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Compared to other respiratory viruses, the proportion of hospitalizations due to SARS-CoV-2 among children is relatively low. While severe illness is not common among children and young individuals, a particular type of severe condition called multisystem inflammatory syndrome in children (MIS-C) has been reported. The aim of this prospective cohort study, which followed a group of individuals under the age of 19, was to examine the characteristics of patients who had contracted SARS-CoV-2, including their coexisting medical conditions, clinical symptoms, laboratory findings, and outcomes. The study also aimed to investigate the features of children who met the WHO case definition of MIS-C, as well as those who required intensive care. A total of 270 patients were included between March 2020 and December 2021. The eligible criteria were individuals between 0-18 with a confirmed SARS-CoV-2 infection at the Infectious Disease Hospital "Prof. Ivan Kirov"in Sofia, Bulgaria. Nearly 76% of the patients were <= 12 years old. In our study, at least one comorbidity was reported in 28.1% of the cases, with obesity being the most common one (8.9%). Less than 5% of children were transferred to an intensive care unit. We observed a statistically significant difference in the age groups, with children between 5 and 12 years old having a higher likelihood of requiring intensive care compared to other age groups. The median values of PaO2 and SatO2 were higher among patients admitted to the standard ward, while the values of granulocytes and C-reactive protein were higher among those transferred to the intensive care unit. Additionally, we identified 26 children who met the WHO case definition for MIS-C. Our study data supports the evidence of milder COVID-19 in children and young individuals as compared to adults. Older age groups were associated with higher incidence of both MIS-C and ICU admissions.Copyright © 2023 P. Velikov et al., published by Sciendo.
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Carbapenem administration is an important therapy for nosocomial infections due to MDRO, especially Acinetobacter baumannii. The global increase in carbapenem-resistant A. baumannii (CRAB) that causes this pathogen has significantly threatened public health due to the lack of adequate treatment options due to the very few currently available antimicrobial agents that actively fight CRAB. Antimicrobial resistance is a major negative impact of inappropriate antimicrobial prescribing. Ineffective empiric treatment (initial antibiotic regimen not sensitive to identified pathogens based on in vitro sensitivity test results) is associated with a higher rate of deaths compared to effective empiric treatment. In this study, we analyzed the correlation between the suitability of empiric and definitive antibiotics and the clinical outcomes of patients with bacteremia due to CRAB treated in the inpatient ward of Dr. Soetomo Tertiary Referral Hospital, Surabaya. There were 227 isolates of bacteremia due to CRAB, consisting of 156 carbapenem-resistant A. baumanni and 71 carbapenem-sensitive A. baumannii. There were 88 isolates that met the inclusion and exclusion criteria, and all of them were resistant to ceftriaxone, cefepime, and ciprofloxacin. A total of 29.5% of the isolates were sensitive to cotrimoxazole, 3.4% of the isolates were sensitive to tigecycline, and 2.3% of the isolates were sensitive to amikacin, levofloxacin, and cefoperazone sulbactam. Adequate empirical antibiotics and definitive antibiotics (sensitive based on culture sensitivity test) amounted to 12.5% and 27.3%, respectively. There is no significant correlation between the suitability of empiric and definitive therapies with the patients' clinical outcomes (death and length of stay).Copyright © 2022 Phcogj.Com.
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Organ transplant recipients receive immunosuppressive drugs and hence are at high risk for COVID-19 due to their compromised immunity. This study assessed 1,370 liver transplant recipients who were followed at our hospital. A total of 12 patients got COVID-19: 5 recipients <50-years-old had mild disease, 7 recipients >60-years-old had moderate to severe disease, and 2 patients died. In addition, not all patients received 2 vaccinations, suggesting that the immunization is important for COVID-19 prophylaxis even in this patient population. One recipient was successfully treated with a combination of a reduced dose of immunosuppressive drugs, dexamethasone, remdesivir, and antibiotics, which is being established as an effective therapy for COVID-19.Copyright © 2022 The Japan Society of Hepatology.
