LibGuides: What’s new in medical literature: What's new in medical literature

Anorexia nervosa and cardiovascular conditions
Weight loss and malnutrition in anorexia nervosa can lead to comorbidities, including cardiovascular conditions such as cardiomyopathy and conduction disorders. A recent study found that the incidence of any cardiac condition at the five-year follow-up was nearly two times greater in those with anorexia nervosa compared with controls without any eating disorder [47]. Patients with anorexia nervosa should be monitored for comorbidities, including structural and functional cardiovascular conditions, that may warrant specific management along with nutritional replenishment. (See "Anorexia nervosa in adults and adolescents: Medical complications and their management", section on 'Any cardiovascular condition'.)

Bleeding risk with direct oral anticoagulants
Direct oral anticoagulants (DOACs) are often preferred to warfarin since they do not require routine monitoring, but bleeding risks are uncertain. A new meta-analysis of data from randomized trials involving over 26,000 individuals prescribed a DOAC or low-dose aspirin reported that bleeding risks with DOACs were similar to low-dose aspirin, which carries a small increase in risk [2]. Clinicians should use caution when comparing bleeding risks between DOACs from different trials, as trial populations may differ and there are very few data from direct comparisons. (See "Risks and prevention of bleeding with oral anticoagulants", section on 'Drug class'.)

Competing risks when resuming direct oral anticoagulants after intracerebral hemorrhage
Patients with atrial fibrillation and intracerebral hemorrhage (ICH) often have long-term competing risks of ischemic stroke and recurrent ICH. Limited data are available to help quantify these risks in patients taking direct oral anticoagulants (DOACs). In an open-label trial of 319 patients with prior ICH and atrial fibrillation who were randomly assigned to treatment with a DOAC or withholding anticoagulation, the subsequent ischemic stroke rate was lower in those assigned to a DOAC (0.8 versus 8.6 per 100 patient-years), but this benefit was partially offset by an increase in ICH recurrence (5 versus 0.8 per 100 patient-years) [1]. All-cause mortality was similar between groups, with wide confidence intervals. These data support the feasibility of resuming anticoagulation with a DOAC in selected patients with ICH but highlight the importance of shared decision-making incorporating these competing risks. (See "Spontaneous intracerebral hemorrhage: Secondary prevention and long-term prognosis", section on 'Therapeutic options'.)

Endoscopic removal of retained packets in asymptomatic body packers
In asymptomatic body packers, whole bowel irrigation (WBI) is the first-line treatment as it is safe and hastens packet removal; endoscopic packet removal is controversial because packet perforation can release dangerous amounts of drug. However, a study with 82 patients who underwent endoscopic removal of retained cocaine packets (all covered with a wax coating) found no evidence of packet rupture [32]. Sophisticated modern packaging techniques (ie, outside wax coating) and improved endoscopic techniques (ie, basketing instead of snaring) likely mitigate the risk of packet perforation. Given these findings, we suggest endoscopic removal in asymptomatic patients who have a few retained packets following WBI or when WBI is otherwise contraindicated. (See "Internal concealment of drugs of abuse (body packing)", section on 'Role of endoscopic removal of packets'.)

Impact of genetic testing on cerebral palsy management
Genetic testing is increasingly performed for individuals diagnosed with cerebral palsy (CP) to identify a specific underlying cause of symptoms, but the clinical implications of testing are unclear. In a meta-analysis of studies that assessed genetic variants in children with CP and included 1841 individuals who underwent exome sequencing, likely pathologic variants were identified in 27 percent, and results led to a change in management in 8 percent [36]. Specific interventions included the initiation of condition-specific medications, stem cell transplantation, dietary changes, and implementation of preventive measures and condition-specific monitoring. These results support the use of genetic testing both to identify underlying causes and to guide treatment of CP. (See "Cerebral palsy: Evaluation and diagnosis", section on 'Metabolic and genetic testing'.)

No benefit of GLP-1 receptor agonists in Parkinson disease
Glucagon-like peptide-1 (GLP-1) receptor agonists have been proposed as neuroprotective agents based on observations that their use in patients with diabetes may be associated with lower risk of Parkinson disease (PD). However, in two recent randomized trials of extended-release exenatide formulations versus placebo in over 450 patients with PD, motor scores and rates of disease progression were similar between groups with up to 96 weeks of treatment [23,24]. An earlier trial of lixisenatide also failed to confirm a benefit. Thus, the available evidence does not support use of GLP-1 receptor agonists as either symptomatic or disease-modifying therapies for patients with PD. (See "Epidemiology, pathogenesis, and genetics of Parkinson disease", section on 'Protective factors'.)

