This episode features Dr. David Nathan, discussing clinical outcomes of metformin use in populations with chronic kidney disease, congestive heart failure, or chronic liver disease; and Dr. Chyke Doubeni, discussing the effectiveness of screening for colorectal cancer using flexible sigmoidoscopy in men and women at different age groups. Dr. Nancy Sokol hosts.

Metformin use in diabetes; Flexible sigmoidoscopy and colorectal cancer screening in older women

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Support for UpToDate Talk is provided by UpToDate, Wolters Kluwer. UpToDate is entirely funded by the subscriptions of its users and does not accept advertising or funding unrelated to subscriptions. The opinions in such podcasts are entirely those of the discussants, and these discussants are authors and editors for UpToDate. View UpToDate’s conflict of interest policy:  http://www.uptodate.com/home/conflict-interest-policy.

Please note that we are no longer producing new clinical podcasts.

Science

This episode features Dr. Robert Wood discussing the results of a trial of oral immunotherapy with a manufactured peanut protein product for peanut desensitization, and its potential role in clinical practice. Dr. Nancy Sokol hosts.

Dr. Wood is Professor of Pediatrics and Director of Pediatric Allergy and Immunology at the Johns Hopkins University School of Medicine and Professor of International Health at the Johns Hopkins Bloomberg School of Public Health. He is Editor-in-Chief of the Allergy and Immunology specialty at UpToDate.

Reference: Bird JA, Spergel JM, Jones SM, et al. Efficacy and Safety of AR101 in Oral Immunotherapy for Peanut Allergy: Results of ARC001, a Randomized, Double-Blind, Placebo-Controlled Phase 2 Clinical Trial. J Allergy Clin Immunol Pract 2018; 6:476.

Contributor Disclosure: Grant/Research/Clinical Trial Support: DBV Technologies; Aimmune; Astellas; HAL-Allergy [Food allergy].

Peanut oral immunotherapy in children and young adults

Dr. Leonard Ganz discusses pharmacologic rate control of atrial fibrillation (AF) and findings of a recent study published in the Journal of the American College of Cardiology regarding the use of digoxin and mortality in patients with AF. Dr. Nancy Sokol hosts.

Dr. Ganz is a clinical cardiologist and Director of Cardiac Electrophysiology at the Heritage Valley Health System, in Western Pennsylvania, and Section Editor of the cardiac arrhythmias section in UpToDate.

Reference: Lopes RD, Rordorf R, De Ferrari GM, et al. Digoxin and Mortality in Patients With Atrial Fibrillation. J Am Coll Cardiol 2018; 71:1063.

Contributor Disclosure: Speaker’s Bureau: Amgen [Heart failure (Ivabradine)]; Pfizer, BMS [Anticoagulation (Apixaban)]; St. Jude Medical, Biotronik [Cardiac rhythm (Pacemaker/ICD)]; Lundbeck [Orthostatic hypotension (Northera)]. Consultant/Advisory Boards: Unequal Technologies [Commotio cordis (Protective equipment)]. Equity Ownership/Stock Options: Unequal Technologies [Commotio cordis (Protective equipment/apparel)].

Digoxin levels and mortality in patients with atrial fibrillation

Dr. Christopher Kabrhel discusses the PERC rule for evaluating patients with suspected pulmonary embolism and a trial exploring the effects of implementing the PERC rule in emergency departments in France, published in JAMA in February 2018. Dr. Nancy Sokol hosts.

Dr. Kabrhel is Associate Professor at Harvard Medical School, an Emergency Medicine physician at Massachusetts General Hospital, and author of several topics on pulmonary embolism for UpToDate.

Reference: Freund Y, Cachanado M, Aubry A, et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA 2018; 319:559.

Contributor Disclosure: Grant/Research Support: Siemens [Venous thromboembolism (D-dimer test)]; Janssen [Venous thromboembolism (Rivaroxaban)]; Diagnostica Stago [Venous thromboembolism (D-dimer test)]. Consultant/Advisory Board: Siemens [Venous thromboembolism (D-dimer test)]; Janssen [Venous thromboembolism (Rivaroxaban)].

PERC criteria for ruling out pulmonary embolism

This episode features Dr. Carol Weitzman discussing a recent study showing a higher incidence of fetal alcohol spectrum disorders in children than previously thought, as well as methods to raise awareness and improve detection. Dr. April Eichler hosts.

Dr. Weitzman is Professor of Pediatrics and Director of the Developmental-Behavioral Pediatrics Program at the Yale School of Medicine. She is an author in the Pediatrics specialty at UpToDate.

Reference: 
May PA, Chambers CD, Kalberg WO, et al. Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities. JAMA 2018; 319:474.

Contributor disclosure: HeartFlow (Investor).

Under-recognition of fetal alcohol spectrum disorders

This episode features Dr. Jose Biller discussing two recent studies showing that intra-arterial mechanical thrombectomy improves neurologic outcomes when performed up to 24 hours after symptom onset for selected patients with ischemic stroke. Dr. April Eichler hosts.

Dr. Biller is a Professor of Neurology and Neurological Surgery and Chairman of the Department of Neurology at the Loyola University Chicago Stritch School of Medicine. He is Section Editor in the Neurology specialty at UpToDate.

References: 
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018; 378:11.

Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 2018; 378:708.

Contributor disclosure: Nothing to disclose.

Metformin use in diabetes; Flexible sigmoidoscopy and colorectal cancer screening in older women

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