Medicine Update

Published in IJCP December 2023 Editorial Medicine Update December 11, 2023 \| Veena Aggarwal Family Medicine Four Stages of Myocardial Injury in Heart Attack An expert consensus statement from the Canadian Cardiovascular Society has classified four stages of an acute atherothrombotic myocardial infarction (MI) based on the severity of myocardial injury as follows: “Aborted MI (no or minimal myocardial necrosis). MI with significant cardiomyocyte necrosis but without microvascular injury. Cardiomyocyte necrosis and microvascular dysfunction leading to microvascular obstruction (‘no-reflow’). Cardiomyocyte and microvascular necrosis leading to reperfusion hemorrhage.” (Source: Canadian Journal of Cardiology. Oct. 28, 2023) CRISPR Gene Editing Approved for Treatment of Blood Disorders for the First Time UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has for the first time approved Casgevy, a therapy that utilizes the CRISPR gene editing tool for treatment of sickle cell disease and β-thalassemia… (Source: Nature. Nov. 16, 2023). Benefits of Intensive BP-lowering: ESPRIT In the ESPRIT trial, intensive lowering of systolic blood pressure (BP) to a target of <120 mmHg (vs. target of <140 mmHg) reduced cardiovascular (CV) events by 12% in high-risk persons including those with diabetes and history of stroke. Death due to CV causes decreased by 39% and death due to any cause reduced by 21%… (Source: Medscape. Nov. 16, 2023). Inadequate Sleep: A Novel Risk Factor for Type 2 Diabetes in Women? Limiting sleep to 6.2 hours or less for 6 weeks, a reduction of only 1.5 hours each night, resulted in nearly 15% rise in insulin resistance in otherwise healthy women, both pre- and postmenopausal. The effects were more pronounced in postmenopausal women with almost 20% increase in insulin resistance… (Source: NIH. Nov. 14, 2023). IBS Patients Commonly Develop Fibromyalgia Patients with irritable bowel syndrome (IBS) are 5 times more likely to develop fibromyalgia and chronic fatigue syndrome (CFS) with adjusted odds ratio (aOR) of 5.33 and 5.4, respectively. Those with IBS-C were at greater risk compared to those with IBS-D. Older persons were at higher risk with aOR of 1.02. Women were also 11 times at greater risk (aOR 11.2)… (Source: Biomedicines. Sept. 22, 2023). FDA Approves Capivasertib + Fulvestrant for HR⁺and HER^- Breast Cancer The Food and Drug Administration (FDA) has approved the use of capivasertib to be used in combination with for adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer. These patients have ≥1 PIK3CA/AKT1/PTEN-alterations and in whom the disease progression occurred on at least one endocrine-based regimen in the metastatic setting or recurrence on or within 12 months of completing adjuvant therapy… (Source: US FDA. Nov. 16, 2023). Recent Surge in Respiratory Illness in China due to Seasonal Infections, Says China: WHO Chinese health authorities attribute the sharp increase in the number of cases of children with respiratory diseases including pneumonia in Northern China to known pathogens such as influenza, Mycoplasma pneumoniae, respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as the advent of winter, says the World Health Organization (WHO). The organization is “closely monitoring the situation and is in close contact with national authorities in China”… (Source: WHO. Nov. 23, 2023). The PROFID EHRA Trial Enrolls its First Patient The first clinical trial to examine the benefits of defibrillator implantation along with drug treatment vis-a-vis medical treatment alone in post-MI patients with symptomatic heart failure and left ventricular ejection fraction of ≤35% has started with enrollment of the first patient from Germany. Some of the outcomes to be examined in the trial include all-cause death and sudden cardiac death. The PROFID EHRA noninferiority trial will be conducted in 13 countries with around 3,505 patients. Results are expected in early 2027… (Source: ESC. Nov. 21, 2023). AGA Publishes Updated Guideline for Use of Biomarkers in Crohn’s Disease The American Gastroenterological Association (AGA) recommends use of serum C-reactive protein (CRP) and fecal calprotectin to monitor patients with asymptomatic or symptomatic Crohn’s disease rather than relying on symptoms alone. It advocates a cut-off of <150 µg/g for fecal calprotectin and/or <5 mg/L for CRP to exclude active inflammation in patients with symptomatic and endoscopic remission, whereas patients with symptomatic but not endoscopic remission should undergo endoscopy to exclude active inflammation… (Source: Gastroenterology. Dec. 2023). Lebrikizumab Approved in Europe for Moderate to Severe Atopic Dermatitis Atopic dermatitis patients who have not responded to topical therapies can now be treated with lebrikizumab, a monoclonal antibody, which inhibits interleukin-13. It has been approved by the European Commission for the treatment of patients aged ≥12 years with moderate to severe atopic dermatitis… (Source: Medscape. Nov. 20, 2023). Upper GI Endoscopy Enables Diagnosis of Iron Deficiency Anemia Etiology in Children The use of upper gastrointestinal endoscopy enabled identification of the cause of iron deficiency anemia in ≥70% of children with severe unexplained iron deficiency anemia. Sixty-eight percent were found to have polyps, gastronodularity or erosions, while 12% had duodenitis or ulcers. Histopathology revealed gastritis in 72% and Helicobacter pylori in 50% of children… (Source: HCPLive. Oct. 23, 2023) A Catheter Lock Solution for Renal Failure Patients on Chronic Hemodialysis A catheter lock solution, Defencath (taurolidine and heparin) has been approved by the US FDA to prevent catheter-related bloodstream infections in patients with renal failure on chronic hemodialysis via a central venous catheter. It is available in single dose 3 mL and 5 mL vials and is to be used only as a catheter lock solution. The product carries a warning about heparin-induced thrombocytopenia… (Source: US FDA. Nov. 15, 2023). Study Links Hippocampal Atrophy to Cognitive Decline Decrease in the volume of the hippocampus is associated with cognitive impairment. The Harvard Aging Brain Study reported that the faster the atrophy of the hippocampus occurred, faster was the cognitive decline. These observations were independent of amyloid-beta (Aβ) and tau levels… (Source: AAN. Nov. 15, 2023) The First Home Diagnostic Test for Common STIs LetsGetChecked’s Simple 2 Test has been accorded marketing approval as the first diagnostic test for two common sexually transmitted infections Chlamydia and gonorrhea for patients aged ≥18 years. It is available over-the-counter and the sample can be collected at home… (Source: US FDA. Nov. 15, 2023).