Society of Critical Care Medicine guidelines for family/caregivers in the intensive care unit
The Society of Critical Care Medicine (SCCM) issued updated guidelines on family/caregiver support in the intensive care unit (ICU) [1]. Using a growing body of evidence, the SCCM issued a strong recommendation for liberal caregiver/family presence in the ICU. This includes family/caregiver presence on rounds and resuscitation, participation in care as well as the provision of dedicated space, ICU diaries, education tools, and psychological, spiritual, and bereavement support. The SCCM also made a conditional recommendation for communication support for both family/caregivers and clinicians. We agree with the recommendations. (See "Post-intensive care syndrome (PICS): Treatment and prognosis", section on 'Post-intensive care syndrome-family'.)

Society of Critical Care Medicine guidelines on critical care ultrasonography use
The Society of Critical Care Medicine (SCCM) recently updated its guidelines on the use of bedside critical care ultrasonography (CCUS) [20]. The SCCM conditionally recommended CCUS use in patients with septic shock, acute respiratory failure, and acute cardiogenic shock as well as in patients with unclear volume status. It was unable to make a clear recommendation for CCUS use in patients undergoing cardiopulmonary resuscitation. We agree with these recommendations. (See "Indications for bedside ultrasonography in the critically ill adult patient", section on 'Introduction'.)

Tumor, Node, Metastasis staging for thoracic cancers (ninth version) (February 2025, Modified March 2025)
The American Joint Commission on Cancer has revised the Tumor, Node, Metastasis (TNM) staging system for a number of cancers [29]. Notable revisions for thoracic cancers include changes to nodal staging in lung cancer (table 1), such that there is now a division of N2 disease into N2a (tumor involvement of a single ipsilateral mediastinal nodal station or of the subcarinal nodal station) and N2b (tumor involvement of multiple ipsilateral mediastinal nodal stations). Revisions have also been made in the staging of pleural mesothelioma (table 2) as well as thymic tumors (table 3). (See "Clinical presentation, diagnosis, and staging of thymoma and thymic carcinoma", section on 'Staging system' and "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer", section on 'Staging'.)

Types of hysterectomy in patients with stage IB1 cervical cancer
For patients with stage IB1 cervical cancer with limited stromal invasion (ie, <10 mm on excisional specimen or <50 percent depth on MRI), we suggest simple hysterectomy plus lymphadenectomy rather than modified or radical hysterectomy (Grade 2C). Patients with stage IB1 cervical cancer have traditionally been treated with radical hysterectomy; however, less extensive surgery has been proposed for carefully selected patients. In a randomized trial including over 640 patients with stage IB1 cervical cancer and limited stromal invasion (ie, <10 mm on excisional specimen or <50 percent depth on MRI), radical hysterectomy versus simple hysterectomy plus lymph node assessment resulted in similar rates of recurrence and survival, with a median follow-up of 4.5 years [16]. Fewer patients in the simple group experienced urinary incontinence and/or retention. Although the study has limitations, for patients with stage IB1 and limited stromal invasion, we now suggest simple hysterectomy plus lymphadenectomy rather than modified or radical hysterectomy. For patients with stage IB1 and more extensive stromal invasion, or in whom the extent of stromal invasion is not known, we continue to suggest modified radical hysterectomy with lymph node assessment. (See "Management of early-stage cervical cancer", section on 'Type of surgery'.)

Universal screening for congenital cytomegalovirus infection
Newborn screening for congenital cytomegalovirus (cCMV) has been proposed by public health experts, but the most reliable and cost-effective method is uncertain. Two recent studies reported on the experience of performing universal cCMV screening with dried blood spots [16,17]. Combined, these studies screened >600,000 newborns, and 863 (0.14 percent) screened positive. The false-positive rate was 4 percent. Among confirmed cases, >80 percent were asymptomatic whereas 12 to 16 percent had either isolated hearing loss or findings consistent with symptomatic cCMV disease. These reports suggest that universal screening is feasible; however, important challenges and uncertainties remain (eg, ensuring timely follow-up and linkage to care after a positive screen, and lack of standardized criteria for initiating antiviral treatment). (See "Congenital cytomegalovirus (cCMV) infection: Clinical features and diagnosis", section on 'Universal newborn screening'.)

