Medical Bulletin 21/June/2023

Here are the top medical news for the day:

Pioneering patient-led intervention tackles multiple challenging symptoms in dialysis patients with success

When a patient with chronic kidney disease finally reaches the point that their kidneys fail, doctors have a treatment available: dialysis. But undergoing dialysis often brings a high burden of other unpleasant symptoms – fatigue, pain, and depression – that are outside the typical nephrologist’s wheelhouse and can be difficult to treat.

A new patient-guided intervention using telemedicine improves these troublesome symptoms with results that persist for several months after the intervention ends, according to the results of a randomized clinical trial published in JAMA Internal Medicine by physician-scientists at the University of Pittsburgh and the University of New Mexico.

The researchers developed the Technology Assisted Stepped Collaborative Care (TĀCcare) trial to test whether 12 weekly sessions of cognitive behavioral therapy delivered via telemedicine either while patients receive their dialysis or at home could improve symptoms. To ensure the results weren’t simply an effect of the added attention from the tele-sessions, they had a comparison group of patients receive weekly health education via telemedicine

Reference: Effects of Technology Assisted Stepped Collaborative Care Intervention to Improve Symptoms in Patients Undergoing Hemodialysis The TĀCcare Randomized Clinical Trial, JAMA Internal Medicine, DOI 10.1001/jamainternmed.2023.2215 

Revolutionary photon-counting CT: A noninvasive approach to detect heart disease in high-risk patients

 New ultra-high-resolution CT technology enables excellent image quality and accurate diagnosis of coronary artery disease in high-risk patients, a potentially significant benefit for people previously ineligible for noninvasive screening, according to a study published in a Radiology journal.

Coronary CT angiography (CCTA) in a high-risk population is difficult due to the high prevalence of coronary calcifications and stents. Coronary calcifications tend to “bloom” on CCTA, making them appear more extensive than they really are. This results in an overestimation of blockages and plaque and false-positive results.

Ultra-high-resolution coronary CT angiography (UHR-CCTA) is a promising tool for the noninvasive assessment of patients at high risk for coronary artery disease. Because it uses recently introduced photon-counting CT scanners, it has not been extensively studied.

Reference: Muhammad T. Hagar et al, Accuracy of Ultrahigh-Resolution Photon-counting CT for Detecting Coronary Artery Disease in a High-Risk Population, Radiology

Regular use of low-dose aspirin linked to a 20% higher risk of anemia in older adults

An analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial found that the use of low-dose aspirin was associated with a 20 percent increased incidence of anemia and a decline in ferritin, or blood iron levels, in otherwise healthy older adults. These findings suggest that periodic monitoring of hemoglobin should be considered in older patients taking aspirin.

 Although the risk for over bleeding due to aspirin has been well characterized, very few studies have measured the effect of aspirin on anemia, particularly in older populations.

Researchers from Monash University, Melbourne conducted a post-hoc analysis of the ASPREE randomized controlled trial. The trial included 19,114 persons aged 70 years or older who were randomly assigned to take 100 mg of aspirin daily or placebo. Hemoglobin was measured annually, and ferritin was measured at baseline and 3 years after randomization. The data showed that the risk for developing anemia was 23.5 percent among those assigned to receive low-dose aspirin. 

Reference: Effect of Low Dose Aspirin versus Placebo on Incidence of Anemia in the Elderly, Annals of Internal Medicine, DOI 10.7326/M23-0675