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Research Roundup

Posted by on Monday, October 18, 2021 in Around the Medical Center, Fall 2021 .

Dexmedetomidine and delirium

In new findings that are exclusively with regard to cardiac surgery patients, intraoperative dexmedetomidine — that is, the drug administered during heart surgery — is associated with 85% greater risk of postoperative delirium and 29% greater risk of postoperative intubation and reintubation.

Meanwhile, dexmedetomidine administered to cardiac surgery patients postoperatively in the ICU is associated with 25% greater risk of 30-day mortality.

These findings, reported in The Annals of Thoracic Surgery by Miklos Kertai, MD, PhD, and colleagues, are based on records of 54,682 cardiac surgery patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The patients underwent cardiac surgery between July 2014 and December 2018.

Dexmedetomidine was also associated with minor, somewhat inconsistent differences in pain scores (at postop day three and hospital discharge).



Treating metastatic prostate cancer

The role of olaparib in treating men with metastatic castration-resistant prostate cancer (mCRPC) should be reconsidered, a new report in JAMA Network Open suggests.

Christopher Wallis, MD, PhD, and colleagues conducted an indirect comparative effectiveness study of olaparib (an inhibitor of the DNA repair enzyme PARP) versus cabazitaxel in men with mCRPC using previously published data from the PROfound and CARD trials. They took advantage of the fact that both trials used a similar comparator group (re-challenge with novel androgen axis signaling inhibitors).

PROfound included 387 patients with mCRPC who had variants in one of 15 genes involved in homologous recombination DNA repair (HRR). CARD included 255 mCRPC patients.

In the indirect comparison, olaparib was associated with superior radiographic progression-free survival (rPFS) only for patients with mutations in BRCA1, BRCA2 or ATM genes. In patients with 12 other HRR gene variants, cabazitaxel was 83% more likely to result in superior rPFS. There was no difference in overall survival for patients treated with olaparib and cabazitaxel across any tested subgroup.

The authors note that numerous active studies will aid in reassessing national guidelines for the use of PARP inhibitors in mCRPC.



COVID-19 complication underdiagnosed

Multisystem inflammatory syndrome (MIS) is the inflammation of various tissues and has been cited as a complication of SARS-CoV-2 infection. Originally identified in children, a form of MIS has since been described in adults (MIS-A).

Giovanni Davogustto, MD, and colleagues identified and collected characteristics of adult patients at risk of MIS-A from electronic health records to better understand its presentation. Patients in the study were narrowed from the pool of patients testing positive for SARS-CoV-2 and separated from those experiencing acute COVID-19 infection.

The research published in JAMA Network Open showed that the average patient affected by MIS-A was younger than the average patient admitted for acute COVID-19 symptoms. Four organ systems were typically involved, with the most common being the gastrointestinal tract, kidneys and hematologic system.

These data suggest a larger variation in clinical presentation, lower illness severity, and underdiagnosis of MIS-A than previously thought.