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Hybrid therapy for H. pylori infection

A 14-day course of hybrid therapy was as effective as 10-day bismuth quadruple therapy, but with fewer side effects, according to results of a randomized trial conducted in Taiwan.

In a prospective, randomized comparative study published in 2017, the eradication rates (93.9%) in patients receiving 14-day bismuth quadruple therapy (pantoprazole, bismuth subcitrate, tetracycline, and metronidazole) were comparable with eradication rates (92.8%) with 14-day hybrid therapy (dual therapy with pantoprazole plus amoxicillin for 7 days, followed by quadruple therapy with pantoprazole, amoxicillin, clarithromycin, and metronidazole for 7 days).

Source: Medscape

Clinic Hours In Article, FDA Updates

FDA approves Ozanimod for Ulcerative Colitis

The US FDA has approved ozanimod (Zeposia) for adults with moderately to severely active ulcerative colitis (UC), the company has announced. Ozanimod (0.92 mg), an oral medication taken once daily, is the first sphingosine-1-phosphate (S1P) receptor modulator approved for UC.

In March 2020, the FDA approved ozanimod for adults with relapsing forms of multiple sclerosis

The approval, awarded to Bristol Myers Squibb, was based on the data from a placebo-controlled phase 3 trial dubbed True North. In the study, researchers evaluated ozanimod as a single, daily oral therapy for both adults and pediatric patients at least 12 years old with moderately to severely active ulcerative colitis.

More Info: FDA

Clinic Hours In 1 min, Article

Mild cortisol excess increases mortality in adrenal incidentaloma

Mortality is two to three times higher in patients with adrenal incidentalomas who have autonomous cortisol secretion levels of 83 nmol/L (3 µg/dL) or more after a 1 mg dexamethasone suppression test (DST) compared with those with levels below this, new research finds.

Autonomous cortisol secretion (ACS) has been linked to hypertension, cardiovascular disease, type 2 diabetes, and early mortality, and risks vary by cortisol level.

Source: Annals of Internal Medicine

Clinic Hours In Article, New Drug

A novel drug most effective in sickest HFrEF patients

The greatest relative benefit from omecamtiv mecarbil, a novel myotropic drug class that improves cardiac performance, is produced in heart failure patients with the lowest left ventricular ejection fraction (LVEF), a new analysis of the recently published phase 3 GALACTIC-HF trial has found.

The phase 3 multinational GALACTIC-HF trial, published earlier this year, linked omecamtiv mecarbil with an 8% reduction in the risk of a heart failure-related events or cardiovascular death, relative to placebo, which was the primary outcome. For entry, HFrEF patients were required to have a LVEF of 35% or less.

Source: Medscape

Clinic Hours In 1 min, Article

Sotagliflozin improves clinical outcomes in patients with HFpEF

The investigational sodium-glucose cotransporter (SGLT) 1/2 inhibitor sotagliflozin is the first agent clearly shown in a prespecified analysis of randomized trials to improve clinical outcomes in patients with heart failure with reduced ejection fraction (HFpEF).

Researchers who ran the SCORED and SOLOIST–WHF pivotal trials for sotagliflozin first made that claim in November 2020 when reporting top-line results from a prespecified meta-analysis of the two trials during the American Heart Association annual scientific sessions.

Source: Medscape

Clinic Hours In Article

Management protocol for Mucormycosis by AIIMS Rishikesh

Management by Inj Liposomal amphotericin B (LAmB):

Test dose

•Inj. Liposomal Amphotericin- B 1 vial (50 mg) to be diluted in 12 ml of the diluent and 0.25ml (1 mg) of a solution made, to be mixed in 100ml Dextrose and to be infused in 30 minutes.
•Observe for fever and reactions

Pre-hydration

•500 mL NS over 30 minutes
•To reduce the risk of renal toxicity and hypokalaemia:- 500ml Normal Saline + 1 Amp (20mmol) KCL

Therapeutic dose

•5mg-10 mg /kg/day Amphotericin B in 500 mL D5 with 10 Units HIR over 3 hrs (To be covered in black sheet)

PostHydration

•500 mL NS over 30 minutes

Postdose

•KFT with Serum electrolytes after Every dose of Amphotericin B
•Fill Amphotericin monitoring chart

Duration: Continue for 14 to 21 days depending on severity/till clinical resolution and radiological stabilization; after 14days of therapy, shift to oral Posaconazole (200mg four times a day) if clinically stable.

Download Full Protocol ›

Source: AIIMS

Clinic Hours In Article, New Drug

Novel IL-6 antibody reduces CRP up to 92% in High-risk ASCVD

Inhibition of interleukin (IL)-6 with ziltivekimab reduces multiple biomarkers of inflammation and thrombosis in patients at high atherosclerotic risk with moderate to severe chronic kidney disease (CKD) and elevated C-reactive protein, results of the phase 2 RESCUE trial show.

At 12 weeks, median levels of high-sensitivity C-reactive protein (hsCRP) were reduced by 77%, 88%, and 92% with 7.5 mg, 15 mg, and 30 mg doses of ziltivekimab, respectively, every 4 weeks, compared with a 4% reduction with placebo.

Source: Medscape

Clinic Hours In Article, COVID-19

Antibody status & incidence of SARS-CoV-2 infection in health care workers

The relationship between the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the risk of subsequent reinfection remains unclear.

The presence of anti-spike or anti-nucleocapsid IgG antibodies was associated with a substantially reduced risk of SARS-CoV-2 reinfection in the ensuing 6 months. Positive baseline anti-spike antibody assays were associated with lower rates of PCR-positive tests.

Full study: NEJM

Clinic Hours In Article, COVID-19

ICMR releases guidelines for COVID-19 associated Mucormycosis

The correlation between COVID-19 and Mucormycosis isn’t surprising, as the biggest risk factors are uncontrolled diabetes and immune suppressant steroids. Rhino-orbital-cerebral and pulmonary infections are the most common syndromes caused by these fungi. The genera most commonly found in human infections are Rhizopus, Mucor, and Rhizomucor; Cunninghamella, Absidia (now reclassified as Lichtheimia), Saksenaea, and Apophysomyces are genera that are less commonly implicated in infection.

Source: ICMR

Clinic Hours In 1 min, Article

Statins: A potential treatment in COVID-19?

In the HARP-2 trial of simvastatin in acute respiratory distress syndrome (ARDS), published a few years ago, the main results were neutral, but in the subgroup of patients with hyperinflammatory ARDS, there was a reduction in mortality with simvastatin in comparison with placebo.

Moreover, in a series of observational studies of patients with COVID-19, use of statins was associated with a reduction in mortality among hospitalized patients. However, there are limited high-quality data to guide clinical practice.

Source: Medscape