Urgent Updates | August 10

Dual Treatment May Boost Efficacy in Chronic Migraine

A new study suggests that combination therapy with anti-CGRP monoclonal antibodies and onabotulinumtoxinA may be more effective than monotherapy for chronic migraines. The investigators reviewed the electronic medical records of 194 patients who had been concurrently treated with anti-CGRP mAbs and onabot. Monotherapy reduced the average number of monthly migraine day (MMDs) from 28 to 18.6, for a reduction of 9.4 days (P > .0001). After initiation of combined therapy, the average number of MMDs decreased further, from 18.6 MMDs to 12.1 MMDs (P > .0001). In all, the combination of onabot and anti-CGRP mAbs resulted in a total MMD reduction of 15.8 (P > .0001). Full Access: Medscape


A Multiplex PCR Assay for Diagnosing Acute Respiratory Infection

In a comparative study, the BioFire PN assay detected more bacterial pathogens than standard sputum culture and predicted absence of infection when results were negative. Of 298 samples (286 expectorated sputum and 12 from TA) deemed of good or moderate quality were obtained from hospitalized adult patients with acute respiratory or cardiopulmonary illness. BioFire PN detected a total of 1.23 bacterial pathogens per sample. Hemophilus influenzae was detected most often (33.0%), followed by Streptococcus pneumoniae and Staphylococcus aureus (20.5% for both), gram-negative bacilli (18.5%), and Moraxella catarrhalis (12.4%). Standard bacterial culture detected only 0.48 organisms per sample (compared with BioFire PN; P<0.001). BioFire PN correctly identified a bacterial pathogen in 95 of 100 cases deemed bacterial based on clinical adjudication; the negative predictive value of BioFire PN was >90%. Full Access: NEJM


WHO Warns of Dengue Risk as Global Warming Pushes Cases Near Historic Highs

The World Health Organization warned on Friday that cases of dengue fever could reach close to record highs this year, partly due to global warming benefiting mosquitoes that spread it. Dengue rates are rising globally, with reported cases since 2000 up eight-fold to 4.2 million in 2022, according to WHO. In January, WHO warned that dengue is the world’s fastest-spreading tropical disease and represents a “pandemic threat”. Full Access: Medscape


Sociodemographic Disparities in Queue Jumping for Emergency Department Care

In this cross-sectional study of 314 841 patients, 90 698 (28.8%) experienced a queue jump. Patients who were non-Hispanic Black, Hispanic or Latino, Spanish speaking, or insured by Medicaid were more likely to be jumped over; patients who were jumped over had higher odds of hallway bed placement and leaving before treatment is complete. These findings suggest EDs should seek to standardize triage processes to mitigate conscious and unconscious biases that may be associated with patient access to emergency care. Full Access: JAMA