The Clinical Chronicle

Welcome to the second edition of The Clinical Chronicle! This issue dives into the latest breakthroughs in medicine, from cutting-edge treatments to innovative diagnostic approaches that are shaping the future of healthcare. Whether you're looking for clinical pearls, or strategies during residency, we've got something for everyone. Plus, don’t miss our events section for upcoming conferences and deadlines. Dive in and stay updated!

Continuous β-Lactam Infusion Improve Survival in Sepsis?

BLING III trial evaluated whether continuous β-lactam infusion improved 90-day mortality in critically ill sepsis patients compared to intermittent dosing. Although continuous infusion slightly reduced mortality (24.9% vs. 26.8%), the difference was not statistically significant. Clinical cure rates were higher with continuous infusion (55.7% vs. 50.0%).

Source: JAMA

Asundexian a Safer Alternative for Stroke Prevention?

In a recent phase 3 trial, high-risk patients with atrial fibrillation were randomized to receive either factor XIa inhibitor Asundexian or apixaban. Results suggest that while Asundexian may offer a bleeding advantage, it might not be as effective as apixaban for stroke prevention in atrial fibrillation patients.

Source: NEJM

No, Seriously, Just Two Workouts a Week Can Do Wonders

New research from the UK Biobank cohort study reveals that the "weekend warrior" exercise pattern can be just as effective as regular exercise spread throughout the week. The study showed significant reductions in cardiometabolic disease risk, including hypertension, diabetes, and obesity, whether spread out or crammed into a few days (150 min of activity per week).

Source: Circulation

Ensifentrine: A New Era in COPD Maintenance Therapy

A Long-Awaited Breakthrough in 20 Years?

A novel phosphodiesterase 3 and 4 inhibitor, has received FDA approval for maintenance treatment in COPD. Clinical trials showed significant improvement in FEV1 and a reduction in exacerbations compared to placebo. While no major adverse effects were reported, patients with a history of depression should be monitored for potential psychiatric reactions. As Ensifentrine's role in treatment guidelines is still being established, it may serve as an add-on therapy for those inadequately managed by standard treatments.

Source: Clinicaltrialsarena

Can Stem Cells Finally Cure Type 1 Diabetes?

First-of-its-kind transplantation shows promise in reversing insulin dependency.

A groundbreaking trial has demonstrated that CiPSC islets successfully reversed insulin dependency in a type 1 diabetes patient one year post-transplant, with time-in-target glycemic range improving from 43.18% to over 98% and HbA1c stabilizing around 5%. Additionally, data from Vertex Pharmaceuticals’ FORWARD trial revealed that all patients receiving VX-880 showed islet cell engraftment and glucose-responsive insulin production by day 90, marking a pivotal advance in stem cell-derived islet therapies.

Source: CELL

Should I SELECT Semaglutide Based on the SELECT Trial Results?

New looks on inflammation, glycemia, and heart failure

The trial demonstrated that semaglutide (2.4 mg) significantly reduces major adverse cardiovascular events (MACE) and cardiovascular mortality in patients with obesity and heart failure. Among 17,604 participants, those with heart failure experienced a 28% reduction in MACE (HR 0.72) and improved heart failure outcomes (HR 0.79). Notably, semaglutide's safety profile showed fewer serious adverse events compared to placebo. These results highlight semaglutide's potential as a vital therapy for this patient population.

Source: thelancet

Thriving in Residency

The Impact of Reduced Bedside Time on Resident Physician Burnout

Dr. Brian Garibaldi from Johns Hopkins highlights that increased bedside time correlates with higher wellness and lower burnout rates among resident physicians. An AMA survey of over 2,000 residents found they spend about 26 hours weekly on direct patient care—just 40% of their total working hours—while dedicating approximately 28 hours to indirect and administrative tasks. This imbalance contributes to a reported burnout rate of 42.5%, underscoring the need for systemic changes in residency programs.

Source: AMA

Early Diagnosis: Why Timing Matters

Are We Catching Lung Cancer Early Enough?

Only 26.6% of cancer cases nationwide are detected at an early stage when the five-year survival rate is significantly higher at 63%. In contrast, 44% of cases are diagnosed at a late stage, where survival rates plummet to 8%. Despite challenges posed by the COVID-19 pandemic, early diagnosis rates remained stable in 2020 and even rose by 9% over the last five years. States like Massachusetts performed best, with 33.3% of cases diagnosed early, while Hawaii lagged behind at 20.3%.

Source: Lung.org