Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients
Findings of this trial indicate that etomidate anesthesia does not increase postoperative morbidity in older patients compared with propofol.
KEY FINDINGS: Results of this trial showed that, compared with propofol, etomidate anesthesia did not increase overall major in-hospital morbidity after abdominal surgery in older patients, although it induced transient adrenocortical suppression.
BACKGROUND: Aim of this study is to test the primary hypothesis that etomidate vs propofol for anesthesia does not increase in-hospital morbidity after abdominal surgery in older patients.
DETAILS: This multicenter, parallel-group, noninferiority randomized clinical trial (Etomidate vs Propofol for In-hospital Complications [EPIC]) was conducted between August 15, 2017, and November 20, 2020, at 22 tertiary hospitals in China. Participants were aged 65 to 80 years and were scheduled for elective abdominal surgery. Patients and outcome assessors were blinded to group allocation. Data analysis followed a modified intention-to-treat principle. Primary outcome was a composite of major in-hospital postoperative complications (with a noninferiority margin of 3%). Secondary outcomes included intraoperative hemodynamic measurements; postoperative adrenocortical hormone levels; self-reported postoperative pain, nausea, and vomiting; and mortality at postoperative months 6 and 12. A total of 1944 participants were randomized, of whom 1917 (98.6%) completed the trial. Patients were randomized to the etomidate group (n = 967; mean [SD] age, 70.3 [4.0] years; 578 men [59.8%]) or propofol group (n = 950; mean [SD] age, 70.6 [4.2] years; 533 men [56.1%]). The primary end point occurred in 90 of 967 patients (9.3%) in the etomidate group and 83 of 950 patients (8.7%) in the propofol group, which met the noninferiority criterion (risk difference [RD], 0.6%; 95% CI, -1.6% to 2.7%; P = .66). In the etomidate group, mean (SD) cortisol levels were lower at the end of surgery (4.8 [2.7] µg/dL vs 6.1 [3.4] µg/dL; P < .001), and mean (SD) aldosterone levels were lower at the end of surgery (0.13 [0.05] ng/dL vs 0.15 [0.07] ng/dL; P = .02) and on postoperative day 1 (0.14 [0.04] ng/dL vs 0.16 [0.06] ng/dL; P = .001) compared with the propofol group. No difference in mortality was observed between the etomidate and propofol groups at postoperative month 6 (2.2% vs 3.0%; RD, -0.8%; 95% CI, -2.2% to 0.7%) and 12 (3.3% vs 3.9%; RD, -0.6%; 95% CI, -2.3% to 1.0%). More patients had pneumonia in the etomidate group than in the propofol group (2.0% vs 0.3%; RD, 1.7%; 95% CI, 0.7% to 2.8%; P = .001). Results were consistent in the per-protocol population.
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Source: Lu, Z., Zheng, H., Chen, Z., et al. (2022). Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients: A Randomized Clinical Trial. Lasers Surg. Med.. 2022; 157(10): 888-895. Published: October, 2022. DOI: 10.1001/jamasurg.2022.3338.
Microbial Dominance in Diabetic Foot Osteomyelitis Determined With Nanopore Sequencing Techniques Predicts Positive Response to Surgical Intervention
In patients with surgically treated OM, nanopore sequencing can generate interpretable metagenomic data from bone specimens that are culture concordant and associated with clinical response. These findings support the feasibility and plausibility of using real-time metagenomic sequencing to improve the clinical management of OM.
KEY FINDINGS: In patients with surgically treated OM, nanopore sequencing can generate interpretable metagenomic data from bone specimens that are culture concordant and associated with clinical response. These findings support the feasibility and plausibility of using real-time metagenomic sequencing to improve the clinical management of OM.
BACKGROUND: Tools to predict successful response to surgery for the treatment of diabetic foot osteomyelitis (OM) are currently lacking. Recent studies in nonbone infections have revealed that nanopore sequencing can provide real-time metagenomic identification of pathogens. In a cohort of patients with diabetic foot OM, we tested the feasibility of generating interpretable metagenomic data from surgically acquired osseous tissue, comparing bacterial community features (pathogen dominance) with clinical outcomes (resolution of infection). Researchers hypothesized that nanopore-generated microbial data can be feasibly generated from surgically acquired bone, aligns with conventional culture results, and is predictive of clinical response.
