor for total joint arthroplasty surgical site infections
No full textACR Appropriateness Criteria® Cervical Pain or Cervical Radiculopathy: 2024 Update
No full textCervical spine pain is one of the most common reasons for seeking medical care as it ranks in the top 5 causes of global years lost to disability. The economic burden of cervical pain is also significant. Imaging is at the center of diagnosis of cervical pain and its causes. However, different symptoms and potential causes of cervical pain require different initial imaging to maximize the benefit of diagnostic usefulness of imaging. In this document we address different cervical pain variants with detailed assessment of the strengths and weaknesses of different modalities for addressing each specific variant. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation
Post-thoracentesis Ultrasound vs. Chest X-ray for the Evaluation of Effusion Evacuation and Lung Re-Expansion, A Multicenter Study
No full textINTRODUCTION: Post-thoracentesis chest radiography (CXR) is often used to evaluate the degree of residual fluid post-thoracentesis. Whether post-drainage ultrasound exam is comparable to CXR in the evaluation of pleural space evacuation is unknown.
RESEARCH QUESTION: How do post-thoracentesis ultrasound and CXR compare in assessing the effectiveness of pleural space evacuation?
METHODS: In this prospective, multicenter study, patients with free-flowing pleural effusions with minimal to no septations requiring thoracentesis were recruited. Post-thoracentesis ultrasound was performed immediately post-procedure; CXR was performed within 4-hours post-procedure. The primary outcome was agreement on complete pleural space evacuation between ultrasound and CXR. Complete pleural space evacuation was defined as the absence of pleural fluid on anterior, mid-axillary, and posterior ultrasound views and lack of costophrenic angle blunting on CXR. Interobserver reliability was assessed via independent image reviews by two pulmonologists and two radiologists blinded to patient/procedure data, with disagreements resolved by a third reviewer.
RESULTS: Of the 147 patients enrolled (February/2021 - May/2022), 145 were included in the final analysis. The median age was 64 years (56-75), and malignancy was the most frequent effusion etiology (n=49). The lung was considered trapped in 50% (n=73). A total of 826 ultrasound images were collected for blind review. The Gwet\u27s Agreement Coefficient 1 (AC1) assessing complete pleural evacuation between ultrasound and CXR was 0.93 (95% CI: 0.83-1.00). When assessing agreement based on the pre-specified criteria of effusion size (small vs large), a substantial level of agreement was observed between ultrasound and CXR, indicated by a kappa of 0.64 (95% CI: 0.51-0.77). There was a strong agreement (kappa= 0.81 (95% CI: 0.71-0.90)) between proceduralist and blind ultrasound reviewers regarding complete pleural space evacuation.
CONCLUSION: Post-thoracentesis ultrasound is an equally effective alternative to CXR in evaluating pleural space evacuation in simple pleural effusions
Patient-Perceived Risk of Hepatocellular Carcinoma and Net Benefit of Surveillance: A Multicenter Survey Study
No full textINTRODUCTION: Hepatocellular carcinoma (HCC) surveillance is underused in clinical practice, and few contemporary data have assessed patients\u27 perceptions of surveillance effectiveness and net benefit.
METHODS: We conducted a survey study among adult patients with cirrhosis at 7 health systems in the United States. The survey was based on validated measures, when available, and assessed patient knowledge about HCC surveillance, attitudes regarding surveillance benefits and harms, perceived HCC risk, and trust in their doctors.
RESULTS: Respondents (n = 665; median age 60; 46.5% female) were knowledgeable about HCC surveillance, with no significant differences across sociodemographic groups; however, approximately 1 in 5 patients had knowledge gaps about the need and benefit of surveillance. Over three fourths of patients believed that surveillance improves early HCC detection (80.3%) and survival (77.9%). While 74.0% of patients reported that doctors had discussed surveillance benefits, only 54.2% recalled a discussion about potential harms. Patients placed greater importance on surveillance benefits, but expressed harms should be measured when assessing the net benefit of surveillance programs. Based on a pictogram depicting current estimates for surveillance benefits and harms, 93.2% of patients chose to undergo surveillance, with no significant differences by race, perceived surveillance benefits, or fear of dying from HCC. Study limitations include response and nonresponse biases, which may result in an overestimation of reported surveillance benefits and patient acceptance.
