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2 Minute Medicine Rewind April 28, 2025
Alcohol Use Disorder Diagnoses Among Individuals Who Take HIV Preexposure Prophylaxis
1. In this cohort of individuals taking preexposure prophylaxis (PrEP), there was an increase in the development of an alcohol use disorder (AUD) within 6 months of initiation.
Evidence Rating Level: 2 (Good)
One way to prevent the HIV epidemic is the use of preexposure prophylaxis (PrEP). There are several important stages of taking PrEP, which may be affected by outside factors such as alcohol use. The existing literature shows mixed findings regarding PrEP adherence and continuation in association with alcohol use. To build on this lacking literature, this retrospective cohort study was conducted to estimate the prevalence of alcohol use disorder (AUD) diagnoses before and after PrEP initiation. Individuals between the ages of 16 and 64 at the initiation time were included in the study. The primary outcome of this study was AUD diagnosis. Based on this, the cohort was divided into three groups: AUD diagnosis before initiation, AUD diagnosis after initiation, and individuals without AUD diagnoses at baseline or during the follow-up periods. After eligibility criteria were met, a total of 43,913 individuals taking PrEP were included (mean [SD] age 35.80 [10.94] years). Among them, 38,050 (86.65%) received TDF/FTC, and 5863 (13.35%) received TAF/FTC. After six months of PrEP initiation, 6274 (14.29%) individuals had a diagnosis of AUD, with 1245 (2.84%) receiving their diagnosis at baseline, and 5029 (11.45%) receiving their diagnosis after starting PrEP. Whether AUD diagnosis was received before or after initiation of PrEP, the associated sociodemographic and clinical factors remained similar. Specifically, male sex assigned at birth (before: adjusted odds ratio [aOR], aOR, 0.62; 95% CI, 0.52-0.73; after: aOR, 0.81; 95% CI 0.52-0.73; after: aOR, 0.81; 95% CI, 0.73-0.90) and mental health conditions such as depression (before: aOR, 2.36; 95% CI, 2.78-3.84; after: aOR, 3.17; 95% CI, 2.88-3.49). Overall, in this cohort study of individuals taking PrEP, almost 15% had an AUD diagnosis within 6 months of initiation.
Cannabis Use and Misuse Following Recreational Cannabis Legalization
1. In this prospective cohort study, cannabis use frequency increased significantly while misuse decreased.
Evidence Rating Level: 1 (Excellent)
Globally, increasing numbers of jurisdictions are legalizing or plan to legalize the use of recreational cannabis. Canada legalized cannabis in 2018, becoming the first country in the Group of Seven to do so. Before legalization, there were concerns that cannabis use and misuse would increase. Since legalization, there is some evidence that supports this however, other studies have found conflicting results. To address this gap, this study sought to examine the changes in cannabis use and misuse in a cohort of adults since legalization in Canada. Additionally, determining if the frequency of cannabis use before legalization altered the trajectory of use post-legalization. Participants between the ages of 18 to 65 were recruited from St. Joseph’s Healthcare Hamilton in Ontario, Canada. Participants were eligible to participate if they had a minimum ninth-grade education and no terminal illness. The primary outcomes of the study were cannabis use frequency and misuse. To measure cannabis use frequency, participants answered questions from the Canadian Cannabis Survey. To measure cannabis misuse, the 8-item Cannabis Use Disorder Identification Test – Revised (CUDIT-R) scale. A total of 1428 adults were included (mean [SD] age, 34.5 [13.9] years). There was a significant increase in cannabis use frequency (β=0.35; 95% CI, 0.19 to 0.51), to the point that the proportion of days using cannabis increased by 0.35% per year. However, the CUDIT-R scores found a significant decrease in cannabis use frequency overall (β=-0.08 [95% CI, -0.10 to -0.06] per year; P<.001). There was a significant decrease in cannabis use among individuals who were weekly cannabis users at baseline, while there was a slight increase in those who were using cannabis monthly or less. In terms of cannabis product preferences, there were significant decreases in the use of solid and liquid concentrates, cannabis oil, among others, and an increase in the use of edibles, liquids, and disposable vape pens. In summary, this prospective cohort study found an increase in cannabis use and a decrease in misuse.
1. In this randomized controlled trial, preoperative probiotic supplementation was associated with a reduced incidence of acute gastrointestinal injury (AGI) and nosocomial infections and shorter ICU stay time.