Published in IJCP December 2023

Editorial

Medicine Update

December 11, 2023 | Veena Aggarwal

Family Medicine

Four Stages of Myocardial Injury in Heart Attack

An expert consensus statement from the Canadian Cardiovascular Society has classified four stages of an acute atherothrombotic myocardial infarction (MI) based on the severity of myocardial injury as follows:

“Aborted MI (no or minimal myocardial necrosis).
MI with significant cardiomyocyte necrosis but without microvascular injury.
Cardiomyocyte necrosis and microvascular dysfunction leading to microvascular obstruction (‘no-reflow’).
Cardiomyocyte and microvascular necrosis leading to reperfusion hemorrhage.”

(Source: Canadian Journal of Cardiology. Oct. 28, 2023)

CRISPR Gene Editing Approved for Treatment of Blood Disorders for the First Time

UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has for the first time approved Casgevy, a therapy that utilizes the CRISPR gene editing tool for treatment of sickle cell disease and β-thalassemia… (Source: Nature. Nov. 16, 2023).

Benefits of Intensive BP-lowering: ESPRIT

In the ESPRIT trial, intensive lowering of systolic blood pressure (BP) to a target of <120 mmHg (vs. target of <140 mmHg) reduced cardiovascular (CV) events by 12% in high-risk persons including those with diabetes and history of stroke. Death due to CV causes decreased by 39% and death due to any cause reduced by 21%… (Source: Medscape. Nov. 16, 2023).

Inadequate Sleep: A Novel Risk Factor for Type 2 Diabetes in Women?

Limiting sleep to 6.2 hours or less for 6 weeks, a reduction of only 1.5 hours each night, resulted in nearly 15% rise in insulin resistance in otherwise healthy women, both pre- and postmenopausal. The effects were more pronounced in postmenopausal women with almost 20% increase in insulin resistance… (Source: NIH. Nov. 14, 2023).

IBS Patients Commonly Develop Fibromyalgia

Patients with irritable bowel syndrome (IBS) are 5 times more likely to develop fibromyalgia and chronic fatigue syndrome (CFS) with adjusted odds ratio (aOR) of 5.33 and 5.4, respectively. Those with IBS-C were at greater risk compared to those with IBS-D. Older persons were at higher risk with aOR of 1.02. Women were also 11 times at greater risk (aOR 11.2)… (Source: Biomedicines. Sept. 22, 2023).