MJA

Accountability, ambition, and quantifiable action in the carbon emission reduction plans of the ten largest pharmaceutical companies in Australia: a cross-sectional analysis
The ten largest pharmaceutical companies in Australia are moving towards net zero greenhouse gas emissions at different rates. Gaps in standardised reporting processes should be closed, and further qualitative research on industry-wide environmental sustainability policy and practice is needed. MJA 4 March 2025

Early cardiovascular collapse after envenoming by snakes in Australia, 2005–2020: an observational study (ASP-31)
The known: Collapse is an infrequent but important manifestation of snake envenoming in Australia.
The new: People who collapse after snake envenoming in Australia do so within an hour of the bite and usually before they reach hospital. It is associated with venom-induced consumption coagulopathy, and is most frequent after brown snake bites. Rates of cardiac arrest and death are higher for people who collapse than for those who do not.
The implications: Early collapse is a high risk feature of Australian snake envenoming. It requires prompt identification and cardiopulmonary resuscitation. MJA 9 March 2025

Platypus envenomation
Lessons from practice

Platypus envenomation presents with severe pain and swelling.
Pain may be refractory to standard opioid analgesia, and regional anaesthesia should be considered.
Surgical washout should be considered for significant penetrating injuries, and this may have a role in reducing infection risk and diluting venom.
There is no role for pressure bandage immobilisation; however, there may be a role for heat as a non-pharmacological analgesic adjuvant.

MJA 13 March 2025

MJA Insight

Do some children need statins?
Familial hypercholesterolemia (FH) is a life-threatening hereditary condition, yet 90% of Australians with FH remain undiagnosed. Experts urge proactive genetic testing to identify children and families at risk. MJA Insight 10 March 2025

Indigenous led programs excel at tackling rheumatic heart disease, research shows
Until we change systemic health care issues in remote communities and prioritise culturally safe health care, Indigenous children and young adults will continue to die from preventable heart disease, experts say. MJA Insight 10 March 2025

Less is more: deprescribing for safer ageing
Australia is facing a pressing challenge as the population ages — the way we manage medicines and how we prescribe for older adults must evolve. MJA Insight 10 March 2025

More people are asking generative AI questions about their health. But the wrong answer can be risky
More people are turning to generative artificial intelligence (AI) to help them in their daily and professional lives. ChatGPT is one of the most well-known and widely available generative AI tools. It gives tailored, plausible answers to any question for free. MJA Insight 3 March 2025

Partnerships across sectors key to eliminate cervical cancer for all culturally diverse communities
International targets have been set to eliminate cervical cancer and Australia Government strategies are in place to achieve this. For this to benefit all diverse communities, authentic cross-sector partnership and community engaged practices are needed. MJA Insight 10 March 2025

The burden of heavy menstrual bleeding
A new study shows a significant proportion of Australian women experience heavy menstrual bleeding, with rates increasing as women age. MJA Insight 10 March 2025

BMJ

Advances in the management of endometrial cancer
Endometrial cancer is now the most lethal gynecologic malignancy, with incidence rates rising globally. Treatment strategies have historically been focused on a combination of surgery, radiation, and/or chemotherapy based primarily on histology and extent of tumor. Advances in the evaluation and treatment of endometrial cancers are occurring at a rapid pace, with a new focus on genomic profiling and targeted therapies. Surgical removal of the tumor remains the mainstay of therapy, but adjuvant treatments are a shifting paradigm. In the realm of gynecologic malignancies, endometrial cancer leads in the evolution of precision medicine. The ability to analyze patients, tumors, and therapy has increased over the past 10 years. Gaps in knowledge about racial and ethnic disparities, as well as pre-invasive disease prevention, are closing. This review describes the advances in endometrial cancer with a focus on people at risk, molecular classification, and modern therapeutic strategies. BMJ 5 March 2025

Assessment and management of common hand fractures in adults
What you need to know

Most closed, stable hand fractures do not require surgery and heal well with immobilisation or protected early range of motion to prevent stiffening as well as dedicated hand therapy
Wash out open fractures thoroughly and promptly in the acute care setting and administer antibiotics to prevent infection, according to local guidelines
With the exception of uncomplicated tuft fractures, refer all fractures to a hand surgeon for evaluation, ideally within a week of injury; bite wounds, open fractures, and irreducible fractures/joints warrant more urgent evaluation

BMJ 6 March 2025

Diagnosis and management of faecal incontinence in primary care
What you need to know

