2 Minute Medicine Rewind July 7, 2025

A Prescribed Digital Health App and Number of Migraine Days

1. Among adult patients with migraine headaches, the use of a prescribed digital health app did not reduce the number of migraine days compared with a control app consisting of only migraine diary features. 

Evidence Rating Level: 1 (Excellent)

Current management of migraines includes both pharmacological and nonpharmacological approaches, including the use of migraine diaries. With newer advancements in digital technology, there has been an increase in the number of apps with comprehensive features for the purposes of diary tracking as well as giving behavioural advice. This randomized controlled trial therefor,e sought to investigate one of the most frequently downloaded headache apps that is commercially available in Germany and to compare its efficacy against a traditional app with only migraine diary features. 476 adult participants with a diagnosis of migraines from Germany were randomized to either the intervention group (n = 238; mean[SD] age = 35.6[10.3] years) or the control group (n = 238; mean[SD] age = 34.8[10.5] years). The primary outcome was migraine days per month (defined as 28 days) after 12 weeks. There was no statistical difference in the number of migraine days per month between intervention and control groups (between-group difference [intervention minus control], 0.38 [95% CI, −0.32 to 1.08] days; P = .29). There was a similar reduction in the number of migraine days in both groups (intervention group mean [SD], 7.74 [3.70] days during baseline to an adjusted mean of 5.79 [95% CI, 5.02-6.57] days during weeks 9 to 12; control group mean [SD], 7.76 [3.69] days during baseline to an adjusted mean of 5.41 [95% CI, 4.63-6.19] days during weeks 9 to 12). Overall, this study found that the use of a prescribed digital health app was not associated with a reduction in the number of migraine days compared with a control app consisting of only migraine diary features. 

 

Marginalized Neighborhoods and Health Outcomes in Younger Myocardial Infarction Survivors

1. In acute myocardial infarction (AMI) survivors younger than the age of 65, living in a marginalized neighbourhood was associated with higher rates of mortality and hospitalizations.

Evidence Rating Level: 2 (Good)

Adults below the age of 65 are increasingly developing AMI, with the burden of coronary artery disease only expected to continue to grow in this population. Importantly, young adults may be disproportionately affected by poorer neighbourhood conditions, yet the association between adverse neighbourhood conditions and AMI outcomes in young adults remains to be investigated. This retrospective cohort study therefore, sought to investigate the association between neighbourhood marginalization (as defined by the Ontario Marginalization Index) and AMI outcomes in adults younger than 65. 65,464 patients (median age[IQR], 56[50-61]) younger than 65 with a first hospitalization for AMI between April 1st, 2010 and March 1st, 2019 from Ontario were included in the study. The primary outcome of the study was all-cause death. After adjusting for confounders, patients in the most marginalized quintile (5th quintile) were at a significantly greater risk of all-cause death (HR, 2.43; 95% CI, 1.41-4.18) and all-cause hospitalizations (HR, 1.16; 95% CI, 1.05-1.28). Three years following initial hospitalization, the adjusted hazard ratios (AHRs) remained preserved with increasing AHRs for all-cause death with increasing degrees of marginalization (2nd quintile AHR, 1.13; 95% CI, 0.95-1.35; 3rd quintile AHR, 1.25; 1.05-1.48; 4th quintile AHR, 1.35; 95% CI, 1.15-1.59; and fifth quintile AHR, 1.52; 95% CI, 1.29-1.80). Overall, this study found that among young survivors of AMI, increasing neighbourhood marginalization was associated with higher rates of all-cause mortality and hospitalizations. 

 

Effects of SGLT2 inhibitors on cognitive impairment in elderly inpatients with heart failure with reduced ejection fraction: a prospective cohort study

1. In elderly patients 65 years of age or older with heart failure with reduced ejection fraction (HFrEF), regular use of sodium-glucose cotransporter 2 inhibitor (SGLT2i) was associated with improved cognitive function after 6 months as defined by the Mini-Mental State Examination (MMSE). 

