Midtown Morning Report: What are the outcomes for treating Streptococcus pneumoniae meningitis with steroids?

The Bottom Line: “An analysis for different bacteria causing meningitis showed that patients with meningitis due to Streptococcus pneumoniae (S pneumoniae) treated with corticosteroids had a lower death rate (29.9% versus 36.0%.”
“Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae (S pneumoniae) meningitis (RR 0.84, 95% CI 0.72 to 0.98.” (Brouwer)

Huppert

NEJM Journal Watch: What is the effect of coffee consumption on mortality?

“Moderate consumption of unsweetened or sugar-sweetened coffee was associated with lower mortality in an observational study.“

Comment:

“Associations between coffee consumption and mortality surely are confounded by numerous factors. If there is really a causal protective link, it might be related to coffee’s chlorogenic acids, which — in addition to caffeine — have an antioxidant effect and inhibit platelet aggregation, as an editorialist notes. A study limitation is that, on average, only 4 g of sugar were added to sweetened coffee (likely less than many Americans add). Nevertheless, this study reaffirms that even sweetened coffee is likely not harmful and might even be beneficial.”

Dressler DD. Coffee and Mortality: Sweetening the Pot NEJM Journal Watch. (June 16, 2022)

Citations:

Liu D et al. Association of sugar-sweetened, artificially sweetened, and unsweetened coffee consumption with all-cause and cause-specific mortality: A large prospective cohort study. Ann Intern Med 2022 May 31

Wee CC. The potential health benefit of coffee: Does a spoonful of sugar make it all go away? Ann Intern Med 2022 May 31

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“Two studies confirm an association between coffee intake and lower risk for death in diverse populations.”

Comment:

“These studies provide support that moderate coffee intake (2–5 cups daily) is safe and associated with reduced risk for death, probably in a dose-dependent fashion. If you’re still debating the health benefits of coffee for your patients, you may want to do it over a cup of joe.”

Dressler DD. Moderate Coffee Consumption and Mortality: Good News NEJM Journal Watch. (July 11, 2017)

Citations

Park S-Y et al. Association of coffee consumption with total and cause-specific mortality among nonwhite populations. Ann Intern Med 2017 Jul 11; [e-pub].

Gunter MJ et al. Coffee drinking and mortality in 10 European countries: A multinational cohort study. Ann Intern Med 2017 Jul 11; [e-pub].

Guallar E et al. Moderate coffee intake can be part of a healthy diet. Ann Intern Med 2017 Jul 11; [e-pub].

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EUH Morning Report: What is the incidence of Pneumocystis jiroveci pneumonia in patients receiving rituximab?

The Bottom Line:

In patients with autoimmunity, rituximab is associated with a complex spectrum of infections. (NEJM JW).

COMMENT: “Understanding the incidence and patterns of infections associated with RTX use in patients with autoimmune disorders is important to guide diagnostic and therapeutic interventions. Sinopulmonary infections and bacteremias were prominent infections, but the spectrum is complex and included infections likely associated with the additional immunosuppressing medications these patients use frequently, such as steroids.”

EUH Morning Report: Can forced expiratory volume (FEV1) clinically predict exacerbation or mortality in patients with COPD?

The Bottom Line:

At the individual patient level, “FEV₁ by itself lacks sufficient precision (i.e., wide variation) to be used clinically as a predictor of exacerbation or mortality in patients with COPD” (GOLD, p. 30).

Thus [FEV₁] cannot be used alone to determine all therapeutic options. (GOLD, p. 31)

EUH Morning Report: How can the Simplified Pulmonary Embolism Severity Index (sPESI) be used to manage patients presenting with a pulmonary embolism?

The Bottom Line: The Pulmonary Embolism Severity Index is a validated tool for predicting 30-day mortality in patients presenting at the hospital with PE.  The Simplified PESI (sPESI) predicts 30-day mortality with accuracy similar to the PESI and can assist in deciding whether inpatient treatment is required or if the patient can safely be treated at home.