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Listeriosis is a saprozoonotic infection that occurs when eating foods contaminated with Listeria. Invasive forms of listeriosis can have extremely severe consequences. Respiratory viral diseases predispose to the occurrence of combined viral-bacterial infections. With a mixed infection of listeriosis and COVID-19, a severe course of the disease is observed, which has a serious prognosis. The aim of the study was to analyze the frequency of various variants of invasive listeriosis and their outcomes in the period before the COVID-19 pandemic and against the background of its development, as well as to determine the genetic diversity of L. monocytogenes isolates. Material and methods. We analyzed 55 cases of invasive listeriosis in patients observed in 2018-2021 in various medical organizations in Moscow. The diagnosis was established on the basis of epidemiological, clinical and laboratory data, listeriosis was confirmed by bacteriological and molecular genetic methods, COVID-19 was confirmed by the detection of SARS-CoV-2 RNA in an oropharyngeal swab using real-time RT-PCR, as well as computed tomography of the lungs. Results. During the current COVID-19 pandemic (2020-2021), the incidence of listeriosis in pregnant women and invasive listeriosis occurring in the form of sepsis and/or lesions of the central nervous system did not differ significantly from similar indicators registered in 2018-2019. Listeria sepsis and/or meningitis/meningoencephalitis in association with severe SARS-CoV-2 novel coronavirus infection are at high risk of death. During the years of the COVID-19 pandemic, the diversity and range of L. monocytogenes genotypes in invasive listeriosis changed, new genotypes appeared that were not previously characteristic of the Russian Federation. Conclusion. The likelihood of developing listeriosis sepsis and/or meningitis/meningoencephalitis against the background of a severe course of COVID-19, and a high risk of an adverse outcome, require increased awareness of medical workers in the field of diagnosis and treatment of invasive listeriosis in order to conduct the earliest and most adequate antibiotic therapy.Copyright © 2022 Geotar Media Publishing Group. All Rights Reserved.
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Coronavirus disease-19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic and is giving rise to a serious health threat globally. SARS-CoV-2 infection ranges from asymptomatic carrier state to severe illness requiring intensive care unit (ICU) management. It is postulated that with COVID-19 infection, children are less prone to develop severe symptoms as compared with adults. The data on immunocompromised children affected with COVID-19 infection is limited and not many publications are there on the effects of 2nd wave of COVID-19 infection in pediatric hematology/oncology patients till date. In our experience during second wave, 17 patients were found to be positive for SARS-CoV-2 with a male: female ratio of 2.4: 1 and median age of 8 years (range 1-18 years). Out of these 17 patients, 10 (58.8%) patients required hospital admission whereas the remaining were managed at home. Only 1 patient required ventilatory support and there was no mortality. Though the number of pediatric patients with COVID-19 infection were more during the second wave but majority had mild to moderate symptoms and were easily managed.Copyright © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics
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AIM: to estimate the features of pseudomembranous colitis in patients with COVID-19, diagnostics, conservative treatment and surgery for complications. PATIENTS AND METHODS: a retrospective analysis of 396 patients with pseudomembranous colitis (PMC) in patients with new coronavirus infection was carried out for the period from March 2020 to November 2021. Among them there were 156 (39.3%) males, females - 240 (60.6%), moderate and severe forms of COVID-19 occurred in 97.48%. The diagnosis of PMC was established due to clinical picture, laboratory, instrumental methods (feces on Cl. difficile, colonoscopy, CT, US, laparoscopy). RESULT(S): the PMC rate in COVID-19 was 1.17%. All patients received antibiotics, 2 or 3 antibiotics - 44.6%, glu-cocorticoids were received by all patients. At 82.8%, PMC developed during the peak of COVID-19. To clarify the PMC, CT was performed in 33.8% of patients, colonoscopy - 33.08%, laparoscopy - in 37.1% (to exclude bowel perforation, peritonitis). Conservative treatment was effective in 88.8%, 76 (19.1%) patients had indications for surgery (perforation, peritonitis, toxic megacolon). Most often, with peritonitis without clear intraoperative confir-mation of perforation, laparoscopic lavage of the abdominal cavity was performed (60 patients - 78.9%, mortality - 15.0%), colon resection (n = 6 (7.9%), mortality - 66.6%), ileo-or colostomy (n = 8 (10.5%), mortality - 37.5%), colectomy (n = 2 (2.6%), mortality - 50.0%). The overall postoperative mortality rate was 22.4%, the incidence of surgical complications was 43.4%. In addition, in the postoperative period, pneumonia was in 76.3%, thrombosis and pulmonary embolism in 22.3% of patients. In general, the overall mortality in our patients with PMC was 11.4%, with conservative treatment - 8.8%. CONCLUSION(S): pseudomembranous colitis is a severe, life-threatening complication of COVID-19. In the overwhelm-ing majority of patients, conservative therapy was effective, but almost 1/5 of patients developed indications for surgery, the latter being accompanied by high mortality and a high morbidity rate. Progress in the treatment of PMC, apparently, is associated with early diagnosis, intensive conservative therapy, and in the case of indications for surgery, their implementation before decompensation of the patient's condition and the development of severe intra-abdominal complications and sepsis.Copyright © 2022, Association of Coloproctologists of Russia. All rights reserved.