Evidence Rating Level: 2 (Good)

Heart failure and cognitive impairment are two frequently co-occurring conditions, yet few investigations have been made into the efficacy of first-line heart failure drugs on cognitive function. Indeed, while SGLT2is have been shown to have mortality benefit in patients with HFrEF, the effects of SGLTis on cognitive function in such patients has not been investigated. This prospective cohort study therefore sought to assess the efficacy of SGLTis on cognitive impairment in elderly patients with HFrEF. 113 elderly patients (mean age, 73.06 ± 5.82 years, 67.9% male) from a single centre in China with HFrEF with cognitive impairment as determined by an MMSE score of <27 were included in this study. 59 patients did not receive SGLT2i while 54 patients received SGLT2i (baseline MMSE, 20.03 ± 1.50 vs 20.19 ± 1.92 (P = 0.640)). After 6 months of follow-up, the MMSE of the group receiving SGLT2is was significantly greater (19.78 ± 1.99 vs 22.28 ± 1.76 (P < 0.05)). Overall, this study found that among elderly patients with HFrEF and cognitive impairment, regular use of SGLT2is over 6 months was associated with improvement in cognitive function. 

 

Oral Vancomycin as an Emerging Therapy for Inflammatory Pouch Conditions Associated With Primary Sclerosing Cholangitis

1. In patients with pouchitis associated with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC), the use of oral vancomycin was associated with endoscopic and clinical improvements characterized by reduced stool frequency, urgency and incontinence.

Evidence Rating Level: 2 (Good)

Pouchitis is a common complication among patients with ileal pouch-anal anastomosis (IPAA) which is commonly required among individuals with IBD-associated PSC. PSC-associated pouchitis (PSC-pouchitis) is a complex and distinct condition lacking standardized guidelines, as it is usually refractory to traditional antibiotic therapy. This retrospective cohort study therefore sought to investigate the clinical and endoscopic outcomes associated with the use of oral vancomycin in patients with PSC-pouchitis. 48 patients with PSC-pouchitis (median age at PSC diagnosis[IQR], 29.7[22.8-39.7] years; 77.1% male) from a tertiary centre in the United States were included in this study. The primary outcome was symptom improvement as defined by a decrease in symptom subscore of the modified Pouch Disease Activity Index (mPDAI) by ≥1 point. Symptomatic improvement occurred in 89.5% of patients (43/48) with a mean change in mPDAI symptom subscore of 2 (IQR, 2-3). Endoscopic improvement occurred in 65% of patients (26/48) with a mean change in mPDAI endoscopic subscore of 2 (IQR, 1-4). Observed clinical outcomes included a decrease in stool frequency from 10.0 (IQR 8.0, 13.2) to 6.0 (IQR 5.0, 7.0) (P-value < .001), a decrease in fecal urgency from 72.9% to 12.5% (P-value < .001) and improvement in fecal incontinence from 33.3% to 4.2% (P-value < .001). Overall, this study found that among patients with PSC-pouchitis, the use of oral vancomycin was associated with endoscopic and clinical improvements. 

 

Fecal Calprotectin is a Useful Biomarker for Defining Small Bowel Endoscopic Remission in Crohn’s Disease Without Active Colonic Lesions: A Prospective Multicenter Study from the IBD-Quality Team

1. In patients with Crohn’s disease (CD), fecal calprotectin (FC) was a useful biomarker for monitoring small bowel lesions and was correlated with small bowel capsule endoscopy (CE) activity with a cutoff level of 175 μg/g.

Evidence Rating Level: 2 (Good)

Current methods of evaluating small bowel lesions in patients with CD include CE, magnetic resonance enterography and abdominal ultrasonography. However, there remains a lack of standardization in indications for such evaluations and a lack of reliable biomarkers to assess for small bowel disease progression. This prospective cohort study therefore sought to investigate the correlation between FC and small bowel lesions detected by CE in patients with CD. 67 patients (median age[IQR], 27[24-32]; 76% male) with CD from 11 centres in Japan were included in the study and received ileocolonoscopy to rule out active lesions in the large bowel and CE with measurements of their FC. CE activity was assessed using the Lewis Score (LS) and the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI). According to severity as determined by the LS, median FC levels for remission were 59.8 μg/g (IQR: 20.1‒140.9), 52.3 μg/g (IQR: 20.8‒577.6) for mild activity, and 446.5 μg/g (IQR: 244.4‒1775.2) for moderate-to-severe activity. The area under the curve (AUC) for the receiver operating characteristic (ROC) curve for endoscopic remission (ER) and FC was 0.828 (95% confidence interval [CI], 0.694‒0.962; P < .001), with a calculated cutoff level of 175 μg/g. Overall, this study found that among patients with CD, FC levels were significantly correlated with small bowel lesions with a cutoff level of 175 μg/g.

Image: PD

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