Easter Article Catchup

Been far too long since a post - here are some brief summaries of articles or posts that I found interesting.

VMAT2 inhibitor (vesicular monoamine 2 transporter - a dopamine regulating pathway)
valbenazine (Ingrezza)
another QT prolonging agent for people already taking QT prolonging agents… awesome!
improves severity of involuntary movements
another VMAT2 approved recently: deutetrabenazine, but for Huntington’s chorea. Would be suprised if they also didn’t try for a TD indication too though. (Also… TEVA makes novel drugs?)

Public healthcare can have its disadvantages, but I would take it over the US’s model any day.
While adjusting for all other risk factors did not change the differences observed in patient outcome between countries, differences in survival did vary depending on U.S. patients’ private insurance status.

Took a few searches to figure out what a virtual glucose management service is, but essentially it looks like an algorithm built into the EMR that detects uncontrolled blood glucose
Helped prevent consecutive high glucose readings; basically physicians can lock things down sooner
Looks like it’ll need far more research to determine if it’s really cost effective but it’s a cool idea nonetheless

Compared xarelto 10mg daily, 20mg daily, and ASA 100mg for VTE prophylaxis in patients with previous clot
10mg did have efficacy with a small bleed risk, but the trial is sponsored by a drug company
- Compared against ASA, which IS recommended in long term prophylaxis once anticoagulation is stopped… still not sure it’s a fair comparitor. Anticoagulants SHOULD be more effective than ASA. I guess they’re trying to get the guidelines changed to low dose NOAC instead.

Very relevant paper for my practice, as we review every active C. difficile case in the hospital
It is (anecdotally) difficult to corroborate PPI with risk of first C. diff incidence, as so many patients are already on PPI; but we are never sure if it is worth tapering PPI to lower recurrence risk
This meta-analysis looked at CDI recurrence 15-90 days post initial episode, and did find an elevated risk of recurrence in the patients receiving PPIs (60.7% of patients looked at were on PPI)
- Interesting: only 47.1% of the patients on PPI had an evidence-based indication
Often, the hardest part about stopping a PPI (esp in elderly patients) is that you have no idea why they were on it to begin with and what will happen if you stop it
- As well, they will be experiencing GI symptoms with the C. diff and it may be hard to tell if stopping the PPI is also having a negative effect.