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Introduction: The clinical outcomes of COVID-19 infection in children with cancer have been variable worldwide. Therefore, we aimed to collect data from all regions in India through a national collaborative study and identify factors that cause mortality directly related to COVID-19 infection. Method(s): Data was collected prospectively on children across India on cancer therapy and diagnosed with COVID-19 infections from 47 centers from April 2020 to October 2021. Information was recorded on the demographics, the number of children that required intervention, and the outcome of the infection. In addition, we analyzed the impact of the delta variant in 2021. Result(s): A total of 659 children were studied, of whom 64% were male and 36% were female. The data from the eastern region was sparse, and this was a collection bias. COVID-19 infection was predominantly seen in children less than five years. The delta variant had a higher impact in the southern region, and this was statistically significant. Of the 659 children, 30 children died (4.5%), however only 7 of the deaths were directly attributed to COVID-19 infection (1%). Conclusion(s): The study reports the largest nationally representative cohort of children with cancer and COVID-19 to date in India. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Complete characterization of the cohort has provided further insights into the effects of COVID-19 on cancer outcomes. The low mortality allows us to recommend that specific cancer treatments be continued without delays in therapy.Copyright © 2022
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IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS) and the Society of Infectious Diseases Pharmacists (SIDP). For the first time since the COVID-19 public health emergency began, IDWeek 2022 returned to in-person attendance. It was held in Washington, D.C., and the meeting comprised 5 days of live sessions and on-demand content that included posters and oral presentations.Copyright © 2023 Clarivate.
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Background: Acute sinusitis is not an uncommon disease that manifests with inflammation of the mucosal lining of the paranasal sinuses. It has varied etiologies including viral, bacterial, fungal, and allergic. Anatomical variations, trauma, auto-immunity, diabetes mellitus, and dental procedures are predisposing factors. With the wide variation in the etiological factors, the management could be tricky. This study is quite relevant with the advent of the relentlessly persisting COVID-19 pandemic which affects the upper respiratory tract as well. Method(s): This is a descriptive hospital-based prospective study conducted at the Khartoum ENT Teaching Hospital, Ibnsina Teaching Hospital, Omdurman Military Hospital, and Omdurman Teaching Hospital in Khartoum State in the period from March 2020 to February 2021. The study included all patients 18 years and older diagnosed with acute sinusitis. The data was collected by a well-structured questionnaire designed to meet the objectives of the study and analyzed using SPSS 20. Any COVID-19 suspect is excluded from the study. Result(s): The total number of patients was 109;of them, 59 (54.1%) were females and 50 (45.9%) were males, and the female to male ratio was 1.18:1. One hundred seven (98.2%) patients received medical treatment and two patients (1.8%) did take the medications. Eighty-one patients (74.3%) were cured with medical treatment and only 28 patients (25.7%) needed surgical intervention. The age group from 25 to 40 years old was the most affected, accounting for 68 patients (62.4%), and the above 60 years old (3.7%) was the least affected group. Conclusion(s): Acute sinusitis is not an uncommon disease, if addressed properly and timely is medically treatable in most cases apart from complicated cases. This study shows that the active working ages (25-40) were the most affected. Few patients needed surgery (FESS). Negligence could result in complications. Diseases like COVID-19 affect the upper respiratory tract, and there is a similarity in symptoms, and in the advent of the COVID-19 pandemic nowadays, differentiation is of paramount importance.Copyright © 2022, The Author(s).
