2022.01 医学新闻

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杨薇 医师

1. 在《新英格兰医学杂志》网站上的一项制造商赞助的试验中,未住院、未接种疫苗的轻至中度 COVID-19 和 ≥1 重病危险因素的患者随机接受静脉注射瑞德西韦或安慰剂 3连续多日。根据研究结果,瑞德西韦可以降低入院率, 但需要多日给药可能限制瑞德西韦在人群中的使用(https://doi.org/10.1056/NEJMoa2116846)。

  1. In a manufacturer-sponsored trial on the website of the New England Journal of Medicine, nonhospitalized, unvaccinated patients with mild-to-moderate COVID-19 and ≥1 risk factor for severe illness were randomized to receive intravenous remdesivir or placebo on 3 consecutive days. Based on the study’s findings, Logistical difficulties in administration of remdesivir is most likely to limit use of remdesivir in this population. 
  1. Findings of a study in the January 1, 2022 issue of The Lancet suggest that administration of low-dose anticoagulation to patients recovering from COVID-19 who are at high risk for venous thromboembolism (VTE) based on a high IMPROVE VTE risk score (https://www.mdcalc.com/improve-risk-score-venous-thromboembolism-vte; ≥4) or a moderate IMPROVE VTE risk score (2-3) plus an elevated d-dimer level (>500 ng/dL) is associated with significantly reduced risk for symptomatic or fatal VTE and similar risk of major bleeding. 
  1. To examine the bleeding risk independently associated with respiratory tract infections (RTIs), investigators identified a cohort of 1200 adult users of warfarin or direct-acting oral anticoagulants who had both a bleeding event and an RTI for which an antibiotic was not prescribed; details of the study appear on the website of The BMJ. RTIs are associated with elevated risk for nonmajor and major bleeding.  
  1. Additional analysis of data from the APPAC II trial, which demonstrated that >70% of patients with uncomplicated appendicitis could avoid surgery if treated with antibiotics, allowed researchers to identify appendiceal diameter ≥15 mm and body temperature >38°C as the main predictors of antibiotic failure. 
  1. In a study in the December 15, 2021 issue of The Journal of Bone & Joint Surgery, patients labeled as penicillin-allergic who were scheduled for total-joint arthroplasty completed a questionnaire and were categorized as intolerant to penicillin, at low risk, or at high risk, based on their responses. Those in the intolerant and low-risk groups received cefazolin for antibiotic prophylaxis. The likelihood of receiving noncephalosporin antibiotics was lower in patients who were risk stratified using this protocol; the incidence of cutaneous reactions in low-risk patients who received cefazolin was similar, compared with that in controls.

2. 2022 年 1 月 1 日《柳叶刀》杂志上的一项研究结果表明,对从 COVID-19 康复且有静脉血栓栓塞 (VTE) 高风险的患者进行低剂量抗凝治疗, 可显着降低症状性或致命性 VTE 的风险, 大出血风险类似(https://doi.org/10.1016/S0140-6736(21)02392-8)。

3. 英国医学杂志的网站上, 一项研究检查了使用华法林或直接作用口服抗凝剂患者呼吸道感染 (RTIs)相关的出血风险。结果表明, 呼吸道感染与非大出血和大出血的风险升高有关(https://doi.org/10.1136/bmj-2021-068037)。 

4. 对 APPAC II 试验数据的补充分析表明,>70% 的单纯性阑尾炎患者如果使用抗生素治疗可以避免手术。研究人员能够确定, 阑尾直径 ≥15 mm 和体温 >38°C 是抗生素治疗失败的主要的预测因子(https://doi.org/10.1001/jamasurg.2021.5003)。 

5. 在 2021 年 12 月 15 日《骨与关节外科杂志》上的一项研究中,被标记为对青霉素过敏且计划进行全关节置换术的患者完成了问卷调查,被归类为对青霉素不耐受、风险低、或高风险。不耐受和低风险组接受头孢唑啉抗生素预防。与对照组相比, 使用该方案进行风险分层的患者接受非头孢菌素抗生素的可能性较低, 皮肤反应发生率相似(https://doi.org/10.2106/JBJS.21.00027)。

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