FDA Approves Capivasertib + Fulvestrant for HR⁺and HER^- Breast Cancer

The Food and Drug Administration (FDA) has approved the use of capivasertib to be used in combination with for adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer. These patients have ≥1 PIK3CA/AKT1/PTEN-alterations and in whom the disease progression occurred on at least one endocrine-based regimen in the metastatic setting or recurrence on or within 12 months of completing adjuvant therapy… (Source: US FDA. Nov. 16, 2023).

Recent Surge in Respiratory Illness in China due to Seasonal Infections, Says China: WHO

Chinese health authorities attribute the sharp increase in the number of cases of children with respiratory diseases including pneumonia in Northern China to known pathogens such as influenza, Mycoplasma pneumoniae, respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as the advent of winter, says the World Health Organization (WHO). The organization is “closely monitoring the situation and is in close contact with national authorities in China”… (Source: WHO. Nov. 23, 2023).

The PROFID EHRA Trial Enrolls its First Patient

The first clinical trial to examine the benefits of defibrillator implantation along with drug treatment vis-a-vis medical treatment alone in post-MI patients with symptomatic heart failure and left ventricular ejection fraction of ≤35% has started with enrollment of the first patient from Germany. Some of the outcomes to be examined in the trial include all-cause death and sudden cardiac death. The PROFID EHRA noninferiority trial will be conducted in 13 countries with around 3,505 patients. Results are expected in early 2027… (Source: ESC. Nov. 21, 2023).

AGA Publishes Updated Guideline for Use of Biomarkers in Crohn’s Disease

The American Gastroenterological Association (AGA) recommends use of serum C-reactive protein (CRP) and fecal calprotectin to monitor patients with asymptomatic or symptomatic Crohn’s disease rather than relying on symptoms alone. It advocates a cut-off of <150 µg/g for fecal calprotectin and/or <5 mg/L for CRP to exclude active inflammation in patients with symptomatic and endoscopic remission, whereas patients with symptomatic but not endoscopic remission should undergo endoscopy to exclude active inflammation… (Source: Gastroenterology. Dec. 2023).

Lebrikizumab Approved in Europe for Moderate to Severe Atopic Dermatitis

Atopic dermatitis patients who have not responded to topical therapies can now be treated with lebrikizumab, a monoclonal antibody, which inhibits interleukin-13. It has been approved by the European Commission for the treatment of patients aged ≥12 years with moderate to severe atopic dermatitis… (Source: Medscape. Nov. 20, 2023).

Upper GI Endoscopy Enables Diagnosis of Iron Deficiency Anemia Etiology in Children

The use of upper gastrointestinal endoscopy enabled identification of the cause of iron deficiency anemia in ≥70% of children with severe unexplained iron deficiency anemia. Sixty-eight percent were found to have polyps, gastronodularity or erosions, while 12% had duodenitis or ulcers. Histopathology revealed gastritis in 72% and Helicobacter pylori in 50% of children… (Source: HCPLive. Oct. 23, 2023)

A Catheter Lock Solution for Renal Failure Patients on Chronic Hemodialysis

A catheter lock solution, Defencath (taurolidine and heparin) has been approved by the US FDA to prevent catheter-related bloodstream infections in patients with renal failure on chronic hemodialysis via a central venous catheter. It is available in single dose 3 mL and 5 mL vials and is to be used only as a catheter lock solution. The product carries a warning about heparin-induced thrombocytopenia… (Source: US FDA. Nov. 15, 2023).

Study Links Hippocampal Atrophy to Cognitive Decline

Decrease in the volume of the hippocampus is associated with cognitive impairment. The Harvard Aging Brain Study reported that the faster the atrophy of the hippocampus occurred, faster was the cognitive decline. These observations were independent of amyloid-beta (Aβ) and tau levels… (Source: AAN. Nov. 15, 2023)

The First Home Diagnostic Test for Common STIs

LetsGetChecked’s Simple 2 Test has been accorded marketing approval as the first diagnostic test for two common sexually transmitted infections Chlamydia and gonorrhea for patients aged ≥18 years. It is available over-the-counter and the sample can be collected at home… (Source: US FDA. Nov. 15, 2023).

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