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Pulmonary parenchymal involvement secondary to the subcutaneous injection of silicone gels is an unusual condition which occurs more frequently in women aged between 22 and 55 years. Although different theories have been put forward about its etiology, it is unknown and the condition may cause local and systemic complications and even have a fatal outcome. Few cases have been reported in South America and there is no report of this unique entity in Peru. We present the case of a previously healthy 28-year-old male transgender patient who, after an illegal subcutaneous injection of silicone gels in the gluteal region given by a non-healthcare professional, showed progressive respiratory distress and stabbing chest pain of approximately 7 out of 10 on the pain scale within the first 24 hours. Upon admission to the emergency room, respiratory failure was objectively evidenced since the patient had an oxygen saturation of 72 % at a FiO2 of 21 %, as well as pulmonary parenchymal involvement both in the CT scan and chest X-ray with signs highly suggestive of this pathology. Using a SARS-CoV-2 RNA real-time RT-PCR test performed on a respiratory specimen, COVID pneumonia, immunodeficiency disorders and pulmonary embolism were ruled out. Since there is no standard treatment, the patient was given relevant support measures such as the administration of supplemental oxygen at a low flow rate by binasal cannula, intravenous systemic corticosteroids and antibiotic therapy, thus achieving good progress with resolution of the initial clinical presentation. Then, after 10 days of intrahospital treatment, the patient was discharged.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.
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A 60-year-old woman with Hepatitis C infection, cirrhosis, recurrent hepatic hydrothorax, and hepatocellular carcinoma was hospitalized with Coronavirus disease-2019 (COVID-19). After her initial discharge, she was re-admitted three weeks later with decompensated liver disease. Imaging revealed extensive thrombosis in the portal vein, superior mesenteric vein, splenic vein and bilateral brachial veins. Given the acute onset and extent of the thrombosis, the patient received therapeutic anticoagulation despite elevated prothrombin time/ international normalized ratio, thrombocytopenia and low fibrinogen. Cirrhotic patients with COVID-19 maybe at high risk of thrombosis, which can present with significant hepatic decompensation.Copyright © 2022 The Author(s)
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Introduction: The course of SARS-CoV-2 disease has a clinical spectrum ranging from mild upper respiratory tract infection to fulminant pneumonia. The use of corticosteroids is recommended in the treatment of severe COVID-19 pneumonia. The present study aimed to compare the efficacy of high-dose methylprednisolone and dexamethasone treatment in patients hospitalized with severe COVID-19 pneumonia. Material(s) and Method(s): The participants were divided into Group M, receiving >=250 mg intravenous methylprednisolone therapy, and Group D receiving 6 mg intravenous dexamethasone therapy. The efficacy of treatments, length of hospital stays, ventilator requirements, anti-cytokine treatment requirements, and mortality rates were evaluated in both groups. Result(s): Two hundred eighty-eight (69.1%) patients received dexamethasone and 129 (30.9%) received methylprednisolone. While overall mortality in the study was 11%, this rate was 10.4% in Group D and 12.4% in Group M (p> 0.05). The rate of patients requiring intensive care was 15.8% in total, with a rate of 14.6% in Group D and 18.6% in Group M (p> 0.05). However, the total length of hospital stay was nine (7-39) days in Group M and 13 (7-29) days in Group D (p= 0.009). Anticytokines were required in 14.4% of the patients during treatment [40 in Group D, 20 in Group M (p> 0.05)]. Conclusion(s): In this study, it was determined that early methylprednisolone treatment shortened the hospital stay. In addition, there was no statistically significant difference between Group M and Group D in terms of mechanical ventilation requirement, which showed an additional positive effect. However, mortality rates in patients receiving dexamethasone were found to be lower than in those receiving methylprednisolone, yet this difference did not reach statistical significance.Copyright © 2023 Bilimsel Tip Yayinevi. All rights reserved.
