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Charité Clinical Journal Club (German) by Fred Luft – 20.03.2019

Charité Clinical Journal Club (German) by Fred Luft – 20.03.2019


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The N Engl J Med image of the week concerns an 18-year-old man who presented to the emergency department with a 1-week history of sore throat, fever, and malaise and a 3-day history of pleuritic chest pain and productive cough. He was found to have multiple pulmonary cavitary lesions and a right internal jugular vein thrombus. What is the most common pathogen isolated from patients with this condition? You are offered Staphylococcus aureus, Aspergillus fumigatus, Pseudomonas aeruginosa, Fusobacterium necrophorum, and Nocardia asteroids. A gram stain is shown so the answer is obvious. Tuberculosis is the leading killer of patients with human immunodeficiency virus (HIV) infection. Preventive therapy is effective, but current regimens are limited by poor implementation and low completion rates. Investigators conducted a randomized, open-label, phase 3 noninferiority trial comparing the efficacy and safety of a 1-month regimen of daily rifapentine (rifampicin derivative) plus isoniazid (1-month group) with 9 months of isoniazid alone (9-month group) in HIV-infected patients who were living in areas of high tuberculosis prevalence or who had evidence of latent tuberculosis infection. The primary end point was the first diagnosis of tuberculosis or death from tuberculosis or an unknown cause. The 1-month group did “no worse than” the 9 month group. Surgical intervention is needed in some cases of spontaneous abortion (Fehlgeburt) to remove retained products of conception. Antibiotic prophylaxis may reduce the risk of pelvic infection, which is an important complication of this surgery, particularly in low-resource countries. Investigators conducted a double-blind, placebo-controlled, randomized trial investigating whether antibiotic prophylaxis before surgery to complete a spontaneous abortion would reduce pelvic infection among women and adolescents in low-resource countries. Investigators randomly assigned patients to a single preoperative dose of 400 mg of oral doxycycline and 400 mg of oral metronidazole or identical placebos. The primary outcome was pelvic infection within 14 days after surgery. Prophylactic antibiotics did not appear to be helpful for these patients. Short-term studies have shown that bempedoic acid, an inhibitor of ATP citrate lyase (acetyl-CoA production), reduces levels of low-density lipoprotein (LDL) cholesterol. Data are limited regarding the safety and efficacy of bempedoic acid treatment in long-term studies involving patients with hypercholesterolemia who are receiving guideline-recommended statin therapy. Investigators conducted a randomized, controlled trial involving patients with atherosclerotic cardiovascular disease, heterozygous familial hypercholesterolemia, or both. Patients had to have an LDL cholesterol level of at least 70 mg per deciliter while they were receiving maximally tolerated statin therapy with or without additional lipid-lowering therapy. (Maximally tolerated statin therapy was defined as the highest intensity statin regimen that a patient was able to maintain, as determined by the investigator.) Patients were randomly assigned in a 2:1 ratio to receive bempedoic acid or placebo…


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