Evidence Rating Level: 1 (Excellent)
Past studies have shown a strong connection between the gut microbiome and cardiovascular health. Previous research has shown that gut microbiota can play a role in cardiovascular disease (CVD), so modifying it could affect the risk of such conditions. More specifically, previous studies have found that acute gastrointestinal injury (AGI) is associated with negative outcomes after CPB. Some recent work has shown the benefits of probiotics in improving prognosis through gut modulation. To assess this, the study employed a double-blinded randomized controlled trial to determine if the use of preoperative probiotic supplementation could reduce the incidence of AGI and improve recovery after CPB surgery. Individuals were included if they were between the ages of 18 to 70, had moderate to severe congestive heart failure or heart valve disease undergoing HVR with CPB. The eligible patients were then randomized 1:1 to either receive probiotics (Lac group) or a placebo (placebo group). Blood samples were collected at 24 h and 72 h post-operation, while fecal samples were collected daily. After meeting eligibility criteria, a total of 52 patients were included, with 26 assigned to the Lac group and 26 to the placebo group. The Lac group had a significantly lower incidence of AGI (15.38%) compared to the placebo group (42.31%) (P=0.032). Patients in the Lac group also had shorter ICU stay times (5 [4, 5.5] vs. 6 [5, 19], P=0.041) and a lower incidence of nosocomial infections compared to the placebo group (11.54% vs. 34.62%, P=0.048). Upon examining the risk factors, probiotic supplementation emerged as the only protective factor against the occurrence of AGI (OR 0.079; 95% CI, 0.007-0.861, P=0.037). These findings support the implementation of preoperative probiotic supplementation as a strategy to reduce the incidence of AGI following CPB.
1. In this cohort of patients with a pulmonary embolism (PE), ultrasound catheter-directed thrombolysis (USAT) is safe for symptomatic patients with intermediate-high and high-risk acute PE.
Evidence Rating Level: 1 (Excellent)
Immediate thrombolytic therapy by intravenous injection of a plasminogen activator is a commonly used treatment to restore blood flow in patients with massive pulmonary embolism (PE). However, systemic thrombolysis is associated with a significant bleeding risk, so appropriate therapy is often delayed to prevent bleeding. To improve safety outcomes, this study assessed the benefits and risks of ultrasound catheter-directed thrombolysis (USAT) in patients with PE. Eligibility for USAT required a diagnosis of acute PE within 14 days of symptom onset, along with evidence of proximal central or segmental filling defects on imaging, suggestive of PE on imaging. The EkoSonic Endovascular System (EKOS) was used to perform USAT following a standardized protocol to enhance lytic efficacy. In-hospital mortality was the main outcome assessed, with periprocedural mortality and other adverse outcomes also evaluated. The study enrolled 315 patients (mean age 64.3±14.2 years); 257 (82%) with intermediate-high risk, and 58 (18%) with high-risk PE. Patients exhibited tachycardia (heart rate 104.3±20.4 bpm), hypoxemia (mean peripheral oxygen saturation 89.2%±7.5%), elevated mean pulmonary and arterial pressure (30.7±8.0 mm Hg), and reduced mixed venous oxygen saturation (58.5%±10.2%). A total of 10 participants (3.2%) died in the hospital, with an additional 2 patients dying in the periprocedural phase. Several participants experienced secondary outcomes including stroke (0.3%), bleeding (7.9%) and recurrent PE (1.0%). This study may be limited in generalizability since participants were only selected from one center with an established PE team. Despite this, the results demonstrate that USAT is a safe and effective treatment in patients with intermediate-high and high-risk acute PE.
1. In this prospective cohort study, a higher early-life risk factor score (ERS) was associated with a dose-dependent increased risk of developing type 2 diabetes (T2D) later in life.
Evidence Rating Level: 1 (Excellent)
Type 2 diabetes (T2D) cases have been rising worldwide, with 90% of the diabetes population classified as type 2 diabetics. The “Developmental Origins of Health and Disease” (DOHaD) theory postulates that early life experiences may impact metabolic development, leading to T2D onset. While several early life risk factors have been identified, it remains difficult to modify these behaviours as people have not reached independence, in contrast to the recommended later cardiovascular-focused lifestyle changes. This study aimed to examine combined early life effects on T2D onset and examine the impact of genetic factors as well as lifestyle modifications on T2D rates. The early development risks examined were breastfeeding, maternal smoking and birth weight. An early life risk factor score (ERS) was constructed and weighed based on factors. Modifiable healthy lifestyle factors (MHS) assessed were sleep health, nicotine exposure, diet and physical activity. Each metric was assessed and categorized into healthy, moderate and unhealthy. T2D incidences that were already prevalent as well as onset during the study. The standard polygenic risk score (PRS) for genetic predisposition for T2D was used in assessment, with participants being classified into low, medium and high risk tertiles. A total of 7,408 individuals had or developed T2D across the study, or 4.98% of the population. ERS was correlated with a higher risk of T2D (P <0.001). Those with 3 ERS had the greatest risk of developing T2D compared to those with 0 ERS (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.65, 2.26). Participants with a higher MHS showed a 53% lower risk of T2D (HR: 0.47; 95% CI: 0.44, 0.51). While ERS across all MHS showed increased risk, no significant interaction was observed (P=0.113). Overall, EHS was associated with an increased risk of T2D onset in a dose-response relationship, without significant changes from MHS or PRS, indicating the need for early intervention in T2D prevention.
Image: PD
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