GI

Excellent performance of CT for diagnosing appendicitis

In this large single center prospective evaluation of patients with suspected appendicitis, 24% were confirmed. CT has very good diagnostic performance, with PPV and NPV of 94% and 100% respectively. The CT also provided an alternative diagnosis in 42% of cases. CT is appropriately becoming the standard of care diagnostic test for patients with suspected appendicitis (abstract)

Fidaxomicin approved for Cdiff treatment

Dificid (fidaxomicin) was approved by the FDA for treatment of Cdiff. In randomized trials, it was found to have similar efficacy to vancomycin, but with fewer relapses. However, due to high cost, it may be best reserved for treatment relapses after metronidazole and/or vancomycin failures (FDA site)

VTE risk in IBD patients

In this large administrative database analysis, the risk of VTE in patients with IBD was twice that of age-sex matched controls. VTE prophylaxis should be considered in all inpatients with IBD (abstract)

More on pneumonia risk with acid suppressive meds

This meta-analysis found that the risk of both hospital and community acquired pneumonia is significantly higher in those on PPI or H2 blockers. This is the strongest evidence to date of the risk elevation of pneumonia in these drugs (adjusted OR range 1.22 to 1.27), which should not be presribed without an definitive indication (abstract)

Predicting Cdiff

In this large retrospective cohort, researchers determined a risk prediction score for Cdiff that had good predictive discrimination (C index 0.88); many of the risk factors are already well known, and include: age, Cdiff "density", previous 60 day admits, modified Acute Physiology Score, high-risk antibiotic days, low albumin, ICU admission, and receipt of laxatives, gastric acid suppressors, or antimotility drugs. If further validated, this risk score may be used clinically to predict risk, and determine which patients need additional preventive strategies layered on (abstract)
...89101112...20...