2 Minute Medicine Rewind August 3 – August 10, 2015
Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans
Post Traumatic Stress Disorder (PTSD) is a common mental health disorder in veterans and other individuals who experience traumatic events. Mindfulness-based intervention has been shown to be effective in major depressive disorder and is thought to be beneficial in PTSD as well. In this randomized, controlled trial of 116 veterans with PTSD at the Minneapolis VA Hospital, participants were randomized to mindfulness-based stress reduction therapy or standard group therapy and followed for 17 weeks in degree of PTSD symptom severity. Using the PTSD Checklist, patients who underwent mindfulness-based stress reduction experienced greater improvement in symptoms during therapy (-7.9 vs. -3.0, p = 0.002, difference -4.95, 95% CI 1.92 – 7.99). and at 2 months ( -9.2 vs. -2.8, p < 0.001, difference -6.44, 95% CI 3.34 – 9.53). There was no statistically significant difference in loss of PTSD diagnosis at 2 months. This study showed a modest but significant effect of mindfulness-based intervention over standard care for veterans with PTSD.
Conventionally, asymptomatic bacteriuria is not treated in non-pregnant women however it is routinely screened for and treated in pregnant women. These population based screening approaches are thought to reduce the rate of preterm birth, pyelonephritis, and neonatal sepsis. In this multicenter randomized, controlled trial of 5621 pregnant women between 16 and 22 weeks of gestation in the Netherlands, participants were randomized to nitrofurantoin or placebo for 5 days after a positive urine dipslide or observed without antibiotics if she declined randomization. In this study, 248 patients out of a final cohort of 4283 with appropriate follow-up had a positive urine dipslide. 40 patients were randomized to nitrofurantoin and 45 patients were randomized to placebo without significant difference in pyelonephritis, preterm birth, or both (2.9% vs. 1.9%, OR 1.5, 95% CI 0.6-3.5). Patients with untreated asymptomatic bacteriuria were more likely to develop pyelonephritis (2.4% vs. 0.6%, OR 3.9, 95% CI 1.4 – 11.4). In this study, asymptomatic bacteriuria was not associated with preterm birth and while increased risk of pyelonephritis, its absolute risk remained small.
Idarucizumab for Dabigatran Reversal
The novel oral anticoagulants have significant advantages over warfarin including stable bioavailability, not needing frequent lab checks for therapeutic window, and not having many drug-drug and drug-food interactions, however a significant limitation is the inability to quickly reverse its therapeutic effect. In this prospective cohort study of intravenous idarucizumab (antibody fragment with affinity for dabigatran), 90 patients who take dabigatran but had serious bleeding or required an urgent procedure were assessed after given 5g of idarucizumab. Among 68 patients with lab abnormalities from dabigatran (elevated dilute thrombin time or elevated ecarin clotting time), idraucizumab normalized 88 to 98% of patient’s test results and median total percentage reversal was 100%. Among 35 patients with active bleeding, hemostasis was achieved 11.4 hours after administration of idarucizumab. This early phase I study suggests safety for idarucizumab in reversing dabigatran related anticoagulation.
There is a significant body of literature suggesting statin therapy is efficacious in preventing future transient ischemic attacks (TIAs) and strokes in patients with an ischemic stroke. In this prospective cohort study of patients with ischemic stroke enrolled in the GWTG-Stroke Registry, 77,468 patients who were not previously taking a statin prior to admission were followed for two years and assess for major adverse cardiovascular events (MACE), death, readmissions, and complications. Of 77,468 patients, 71% were discharged on statin therapy, of which 31% received a high-intensity statin. Patients who were discharged home with statin therapy had decreased MACE (HR 0.91, 95% CI 0.87-0.94, p < 0.001) and had 28 more days at home following discharge. There was no difference in hemorrhagic stroke, and there was no difference in outcome among patients with moderate-intensity statin vs. high-intensity statin. This study of patients in the community who had an ischemic stroke confirm the benefit of statins in reducing MACE.
Predictors of Pregnancy Outcomes in Patients With Lupus
Patients with systemic lupus erythematosus (SLE) affect many women of reproductive age and impact fertility, pregnancy viability, and increase the risk of pregnancy-related complications. In this prospective cohort study of 385 pregnant patients with SLE, participants were followed during pregnancy and observed for SLE disease activity, and adverse pregnancy outcomes including premature birth, fetal or neonatal death, and small-for-gestational-age births. Adverse pregnancy outcomes occurred in 19% of pregnancies, of which fetal death occurred in 4%, neonatal death occurred in 1%, and preterm delivery occurred in 9% of pregnancies. SLE flares occurred 2.5-3% during the second and third trimesters of pregnancy. The presence of a positive lupus anticoagulant test, use of blood pressure medications, high SLE activity, and low platelet counts were associated with adverse pregnancy outcomes. Without these risk factors, adverse events occurred 7.8% of pregnancies. This study characterized the risk of adverse pregnancy outcomes in patients with SLE, which is accentuated in patients with active or severe disease.
Image: PD
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