ADARRC

How effective are current vaccines against the delta variant of SARS-CoV-2? Fortunately, the existing Pfizer-BioNTech and Oxford-AstraZeneca vaccines appear to offer robust protection against the widespread delta variant. Efficacy is much better after 2 doses than after only a single dose. Lopez Bernal J, Andrews N, Gower C, et al. Effectiveness of Covid-19 vaccines against the B.1.617.2 (delta) variant. N Engl J Med 2021 2021;385(7):585-594.

Are steroid bursts in children potentially harmful? Although corticosteroid bursts have potential for improving outcomes for many acute illnesses, this study shows that the potential harms are not trivial. Yao TC, Wang JY, Chang SM, et al. Association of oral corticosteroid bursts with severe adverse events in children. JAMA Pediatr 2021;175(7):723-729.

Is 7 days of antibiotic therapy noninferior to 14 days of therapy when treating urinary tract infection symptoms in afebrile men? This study found that 7 days of antibiotic therapy with either ciprofloxacin or trimethoprim/sulfamethoxazole is noninferior to 14 days of treatment for UTI symptoms among afebrile men. Drekonja DM, Trautner B, Amundson C, Kuskowski M, Johnson JR. Effect of 7 vs 14 days of antibiotic therapy on resolution of symptoms among afebrile men with urinary tract infection. A randomized clinical trial. JAMA 2021326(4):324-331.

Is high-frequency spinal cord stimulation added to conventional medical management effective in alleviating pain in persons with painful diabetic neuropathy refractory to medical therapy? In this study with multiple biases in favor of intervention, patients with painful diabetic neuropathy treated with conventional medical management plus high-frequency spinal cord stimulation (CMM+SCS) experienced dramatic improvement compared with those who continued to use their previous ineffective therapy. Given the methodologic issues with this study, more rigorous trials are needed. Petersen EA, Stauss TG, Scowcroft JA, et al. Effect of high-frequency (10-kHz) spinal cord stimulation in patients with painful diabetic neuropathy: a randomized clinical [...]

What is the optimal duration of oral antibiotic therapy after surgical treatment for prosthetic hip or knee joint infections? Following surgical treatment for prosthetic joint infections, a 6-week course of oral antibiotic therapy is not as effective as a 12-week course and leads to a higher number of persistent or recurrent infections at 2 years. Bernard L, Arvieux C, Brunschweiler B, et al. Antibiotic therapy for 6 or 12 weeks for prosthetic joint infection. N Engl J Med 2021;384(21):1991-2001.

Are multiple intra-articular corticosteroid injections more effective and safer than other joint injections in patients with degenerative joint disease? In this systematic review, patients with degenerative joint disease who received multiple corticosteroid injections did not have more meaningful pain relief than those who received other injections. Since 2 studies reported either cartilage loss or joint space narrowing among steroid-treated patients, more data are needed to determine just how safe they are. Ayub S, Kaur J, Hui M, et al. Efficacy and safety of multiple intra-articular corticosteroid injections for osteoarthritis—a systematic review and meta-analysis of randomized controlled trials and observational [...]

Are flat flexible shoes as effective as stable supportive shoes to decrease pain in patients with knee osteoarthritis? Tell patients with knee pain to experiment to see if changing their shoe type produces pain relief. In this study, supportive shoes produce a little more pain relief in patients with moderate to severe osteoarthritis than minimalist flat and flexible shoes, but the difference is not likely clinically relevant. Function, knee-related quality of life, and hip pain are not significantly better, on average, with one type of shoe over another, though patients in each group responded to their new shoes. Paterson [...]

The U.S. Food and Drug Administration (FDA) has approved Saphnelo™ (anifrolumab-fnia) as a treatment for adults with systemic lupus erythematosus (SLE) who are receiving standard therapy. It is the third U.S. FDA approval of a lupus therapy since 2011, expanding treatment options for this medically underserved and life-threatening autoimmune disease.Saphnelo inhibits a key protein in the immune system called the IFNAR receptor that acts as a transmitter, amplifying signals from tiny messengers called type I interferons. This process activates many parts of the immune system and can trigger major inflammation. Saphnelo dampens the excessive type I interferon signature found in [...]

How accurate are rapid antigen tests for COVID-19 in both asymptomatic and symptomatic patients? A rapid antigen test (Sofia FIA from Quidel) was highly specific, but sensitivity was 80% in symptomatic patients and only 40% in asymptomatic patients. In asymptomatic patients, due to the low prevalence in this sample (2%), there was also a high false positive rate of 67%. Pray IW, Ford L, Cole D, et al, for the CDC COVID-19 Surge Laboratory Group. Performance of an antigen-based test for asymptomatic and symptomatic SARS-CoV-2 testing at two university campuses - Wisconsin, September-October 2020. MMWR Morb Mortal Wkly Rep 2021;69(5152):1642–1647. [...]

For patients with sciatica, do epidural corticosteroid injections safely reduce pain and disability? Epidural corticosteroid injections provide a small and probably clinically insignificant reduction in leg and back pain in the immediate term (< 2 weeks), and a small to moderate reduction in disability in the short to intermediate term. Adverse events and safety were not well reported. Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for sciatica an abridged cochrane systematic review and meta-analysis. Spine 2020;45(21):E1405-E1415.