1/ COVID-19
The French Medicine Agency published data on treatment consumption during the COVID period. It is interesting to see the increase in dispensing of antihypertensive, antidiabetic, diuretic and antidepressant drugs. Is this related to decompensation or did patients anticipate their renewals to avoid shortages? Of course, there is a strong decrease in the dispensing of what requires a medical act (vaccine, intrauterine devices...). We can clearly see the drop in the delivery of ibuprofen, the instructions have been heard. But the increase of 145% in the dispensing of hydroxychloroquine and 72% of azithromycin is also visible...
The French Academy of Medicine has written a statement advocating the use of cloth masks in the general population.
A publication from Jama describes the characteristics of New York patients with COVID-19 who are hospitalized. More than 50% were hypertensive and 40% had a BMI >30. Only 20% had an SpO2 < 90% and 17% had a respiratory rate greater than 24. They often had lymphopenia, elevated liver enzymes, a blood inflammation and increased BNP. During the study period, among the 2634 patients for whom an endpoint was known, 14% of patients were admitted to intensive care units, 12% had mechanical ventilation and 21% of patients died. The remaining 3,066 patients were still hospitalized, for a mean of 4.5 days.
2/ Cardiovascular diseases
Exercer published a review of guidelines concerning pulmonary embolism and deep vein thrombosis (I talked about these guidelines here and there). There are a few points that I hadn't noted regarding the interest of starting anticoagulation while waiting for the diagnosis of certainty. The authors suggest starting it if the risk is high at the Geneva score or if the risk is intermediate and the diagnosis cannot be made within 4 hours or if the risk is low and the D-Dimer results are not available within 24 hours.
3/ Oncology
This BJGP article, is about the place of the GP in the health care system. The authors find that patients referred promptly by their GP to specialists on suspicion of cancer had reduced mortality for colon, breast, lung and prostate cancer. This benefit was related to the stage of the cancer except for colon cancer for which the benefit was independent of the stage.
4/ ENT
The Jama talks about tinnitus in a narrative review. Tinnitus requires a search for a triggering factor (acoustic trauma?), the type of tinnitus (pulsating or not) and whether it is associated with other ENT symptoms (deafness, dizziness, etc.). After a clinical examination of the head, cervical spine and neurological examination, an audiometry is recommended. In the case of pulsatile tinnitus, an injected MRI is indicated (suspicion of vascular damage or intracranial hypertension). The treatment is Tinnitus Retraining Therapy: treatment for tolerance to tinnitus. Cognitive-behavioural therapies with a higher level of evidence can also be offered.
5/ Diabetology
The Lancet Diabetes &Endocrinology has published a systematic review of diabetes treatments. The conclusion of this review, which included more than 220,000 patients, found that treatments for diabetes reduce cardiovascular events. Now, let's look by drug class and we see that only GLP-1 analogues and SGLT-2 inhibitors reduce cadiovascular events (nothing new). We see that glitazones could also have an effect (but are no longer authorized in France because of an increased risk of bladder cancer), and that intensive control decreases cardiovascular events, but we have already discussed this here . In the appendices, we see that on mortality, it is indeed the aGLP-1 and iSGLT2 that bring the benefit. We also see that there is no study evaluating metformin alone...
6/ The qualitative study of the week by @DrePetronille
As populations are aging, this article in BMC Family practice examined the relationship between primary care and community health and social services (HSS) caring for the elderly through focus groups conducted in Canada. HSS, often volunteers, have several roles, including accompanying seniors in missions such as wellness, transportation, coordination, and home visits. The results are not surprising: polypathological elderly subjects have more needs in terms of social accompaniment, the delay before inclusion in assistance programs is often too long (initial refusal of families, limited places in accompaniment structures), communication is difficult between primary care and social services with complex administrative files to set up..
Thank you for your support. This post was quite short, I hope you had time to finish your breakfast anyway (for morning readers), and see you next week!
@Dr_Agibus
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