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Spontaneous pneumomediastinum (SPM) is a decisive complication reported to be associated with COVID-19. Here, we present a case of SPM in a COVID-19positive patient that was not caused by any iatrogenic or known reasons. At the time of admission, the patient was COVID-positive and distressed. He was immediately subjected to hematological and radiological investigations (chest X-ray, HRCT), which confirmed pneumomediastinum. The patient was hypoxic and hypotensive even after receiving ionotropic support. Considering the patient's critical condition, a mediastinal pigtail catheterization was performed instead of a thoracotomy, and the catheter was in situ for nine days. Arterial blood gas was monitored during the hospital stay, and supplementary oxygen therapy was provided accordingly. The patient subsequently recovered and was discharged. Hence, SPM in this COVID patient was treated by pigtail catheterization, and major surgical interventions were avoided.Copyright © 2023 LookUs Scientific. All rights reserved.
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The objective of this review was to summarize impact of the widespread administration of antibiotics in treatment algorithms for patients with COVID-19 on treatment outcomes. The experience of antimicrobial use agents during COVID-19 pandemic did not show any life-saving effect. It justifies a need to limit their administration to COVID-19 patients.Copyright © 2021, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
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Over the past two years, the SARS-CoV-2 pandemic has dominated all aspects of health care around the world, often leaving other long-term public health problems in the background. Despite the fact that COVID-19 is a viral disease, the use of antibiotics in these patients was common practice, especially at the beginning of the pandemic. The use of antibiotics (ABs) in patients with the novel coronavirus infection (NCI) reaches over 70% cases. Suspected concomitant bacterial infection, lack of effective means of treating NCI, terminological problems associated with the definition of <<pneumonia>> may have been the motivating factor for such widespread use. The data of the conducted studies indicate that there is currently insufficient evidence for the widespread empirical use of antibiotics in the majority of hospitalized patients, as the total proportion of bacterial infections in COVID-19 is quite low. Thus, according to most researchers, combined bacterial infection is rare and is less than 10%. Unjustified prescription of ABs to patients with COVID-19 can lead to complications that could otherwise have been avoided, including increased bacterial resistance, Clostridioides difficile infection, kidney failure, and much more. The article provides information on the frequency of AB therapy at various stages of medical care. The analysis of data on the nature of antibiotics prescribed to inpatients and outpatients with COVID-19 in different countries was carried out. Recommendations from different countries on AB therapy in patients with COVID-19 are presented. Conclusion. The data reviewed confirm the discrepancy between the unjustified and excessive prescribing of antibiotics to patients with COVID-19 and the small number of evidence of associated bacterial infections.Copyright © Team of Authors, 2022.
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The aim. To investigate the clinical peculiarities of adult patients with diarrheal syndrome, associated with coronavirus infection COVID-19. The materials and methods. There has been carried out the analysis of 56 patients aged 26-81 years, hospitalized with acute enteric infection at the Municipal Infectious Diseases Hospital 8 (not reprofiled as hospital for the treatment of coronavirus infection COVID-19 patients) in the course of August 2020 - February 2021 and the patients with cause-effect relationship with COVID-19. There have been used the routine diagnostic methods, the analysis of feces for causative agents of diarrhea was tested by the methods of bacteriological and immunoenzymatic analysis, the analysis of feces for toxins A and B Clostridium difficile was tested method of immunochromatographic assay;the blood serum was tested by method of immunoenzymatic analysis and the analysis of nasopharyngeal swabs was tested by immunochromatographic assay and PCR test for markers SARS-COV-2. The statistical material treatment has been done using Statistical Package of IBM SPSS Statistics-22. The results. There have been registered 51,8% of cases - diarrhea as one of the clinical manifestations of COVID-19 in adult patients (the first group of patients), in 48,2% of cases - diarrhea as a result of recently treated COVID-19 and a massive course of antibiotics (the second group of patients). In the second group 12 patients have been diagnosed with clostridial infection, 15 patients - with antibiotic-associated diarrhea. There has been registered the main severity of clinical manifestations in patients with clostridial infection. The disease being characterized by severity of colitis syndrome, the blood sedimentation rate increasing, hyperleukocytosis in haemogram, hypoproteinemia and hypoalbuminemia. The aggravating factors are combined comorbidity and patients aged over 55 years. The conclusion. There should be used the differential approach for diarrheal syndrome in patients with coronavirus infection. Taking into account the massive course antibiotics' side effects, the analysis of feces for pathogenic flora must be included into the medical examinations such as Clostridium difficile and the course of probiotic and anticlostridial medicines should be done.Copyright © 2022 Authors. All rights reserved.
