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Cardiac Stenting No Better Than Aggressive Medical Management for Stable Angina and Single Vessel Disease

Investigators conducted the first blinded, randomized trial comparing percutaneous coronary intervention with medical management.

Migraine With Aura, Stroke Risk, and Biomarkers

The authors of a longitudinal cohort study of twins found no increased stroke risk related to migraine overall, but there was a modestly increased risk for stroke related to migraine with aura. Familial factors and vascular biomarkers associated with migraine with aura may explain its correlation with vascular disease.

Procalcitonin to Guide Antibiotic Therapy for Acute Respiratory Infections

The authors of this meta-analysis reviewed patient-level data on 6,708 patients from 26 randomized studies that examined procalcitonin-directed antibiotic therapy for acute respiratory tract infections. They found a 1% reduction in mortality and a 2.4-day reduction in antibiotic exposure for the procalcitonin-directed therapy groups. How procalcitonin can be incorporated into routine clinical practice, in what settings, and whether it is cost-effective are still unclear.

Reducing Falls Among Older Adults

Exercise, correction of impaired vision, supplemental calcium/vitamin D, and environmental interventions reduce falls. Interventions that are multimodal appear to produce additive benefits.

Dealing With Severe Acute Pain in the ED

The success of a non-opioid treatment arm in direct comparison with three opioid treatment arms should justify greater consideration of non-opioid treatment for acute severe pain.

The Ever-elusive Prescription for the Optimum Diet

Somewhat contrary to the prevailing wisdom, intake of total fat was inversely associated with total mortality. Even the much-maligned saturated fat in the diet was associated with a reduced hazard ratio for total mortality.

Diuretic Use in Heart Failure

For diuretic resistance, the authors endorsed continuous diuretic infusion with stepwise dose increases to achieve a 3-5 liter/day urine volume until euvolemia is achieved.

When Gastrointestinal Complaints Are Not Prominent

In a review of patients with biopsy-proven celiac disease, those who presented with gastrointestinal symptoms exhibited a median time to diagnosis of 2.3 months, compared to 42 months for those without gastrointestinal symptoms.

Sexual Dysfunction Among Diabetics

In a review of diabetic men and diabetic women, evaluations of sexual quality of life in both genders was meaningfully affected by partner sexual dysfunction. Perhaps not surprisingly, age and duration of diabetes were the strongest predictors of sexual dysfunction in diabetic men. The authors opined that insufficient attention has been given to the presence and effect of sexual dysfunction on the quality of life of patients and their partners.

FDA Actions

In this section: FDA approves treatment for opioid use disorder, greenlights product to reduce cardiovascular events, gives the go-ahead to the eighth biosimilar, and approves a two-drug HIV regimen.