Hello! This is the end of the semester for our residents, I hope next semester will be more "usual", even though already short of one month. Here are the articles of the week, good reading!
1/ COVID-19
The French Academy of Medicine (link in French) takes position in favor of a vitamin D deficiency screening for COVID patients older than 60 and then a treatment if deficiency is proven ; and in favor of a treatment without prior screening for COVID patients younger than 60. This advice relies on a correlation that was found in only one study. For years, vitamin D has been promoted with many advantages but supplementation (blog post in French) does not manage to improve clinical outcomes. Only in respiratory diseases, in case of deficiency, it seems there are less complications in COPD and asthma patients (blog posts in French) after supplementation.
Following the Lancet article last week, the French High Council for Public Health (link in French) advises not to use hydroxycholoroquine to treat COVID-19 anymore.
In order to confirm this position, here is a systematic review that was published in Annals of Internal Medicine. The authors did not find any published study about using (hydroxy)chloroquine as a preventive treatment. The benefits from this medication on mortality, clinical aggravation, intubation needs and symptom resolution were globally similar to those from conventional treatment. The side effects were mainly a QT-interval increase among patients with (hydroxy)chloroquine, but without any clinical consequences. I think that, in a study, one stops the treatment and does not wait for the ventricular arrhythmia to happen.
And for those performing nasopharyngeal swabs, the best way to do it is to aim for the ear lobe.
2/ Cardiovascular diseases
For patients with infrarenal aortic aneurysms of small size (< 50 mm), a randomized controlled trial tested the use of doxycycline 100 mg daily during 2 years. And we have to admit that it does not work to slow down the progress of the aneurysm. Next time, they may try hydroxycholoroquine!
After all, both are malaria medications so why not?
After all, both are malaria medications so why not?
3/ Infective diseases
Perfect transition to speak about 2020 health guidelines for travellers (link in French), published by the High Council for Public Health. Compared to 2019 ones (blog post in French), I have not found any changes. So, for this year, I want to speak about venous thromboembolic events prevention. Class II compression stockings are advised for people with risk factors or not able to wander in the plane during flights over 6 hours long. LMWH do not possess any valid indication but could sometimes be prescribed if stockings cannot be used or in case of very high risk, notably in case of past medical history of travel-related DVT (see here, blog post in French).
Now let us talk about Lyme disease, with a BMJ review. Erythema migrans appears between few days to few weeks after the bite, unlike the bite rash which appears between few hours to few days and disappears during the next few days (and which does not need any treatment). Erythema migrans has a clear centre only for Borellia Afzelli (which is present in Europe in 60% of cases), whereas B. Burgdorferi (in the USA) and B. garinii are responsible for homogeneous erythemas. So, in more than half of cases, if it is homogeneous, it is still a Lyme disease! Doxycycline is now the first-line treatment, as described in French and English guidelines. Chronic symptoms attributed to the Lyme borreliosis happen in 5-10% of patients who were treated and are still symptomatic. Criteria are 1/ documented infection at an early or late stage ; 2/ improvement after treatment ; 3/ onset within 6 months and for at least 6 months of musculoskeletal impairment, cognitive impairment or fatigue. In these cases, antibiotic treatment does not work and is not advised because the disease is not "active", it is only sequelae symptoms. Some scientific societies offer, on a case-by-case basis, 3 to 6 weeks of antibiotics once, suspecting an insufficient early treatment or a secondary infection. Regarding treatment after the bite, only the "International society of Lyme disease" recommends it systematically ; otherwise it is more about careful monitoring and treatment only if erythema migrans appears (for Americans, according to some criteria seen here).
4/ Respiratory medicine
European guidelines about mesothelioma management have just been published. I confess that this is not really general practice... but there is a small part about screening. And in at-risk populations, standard X-Rays were the most used. So, we now know that the existence of pleural plaques is only a sign of asbestos exposure and not an additional risk factor (even though it is correlated with cancer since mesothelioma is linked to asbestos). Injected CT-scan is to be recommended as more precise but we lack studies on the screening benefits (see French guidelines here).
5/ Neurology
My grandmother knew it: eating fish is good for memory! This article speaks about the Mediterranean diet and finds out that a diet with a lot of fish decreases the risk of dementia and slows down the progress of memory impairment. This result comes from ancillary analyses from 2 current randomized trials studying the progress of macular degeneration.
After the failure of the ASPREE study to show efficacy of aspirin in primary prevention on global and cardiovascular mortality (blog post in French), here is the ASPREE analysis about the efficacy of aspirin on the risk of cognitive disabilities: no benefit on reducing the risk of dementia either.
This is the end for this week. To avoid missing anything, you should subscribe on Facebook, Twitter or to the e-mail newsletter if not already done. You have to put your e-mail address in the top right field of this page and confirm the subscription in an e-mail entitled "FeedBurner Email Subscriptions" that will be sent to you and may land in your junk folder.
Have a good day, good luck to the new residents and see you next week!
@Dr_Agibus (free translation by @carttom)
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