Publication highlights: 27 Feb-3 Mar 2023

1. Reducing antibiotic use in uncomplicated urinary tract infections in adult women

This was a systematic review and meta-analysis of RCTs investigating any strategies to reduce #antibiotics vs. immediate antibiotics in adult women with uncomplicated #urinarytractinfection (uUTI) in primary care. It was found that compared to immediate antibiotics, non-antibiotic strategies reduce overall antibiotic use but result in poorer clinical outcomes. ?Incomplete recovery was more likely when there were erythrocytes in urine and urine cultures were positive, but there was no difference between immediate antibiotics and non-antibiotic strategies when both were negative.?Thus, the presence of erythrocytes and #urinetests to confirm bacteria in urine could be used to target #antibiotic prescribing.

2. Non-proliferative diabetic #retinopathy (NPDR) with good vision and without centre-involved diabetic macular edema (CI-DME): Aflibercept as a preventive results in significant anatomic improvement, but no improvement in visual acuity

This study presents 4-year primary outcomes of a randomized clinical trial that included 328 patients (399 eyes), randomized to 2.0 mg aflibercept injections or sham injections. Among those receiving aflibercept, proliferative diabetic retinopathy or CI-DME developed in 33.9% vs 56.9% among those who received sham—a difference that was statistically significant. Change in visual acuity was ?2.7 vs ?2.4 letters, a difference that was not statistically significant.

3. Widely used artificial sweetener erythritol is associated with incident major adverse cardiovascular events (#MACE ) risk and enhanced thrombosis

Erythritol is naturally present in low amounts in fruits and vegetables16, but when incorporated into processed foods, it is typically added at levels 1,000-fold higher than endogenous levels (for example, up to 60% of food weight in some creams or pastry products). This study found that circulating levels of erythritol were associated with incident adverse cardiovascular event risk independent of traditional CVD risk factors.

https://www.nature.com/articles/s41591-023-02223-9.epdf?sharing_token=_ShX7ZyBlhEwQMEOWibistRgN0jAjWel9jnR3ZoTv0MTnVt_Yzm2YDkmKtSZJOysYZlROr0ymfAdj9yPHH8bMbIvXGpNB0TiBH_G-VgdpV-Q1rswXVVrcTprlDJ0i-FK-R6ghKtO7BjYj5OaQtuxKz7Liaji4AT1-AoqAbwgZUqjbErBzVE1mdRMFxe0lAc2wCK0hpkPiEz2NYvYE7uPQOY_i2rlgkeigyqaLi5W8yw%3D&tracking_referrer=www.statnews.com

4. First-Line Single-Inhaler Triple (SITT) versus Dual Therapy (SIDT) in Controller-Na?ve and Symptomatic Adults with Asthma

This prospective study found that that the SITT improved disease control, especially nocturnal symptoms, faster than the SIDT in controller-na?ve and symptomatic adult patients with #asthma .

5. The effect of linagliptin on microalbuminuria in patients with diabetic nephropathy

There are several previous studies on the effectiveness or ineffectiveness of #linagliptin on #albumin excretion in urine. In this prospective study, linagliptin did not cause a significant decrease in urinary albumin excretion in diabetic patients with nephropathy compared to the control group; however, the percentage of improvement in #microalbuminuria (UACR < 30?mg/g) in the linagliptin group was significantly higher than that of the control group during 24?weeks of intervention. However, the researchers recommend that more research is required to elucidate the renal biology and pathophysiology of DPP-4 in this regard.

6. Is it ok to discontinue Renin–angiotensin–aldosterone-system-inhibitors (RAASi)?after recovery of left ventricular systolic function?post myocardial infarction?

13,104 consecutive patients with baseline left ventricular ejection fraction (#LVEF < 50%) that was restored to ≥ 50% at 12-month follow-up were selected. ?Of 726 post-acute #MyocardialInfarction #heartfailure patients with restored LVEF,?544 maintained #RAASi (Maintain-RAASi) beyond 12-month, 108 stopped RAASi (Stop-RAASi), and 74 did not use RAASi (RAASi-Not-Used) at baseline and follow-up. In post-AMI HF patients with restored LV systolic function, RAASi discontinuation was associated with significantly increased risk of all-cause death, MI, or rehospitalization for HF.

7. Moderate-intensity statin and ezetimibe is comparable to high-intensity statin monotherapy in Patients With diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD)

In this randomized controlled trial, it was seen that moderate-intensity #statin with #ezetimibe combination therapy could be used as a suitable alternative to high-intensity monotherapy if high-intensity statins cannot be tolerated or further reduction in #LDL cholesterol is required for managing #dyslipidemia among patients with #diabetes and #ASCVD .

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