Updated in medicine 2

1. Updates in Medicine 2
Spooky Edition

2. Partial Oral versus Intravenous Antibiotic
Treatment of Endocarditis
• In patients with endocarditis on the left side of the heart who were in
stable condition, changing to oral antibiotic treatment was
noninferior to continued intravenous antibiotic treatment.
• https://www.nejm.org/doi/full/10.1056/NEJMoa1808312

3. Expanded HPV Vaccination
Ages – Twiggy Lee
• FDA approves HPV vaccine for people up to
45
• https://www.washingtonpost.com/health/2
018/10/05/fda-approves-hpv-vaccine-
people-
up/?noredirect=on&utm_term=.90c8361ea
4f0

4. Zika
• The medians and 95th percentiles for the time until the loss of ZIKV
RNA detection were 15 days (95% confidence interval [CI], 14 to 17)
and 41 days (95% CI, 37 to 44), respectively, in serum; 11 days (95%
CI, 9 to 12) and 34 days (95% CI, 30 to 38) in urine; and 42 days (95%
CI, 35 to 50) and 120 days (95% CI, 100 to 139) in semen. Less than
5% of participants had detectable ZIKV RNA in saliva or vaginal
secretions.
• https://www.nejm.org/doi/full/10.1056/NEJMoa1613108

5. Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-
like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 InhibitorsWith All-Cause
Mortality in Patients With Type 2 Diabetes – Dr. Mohanachandran
• the use of SGLT-2 inhibitors or GLP-1 agonists was associated with
lower mortality than DPP-4 inhibitors or placebo or no treatment. Use
of DPP-4 inhibitors was not associated with lower mortality than
placebo or no treatment
• all-cause mortality was reduced only with 1 SGLT-2 inhibitor: empagliflozin
(HR, 0.68 [95% CrI, 0.57 to 0.82]; absolute RD, −1.3% [95% CrI, −1.7% to
−0.7%]), and 2 GLP-1 agonists: liraglutide (HR, 0.85 [95% CrI, 0.75 to 0.98];
absolute RD, −0.9% [95% CrI, −1.5% to −0.1%]) and exenatide (HR, 0.86 [95%
CrI, 0.77 to 0.97]; absolute RD, −0.9% [95% CrI, −1.5% to −0.2%])
• https://jamanetwork.com/journals/jama/fullarticle/2678616

6. ASA Quad Coming Up

7. Effects of aspirin on risks of vascular events and cancer
according to bodyweight and dose – Norris Kamo
• Low doses of aspirin (75–100 mg) were only effective in preventing
vascular events in patients weighing less than 70 kg, and had no
benefit in the 80% of men and nearly 50% of all women weighing 70
kg or more. By contrast, higher doses of aspirin were only effective in
patients weighing 70 kg or more. Given that aspirin's effects on other
outcomes, including cancer, also showed interactions with body size,
a one-dose-fits-all approach to aspirin is unlikely to be optimal, and a
more tailored strategy is required.

8. Aspirin in Reducing Events in the Elderly
(ASPREE) trial – Erika Cunningham
• Higher all-cause mortality was observed among apparently healthy
older adults who received daily aspirin than among those who
received placebo and was attributed primarily to cancer-related
death?
• https://www.nejm.org/doi/full/10.1056/NEJMoa1803955

9. Effect of Aspirin on Cardiovascular Events and
Bleeding in the Healthy Elderly
• The use of low-dose aspirin as a primary prevention strategy in older
adults resulted in a significantly higher risk of major hemorrhage and
did not result in a significantly lower risk of cardiovascular disease
than placebo.
• https://www.nejm.org/doi/full/10.1056/NEJMoa1805819

10. Effects of Aspirin for Primary Prevention in
Persons with Diabetes Mellitus - ASCEND
• Aspirin use prevented serious vascular events in persons who had
diabetes and no evident cardiovascular disease at trial entry, but it
also caused major bleeding events. The absolute benefits were largely
counterbalanced by the bleeding hazard.
• https://www.nejm.org/doi/pdf/10.1056/NEJMoa1804988