Dolutegravir Regimen Superior to Standard Combination ART for HIV

hivReplicationCycleAn HIV treatment regimen of dolutegravir plus abacavir-lamivudine is superior to a currently recommended combination pill, according to a phase III trial published in the New England Journal of Medicine.

In the manufacturer-conducted SINGLE study, roughly 850 treatment-naive patients were randomized to dolutegravir (an integrase inhibitor) plus abacavir-lamivudine or to efavirenz-tenofovir disoproxil fumarate-emtricitabine (EFV/TDF/FTC). After 48 weeks of treatment, the dolutegravir group had a higher percentage of patients with HIV-1 RNA levels under 50 copies per milliliter (88% vs. 81%). The number of adverse events was lower in the dolutegravir group.

In his blog HIV and ID Observations, Paul Sax writes: “Up until the SINGLE study, one could argue that EFV-based treatments — especially TDF/FTC/EFV — represented the gold standard against which all other regimens must compete. Has that now changed? I think it has.”

Abstract from the NEJM:

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Afib May Spark MI

Atrial fibrillationAlthough myocardial infarction is a known risk factor for the development of atrial fibrillation, the relationship might work the other way around, too, researchers found.

Among patients without a history of coronary heart disease, those with atrial fibrillation were 70% more likely to have an MI through an average of about 7 years of follow-up after accounting for other potential risk factors (HR 1.70, 95% CI 1.26-2.30), according to Elsayed Soliman, MD, of Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues.

That risk was greatest among women (HR 2.16, 95% CI 1.41-3.31) and black individuals (HR 2.53, 95% CI 1.67-3.86), they reported online in JAMA Internal Medicine.

Full article:

Acid-Base Disorders: An Overview

Acid-base disorders are commonly encountered in medicine. It is therefore important for the practitioner to know how to accurately interpret acid-base information as obtained from arterial blood gases, serum chemistries, urine electrolytes, and other sources. The below table can be used to quickly evaluate acid-base disorders. Continue reading

Comprehensive Management of Diabetes – 2013 AACE Guidelines

Diabetes. It’s something we all have to manage at some point. Whether you are working in a primary care clinic or working as a hospitalist, there is a very good chance that at least some of your patients will have diabetes. So, in order to deliver the best care in an evidence-based way, guidelines have been developed and are routinely updated.

Below are the 2013 guidelines on the comprehensive management of diabetes from the American Association of Clinical Endocrinologists. Continue reading

BP in Patients with Chronic Kidney Disease: Do the Usual Targets Apply?

Although these findings are observational and require confirmation in a randomized trial, they suggest that achieving ideal systolic blood pressure at the expense of low diastolic BP is not advantageous in adults with chronic kidney disease. While awaiting updated BP recommendations in forthcoming guideline revisions, clinicians should pay close attention to the diastolic pressure when treating systolic hypertension in these patients.

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Medical Clearance How-To

ACC/AHA Preoperative screening guidelines

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