DETAILS: Researchers performed a pilot feasibility study of 10 consecutive patients hospitalized with diabetic foot OM who underwent surgery for OM. We performed metagenomic sequencing of surgical bone samples using the MinION (Oxford Nanopore). The primary metagenomic index was community dominance (relative abundance of most abundant species). The primary clinical end point was the clinical response to surgery, adjudicated at 1 year. Authors successfully generated interpretable metagenomic data from all 10 specimens, including 2 with negative culture growth. Among culture-positive specimens, the culture-identified pathogen was either the first or second most abundant organism in all cases. Patients with favorable clinical response exhibited greater pathogen dominance than those with unfavorable response (P = .002).
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Copyright © The Authors. Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
Source: Schmidt, B. M., Ranjan, P., Erb-Downward, J., et al. Microbial Dominance in Diabetic Foot Osteomyelitis Determined With Nanopore Sequencing Techniques Predicts Positive Response to Surgical Intervention. The Journal of Infectious Disease. 2026; 233(3): 458-464. Published: March 15, 2026. DOI: 10.1093/infdis/jiaf617
Risk of Dyslipidemia Associated With Oral Janus Kinase Inhibitors
The meta-analysis found that all four JAKi drugs examined - baricitinib, upadacitinib, tofacitinib, and decernotinib - were associated with measurable increases in both HDL and LDL cholesterol compared to placebo. Notably, LDL elevations ranged from approximately 9 to 16 mg/dL depending on the drug, raising potential cardiovascular concerns. The authors conclude that dyslipidemia is a meaningful risk associated with JAKi therapy, and recommend that clinicians conduct routine lipid monitoring and regular cardiovascular risk assessments for patients on these medications to ensure long-term safety.
Summary
A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials
[Posted 16/Mar/2026]
AUDIENCE: Dermatology, Oncology
KEY FINDINGS: This systematic review and meta-analysis highlight the risk of dyslipidemia during treatment with JAKi, which could pose cardiovascular risks. Thus, regular assessments of cardiovascular risk factors and routine lipid monitoring in patients undergoing JAKi therapy may be essential for managing dyslipidemia and evaluating long-term cardiovascular safety.
BACKGROUND: Janus kinase inhibitors (JAKi) have sparked a new era in the treatment of immune-mediated diseases. While some studies have reported an increased incidence of dyslipidemia in JAKi-treated patients, the full extent of this adverse event is not established. The study aimed to assess the association between treatment with oral JAKi and dyslipidemia in phases 2 and 3 placebo-controlled randomized clinical trials (RCTs).
DETAILS: Janus kinase inhibitors (JAKi) have sparked a new era in the treatment of immune-mediated diseases. While some studies have reported an increased incidence of dyslipidemia in JAKi-treated patients, the full extent of this adverse event is not established. The study aimed to assess the association between treatment with oral JAKi and dyslipidemia in phases 2 and 3 placebo-controlled randomized clinical trials (RCTs). A systematic review and meta-analysis were conducted, encompassing phase 2 and 3 RCTs. The Embase, PubMed, and Web of Science databases were searched up to March 9, 2025. Only RCTs reporting lipid levels before and after treatment with JAKi were included. Data were extracted for changes in high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG) with values reported in mg/dL. A total of 13 studies were included in the analysis, comprising nine studies on rheumatoid arthritis, two on atopic dermatitis, one on Crohn's disease, and one on psoriasis. The studies encompassed a total of 3978 patients treated with JAKi and 1680 controls. Across all indications, the mean difference between JAKi and placebo for individual drug, was increased by 6.07 mg/dL (95% confidence interval [CI], 5.01-7.14) for HDL and 9.05 mg/dL (95% CI, 7.78-10.32) for LDL for baricitinib; HDL 5.4 mg/dL (95% CI, 3.2-7.7) and LDL 12.4 mg/dL (95% CI, 8.9-15.9) for upadacitinib; HDL 7.0 mg/dL (95% CI, 5.7-8.3) and LDL 15.7 mg/dL (95% CI, 12.9-18.6) for tofacitinib; and lastly HDL 3.0 mg/dL (95% CI, 0.2-5.8) and LDL 14.9 mg/dL (95% CI, 3.6-26.3) for decernotinib.
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Source: Isufi, D., Javanmardi, N., Jense, M. B., et al. Risk of Dyslipidemia Associated With Oral Janus Kinase Inhibitors: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. International Journal of Dermatology. 2026; 65: 737-745. Published: March, 2026. DOI: 10.1111/ijd.70122
Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications
Complication rates were low after vaginal hysterectomy and laparoscopic hysterectomy. The study results suggest that vaginal hysterectomy is not clearly a preferred route for hysterectomy over laparoscopic hysterectomy. The data support further investigation of the optimal surgical approach for hysterectomy with large, prospective clinical studies.
