Internal Medicine
Audio Summaries

Impact of introducing RTS,S/AS01_E malaria vaccine on mortality in young children in Ghana, Kenya, and Malawi: an observational evaluation of a cluster-randomised implementation programme

This study evaluates the impact of the RTS,S/AS01_E malaria vaccine on mortality rates in young children in Ghana, Kenya, and Malawi over a 46-month period following its introduction in 2019. The authors aimed to determine whether the vaccine significantly reduced overall mortality in children eligible for three doses compared to non-eligible children, finding a notable reduction in mortality, with approximately one in eight deaths averted in areas with moderate vaccine coverage. The results underscore the importance of accelerating malaria vaccine deployment in regions where malaria remains a leading cause of child mortality.

Blinded withdrawal of randomized treatment with low-dose digoxin or placebo in patients with heart failure: the DECISION trial

The DECISION trial aimed to determine the safety of withdrawing digoxin in patients with heart failure who were optimized on contemporary medical therapy. The study found that discontinuation of digoxin led to a significant increase in adverse cardiovascular events and clinical deterioration compared to placebo, suggesting that caution is warranted when stopping digoxin in this patient population.

Enpatoran, a Toll-like receptor 7/8 inhibitor, in moderate-to-severe systemic lupus erythematosus: findings from Cohort B of a multicentre, international, double-blind, placebo-controlled dose-finding phase 2 trial

This study aimed to evaluate the efficacy and safety of enpatoran, a TLR7/8 inhibitor, in improving disease activity in patients with moderate-to-severe systemic lupus erythematosus (SLE) compared to placebo. Although enpatoran showed improved British Isles Lupus Assessment Group-based Composite Lupus Assessment (BICLA) response rates at various doses, the primary objective of demonstrating a statistically significant dose-response relationship was not achieved. Overall, enpatoran was well tolerated among participants.

Endovascular thrombectomy for patients with large-core ischaemic stroke presenting up to 24 h after onset (ATLAS): a systematic review and individual patient data meta-analysis with central imaging adjudication

The authors aimed to evaluate the efficacy and safety of endovascular thrombectomy in patients with large-core ischaemic stroke presenting within 24 hours of onset, a group often excluded from such treatments. Their systematic review and meta-analysis of individual patient data from six trials found that endovascular thrombectomy significantly improved functional outcomes and reduced mortality compared to medical management, although the benefits were less clear for patients with very large ischaemic core volumes (≥150 mL). Overall, the findings suggest that endovascular thrombectomy is beneficial for most patients with large-core ischaemic strokes, except in cases of extensive ischaemic changes presenting beyond 6 hours.

Digoxin in Patients With Symptomatic Rheumatic Heart Disease: A Randomized Clinical Trial

The study aimed to determine whether digoxin improves outcomes related to death or worsening heart failure in patients with symptomatic rheumatic heart disease compared to a placebo. The results indicated that digoxin significantly reduced the risk of the composite outcome of all-cause death or new-onset/worsening heart failure, with a low incidence of toxicity. Overall, digoxin appears to be a beneficial treatment option for this patient population.

Efficacy and Safety of Digitalis Glycosides in Heart Failure: A Meta-Analysis

The authors aimed to evaluate the efficacy and safety of digitalis glycosides in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or reduced ejection fraction (HFrEF). Their meta-analysis of three randomized controlled trials involving 9,013 patients found that digitalis glycosides significantly reduced the risk of cardiovascular death or first worsening heart failure event, primarily by lowering the incidence of worsening heart failure. These findings suggest that digitalis glycosides may be a beneficial adjunct therapy for managing these heart failure conditions.

Renin-angiotensin-aldosterone system inhibition and haemocompatibility-related adverse events in patients with durable left ventricular assist device: the MOMENTUM-3 trial 

The authors aimed to determine whether inhibition of the renin-angiotensin-aldosterone system (RAASi) is associated with a reduction in hemocompatibility-related adverse events (HRAE) in patients with durable left ventricular assist devices (LVAD). Their analysis of 1,855 patients from the MOMENTUM-3 trial revealed that RAASi therapy significantly lowered the rates of composite HRAEs, particularly non-surgical bleeding, suggesting that pharmacological modulation of neurohormonal pathways could enhance long-term outcomes in LVAD therapy.

Randomized Sham Controlled Trial of Translumbosacral Neuromodulation Therapy for Fecal Incontinence

The authors aimed to evaluate the efficacy and safety of translumbosacral neuromodulation therapy (TNT) for treating fecal incontinence (FI) in a randomized sham-controlled trial. Results indicated that both 2400 and 3600 magnetic pulse treatments significantly reduced weekly FI episodes and improved bowel symptoms compared to sham treatment, with no serious adverse events reported, demonstrating that TNT is a promising non-invasive option for FI management.

The role of community-based blood pressure screening in improving hypertension care

The authors argue against the viewpoint that mass blood pressure screening detracts from hypertension care, positing instead that community-based screening can enhance hypertension detection, especially in underserved populations. They emphasize that such screening, when conducted with validated methods, can effectively identify individuals with elevated blood pressure and raise awareness about hypertension, ultimately supporting better management and control of the condition. The paper advocates for integrating community screening with primary care to address the global challenge of hypertension.

Serum trace and heavy metal exposure and IVF/ICSI outcomes: modifying effects of maternal diet in a prospective cohort

The authors aimed to investigate the associations between serum concentrations of ten trace and heavy metals and outcomes of IVF/ICSI, while also examining how maternal dietary patterns might modify these relationships. The study found that higher levels of magnesium and calcium were linked to improved embryo quality, whereas elevated lead levels negatively impacted embryo rates. Additionally, dietary habits, particularly high caffeine consumption, influenced these associations, suggesting that optimizing maternal diet could enhance resilience against metal-related reproductive risks.