Research Spotlight

Ahmad, K. A., M. M. Bennett, S. F. Ahmad, R. H. Clark and V. N. Tolia (2019). “Morbidity and mortality with early pulmonary haemorrhage in preterm neonates.” Arch Dis Child Fetal Neonatal Ed 104(1): F63-f68.

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OBJECTIVE: There are no large studies evaluating pulmonary haemorrhage (PH) in premature infants. We sought to quantify the clinical characteristics, morbidities and mortality associated with early PH. DESIGN: Data were abstracted from the Pediatrix Clinical Data Warehouse, a large de-identified data set. For incidence calculations, we included infants from 340 Pediatrix United States Neonatal Intensive Care Units from 2005 to 2014 without congenital anomalies. Infants <28 weeks' gestation with PH within 7 days of birth were then matched with two controls for birth weight, gestational age, gender, antenatal steroid exposure, day of life 0 or 1 intubation and multiple gestation. RESULTS: From 596 411 total infants, we identified 2799 with a diagnosis of PH. Peak incidence was 86.9 cases per 1000 admissions for neonates born at 24 weeks' gestation. We then identified 1476 infants <28 weeks' gestation with an early PH diagnosis at

Abramovits, W., A. Wiqas, K. D. Vincent, S. G. Versteeg and A. K. Gupta (2018). “Cimzia (Certolizumab Pegol).” Skinmed 16(6): 400-402.

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CIMZIA (certolizumab pegol) is a recombinant monovalent monoclonal antibody with a specificity for tumor necrosis factor (TNF-a). This TNF blocker is a humanized antigen-binding fragment (Fab) with an attached polyethylene glycol polymer (PEG2MAL40K). This attached polyethylene glycol enhances the bioavailability of the Fab fragment and extends its half-life. In May 2018, certolizumab pegol was approved for the treatment of moderate-to-severe plaque psoriasis. It is also indicated for the treatment of moderate-to-severe active Crohn’s disease, moderate-to-severe rheumatoid arthritis, active psoriatic arthritis, and active ankylosing spondylitis. Certolizumab pegol is manufactured by UDB, Inc. and is available in a single-dose pre-filled syringe for patient administration and a lyophilized powder (200 mg) for reconstitution for administration by a healthcare professional. (Excerpt from text, p. 400; no abstract available.)

Abramovits, W. (2019). “Conceptual issues in dermatology and medicine: Where do nonphysician practitioners rightfully belong-a dermatologist’s perspective.” Clin Dermatol 37(1): 12-15.

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The invasion of the turf of medicine by nonphysician practitioners has not spared dermatology. The reasons behind this phenomenon are complex, as so many political issues are; some may be reasonable, others concerning. An undeniable consequence is that patients are being cared for by providers with significantly lower levels of medical education than that of medical doctors. The proper practice of dermatology, a visual specialty, is unquestionably dependent on experience complemented by scientific information; for this, years of postgraduate education are required. In this article, I expose, as I was invited to do with limitations, my opinions about the concept of having “midlevels,” providing medical care to patients afflicted by skin disease.

Wells, K. and J. Fleshman (2018). “Nonsurgical, Minimally Invasive, and Surgical Methods in Management of Acute Diverticulitis.” JAMA Surg Nov 21. [Epub ahead of print].

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The surgical approaches for complicated diverticulitis are shifting, with more stringent absolute indications for resection in practice today. Clinical trials have failed to demonstrate measurable benefit of LL over sigmoid resection, and LL is currently not supported as a standard of care. Resection is recommended in patients with stricturing or fistulizing disease and those with significant comorbidity, including immunocompromise, for whom repeated attacks would have severe consequences. These specific conditions aside, elective resection should be a consideration but not a mandate for patients whose disease resolves after acute presentation; however, surgeons lack specific predictors of failure of expectant management to fully inform this decision. Although the research is in its infancy, genetic predictors have come to light that may, in the future, establish criteria for elective resection. (Excerpt from text, p. e2; no abstract available.)

Arnold, S. V., Z. Li, S. Vemulapalli, S. J. Baron, M. J. Mack, A. S. Kosinski, M. R. Reynolds, J. B. Hermiller, J. S. Rumsfeld and D. J. Cohen (2018). “Association of Transcatheter Mitral Valve Repair With Quality of Life Outcomes at 30 Days and 1 Year: Analysis of the Transcatheter Valve Therapy Registry.” JAMA Cardiol Nov 21. [Epub ahead of print].

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Importance: Improvements in symptoms, functional capacity, and quality of life are among the key goals of edge-to-edge transcatheter mitral valve repair (TMVR) for mitral regurgitation. Objective: To examine health status outcomes among patients undergoing TMVR in clinical practice and the factors associated with improvement. Design, Setting, and Participants: This cohort study used the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, which contains data on patients with severe mitral regurgitation treated with TMVR from 2013 through 2017 in 217 US hospitals. Main Outcomes and Measures: Change in disease-specific health status (Kansas City Cardiomyopathy Questionnaire-Overall Summary score [KCCQ-OS]; range 0-100 points, with higher scores indicating better health status) at 30 days and 1 year after TMVR. We also examined factors associated with health status at 30 days after TMVR, by means of multivariable linear regression using a generalized estimating equations approach to account for clustering of patients within sites. Results: The KCCQ data were available in 81.2% at baseline, 69.3% of survivors at 30 days, and 47.4% of survivors at 1 year. Among 4226 patients who underwent TMVR, survived 30 days, and completed the KCCQ at baseline and follow-up, the KCCQ-OS increased from 41.9 before TMVR to 66.7 at 30 days (mean change 24.8 [95% CI, 24.0-25.6] points; P < .001), representing a large clinical improvement. The KCCQ scores remained stable from 30 days to 1 year after TMVR, with no further significant increase or decline. On multivariable analysis, atrial fibrillation (-2.2 [95% CI, -3.7 to -0.6] points; P = .01), permanent pacemaker (-2.1 [95% CI, -3.7 to -0.4] points; P = .01), severe lung disease (-3.9 [95% CI, -6.2 to -1.5] points; P = .001), home oxygen (-2.7 [95% CI, -4.9 to -0.4] points; P = .02), and lower KCCQ scores at baseline (3.9 points for each 10-point increase [95% CI, 3.6-4.2]; P < .001) were independently associated with lower 30-day KCCQ-OS scores. In-hospital renal failure was uncommon but was also associated with significant reductions in 30-day KCCQ-OS scores (-7.3 [95% CI -13.3 to -1.2] points). In estimates calculated with inverse probability weighting, after 1 year after TMVR, 54.2% (95% CI 52.2%-56.1%) of patients were alive and well; 23.0% had died, 21.9% had persistently poor health status (KCCQ-OS <60 points), 5.5% had a health status decline from baseline, and 4.6% had both poor health status and health status decline. Conclusions and Relevance: In a national cohort of US patients undergoing edge-to-edge TMVR in clinical practice, health status was impaired prior to the procedure, improved within 30 days, and remained stable through 1 year among surviving patients with available data. While long-term mortality remains high, most surviving patients demonstrate improvements in symptoms, functional status, and quality of life, with only modest differences by patient-level factors.