👉Oral fluconazole use in the first trimester and risk of congenital malformations: population based cohort study.
📌Oral fluconazole use in the first trimester was not associated with oral clefts or conotruncal malformations, but an association with musculoskeletal malformations was found, corresponding to a small adjusted risk difference of about 12 incidents per 10 000 exposed pregnancies overall.
🔗https://www.bmj.com/content/369/bmj.m1494
👉open access
#fluconazole #drugs #pregnancy #bmj
📌Oral fluconazole use in the first trimester was not associated with oral clefts or conotruncal malformations, but an association with musculoskeletal malformations was found, corresponding to a small adjusted risk difference of about 12 incidents per 10 000 exposed pregnancies overall.
🔗https://www.bmj.com/content/369/bmj.m1494
👉open access
#fluconazole #drugs #pregnancy #bmj
👉Reporting of drug trial funding sources and author financial conflicts of interest in Cochrane and non-Cochrane meta-analyses: a cross-sectional study
📌Reporting of trial funding sources, trial author–industry financial ties and trial author–industry employment in Cochrane meta-analyses has improved since 2010 and is higher than in non-Cochrane meta-analyses.
🔗https://bmjopen.bmj.com/content/10/5/e035633?rss=1
https://bmjopen.bmj.com/content/bmjopen/10/5/e035633.full.pdf
https://www.bmj.com/content/369/bmj.m1505?
https://blogs.bmj.com/bmj/2020/05/28/ray-moynihan-the-worlds-most-influential-medical-leaders-are-still-dining-on-pharmas-pizza/
#ebm #bmj #cochrane #metaanalysis
📌Reporting of trial funding sources, trial author–industry financial ties and trial author–industry employment in Cochrane meta-analyses has improved since 2010 and is higher than in non-Cochrane meta-analyses.
🔗https://bmjopen.bmj.com/content/10/5/e035633?rss=1
https://bmjopen.bmj.com/content/bmjopen/10/5/e035633.full.pdf
https://www.bmj.com/content/369/bmj.m1505?
https://blogs.bmj.com/bmj/2020/05/28/ray-moynihan-the-worlds-most-influential-medical-leaders-are-still-dining-on-pharmas-pizza/
#ebm #bmj #cochrane #metaanalysis
👉Lyme borreliosis: diagnosis and management
📌Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.
🔗https://www.bmj.com/content/369/bmj.m1041
👉open access
#lyme #review #infections #bmj
📌Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.
🔗https://www.bmj.com/content/369/bmj.m1041
👉open access
#lyme #review #infections #bmj
👉Data transparency: “Nothing has changed since Tamiflu”
🔗https://www.bmj.com/content/369/bmj.m2279
#bmj #jefferson #ebm #tamiflu
🔗https://www.bmj.com/content/369/bmj.m2279
#bmj #jefferson #ebm #tamiflu
👉How to use abdominal X-rays in preterm infants suspected of developing necrotising enterocolitis
📌Necrotising enterocolitis (NEC) in preterm babies is a serious gastrointestinal emergency with potentially devastating consequences. Prompt and accurate diagnosis continues to be a challenge for health professionals. Early identification of clinical warning signs is extremely important, but the diagnosis relies heavily on the interpretation of abdominal radiographs. Postgraduate training of paediatricians and neonatologists in neonatal abdominal radiography is scarce, and there is variability of radiological input to neonatal services. Lack of a standardised approach and descriptive terminology for interpretation may result in inadequate communication between clinical and surgical teams, inaccurate diagnosis, inappropriate treatment, and unnecessary cessation of feeds and transfers to surgical units. This paper offers a guide designed for the doctor who on a busy night shift needs to interpret an abdominal radiograph and decide on a differential diagnosis of NEC in a preterm baby. It helps to provide structure and standardisation to interpretation of radiological signs using a comprehensive but simple method to support the clinical diagnosis. Our aim is to enhance the correct diagnosis of NEC.
🔗https://ep.bmj.com/content/105/1/50
#nec #imaging #bmj
📌Necrotising enterocolitis (NEC) in preterm babies is a serious gastrointestinal emergency with potentially devastating consequences. Prompt and accurate diagnosis continues to be a challenge for health professionals. Early identification of clinical warning signs is extremely important, but the diagnosis relies heavily on the interpretation of abdominal radiographs. Postgraduate training of paediatricians and neonatologists in neonatal abdominal radiography is scarce, and there is variability of radiological input to neonatal services. Lack of a standardised approach and descriptive terminology for interpretation may result in inadequate communication between clinical and surgical teams, inaccurate diagnosis, inappropriate treatment, and unnecessary cessation of feeds and transfers to surgical units. This paper offers a guide designed for the doctor who on a busy night shift needs to interpret an abdominal radiograph and decide on a differential diagnosis of NEC in a preterm baby. It helps to provide structure and standardisation to interpretation of radiological signs using a comprehensive but simple method to support the clinical diagnosis. Our aim is to enhance the correct diagnosis of NEC.
🔗https://ep.bmj.com/content/105/1/50
#nec #imaging #bmj
👉Pharmacokinetics during therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy: a literature review
📌Depending on the drug-specific disposition characteristics, therapeutic hypothermia in neonates with hypoxic ischaemic encephalopathy affects pharmacokinetics.
🔗http://dx.doi.org/10.1136/bmjpo-2020-000685
#hypothermia #pharmacology #hie #bmj #review
📌Depending on the drug-specific disposition characteristics, therapeutic hypothermia in neonates with hypoxic ischaemic encephalopathy affects pharmacokinetics.
🔗http://dx.doi.org/10.1136/bmjpo-2020-000685
#hypothermia #pharmacology #hie #bmj #review
👉Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study
📌Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.
🔗https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02129-2
#respiration #bld #preterm #bmj #ventilation
📌Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.
🔗https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02129-2
#respiration #bld #preterm #bmj #ventilation
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👉Fifteen-minute consultation: Point of care ultrasound in the management of paediatric shock
📌The use of point of care #ultrasound (POCUS) in the assessment of the acutely shocked adult patient has been well established for over a decade. Comparatively, its use in paediatrics has been limited, but this is starting to change with the recent introduction of Children’s Acute Ultrasound training. This article highlights the pathophysiology of #shock in children and demonstrates how bedside ultrasound can be used to assist decision making in the clinical assessment of the neonate, infant or older child presenting with undifferentiated shock. We discuss a structured protocol to use when performing the POCUS examination and explain how this could lead to a more rapid correlation of the ultrasound findings with the underlying cause of shock. #bmj
🔗http://dx.doi.org/10.1136/archdischild-2019-317972
👉Fifteen-minute consultation: Point of care ultrasound in the management of paediatric shock
📌The use of point of care #ultrasound (POCUS) in the assessment of the acutely shocked adult patient has been well established for over a decade. Comparatively, its use in paediatrics has been limited, but this is starting to change with the recent introduction of Children’s Acute Ultrasound training. This article highlights the pathophysiology of #shock in children and demonstrates how bedside ultrasound can be used to assist decision making in the clinical assessment of the neonate, infant or older child presenting with undifferentiated shock. We discuss a structured protocol to use when performing the POCUS examination and explain how this could lead to a more rapid correlation of the ultrasound findings with the underlying cause of shock. #bmj
🔗http://dx.doi.org/10.1136/archdischild-2019-317972