Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society answers very critical questions regarding unprovoked first seizure.
1. The recurrence of an unprovoked first seizure is greatest early within the first 2 years (21%-45%)
2. Increased risk may include a prior brain insult (Level A), an EEG with epileptiform abnormalities (Level A), a significant brain-imaging abnormality (Level B), and a nocturnal seizure (Level B).
3. Immediate antiepileptic drug (AED) therapy, as compared with delay of treatment pending a second seizure, is likely to reduce recurrence risk within the first 2 years (Level B) but may not improve quality of life (Level C).
4. Over a longer term (>3 years), immediate AED treatment is unlikely to improve prognosis as measured by sustained seizure remission (Level B).
5. Patients should be advised that risk of AED adverse events (AEs) may range from 7% to 31% (Level B) and that these AEs are likely predominantly mild and reversible.
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You have a septic patient with PCN allergies! and now you are in trouble to start appropriate antibiotics due to cross reactivity. This is an Italian based study, that studied the cross-reactivity and
tolerability of aztreonam and imipenem-cilastatin, meropenem, and ertapenem among patients with documented IgE-mediated hypersensitivity to penicillins. They enrolled 212 patients with immediate reactions to penicillins and positive results on skin tests to penicillin reagent underwent skin tests with aztreonam and carbapenems. All subjects displayed negative skin test results to both aztreonam and carbapenems. The conclusion is: These data indicate the tolerability of both aztreonam and carbapenems in penicillin-allergic subjects.
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New guideline by MMWR in June 2015, reviewing most important topics in STD. This guideline is very comprehensive and answers several critical questions regarding current and future therapy and focuses on STD.
Mycoplasma genitalium, is more common than N. gonorrhoeae but less common than C. trachomatis. in case of Urethritis and Cervicitis, the 7-day doxycycline regimen recommended for treatment of urethritis is largely ineffective against M. genitalium with a median cure rate of approximately 31% . The 1-g single dose of azithromycin was significantly more effective against M. genitalium than doxycycline in two randomized urethritis treatment trials, and is preferred over doxycycline. However, resistance to azithromycin appears to be rapidly emerging.
Link to Guideline
Having a pregnant patient with suspected PE, you know what I’m talking about. It is usually a disaster, mom is worry about fetus, dad is worry about mom, you are worry about both! how much is the risk of PE in pregnancy?
Meng etal, reviewed 27 articles related to this topic in a meta-analysis. They found 1.1‰ (1.0-1.3‰) for deep vein thrombosis (DVT) and 0.3‰ (0.2-0.4‰) for pulmonary embolism (PE). Risk of VTE after postpartum was significantly higher.
link to article
But there is a JAMA article published today regarding this topic: Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis, There were 273 patients in the surgical group and 257 in the antibiotic group. Patients randomized to antibiotic therapy received IV ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500 mg once daily) and metronidazole (500 mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy.
The result showed that 27 % of patients treated with antibiotics instead of surgery have a recurrence within 1 year. Their conclusion is among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the pre-specified criterion for non-inferiority compared with appendectomy.
Probably this will come to our practice in near future (next 5-10 years) we will give options to patient to have abx vs surgery.
In a meta-analysis published in Resuscitation, 10 observational study reviewed and showed among patients with out of hospital cardiac arrest, patients who intubated via ETT had significantly better
outcome among survivors of OHCA.
Link to article