2 Minute Medicine Rewind March 9 – March 15, 2015

In this section, we highlight the key high-impact studies, updates, and analyses published in medicine during the past week.

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

With current ischemic stroke treatment options, approximately 60 to 80% of patients suffering from a stroke involving the proximal vessel occlusion in the anterior circulation either die within the first 90 days of the event onset or fail to regain functional independence. In this multi-center worldwide study, 238 patients with acute ischemic stroke with proximal vessel occlusion, a small infarct core, and moderate to good collateral circulation were randomized to receive either the standard care (control group, n=118) or the standard care plus endovascular treatment (intervention group, n=120). Patients’ scores on the modified Ranking scale at 90 days were then compared. This study was stopped prematurely due to efficacy. The rate of functional independence was higher in the intervention group compared to control group (53% compared to 29.3%, p<0.001). Scores on the modified Rankin scale were lower in the intervention group (common odds ratio, 2.6; 95% CI: 1.7-3.8; p<0.001). The intervention group had lower overall mortality compared to the control rate (10.4% compared to 19.0%, p=0.04). The course was complicated by the intracerebral hemorrhage in 3.6% of patients in the intervention group compared to 2.7% of patients in the control group (p=0.75). Thus, this study concluded that for stoke patients with proximal vessel occlusion, small infarct core, and moderate to good collateral circulation, endovascular treatment in addition to standard therapy improves outcomes.

Eczema and cardiovascular risk factors in 2 US adult population studies

The prevalence of eczema in the US has been estimated to be approximately 7.2%, and eczema has been associated with a number of co-morbidities. This study focused on cardiovascular risk factors and aimed to understand whether patients suffering from eczema have an increased cardiovascular risk by reviewing information from 27,157 and 34,525 patients from the 2010 and 2012 National Health Interview Surveys. Patients with eczema were found to have higher adjusted odds of smoking 100 cigarettes over their lifetimes (aOR: 1.32; 95% CI, 1.18-1.47), current smoking rates (aOR: 1.28; 95% CI, 1.12-1.45), current moderate alcohol intake (aOR: 1.33; 95% CI, 1.09-1.62), and current heavy alcohol intake (aOR: 1.58; 95% CI, 1.23-2.03) compared to patients without eczema. Eczema patients also had lower odds of pursuing daily vigorous physical activity (aOR: 0.79; 95% CI, 0.63-0.99) compared to those without eczema. Eczema patients were more likely to have a body mass index of 35 or greater (aOR: 1.54; 95% CI, 1.16-2.05), hypertension (aOR: 1.48; 95% CI, 1.18-1.85) and pre-diabetes (aOR: 1.71; 95% CI, 1.19-2.45) compared to their non-eczema controls. Eczema was also associated with sleep disturbances, higher levels of fatigue, daytime sleepiness, and insomnia, which were further associated with higher rates of obesity, hypertension, and pre-diabetes. This study demonstrated that eczema appears to be correlated with diseases associated with cardiovascular risk.

Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomized controlled trial

To date, little evidence exists to support the effectiveness of the mechanical chest compression devices in cardiopulmonary resuscitation (CPR). This cluster-randomized, open label trial in the UK focused on out-of-hospital cardiac arrests and examined whether the introduction of mechanical CPR devices in the emergency response vehicles would improve survival. 91 urban and semi-urban ambulance stations were enrolled in the study, with the ambulance vehicles randomly assigned to either the mechanical CPR device or the manual CPR. 4,471 eligible patients were resuscitated, with 2,819 assigned to the control group and 1,652 to the mechanical CPR device group. The primary end point was the survival at 30 days following the cardiac arrest. The 30 day survival did not differ significantly between the control and intervention groups, with 7% mortality reported in the control group and 6% mortality reported in the intervention group (aORL 0.86; 95% CI 0.64 – 1.15). No serious adverse events occurred in either group; however, seven clinical adverse events and fifteen device incidents were reported in the intervention group. This study concluded that the use of a mechanical CPR device does not appear to improve survival.

How Do Gastroenterologists Assess Overall Activity of Eosinophilic Esophagitis in Adult Patients?

Eosinophilic esophagitis is a relatively new disorder, with the first case report documenting the disease dating back to approximately 20 years, and has an estimated prevalence of approximately 1/2,000. Patients with eosinophilic esophagitis typically present with dysphagia, pain upon swallowing, or heartburn. To date, no consensus has been reached on a formula for determining the disease activity for eosinophilic esophagitis, with physicians relying on patient’s report of symptoms as well as endoscopy and histological findings in assessing the state of the disease. This study aimed to compare physicians’ judgments of the eosinophilic esophagitis disease severity with the patients’ judgments of their symptoms. This study enrolled 149 patients with eosinophilic esophagitis who have been examined by six eosinophilic esophagitis disease experts. Patients were asked to complete a symptom assessment and determine their global assessment of the eosinophilic esophagitis disease severity on a scale from 0 (inactive disease) to 10 (most active disease). Patients then underwent endoscopy studies with biopsies. Based on patients’ reports of symptoms as well as the results of the endoscopy and biopsies, physicians then made their assessments of the disease severity, again ranging from a score of 0 (inactive disease) to 10 (most active disease). A moderate correlation between patient and physician assessments of the disease severity was observed (rho = 0.442, p<0.001). Endoscopic findings, patients’ report of symptoms, and histologic findings explained 53%, 49%, and 30% of the variability in physicians’ scores of the disease activity, respectively. Overall, endoscopic findings, patients’ report of symptoms, and histologic findings explained 75% of variability in the physicians’ scores of the disease activity.

Association Between Familial Hypercholesterolemia and Prevalence of Type 2 Diabetes Mellitus

Transmembrane cholesterol transport may be linked to the development of type 2 diabetes. Statins, for instance, increase cholesterol uptake into the peripheral tissues and are associated with higher risk of type 2 diabetes. In familial hypercholesterolemia, on the other hand, the uptake of cholesterol into the peripheral tissues is impaired. This Dutch study aimed to explore the association between familial hypercholesterolemia and diabetes. 63,320 patients whose diagnosis of familial hypercholesterolemia was confirmed with the DNA testing were enrolled and the prevalence of type 2 diabetes was explored in this population. Type 2 diabetes had a prevalence of 1.75% in patients with familial hypercholesterolemia as compared to 2.93% in their unaffected relatives (OR, 0.62; 95% CI 0.55-0.69; p<0.001). When patients with familial hypercholesterolemia were separated based on different mutations involved, the prevalence of diabetes varied by the mutation type. For instance, the prevalence of type 2 diabetes in patients with APOB versus LDL receptor gene mutations was 1.91% versus 1.33% (OR, 0.65; 95% CI: 0.48-0.87 versus OR, 0.45; 95% CI: 0.38-0.54). Prevalence of diabetes in patients with receptor-deficient versus receptor negative mutation carriers was 1.44% versus 1.12% (OR, 0.49; 95% CI: 0.40-0.60 versus OR, 0.38; 95% CI: 0.29-0.49). Thus, this study showed that the prevalence of type 2 diabetes is lower in patients with familial hypercholesterolemia as compared to their unaffected relatives, opening a possibility of association between cholesterol transport and type 2 diabetes.

Image: PD

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