Info Bites

Info Bites

ASSOCIATION BETWEEN EARLYCHILDHOOD ANTIBIOTIC EXPOSURE AND SUBSEQUENT ASTHMA IN THE US MEDICAID POPULATION

In this retrospective cohort analysis involving a sample of the paediatric US Medicaid population, researchers assessed the risk of developing asthma in relation to antibiotic fills in the first 2 years of life in these individuals. Participants included children with continuous medical and pharmacy coverage from birth to 2.5 years of age. Those who received a diagnosis of asthma prior to 2.5 years of age were removed from the study. Of 79,582 children included, antibiotic prescriptions filled were 0, 1-2, or ≥ 3 for 29,931 (37.6%), 27,403 (34.4%), and 22,248 (28.0%) children, respectively. A follow-up of 89,545 personyears was performed, during which time 2,381 new cases of asthma were documented. In this Medicaid population, an increased risk of asthma diagnosis from 2.5 to 5 years of age was observed in relation to antibiotic prescriptions filled in the first 2 years of life.

Fishman E, Crawford G, DeVries A, et al. Association between early-childhood antibiotic exposure and subsequent asthma in the US Medicaid population. Annals of Allergy, Asthma, and Immunology | August 01, 2019

ARE WE MAXIMISING OUR USE OF ONLINE RESOURCES?

Researchers examined the current practices of New Zealand (NZ) healthcare providers in recommending online resources for persistent pain management. In addition, they assessed factors that predict healthcare providers’ recommendations, and investigated common concerns. Via performing an online survey, they collected and analysed data from 213 NZ healthcare providers involved in the management of persistent pain. Recommendation for online resources was reported to be valued by only half of the healthcare providers surveyed, suggesting limited confidence in recommending, or knowledge of, existing online resources for persistent pain management. Recommendations for online resources was positively influenced by specialist interest in treating pain, and level of confidence. Findings suggested the necessity for ongoing education for healthcare providers on evidence-based online resources to promote online resources as a self-management support tool for people with persistent pain.

Devan H, Godfrey HK, Perry MA, et al. Current practices of health care providers in recommending online resources for chronic pain self-management. Journal of Pain Research | August 13, 2019

CONCERNS OVER OSTEOPOROTIC MEDICATION APPEAR UNFOUNDED

Through a meta-analysis of 38 randomized clinical trials involving 101,642 participants that assessed drug therapies for osteoporosis, researchers determined whether randomized clinical trials showed that treatment with bisphosphonates, especially zoledronate, was correlated with decreased mortality rates. Between all drug treatments, no important relation for osteoporosis and the overall mortality rate was evident, and no meaningful relationship between clinical trials of bisphosphonate treatment and overall mortality was noted. Moreover, clinical trials of zoledronate treatment demonstrated no relationship with the overall mortality rate, though, for heterogeneity of the results, evidence existed. Thus, bisphosphonate treatment may not be related to decreased overall mortality rates in addition to reduced fracture risk and should only be suggested to reduce fracture risk.

Cummings SR, et al. Association between drug treatments for patients with osteoporosis and overall mortality rates: A meta-analysis. JAMA | August 23, 2019

HOWEVER, CONCERNS OVER NSAID’S GROW, THIS TIME FOR NEPHROTIC SYNDROME.

In this matched case-control study, researchers examined the link between NSAID use and the risk of nephrotic syndrome via using the UK primary care database. Patients with a first diagnosis of nephrotic syndrome comprised cases. Patients without nephrotic syndrome served as controls. Based on cyclooxygenase enzyme selectivity and chemical groups, the investigators categorized NSAID exposure as either current, recent, or past use. According to findings, the use of conventional NSAIDs was related to a higher risk of nephrotic syndrome starting from at least 2 weeks of exposure, as well as for recent and past exposure up to 2 years prior to the diagnosis of nephrotic syndrome. Mainly acetic acid and propionic acid derivatives seemed to be responsible for this higher risk.

Bakhriansyah M, et al. Risk of nephrotic syndrome for non-steroidal antiinflammatory drug users. Clinical Journal of the American Society of Nephrology | August 19, 2019

MORE ON NSAIDS AND CARDIOVASCULAR DISEASES.

The authors sought to disentangle the role of NSAIDs in the increased risk of CVD among OA patients. To this end they conducted a longitudinal study based on linked health administrative data (HAD) from British Columbia, Canada. From a population based cohort of 720,055 British Columbians, they matched on age and sex to assemble 7,743 Osteoarthritis (OA) patients and 23,229 non OA controls. They found that people with OA had a higher risk of developing CVD compared to people without OA. Approximately 41% of the total effect of OA on increased CVD risk was mediated through NSAID. Among the secondary outcomes, the proportion mediated through NSAID was 23%, 56% and 64% for CHF, IHD and stroke, respectively.

Atiquazzaman et al. Role of Non Steroidal Anti Inflammatory Drugs (NSAIDs) in the Association between Osteoarthritis and Cardiovascular Diseases: A Longitudinal Study. Arthritis & Rheum. 2019.

TIME TO RETHINK LASLETT’S CRITERIA FOR DETECTING SIJ PROBLEMS...

Participants underwent fluoroscopically guided SIJ intra-articular injection with 1 cc of 2% lidocaine and 1 cc of triamcinolone 40mg. Patients’ pain was assessed via 0–10 NRS pre-injection and immediately post-injection to determine positive anaesthetic response to the injection. Six physical exam manoeuvres (thigh thrust, Geanslen’s test, FABER test, distraction test, compression test, and sacral thrust) were performed pre-injection and 15minutes post-injection. The results of these SIJ physical exam manoeuvres were evaluated singly and in combinations for diagnostic power in relation to a positive anaesthetic response (>80% relief) to the injection. No association was found between a single SIJ physical exam manoeuvre or combination of manoeuvres and anaesthetic response to the injection.

The authors concluded that in this cohort, patient physical exam manoeuvres to identify intra-articular SIJ pain did not demonstrate diagnostic value when compared with the reference standard of an intra-articular anaesthetic block.

Schneider et al. Validity of Physical Exam Manoeuvres in the Diagnosis of Sacroiliac Joint Pathology. Pain Medicine, 2019.