Faecal incontinence is the recurrent, involuntary passage of stool, and has a global pooled prevalence of 8%
Identify whether patients have urge or passive incontinence, and what contributory factors are present, including sphincter dysfunction, altered anatomy or physiological function of the rectum, or neurogenic causes
Perform a digital rectal examination to assess sphincter muscle function
Management can take a step-up, individualised approach within primary care, and includes dietary changes, anti-diarrhoeal medication such as loperamide, and pelvic floor exercises
Refer urgently to secondary care patients with red flag features, including rectal bleeding, substantial unintentional weight loss, iron deficiency anaemia, or recent onset sustained change in bowel habit

BMJ 3 March 2025

Identification, assessment, and management of gambling-related harms: summary of NICE guideline
What you need to know

Consider asking questions such as “Do you gamble?” or “Are you worried about your own or another person’s gambling?” when asking about smoking, alcohol consumption, or use of other substances. It may also be useful to ask people who disclose gambling about the frequency and duration of episodes
Refer people experiencing gambling-related harms for support or treatment, or advise them that they can self-refer
Current evidence suggests that group cognitive behavioural therapy may be the most clinically and cost effective psychological treatment for reducing gambling severity

BMJ 11 March 2025

Projections for prevalence of Parkinson’s disease and its driving factors in 195 countries and territories to 2050: modelling study of Global Burden of Disease Study 2021
By 2050 Parkinson’s disease will have become a greater public health challenge for patients, their families, care givers, communities, and society. The upward trend is expected to be more pronounced among countries with middle Socio-demographic Index, in the Global Burden of Disease East Asia region, and among men. This projection could serve as an aid in promoting health research, informing policy decisions, and allocating resources. BMJ 5 March 2025

JAMA

Adjuvant chemoradiotherapy vs radiotherapy alone for patients with intermediate-risk cervical cancer
The results of this cohort study suggest that adding chemotherapy to radiotherapy was not associated with improved overall survival for patients with intermediate-risk cervical cancer. JAMA 13 March 2025

Awake prone positioning in adults with COVID-19: An individual participant data meta-analysis
These results suggest that among patients with COVID-19 and acute hypoxemic respiratory failure, awake prone positioning (APP) is associated with improved clinical outcomes. JAMA 10 March 2025

High-dose Vitamin D in clinically isolated syndrome typical of Multiple Sclerosis: The D-Lay MS randomized clinical trial
Oral high-dose cholecalciferol reduced disease activity in clinically isolated syndrome and in early relapsing-remitting multiple sclerosis. JAMA 10 March 2025

Persistent prostate-specific antigen following radical prostatectomy for prostate cancer and mortality risk
Prostate-specific antigen (PSA) level should be assessed for at least 3 months postoperatively to minimize overtreatment, and a higher persistent PSA level was associated with a worse prognosis. JAMA 13 March 2025

Risk prediction models for Sentinel Node Positivity in Melanoma: A systematic review and meta-analysis
This systematic review and meta-analysis found several risk prediction models that have been externally validated with strong discriminative performance. Further research is needed to evaluate the associations of their implementation with preprocedural care. JAMA 12 March 2025

NEJM

Infertility evaluation and treatment

The age of the childbearing female partner is the most important predictor of live birth with natural conception as well as with assisted conception.
The probability of live birth with a single cycle of in vitro fertilization therapy exceeds the monthly fecundability of natural conception, thereby leading to its dominant role in fertility treatment.
At least one third of infertility cases are due to male reproductive issues that could be effectively managed with assisted conception.
An evaluation should focus on clinical information relevant to common causes of infertility: extremes of weight, signs and symptoms of polycystic ovary syndrome, and other possible endocrine disturbances.

NEJM 12 March 2025

Male-partner treatment to prevent recurrence of Bacterial Vaginosis
The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care. NEJM 5 March 2025

Micronutrients — Assessment, requirements, deficiencies, and interventions

Inquiry about the usual dietary pattern, with a focus on the omission of specific foods that can increase the risk of inadequate intake of micronutrients, is an important part of the assessment of micronutrient status.
Micronutrient deficiencies, especially those identified on the basis of laboratory assessment, are generally uncommon in the United States.
In addition to low dietary intake, certain clinical factors (e.g., malabsorption, intestinal surgery, alcoholism, some medications, anorexia, and pernicious anemia) increase the risk of micronutrient deficiency.
Dietary and biochemical assessments are complementary, and there are reasons why they may not always be in agreement.
Because national data on micronutrient intakes and status are collected cross-sectionally, it is difficult to determine the extent to which deficiencies are causal factors for chronic diseases and poor health.
Future research should include more sensitive and informative methods of assessment for micronutrient deficiencies, such as “omics,” to detect effects on metabolism, gene expression, and proteins.

