Cervical Artery Dissection Diagnosed Following Chiropractic Cervical Manipulation: A STOP-CAD Subanalysis
About 1 in 20 cases of cervical artery dissection (CeAD) in the registry reported antecedent manipulation; these manipulation-associated cases occurred more often in younger patients and females, were more often vertebral dissections, and were linked with neck pain compared with non-manipulation cases. Clinical implications: this suggests that while the absolute risk of CeAD post-manipulation appears very low, clinicians should be aware of the distinct demographic and clinical features associated with these cases and maintain a high index of suspicion for CeAD in younger women presenting with neck pain after manipulation. Full Access: PubMed
Cardamyst Nasal Spray Now Available for Self-Treatment of PSVT Episodes
CardaMyst (etripamil) nasal spray has received FDA approval as the first self-administered, rapid-acting treatment for acute episodes of paroxysmal supraventricular tachycardia (PSVT) in adults. The approval was supported by robust evidence from the Phase 3 RAPID trial showing significantly faster conversion to normal sinus rhythm with CardaMyst vs placebo and a shortened median time to conversion. Clinical implications: This novel calcium channel blocker provides patients the ability to treat unpredictable PSVT episodes outside hospital settings, potentially reducing emergency department visits and anxiety associated with recurrent arrhythmias. Clinicians must counsel patients on proper use and monitor for side effects like nasal discomfort and dizziness. Full Access: MPR
The CDC’s Respiratory Virus Activity Levels
The CDC reports current surveillance data on COVID-19, influenza, and RSV spread nationally and by state using multiple indicators, including emergency department visits, test positivity rates, and wastewater viral activity. It uses the acute respiratory illness (ARI) metric — which captures a broad range of respiratory illness presentations — to classify activity into five levels from Very Low to Very High, giving a more complete picture than older influenza-only metrics. Clinical implications: these data help clinicians anticipate surges in respiratory illnesses. They also underscore the value of broad surveillance (including ED and wastewater data) in detecting shifts in respiratory pathogen transmission that could affect patient care and infection control practices. Full Access: CDC
Evaluation of Risk Factors for Failed Seroconversion in The Management of Potential Lyssavirus Exposures
The study analyzed 181 potential lyssavirus (rabies) exposures in Southeast Queensland to identify factors linked with failed seroconversion after rabies post-exposure prophylaxis (PEP). Incorrect rabies vaccine administration site and giving vaccine into the same arm within 72 hours of rabies immunoglobulin were strongly associated with non-therapeutic antibody responses. Older age (>65 years) was also independently linked to a higher risk of failed seroconversion. Clinical implications: Ensuring correct vaccine site and timing relative to immunoglobulin is crucial to optimize seroconversion and avoid PEP failure. In cases of administration error, immediate repeat vaccination should be considered without waiting for serology. Enhanced vigilance may be warranted in older patients. Full Access: IDSA