Hello everyone! It is time for a new season of Dragi Webdo and time to go back to work for many. Here are the news that I have seen during the summer. To begin with, I can only recommend you to read the article about using placebo in chronic pain that was published in the BMJ and that shows that a placebo, even when telling it is a placebo, has a certain placebo effect and the importance of the patient-doctor relationship in the placebo effect. Have a good reading!
1/ Pharmacovigilance
The risk of lower limb amputation with canaglifozine was evaluated in the BMJ through a cohort study comparing canaglifozine to GLP-1 receptor agonist with propensity score match. The authors confirm the higher risk, but only for patients over 65 with a past medical history of cardiovascular disease. The number of patients to treat each year to cause an amputation (NNH) is 274.
The French Agency for Drug Safety informs about the risk of QT prolongation with levetiracetam, in order to prevent doctors associating it with other medications responsible for this cardiac abnormality.
2/ COVID-19
As we get closer to the end of school holidays (in the Northern hemisphere), the French association of community paediatricians and the French society of paediatrics have published guidelines building on the advice from the French Academy of medicine. They advise a reinforcement of immunization strategies: against influenza (according to the usual criteria, not for every child contrary to the USA) and against rotavirus (which is usually recommended in the USA). This last one is actually not recommended anymore in France since 2015 due to insufficient medical benefit, partly because of the risque of intussusecption. Limiting the prevalence of theses diseases may limit the burden of emergency rooms according to the authors. The press release of the Academy of medicine has only one reference, it's not much and the vaccine remains being not reimbursed. Regarding management of COVID-19 before 6 years old, the authors only recommend a screening test only for severe cases or persisting symptoms over 3 days or in case of contact with a COVID+ patient. For children over 6, all should be tested if symptomatic. The time off school should be at least 7 days and until symptoms disappear.
The BMJ has published an article regarding physical distancing, advising for 2 metres rather than 1 metre between people. They have also produced a table estimating the risk of transmission according to different situations:
An article in the JAMA has found out that, among patients hospitalized for COVID, 87% had a post-COVID syndrome, defined as symptoms persisting despite a normal PCR test. The patients had been followed for around 2 months and were presenting mostly with fatigue (53%), dyspnea (43%), joint pain (27%) and chest pain (22%).
3/ Respiratory medicine
I have already written several times about the possible benefit of vitamin D for childhood asthma (here and a bit there). In a study published in the JAMA, 200 children with vitamin D deficiency and an ICS-controlled asthma were randomized between a placebo group and a vitamin D 4,000 IU per day group. After 48 weeks, there had not been any improvement for the delay until the first severe exacerbation. One can regret that, in this article, there is not any information about the non-severe asthma attacks and the use of short-term relievers, but there was not any difference for ICS use. Overall, this study should be included in the next Cochrane meta-analysis on this topic.
In a NEJM study, the treatment with 3 days of amoxicillin was studied against placebo, for non severe pneumonias of children aged between 2 months and 5 years in Pakistan, in general practice. The reasoning was that, considering the pneumococcal vaccination, the amoxicillin was not useful anymore. As a matter of fact, with this vaccination, atypical pneumonia are the most frequent ones after 3 years old; macrolides do not have much use (see this Cochrane review). The failure rate at day 3 was significantly larger in the placebo group (NNT = 43; 4.8% vs 2.5%), no difference at day 14. So, we can draw 2 interesting findings: 3 days of amoxicillin seem to be enough, instead of 5; and even we miss a pneumonia, it seems to evolve favorably.
4/ Diabetes
I wanted to finish with the guidelines regarding the Latent Autoimmune Diabetes in Adults (LADA), a diabetes mellitus intermediate between type 1 and type 2, affecting between 2 to 12% of the diabetic patients (quite a lot!). The diagnosis is usually made among patients over 30 years old with a low BMI and anti-GAD+ antibodies. These patients usually have a C-peptide that decreases much less faster than type 1 diabetes patients and therefore can be treated by non-insuline antidiabetic drugs. But few patients will have a low C-peptide and will require insulin. I won't discuss this further.
And that's all for the comeback ! Thanks for your loyalty. If not already done, do not hesitate to subscribe on Facebook, Twitter or to the newsletter by e-mail: 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.
See you next week!
@Dr_Agibus (free translation by @carttom)
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