DISCUSSION: Most patients with cirrhosis followed at academic health systems have high knowledge about HCC surveillance, believe that it is beneficial, and express interest in undergoing surveillance after being counseled about the benefits and harms
Unilateral access in TF-TAVR: Promising innovation, but rigor and generalizability await validation, a letter to editor
No full textNew atrial fibrillation guideline: Modify risk, control rhythm, prevent progression
No full textThe latest (2023) guideline on atrial fibrillation from the American College of Cardiology, American Heart Association, American College of Chest Physicians, and Heart Rhythm Society introduces a new staging system for the disease, emphasizes risk-factor modification, prioritizes rhythm control over rate control, and clarifies which patients should be considered for catheter ablation. It also delves deeper than earlier guidelines into calculations of risk of thrombosis when deciding whether to start anticoagulant therapy
Daily solriamfetol improved performance on a memory and attention task in people with obstructive sleep apnea and excessive daytime sleepiness: a plain language summary
No full textWhat is this summary about? The SHARP study looked at the effects of a medication called solriamfetol in people with obstructive sleep apnea (sleep apnea for short) who were very sleepy during the day (called excessive daytime sleepiness) and had trouble with things like thinking, concentrating, and remembering (called cognitive impairment). In people with sleep apnea, breathing is regularly interrupted during sleep. This can lead to many problems, including excessive daytime sleepiness and cognitive impairment.In previous studies, people with sleep apnea and excessive daytime sleepiness who took solriamfetol felt more awake during the day compared with people who took an identical tablet with no medication (called a placebo). The SHARP study looked at the effects of solriamfetol on symptoms related to cognitive impairment. To avoid bias from people’s personal feelings about their cognition, the cognitive function of people who participated in the study was measured by a cognitive performance test (called objective cognitive function). Subjective ratings were also used; these measured people’s personal feelings about their cognitive function (called subjective cognitive function), the severity of their cognitive impairment, and their sleepiness during the day.
What are the key takeaways? In the SHARP study, people had more improvement in their objective cognitive function when taking solriamfetol than when they took placebo, and this benefit lasted for 8 hours. People also reported that their subjective cognitive function had improved, their cognitive impairment was less severe, and their daytime sleepiness was better with solriamfetol. The most common side effects were nausea and anxiety.
What were the main conclusions reported by the researchers? These findings show that solriamfetol can improve cognitive function in people with cognitive impairment related to sleep apnea and excessive daytime sleepiness
A randomized controlled trial of telemedicine CBTI and PUMAS for prenatal insomnia: Reducing nocturnal cognitive arousal is a treatment mechanism for alleviating insomnia and depression during pregnancy
No full textOBJECTIVE: Insomnia is common in pregnancy and fuels perinatal depression (PND). Cognitive-behavioral therapy for insomnia (CBTI) is effective during pregnancy, but unresolved cognitive arousal limits treatment outcomes. Enhancing reduction of cognitive arousal may improve patient outcomes. This randomized controlled trial (RCT) evaluated the effectiveness of CBTI and Perinatal Understanding of Mindful Awareness for Sleep (PUMAS, which combines mindfulness with behavioral sleep strategies) on insomnia, depression, and nocturnal cognitive arousal relative to sleep hygiene education (SHE).
METHODS: A single-site, three-arm RCT of N = 64 pregnant women with clinically significant insomnia symptoms who received CBTI, PUMAS, or SHE. Active treatment was delivered via six weekly telemedicine video sessions. Outcomes included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), and the pre-sleep arousal scale\u27s cognitive factor (PSASC; nocturnal cognitive arousal).
RESULTS: Over 95 % of active therapy patients completed ≥ 4 sessions, indicating high engagement. CBTI (ΔISI = -11.20 ± 6.93; 65.0 % insomnia remission) and PUMAS (ΔISI = -11.05 ± 3.84; 81.8 % insomnia remission) significantly alleviated insomnia relative to SHE (ΔISI = -4.50 ± 1.71; 13.6 % remission), which was replicated in women with comorbid OSA. PUMAS produced large reductions in PND and nocturnal cognitive arousal relative to SHE, whereas CBTI did not. Mediation analyses supported reducing cognitive arousal as a key mechanism by which PUMAS alleviated insomnia and PND.
CONCLUSIONS: CBTI and PUMAS are effective for prenatal insomnia, even in women with comorbid OSA. PUMAS may be especially beneficial for pregnant women presenting with PND and/or high cognitive arousal (including perinatal rumination and worry), whereas CBTI may yield more modest benefits for these non-sleep outcomes