Background Decision-making regarding nonoperative versus operative treatment of patients with thoracolumbar burst fractures in the absence of neurologic deficits is controversial. Lack of evidence-based practice may result in patients being treated inappropriately and being exposed to unnecessary adverse consequences.

Acute gout episodes in hospital are variably investigated and treated with frequent suboptimal management. We recommend establishment of a hospital-wide protocol to support decision-making regarding investigations, treatment and follow up.

Routine invasive therapy reduces MI and repeat revascularisation and may reduce mortality at the expense of major bleeding in elderly patients with NSTEACS. Our findings highlight the need for further RCTs to better determine the effect on mortality and contemporary bleeding risk.

Background Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin‐angiotensin system inhibitors (RASi) in adults with COVID‐19. We therefore performed a meta‐analysis to assess the safety and efficacy of RASi in adults with COVID‐19. Methods and Results MEDLINE, EMBASE, ClinicalTrials.gov , and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID‐19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all‐cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow‐up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all‐cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69–1.30]) either overall or in subgroups defined by COVID‐19 severity or trial type. Network meta‐analysis identified no difference between angiotensin‐converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33–1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05–3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. Conclusions This meta‐analysis of randomized controlled trials evaluating angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID‐19 found no difference in all‐cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID‐19.

Following introduction of a hospital-wide protocol for acute gout management, there have been significant improvements in the management of acute gout by non-rheumatologist clinicians.

IntroductionWhether ACE inhibitors (ACEi) or angiotensin II receptor blocker (ARB) therapy should be continued, initiated or ceased in patients with COVID-19 is uncertain. Given the widespread use of ACEi/ARBs worldwide, guidance on the use of these drugs is urgently needed. This prospective meta-analysis aims to pool data from randomised controlled trials (RCTs) to assess the safety and efficacy of ACEi/ARB therapy in adults infected with SARS-CoV-2.Methods and analysisRCTs will be eligible if they compare patients with COVID-19 randomised to ACEi/ARB continuation or commencement versuss no ACEi/ARB therapy; study duration ≥14 days; recruitment completed between March 2020 and May 2021. The primary outcome will be all-cause mortality at ≤30 days. Secondary outcomes will include mechanical ventilation, admission to intensive care or cardiovascular events at short-term follow-up (≤30 days) and all-cause mortality at longer-term follow-up (>1 month). Prespecified subgroup analyses will assess the effect of sex; age; comorbidities; smoking status; ethnicity; country of origin on all-cause mortality. A search of ClinicalTrials.gov has been performed, which will be followed by a formal search of trial registers, preprint servers, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify RCTs that meet inclusion criteria. To date, a search of ClinicalTrials.gov identified 21 potentially eligible trials for this meta-analysis. We will request trial investigators/sponsors to contribute standardised grouped tabular outcome data.Ethics and disseminationEthics approval and informed consent will be the responsibility of the individual RCTs. Dissemination of results will occur by peer-reviewed publication. The results of our analysis can inform public health policy and clinical decision making regarding ACEi/ARB use in patients with COVID-19 on a global scale.

Introduction: Cuffless blood pressure (BP) monitoring offers great potential in assessing 24-hour BP without user disturbance. Despite the myriad of commercially available cuffless BP devices, it is uncertain whether these devices can accurately track BP changes during usual daily activities and sleep as with standard 24-hour ambulatory BP monitoring (ABPM). Hypothesis: A commercially available cuffless wearable BP device, previously demonstrated to have good accuracy for seated BP, can track 24-hour BP changes as well as standard ABPM. Methods: We included 45 individuals (36 hypertensive, 15 female, age 58±14 years [mean±SD]) in two centres (Perth, Australia; Athens, Greece). Participants used a cuffless wearable BP device (Aktiia, Switzerland) continuously for 7-10 days and 24-hour ABPM (MicroLife WatchBP O3, Switzerland) on the first and the last day of cuffless BP monitoring. Daily 24-hour, daytime, and nighttime BP values were averaged across the total study days for the cuffless device and across the two ABPM days. Results: Compared to ABPM, the cuffless device reported higher 24-hour systolic BP (SBP) by 6.8 mmHg, 95% CI [3.7, 9.7], higher daytime SBP by 3.8 mmHg [1.0, 6.7], and higher nighttime SBP by 17.5 mmHg [13.6, 21.4] (all p≤0.01). Cuffless 24-hour diastolic BP (DBP) was comparable with ABPM (difference 1.2 mmHg, 95% CI [-1.0, 3.5]), as was daytime DBP (difference -0.8 mmHg, [-3.0, 1.3]) (both p≥0.27), but nighttime DBP was higher by 9.2 mmHg, [6.3, 12.2] (p<0.001). Nighttime dip in SBP (-5.1 mmHg, 95% CI [-13.7, 3.6]) and DBP (-3.8 mmHg, [-11.6, 4.2]) as measured by the cuffless device were substantially less than ABPM (SBP dip: -18.0 mmHg, [-35.5, -1.2]; DBP dip: -13.8 mmHg, [-27.2, -0.8]). The cuffless device identified 44 nighttime non-dippers (defined as a relative dip < 10%) for SBP and 42 non-dippers for DBP, compared to 10 non-dippers for both SBP and DBP as identified by ABPM (both comparisons p<0.001). Conclusions: A commercially available cuffless wearable BP device was unable to adequately track diurnal BP variation and considerably overestimated average SBP over 24 hours as compared to standard ABPM.

No abstract