Questioning Medicine Questioning Medicine

SGLT-2 inhibitors have not been evaluated in patients with stage 5 CKD (CKD 5; eGFR, ≤15 mL/minute/1.73 m2). Investigators in Taiwan retrospectively assessed 5 years of outcome data for nearly 48,000 patients with type 2 diabetes and CKD 5 — half of patients had newly initiated SGLT-2 inhibitors, and half were not taking these drugs.compared with no SGLT2i use, SGLT2i use was associated with lower risks for dialysis (hazard ratio [HR], 0.34 [95% CI, 0.27 to 0.43]), hospitalization for heart failure (HR, 0.80 [CI, 0.73 to 0.86]), AMI (HR, 0.61 [CI, 0.52 to 0.73]), DKA (HR, 0.78 [CI, 0.71 to 0.85]), and AKI (HR, 0.80 [CI, 0.70 to 0.90]), but there was no difference in the risk for all-cause mortality (HR, 1.11 [CI, 0.99 to 1.24]).    So almost higher rates of mortality if you are betting man with 95% confidencehttps://www.acpjournals.org/doi/10.7326/M23-1874

glucagon-like peptide-1 (GLP-1) receptor agonists can delay gastric emptying, the American Society of Anesthesiologists (ASA) say For patients on daily dosing consider holding GLP-1 agonists on the day of the procedure/surgery. For patients on weekly dosing consider holding GLP-1 agonists a week prior to the procedure/surgery.  Now, the American Gastroenterological Association (AGA) has published a “Rapid Clinical Practice Update,” note that evidence is insufficient to make strong recommendations about continuing or withholding GLP-1 agonists prior to endoscopy. The AGA suggests an individualized approach: GLP-1 agonists “could be withheld” in patients who take the drugs solely for obesity, but the authors worry that omitting a dose in a patient with diabetes might confer more risk than benefit. They say the scope should go on as long as the pt has been on an 8 hour solid fast and a 2 hour liquid fasthttps://www.sciencedirect.com/science/article/pii/S1542356523008698?via%3Dihub

But now we have RCT data—278 adults with moderate CAP who were hospitalized (but not in intensive care) to receive either a β-lactam antimicrobial plus clarithromycin or a β-lactam alone. (all patients met sepsis or severe sepsis criteria) composite primary endpoint of improved respiratory symptoms and improved SOFA score by day 4 occurred in significantly more patients in the dual-antibiotic group (68% vs. 38%; number needed to treat, ≈3). Individuals on dual antibiotics also were significantly less likely to develop sepsis (13% vs. 24%; NNT, 10), significantly more likely to be discharged and alive at 3 months (79% vs. 62%; NNT, 6), and less likely to be readmitted within 90 days (8% vs. 15%; NNT, 14; P=0.09)https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S2213260023004125?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2213260023004125%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.jwatch.org%2F

AI technology was highly accurate at identifying malignancies and tumor origins — as accurate as senior pathologists, and significantly more accurate than junior pathologists.   Patients with cancer of unknown primary site who received treatment concordant with tumor origins predicted by AI had significantly longer overall survival than those whose treatment was discordant with AI predictions (27 vs. 17 months).https://www.nature.com/articles/s41591-024-02915-w

HERE IS WHEN IT IS RECOMMENDED TO USE ALBUMINIn patients with cirrhosis and spontaneous bacterial peritonitis, to substantially limit kidney impairment and mortality (low-certainty evidence) THIS IS THE ONLY THING YOU HAVE TO REMEMBER FORGET THE REST!In patients with cirrhosis and ascites who undergo large volume paracentesis (LVP; >5 L) to significantly lower the incidence of paracentesis-induced hypotension, but they had no substantial improvement in recurrent ascites or renal impairment and no mortality benefit. (very-low–certainty evidence)New guidelines on the use of albumin (remember albumin is a blood product so if you have a Jehovah’s witness or any patient that avoids blood products you need to ask them if it is ok)https://www.sciencedirect.com/science/article/pii/S001236922400285X?via%3Dihub

The results for weight loss was  Tirzepatide also known as mounjaro – 8.5 kg  Semaglutide also known as Ozempic -3.1 kg lost Liraglutide aka Victoza – 1.3 kg lostTirzepatide also known as mounjaro – 8.5 kg But almost all of these weight loss drugs seem to lose the effect over time and as you increase the dose and increase the weight loss you can expect to increase the GI side effects https://www.bmj.com/content/384/bmj-2023-076410