NEJM 5 March 2025

Other journals

AI-assisted decision-making in mild traumatic brain injury
GPT-4 demonstrates potential utility in clinical decision-making for mild TBI management, offering scientifically appropriate and comprehensible responses. However, critical errors and readability issues limit its immediate implementation in emergency settings without oversight by experienced medical professionals. BMC emergency medicine 12 March 2025

Characteristics, outcomes, and complications among nonagenarian and centenarian patients admitted to the intensive care unit: a scoping review
Nonagenarians and centenarians admitted to ICU are a highly comorbid and vulnerable population who experience prolonged hospital stays and complications. However four out of five survive to hospital discharge and half are alive at one year after admission. Therefore, through judicious patient selection, ICU care can be both meaningful and beneficial. Critical care 13 March 2025

Double gloving for self-protection in high-risk surgeries: a systematic review and meta-analysis
Double gloving is recommended over single gloving for better safety of surgical personnel and indicator gloves for better detection of perforations during surgery so that it can be changed timely, but it does not provide any additional protection. Systematic reviews 8 March 2025

Effect of non-invasive rhythm control on outcomes in patients with first diagnosed atrial fibrillation presenting to an emergency department
Real-world data from first diagnosed atrial fibrillation (FDAF) patients presenting to an ED showed a benefit regarding all-cause mortality and MI favouring a non-invasive rhythm control strategy. Further prospective research is needed to validate this hypothesis. BMC emergency medicine 3 March 2025

Efficacy and safety of corticosteroids for stroke and traumatic brain injury: a systematic review and meta-analysis
Corticosteroids reduced the risk of death and in selected patients with stroke, such as those with large artery occlusion after thrombectomy, but increased the risk of death after TBI, had no effect on functional outcomes. Further trials are needed to identify individual stroke patients who may benefit from corticosteroids. Systematic reviews 4 March 2025

Enhancing clinical risk assessment in pediatric blunt abdominal trauma: A novel scoring system using ultrasound and laboratory data
This study shows that a scoring system based on positive ultrasound (US) findings, abdominal tenderness, hematuria, and high WBC levels effectively diagnoses intra-abdominal injury (IAI) in blunt abdominal trauma (BAT) children. BMC emergency medicine 1 March 2025

Key interventions and outcomes in perioperative care pathways in emergency laparotomy: a systematic review
Current perioperative pathways in Emergency laparotomy (EmLap) setting are underpinned by variable component interventions, with a lack of in-depth intervention reporting and evaluation. Future studies should incorporate the Template for Intervention Description and Replication (TIDieR) checklist when reporting on perioperative pathways in the EmLap setting. World journal of emergency surgery 10 March 2025

Local analgesia for the relief of pain in children undergoing venipuncture and intravenous cannulation: a systematic review and network meta-analysis
Most local analgesia methods were effective in relieving pain in children undergoing venipuncture and intravenous cannulation except vapocoolant spray which did not show greater pain reduction than placebo or routine care. Amethocaine, Buzzy and lidocaine iontophoresis are the top 3 local analgesia methods to relieve pain in children undergoing venipuncture and intravenous cannulation. However, due to the limited number of direct comparisons, interpretation of some results should be made with caution. BMC anesthesiology 7 March 2025

The effect of COVID-19 vaccination on the risk of persistent post COVID-19 condition: Cohort study
The authors conducted a population-based cohort study in Stockholm, Sweden, to investigate the effect of COVID-19 vaccination on the risk of developing persistent PCC in individuals surviving the first year after a SARS-CoV-2 infection. 331,042 individuals were included, of which 852 had persistent PCC. The adjusted RR (95% CI) for developing persistent PCC compared with unvaccinated individuals was 0.81 (0.59-1.10) for 1 dose, 0.42 (0.35-0.52) for 2 doses, and 0.37 (0.27-0.52) for three doses. Reduced risks for vaccinated individuals were also observed when restricting the analyses to pre-Omicron and Omicron, as well as all subgroups including sex, age, and previous infection. Journal of infectious diseases 12 March 2025

Ultra-processed foods and risk of all-cause mortality: an updated systematic review and dose-response meta-analysis of prospective cohort studies
This updated meta-analysis, incorporating a greater number of newly published cohort studies using NOVA classification with the largest sample size to date, strengthens the evidence linking higher Ultra-processed food (UPF) consumption to increased all-cause mortality risk. Strategies such as dietary guidelines and policies for limiting UPF consumption worldwide should be encouraged. Systematic reviews 3 March 2025

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What’s new in medical literature

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