Q3 Urgent Caring- Urgent Updates

West Nile Infections Rising in the US

West Nile Virus is the leading cause of mosquito-borne disease in the continental U.S. And as of August 8, 126 human cases had been identified across 22 states, according to the Centers for Disease Control and Prevention (CDC). Full Access: Medscape

Bird Flu Researchers Turn to Finland’s Mink Farms, Tracking A Virus with Pandemic Potential

H5N1 virus does not infect people easily. But the fear is that uncontrolled spread in animals like mink gives the virus plenty of chances to evolve in ways that could enable it to spill over into people. Already in Finland, a paper from government researchers indicated the virus has spread from mammal to mammal at the farms — and in some cases has picked up mutations indicating an adaptation toward replicating in mammalian cells. Full Access: STAT

FDA Approves First Oral Treatment for Postpartum Depression

The U.S. Food and Drug Administration approved Zurzuvae (zuranolone), the first oral medication indicated to treat postpartum depression (PPD) in adults. PPD is a major depressive episode that typically occurs after childbirth but can also begin during the later stages of pregnancy. The efficacy of Zurzuvae for the treatment of PPD in adults was demonstrated in two randomized, double-blind, placebo-controlled, multicenter studies. Full Access: FDA

Identifying Children Likely to Benefit from Antibiotics for Acute Sinusitis – A Randomized Clinical Trial

Randomized clinical trial including 515 children aged 2 to 11 years diagnosed with acute sinusitis based on clinical criteria. The trial was conducted at primary care offices affiliated with 6 U.S. institutions and was designed to evaluate whether symptom burden differed in subgroups defined by nasopharyngeal Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis on bacterial culture and by the presence of colored nasal discharge. In children with acute sinusitis, antibiotic treatment had minimal benefit for those without nasopharyngeal bacterial pathogens on presentation, and its effects did not depend on the color of nasal discharge. Testing for specific bacteria on presentation may represent a strategy to reduce antibiotic use in this condition. Full Access: JAMA

Prescribing Medications for Alcohol Use Disorder: A Qualitative Study of Primary Care Physician Decision Making

Over 29 million Americans have alcohol use disorder (AUD). Though there are effective medications for AUD (MAUD), they are underutilized. Physicians endorsed that it is challenging to prescribe MAUD due to several reasons, including: (1) somewhat negative personal beliefs about medication effectiveness and likelihood of patient adherence; (2) competing demands in primary care that make MAUD a lower priority; and, (3) few positive subjective norms around prescribing. There is a challenging implementation context for MAUD. Full Access: Annals of Family Medicine

The Efficacy and Safety of Metoclopramide in Relieving Acute Migraine Attacks Compared With Other Anti-Migraine Drugs: A Systematic Review and Network Meta-Analysis Of Randomized Controlled Trials

A significant decrease in headache scores was seen with the administration of intravenous (IV) metoclopramide, compared with placebo and sumatriptan, according to the findings of a study published in the journal BMC Neurology.  Sixteen studies were included with a total of 1934 patients: 826 received metoclopramide, 302 received placebo, and 806 received other active drugs. Metoclopramide was effective in reducing headache outcomes even for 24 h. Regarding side effects, metoclopramide showed a lower incidence of mild side effects than pethidine and chlorpromazine and showed a higher incidence of mild side effects than placebo, dexamethasone, and ketorolac. Full Access: BMC Neurology

The Burden of Antimicrobial Resistance in The Americas in 2019: A Cross-Country Systematic Analysis

Antimicrobial resistance (AMR) is an urgent global health challenge and a critical threat to modern health care. Researchers estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen–drug combinations for countries in the WHO Region of the Americas in 2019. They estimated 569,000 deaths (95% UI 406,000–771,000) associated with bacterial AMR and 141,000 deaths (99,900–196,000) attributable to bacterial AMR among the 35 countries. Lower respiratory and thorax infections, as a syndrome, were responsible for the largest fatal burden of AMR in the region. Full Access: The Lancet

Management of Acetaminophen Poisoning in the U.S. and Canada – A Consensus Statement

This qualitative study used an expert-derived consensus according to a modified Delphi process to provide explicit clinical guidance on the assessment, management, and treatment of acetaminophen poisoning. The panel developed guidelines for emergency department management of single or repeated ingestion of acetaminophen. In addition, the panel addressed extended-release formulation, high-risk ingestion, co-ingestion of anticholinergics or opioids, age younger than 6 years, pregnancy, weight greater than 100 kg, and intravenous acetaminophen use. Full Access: JAMA

Thromboprophylaxis for Lower Limb Immobilization

Venous thromboembolism (VTE) occurs in approximately 1-2% of patients who have lower limb immobilization after injury. The National Institute for Health and Care Excellence (NICE) recommends VTE risk assessment to determine prescribing but is not prescriptive on method and advocates only parenteral prophylaxis. This was a cross-sectional survey sent to EDs in the UK to evaluate present practice by clinicians and was conducted between February and March 2022.

The authors received responses from m 116 EDs (England 89, Scotland 15, Wales 6 and Northern Ireland 6) accounting for 69.5% of type 1 (EM specialist led with 24-hour resuscitation capabilities) UK departments. ≥95% respondents reported considering thromboprophylaxis in ambulatory patients managed in a lower limb rigid cast of any sort, while half would do so for a walking boot and 20% when using removable knee splints. 

Comments – Although this was an ED based survey, some of the considerations regarding use of VTE thromboprophylaxis would be useful for UC practitioners, when treating patients who require lower limb immobilization. Use of locally agreed guidelines would help in the matter and where possible potential UC/secondary care interphase could help with patient journeys. Full Access: BMJ

The OPAL Trial – Are Opioids Really Necessary to Treat Lower Back and Neck Pain?

Lower back and neck pain are common presentations to UC. Most of the present clinical guidelines suggest the prescription of opioids for these conditions only as a last resort measure and limiting the use of opioids due to the risks of adverse events including dependency. This study set out to investigate the efficacy and safety of a judicious short course of an opioid analgesic for the management of acute non-specific low back and neck pain. Participants were randomly assigned (1:1) to the opioid or placebo group. The opioid group were treated with 5 mg oxycodone and 2.5 mg naloxone as a modified release tablet, twice a day and titrated up to a maximum of 10 mg, twice a day, based on individual participant progress, tolerability, and sedation score. The placebo group received identical-looking tablets made of colloidal silicon dioxide, microcrystalline cellulose, sodium starch glycolate, and sodium stearyl fumarate, coated in brilliant blue. 

347 participants were randomly assigned to a treatment or control groups, (174 opioid, 173 placebo). No significant difference was found in pain scores at 6 weeks between the opioid group and the placebo group. Pain severity was not significantly different between groups at week 12. No significant difference was found in physical functioning measured by the generic scale or condition-specific scale for patients with neck pain. No significant difference was found between groups for quality of life on the physical function subscale, but a small yet significant difference favoring placebo for the mental health subscale was found at 6 weeks and 12 weeks. 

Comments – The findings of this study further highlight the lack of evidence for the prescribing of opioids in acute back pain and correlates with other previous studies on the matter. As UC practitioners, we need to be able to convey this message to our patients as part of managing expectations during our consultations. Full Access: The Lancet