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The overall incidence of healthcare-associated infections (HAIs) in patients with COVID-19 is lower than 15%. However, in critical COVID-19 patients, the incidence of HAIs may reach 50%, and the mortality rate may exceed 50%. This makes effective antibiotic therapy in this category of patients extremely important. The aim of the study was to assess the rationality of antibiotic therapy in critically ill COVID-19 patients with HAIs, as well as analyse the timeliness and sufficiency of microbiological and laboratory diagnostic testing in these patients. Material(s) and Method(s): the study comprised a retrospective analysis of medical records of the patients with COVID-19 complicated by HAIs who had been admitted to an intensive care unit of Moscow City Clinical Hospital 4 from 27.04.2020 to 01.11.2020. Antibacterial therapy was analysed in accordance with the principles set forth in the Strategy for the Control of Antimicrobial Therapy (antimicrobial stewardship) and the current Interim Guidelines on the Prevention, Diagnosis and Treatment of Novel Coronavirus Infection (COVID-19) of the Russian Ministry of Health. Statistical significance was evaluated using Student's unpaired t-test. The qualitative comparison of independent groups was made using the chi2 test. Result(s): HAIs developed in 138 (20.8%) of 664 patients admitted to the intensive care unit. The authors considered empirical antibiotic therapy irrational in 53.6% of these cases (74/138 patients) due to nonconformity to the current clinical recommendations. Empirical antimicrobial therapy was rational in 68.6% of survivors and 33.3% of non-survivors (p < 0.001). It was corrected based on the results of microbiological testing in 56.9% of survivors and 30.2% of non-survivors (p = 0.005). Procalcitonin levels, as a marker of bacterial infection, were determined in 74.5% survivors and 48.3% of non-survivors (p = 0.003). Conclusion(s): Antibiotic therapy was rational in less than 50% of critically ill COVID-19 patients with HAIs. Having demonstrated a significant mortality decrease in the category of studied patients with rational antibiotic therapy, the study suggests that it is necessary to follow the current recommendations more carefully. The success of therapy also largely depends on its timely correction based on the results of HAI pathogen identification and other diagnostic measures, in particular, procalcitonin biomarker tests.Copyright © 2022 Obstetrics, Gynecology and Reproduction. All rights reserved.
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The 2019 novel coronavirus (SARS-CoV-2) causes severe pneumonia called COVID-19 and leads to severe acute respiratory syndrome with a high mortality rate. The SARS-CoV-2 virus in the human body leads to jumpstarting immune reactions and multi-organ inflammation, which has poorer outcomes in the presence of predisposing conditions, including hypertension, dyslipidemia, dysglycemia, abnormal adiposity, and even endothelial dysfunction via biomolecular mechanisms. In addition, leucopenia, hypoxemia, and high levels of both cytokines and chemokines in the acute phase of this disease, as well as some abnormalities in chest CT images, were reported in most patients. The spike protein in SARS-CoV-2, the primary cell surface protein, helps the virus anchor and enter the human host cells. Additionally, new mutations have mainly happened for spike protein, which has promoted the infection's transmissibility and severity, which may influence manufactured vaccines' efficacy. The exact mechanisms of the pathogenesis, besides molecular aspects of COVID-19 related to the disease stages, are not well known. The altered molecular functions in the case of immune responses, including T CD4+, CD8+, and NK cells, besides the overactivity in other components and outstanding factors in cytokines like interleukin-2, were involved in severe cases of SARS-CoV-2. Accordingly, it is highly needed to identify the SARS-CoV-2 bio-molecular characteristics to help identify the pathogenesis of COVID-19. This study aimed to investigate the bio-molecular aspects of SARS-CoV-2 infection, focusing on novel SARS-CoV-2 variants and their effects on vaccine efficacy.Copyright © 2022 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.
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This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men;rectal bleeding in women;and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.Copyright © 2022 American Academy of Family Physicians.