Apr 7, 2017

Hot in here

The story

If you think you sweat when you're the code resident and you have to use the bathroom, then imagine life as a menopausal woman with hot flashes. A novel hormone-sparing treatment may help.

The basics

More than two-thirds of women will experience vasomotor symptoms like hot flashes and night sweats during menopause, and cancer patients on endocrine therapies (breast in women, prostate in men) can be especially hard hit. Scientists point the finger at the loss of systemic estrogen, and while estrogen supplementation is the gold-standard of treatment, it can take weeks to kick in and is contraindicated in patients with breast cancer. 

The pill

Since many think a neuropeptide-driven signaling system in the hypothalamus regulates temperature fluctuation in menopause, researchers developed an oral medication designed to block the activity of a neuropeptide called neurokinin 3. In a 30-patient phase II trial, menopausal women on the investigational compound MLE4901 had a 45% reduction in the total number of weekly hot flashes compared to placebo after 4 weeks. Temperatures measured by skin conductance monitors were also lower, and women in the treatment group reported higher quality-of-life scores.

The takeaway

Obviously phase III is up next, but MLE4901 was well-tolerated and provided clinical relief in a short timeframe. The medication could provide much needed help to those who can't receive estrogen due to cancer or prior stroke.

Say it on rounds

When the cath lab will take anyone

Business is booming, and shows no signs of slowing down. A study of percutaneous coronary intervention (PCI) on culprit lesions alone vs. a 'complete revascularization' strategy of PCI on infarct and non-infarct related lesions found that complete revascularization reduced a composite outcome of major cardiovascular events at 1 year in a 900-patient RCT. The average additional time for complete revascularization was 6 minutes. 

When your temper is in short supply

Probably not the right time for an experiment. But researchers used a 3-month shortage of norepinephrine in 2011 to form a natural experiment comparing mortality rates when the pressor was and was not available. Critically ill septic patients had a 4% increase in in-hospital mortality during the shortage in this retrospective cohort of 27,000 patients. Phenylephrine was the most frequently used replacement pressor.

When you feel a bit bloated after noon conference

Try not to take things to the extreme. In a getting-its-feet-wet kind of clinical trial, an endoscopic weight loss device that allows patients to remove food from their stomach via an external drainage tube helped patients lose about a third of their excess body weight on average. The tube system, called AspireAssist (a cartoon demo is here) helped patients lose more weight than lifestyle counseling alone in a trial of 200 morbidly obese patients. Adverse events included abdominal pain, stomal complications and periop discomfort. 
Am J Gastroenterol

Brush up

Idiopathic pulmonary fibrosis

Most experts think that genes, aging, and environmental exposures combine to cause idiopathic pulmonary fibrosis (IPF). Symptoms are non-specific and often include non-exertional dyspnea and dry cough. Listen for high-pitched inspiratory crackles (audio) on exam, and keep an eye out for clubbing. Early recognition is critical because delays in diagnosis are associated with increased mortality. High-resolution chest CT is the initial step in diagnosis. 

What's the evidence

For staging in IPF? A 2012 index of gender (G), age (A), and pulmonary function tests (P) was able to accurately predict mortality for IPF patients in a 200-patient derivation and 300-patient validation cohort. The GAP index reports 3 stages for IPF, with 1-year mortality rates of 6%, 16%, and 39% for stage I, II, and III, respectively. An index calculator is available here.

What your family planning friends are talking about

Looking to get pregnant? Consider putting that trip to the tropics on hold. A CDC report found that 1 in 10 US pregnant women with confirmed Zika infection had infants with serious birth defects. Scientists worry that the study underestimates the virus's impact.

Spread the word

Send your interns something to look forward to.


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