ADARRC

Do pregnant women who become ill with COVID-19 have worse outcomes than pregnant women who are not infected with COVID-19? Pregnant women who become ill with COVID-19 are more likely to die and have adverse perinatal and neonatal outcomes than pregnant women who are uninfected with COVID-19. Villar J, Ariff S, Gunier RB, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr 2021;175(8):817-826.

Are interleukin-6 antagonists effective in decreasing mortality among persons hospitalized with COVID-19? Based on this systematic review, it is unclear if IL-6 antagonists decrease mortality among persons hospitalized with COVID-19. Co-intervention with corticosteroids has muddied the waters, and the data so far are dominated by a single agent (tocilizumab). The other agents do not appear to be effective. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Shankar-Hari M, Vale CL, et al. Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19: a meta-analysis. JAMA 2021;326(6):499-518. [...]

What is the best treatment for multisystem inflammatory syndrome in children? For children with MIS-C caused by SARS-CoV-2, the preferred initial treatment is IVIG plus corticosteroids. Son MB, Murray N, Friedman K, et al, for the Overcoming COVID-19 Investigators. Multisystem inflammatory syndrome in children — initial therapy and outcomes. N Engl J Med 2021;385(1):23-34.

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 [...]