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To the Editor The recent Review about pulmonary embolism (PE) did not mention the potential benefits of pulmonary embolism response teams (PERTs) for management of acute PE. PERTs streamline care in the setting of challenging and complex acute PE cases; facilitate rapid, effective, and efficient multidisciplinary communication; and allow for rapid mobilization of resources. Since their inception in North America, PERTs have expanded to many areas of the world, including Asia-Pacific, Latin America, and Europe.

This Medical News article discusses a clinical trial for an HIV vaccine that uses germline targeting, a novel technique to induce rare immune cell precursors of broadly neutralizing antibodies.

In this narrative medicine essay, an obstetrician finds relief from the frenetic intrusions of text messages, pages, and emails when in the operating room, where all devices are turned off and all her attention is turned on to her patient.

An estimated 491 000 fewer people than expected began antihypertensive medications in the UK between March 2020 and July 2021 during the COVID-19 pandemic. The decline, reported in Nature Medicine, could result in more than 13 000 additional cardiovascular disease events, including nearly 2300 myocardial infarctions and 3500 strokes, should these patients remain untreated over their lifetimes, the authors predicted.

Patients with sepsis-induced hypotension resuscitated in the first 24 hours with lower volumes of intravenous fluid and greater vasopressor use were about as likely to survive as patients treated with higher intravenous fluid volumes prioritized over vasopressors. The trial results, reported in the New England Journal of Medicine, contradicted the initial hypothesis that a restricted fluid strategy would reduce mortality.

It is well known that the frequency, severity and mortality of many diseases vary with different seasons of the year. That acute respiratory infections reach a peak in the late winter months, with a minor peak in the late autumn, is attributed to a lowered local resistance to infection with the unknown virus of “common colds” and the known pathogenic cocci, although as yet we have no satisfactory explanation as to why the exposure to cold lowers the resistance. To be sure, a physical chemist, Schade, would attribute to a decreased dispersion of the tissue colloids on cooling the increased vulnerability to bacteria, but this is pure hypothesis and does not explain how the invading bacteria fail to suffer a correspondingly reduced activity when chilled. In the lower animals, seasonal changes in metabolism are well recognized, such as the hibernation of some species, and the seasonal variation in reproductive activity, as well as the variations in growth of hair, feathers and antlers. Beckmann, in a consideration of the effect of season on disease, attributes the absence of such marked seasonal alterations in man to the fact that with higher development comes a better regulating mechanism against extraneous influences. But even in man there are distinct alterations in metabolic activity at different times of the year. Thus, measurements have shown that in spring the hair grows more rapidly than at other times, while body activity as a whole is lessened in winter, so that the usual amount of time spent in sleep is much increased over the summer sleep among people not too artificially regulated by customs and alarm clocks. Presumably this is related to hibernation in other species. It is said that pulse rate, temperature and respiration are highest in winter, and recently it has been found that the height of the capacity of the blood to bind carbon dioxid is reached with the shortest days of the year. In the spring there is a distinct fall in the carbon dioxid tension of the blood, which implies a decrease in the alkali reserve.

This study examines practices related to trial registration and results submission in ClinicalTrials.gov and publication of pediatric clinical trials funded by the National Institutes of Health.

To the Editor I am writing to address several issues in the recent Review on PE. First, the authors stated that smoking is not associated with higher rates of venous thromboembolism (VTE). However, in a meta-analysis that included 3 966 184 people and 35 151 VTE events, the VTE risk increased by 10.2% for every additional 10 cigarettes per day or by 6.1% for every additional 10 pack-years of smoking.

Better nursing home protections are needed for future health emergencies, says a data brief from the US Department of Health and Human Services Office of Inspector General (OIG).

To the Editor The recent Review of PE provided 3 recommendations about antenatal PE diagnostic testing that warrant some qualification. The first addressed which pregnant persons with PE symptoms should undergo lower-limb Doppler ultrasonography prior to advanced chest imaging. As the authors pointed out, detecting deep venous thrombosis (DVT) in pregnant patients with PE symptoms allows initiation of anticoagulation without the need for advanced chest imaging, thereby sparing the patient and fetus exposure to radiation. However, the yield of Doppler ultrasonography in pregnant persons without signs or symptoms suggestive of DVT is low and is likely an inefficient use of resources. Accordingly, professional societies in North America and Europe recommend that DVT testing be used selectively only for patients with elevated pretest probability. This contrasts with the Review’s recommendation to undertake Doppler ultrasonography regardless of symptoms or examination findings suggestive of DVT.

A recent systematic review of studies found that people who have been vaccinated against COVID-19 and have had a previous SARS-CoV-2 infection, known as having hybrid immunity, have better protection against the Omicron variant than those with only a previous infection.

To the Editor A recent study evaluating the safety and efficacy of roflumilast cream, 0.3%, for chronic plaque psoriasis involving 2% to 20% of body surface area concluded that daily use of roflumilast cream for 8 weeks was more effective than vehicle cream. We would like to point out some limitations of this study that decrease its generalizability.

This JAMA Patient Page describes the autoimmune disease Guillain-Barré syndrome and its risk factors, diagnosis, treatment, and prognosis.

This Viewpoint discusses the failure of the Centers for Medicare & Medicaid Services’ SEP-1 sepsis outcome improvement initiative to improve patients’ sepsis outcomes and suggests changing the focus of sepsis quality metrics from processes to outcomes.

In Reply In response to our recent Review, Dr Porres-Aguilar and colleagues highlight the potential benefits of PERTs for the management and diagnosis of PE. Although these teams may have potential to improve the prognosis of patients with diagnosed PE, data are currently scarce to support the implementation of PERTs, and the generalizability of preliminary studies to different settings and countries remains to be assessed.

Clinical Pharmacology &Therapeutics, EarlyView.

Clinical Pharmacology &Therapeutics, EarlyView.

Clinical Pharmacology &Therapeutics, Accepted Article.

Clinical Pharmacology &Therapeutics, Accepted Article.

Paese: Francia Data di riferimento: 26/01/2023