Dr. Cooper, a nephrologist who practices hospital medicine at Massachusetts General Hospital, Boston, ran through several kidney-related studies. Among these was a retrospective study of the use of IV contrast for computerized tomography (CT), examining the risk of acute kidney injury when patients who received IV contrast were compared both with those who had a CT without contrast and with those who did not have CT. Nearly 17,000 patients were included, with propensity matching used to limit confounding.
Both in this study and in a later meta-analysis, no significant differences were seen in acute kidney injury, the need for renal replacement therapy, or mortality after CT with contrast. However, Dr. Cooper said that as a nephrologist, “This doesn’t make physiological sense to me, so I’m not convinced,” she said. “Ultimately, we need to have a randomized, controlled trial, though it’s hard to imagine” just how such a study could be structured and conducted, she said.
“Influenza H3N2 has dominated outbreaks in the United States over the last few years,” and this fact contributed significantly to the severity of the past year’s influenza season, said Dr. Cooper. Not only does this strain “seem to have greater variability in how often it mutates,” but “it’s also less likely to grow in egg media – so it’s less likely to appear in the vaccine,” she said.
Antivirals are effective only if instituted promptly, meaning that many patients who are admitted to the hospital with influenza and pulmonary infiltrates are beyond this window. Building on what was known about the theoretical efficacy of both macrolides and NSAID medications, a group of researchers in Hong Kong conducted a randomized placebo-controlled trial to compare outcomes when 500 mg of clarithromycin and 200 mg of naproxen were added on days 1 and 2 of hospitalization.
When these two interventions were added to the usual regime of amoxicillin clavulanate, oseltamivir, and esomeprazole, hospital stay was 1 day shorter. Importantly, said Dr. Cooper, 30-day and 90-day mortality rates were shorter and there was a significant reduction in viral titer. This is a strategy Dr. Cooper plans to implement. “My expectation is just like this past year, next year will likely be a bad year for influenza,” she said.
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