Simplified Pulmonary Embolism Severity Index (sPESI)

• see QxMD sPESI Calculator
• determine risk of adverse outcomes and appropriate treatment setting in patients without hemodynamic instability (ESC/ERS Class I, Level B)
• consider using risk calculators (Pulmonary Embolism Severity Index [PESI] or Simplified PESI [sPESI]) (ESC/ERS Class IIa, Level B); sPESI risk stratification
  • score 0 = low risk
  • score ≥ 1 = high risk

The simplified PESI predicts 30-day mortality risk with accuracy similar to PESI. Investigators condensed the 11 PESI criteria to 7, each worth 1 point. (Jiménez, et al. 2020)

Grady Morning Report: What is the diagnostic criteria for inflammatory myopathies and how are they treated?

The Bottom Line:

Diagnosis

Each of the idiopathic inflammatory myopathies (IIMs) have their own set of suggested diagnostic criteria based on clinical presentation, laboratory findings, and muscle and/or skin pathology findings.

• Dermatomyositis usually presents with progressive, mild-to-moderate proximal muscle weakness of the shoulders and hips in a symmetrical pattern plus distinct cutaneous findings including a heliotrope rash, Gottron papules, Shawl and V-sign rashes, periungual telangiectasias, and calcinosis cutis.
• Polymyositis presents with moderate-to-severe muscle weakness and other complications similar to dermatomyositis, but skin findings are absent.
• Immune-mediated necrotizing myopathy usually presents with acute or subacute proximal muscle weakness that may be severe and associated with myalgia.
• Sporadic inclusion body myositis usually presents with asymmetric proximal (typically quadriceps) and distal muscle weakness, but without myalgia.

EUH Morning Report: How do you diagnosis lupus myocarditis and what are the outcomes?

The Bottom Line: 

The natural history of lupus myocarditis has a variable presentation. Clinical features of and diagnosis of lupus myocarditis include:

• Presenting symptoms:
  • chest pain
  • dyspnea
  • fever
  • palpitations
• Significant elevation of the erythrocyte sedimentation rate and troponin levels; decreased complement C3 and C4.
• An echocardiogram may demonstrate global hypokinesis.
• Cardiac magnetic resonance imaging (cMRI) using T2-related images demonstrate delayed gadolinium enhancement, although this finding is not specific to SLE-associated myocarditis.
• The gold standard for diagnosis is endomyocardial biopsy, however it has low sensitivity and potential complications.
• Common serological findings reflect lupus activity and include increased anti-double strand deoxyribonucleic acid (dsDNA) and anti–ribonucleoprotein antibody (aRNP).

Hunt Conference: What are the prognostic factors and survival rates of metastatic melanoma?

The Bottom Line:

Survival:

• mortality varies with stage at presentation [2]
• for localized disease with tumors ≤ 1 mm deep, > 90% survival at 5 years
• for localized tumors > 1mm deep, about 50%-90% survival at 5 years
• for metastatic disease, < 10% survival long-term

Grady Kokkito conference: Review of large b-cell non-Hodgkin lymphoma (NHL) in the small intestine

The Bottom Line: Primary gastrointestinal NHL (gNHL) is rare, comprising approximately 30-40% of extranodal NHL cases and 10-15% of NHL cases. It occurs most frequently in the stomach (60-70%), small intestine (20%), and ileocecal region. Intestinal B-cell lymphomas are approximately six times more common than T-cell lymphomas. “The most common symptoms are abdominal pain, nausea, vomiting, diarrhea, and malabsorption. Vio­lent manifestations of the disease in the form of GI bleeding, perforation(,) or intestinal obstruction are not so frequent.”¹ Endoscopic ultrasonography is used for diagnosis. Some of the few familiar risk factors of gNHL, like Helico­bacter pylori (H. pylori) infection, affect therapeutic decisions.¹ In addition to risk factors, treatment depends on age, stage, location, and cell type.^1-2 See Table 1¹ for staging systems and NNCN-IPI for prognoses.²

Krakow Conference: What lab values are prognostic for poor outcomes in severe accidental hypothermia?

The Bottom Line:

Lab values that are prognostic of poor outcomes in severe accidental hypothermia:

• serum potassium level > 10 mEq/L
• ammonia level > 250 micromol/L
• fibrinogen level < 50 mg/dL
• acidosis on admission
• coagulopathy

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. Accidental Hypothermia; [updated 2018 Nov 30, cited 2019 Dec 6].