Hello! To begin with, here is a simple handy guide about "healthcare professionals taking care of trans people". Have a good reading!
1/ Pharmacovigilance
A systematic review about the use of ibuprofen for children was published to produce a facts sheet, to compared with paracetamol. The main difference is an average apyrexia time of 2.5 hours with ibuprofen versus 2 hours with paracetamol, both treatments being able to lower the temperature by 1.6 °C (= 35 °F). These treatments are responsible for rare adverse effects but there is a suspicion of a higher risk of secondary infection for ibuprofen.
2/ Infective diseases
The French Academy of Medicine discusses the unusual COVID-specific symptoms. The authors describe neurological impairments such as dysgueusia and anosmia but also memory disorders and Guillain-Barré syndromes. There is skin damage such as frostbites, dyshydrosis, urticaria, purpura and Kawazaki syndrome. Also, lymphopenia, hypokaliemia, hyperglycaemia and hyperlipidemia can be be observed.
The BMJ discusses vulvo-vaginal recurrent candidiasis that is defined by 4 episodes over 12 months (with at least 2 confirmed on a swab). Contributing factor must be sought: antibiotics, estrogens, HRT, diabetes, clothes, vaginal showers and daily pads. The clinical exam is mandatory and allows to distinguish between candidiasis, lichen sclerosus, vulvodynia, contact dermatitis and eczema (lichen simplex). The vaginal swab is required to look for both fungal and bacterial (including STI) causes. A fasting blood sugar can also be useful in this context. In case of Candida infection, a treatment by fluconazole 150 mg every third day during 6 days (3 doses total) followed by a weekly dose every week is proposed. In case of an infection with an other germ than Candida, 100,000 IU nystatin pessaries are recommended during 14 nights in a row every month for 6 months. It is not useful to screen sexual partners or to use probiotics but cetirizine can be useful in case of major itch.
Candidiasis
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Lichen sclerosus
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Vulvodynia
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Contact dermatitis
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Lichen simplex
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Erythema
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Fissure
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Exsudat
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Oedema
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Other
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Satellite lesions
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Palor, atrophia
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Painful swabbing
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Exsudat
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Lichenification
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Considering the current tick-borne encephalitis cluster in Auvergne-Rhône-Alpes, this disease has become a disease with mandatory notification.
3/ Oncology
I have already spoken about faecal calprotectin which seemed to be efficient to rule out an inflammatory or cancerous origin for intestinal transit disorders (see here). The French High Autority in Health re-evaluated its use to answer a query from professionals. Calprotectin might be useful for the initial investigations of transit disorders for patients with normal CRP and no red flags. A negative faecal calprotectin could allow to diagnose IBS, a colonoscopy being required if the test is positive. However, the HAS does not align totally with guidelines from other countries, finding that evidence is lacking and French studies must be conducted. This decision is partly due to disagreements about thresholds.
A Lancet study was published about the prescription of aspirin in prevention of colorectal cancer among very high-risk patients, with a Lynch syndrome (the topic is indeed in debate, see here). As their patients were having a regular follow-up because of their condition, we can assume that both groups were having systematic colonoscopies. In this article, the patients were followed up during 10 years and 9% of patients with aspirin have had a cancer vs 13% without. But there is no data about mortality.
Regarding prostate cancer, a new "PREDICT" algorithm allows to evaluate the mortality risk for the affected patients in order to discuss possible treatments.
On this topic as well, one can find in this NEJM article the graphs showing a decreased mortality for prostate cancer from the 90's. This trend is comparable to the ones for breast and lung cancer (without any screening available for the latter). We can also see that the numbers of patient to screen to avoid 1 death by lung cancer is between 380 and 570, whereas the number of patients to screen that can lead to overdiagnosis is between 11 and 18! Overall, around 30 overdiagnoses to reduce the specific (and not global) mortality of 1 patient.
4/ Genetics
Here is now a very comprehensive review article from the NEJM about Down syndrome. I will focus on the most common associated conditions and complications needed to be known for the regular follow-up of affected patients. 44% of patients have a cardiac malformation, 30% to 40% infections linked to immunodeficiency, more than 80% hearing impairment, 50% visual impairment, 50% thyroid disorder. Also, there are iron-deficiency anemias with an increased MCV and increased risk of leukemia and testicular cancer. The atlantoaxial instability is a source of complications but its screening does not yield any benefit on the risk of myelopathy.
5/ Diabetology
We already talked about it but a new Cochrane systematic review was published about metformin: there is no sound evidence for the efficacy of metformin versus no intervention, versus other antidiabetic drugs and versus behaviour changing interventions.
We were talking about the "time in range" (TIR) last week. It seems that at the #ADA2020 conference (American Diabetes Association), a study was presented with a decrease in cardiovascular events for patients with TIR >50-70% or TIR >70% versus patients with TIR <50%. But these measures were done on repeated self-tests and not on continuous glucose monitoring data.
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See you next week !
@Dr_Agibus (free translation by @carttom)
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