Summary
Complications and Length of Stay in a National Analysis of Contemporary Data
[Posted 3/Mar/2026]
AUDIENCE: Ob/Gyn, Oncology
KEY FINDINGS: Complication rates were low after vaginal hysterectomy and laparoscopic hysterectomy. The study results suggest that vaginal hysterectomy is not clearly a preferred route for hysterectomy over laparoscopic hysterectomy. The data support further investigation of the optimal surgical approach for hysterectomy with large, prospective clinical studies.
BACKGROUND: The current recommendation to select vaginal hysterectomy for benign indications whenever feasible is based on clinical trials with limited cohorts and older data. This study aimed to evaluate the association between the hysterectomy route (vaginal hysterectomy or laparoscopic/robotic hysterectomy) and short-term outcomes.
DETAILS: A cohort study was conducted using prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2022. Women who underwent vaginal hysterectomy or laparoscopic hysterectomy for benign indications were included. Abdominal hysterectomies, laparoscopic/robotic supracervical hysterectomies, laparoscopic-assisted vaginal hysterectomies, and emergent surgical procedures were excluded. Propensity score matching and multivariate regression analyses were performed to assess outcomes. The primary outcome was the occurrence of complications within 30 days, which was stratified using the Clavien-Dindo classification. The secondary outcomes included operative time, overnight admission, and hospital length of stay. After propensity score matching for patients’ demographics and surgical characteristics, including uterine weight (<250 g or >250 g) and concomitant procedures performed, 83,436 women were included in the analysis, with 41,718 patients each in the vaginal hysterectomy and laparoscopic hysterectomy groups in a 1:1 ratio. Postoperative complications were low in the vaginal hysterectomy and laparoscopic hysterectomy groups (8.2% vs 6.4%, respectively; P<.001; adjusted odds ratio, 1.23 [95% confidence interval, 1.15-1.31]). Major and minor complication risks were minimally increased in the vaginal hysterectomy group. Specifically, vaginal hysterectomy was associated with higher risks of blood transfusion, urinary tract infection, organ/space infection, and reoperation, and laparoscopic hysterectomy was associated with higher risks of wound dehiscence and pulmonary embolism. Operative time was shorter in the vaginal hysterectomy group than in the laparoscopic hysterectomy group (109.6 vs 137.0 minutes, respectively; P<.001). The proportions of overnight admission were 35.5% after vaginal hysterectomy and 27.2% after laparoscopic hysterectomy (adjusted odds ratio, 2.10 [95% confidence interval, 2.02-2.18]). Hospital lengths of stay for >=1 day were 77.9% in the vaginal hysterectomy group and 77.1% in the laparoscopic hysterectomy group (adjusted odds ratio, 1.90 [95% confidence interval, 1.82-1.99]). In addition, hospital lengths of stay for >=2 days were 13.2% in the vaginal hysterectomy group and 10.1% in the laparoscopic hysterectomy group (adjusted odds ratio, 1.55 [95% confidence interval, 1.47-1.63]).
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Source: Meyer, R., Hamilton, K. M., Ezike, O., et al. Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications: Complications and Length of Stay in a National Analysis of Contemporary Data. American Journal of Obstetrics & Gynecology. 2026; 234(3): 620-631. Published: March, 2026. DOI: 10.1016/j.ajog.2025.10.027.
Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy
Topical MB-mediated PDT successfully managed HPV-related FEH in an immunocompromised individual with history of valve disease. This outcome supports the need for further validation through clinical trials.
KEY FINDINGS: PDT mediated by MB is an effective and affordable approach for treating FEH associated with HPV in immunosuppressed patients, offering favorable outcomes and improved quality of life.
BACKGROUND: Human papillomavirus (HPV) infections are a major cause of oral lesions, and in individuals living with HIV, lesions such as focal epithelial hyperplasia (FEH) may persist or exhibit atypical features, potentially progressing to more severe conditions if untreated. Managing oral HPV lesions in immunocompromised patients is challenging, as conventional therapies may carry higher risks or show limited efficacy.
DETAILS: This study reports the case of a 49-year-old HIV-positive male with valve disease and arthritis, requiring crutches for mobility. He presented with multiple painless oral lesions, diagnosed as FEH associated with oral HPV, and had previously undergone unsuccessful treatments. Photodynamic therapy (PDT) using methylene blue (MB) and a red laser was proposed as a treatment. Topical MB-mediated PDT successfully cleared the FEH lesions, with no recurrence observed over 24 months.
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Source: de Araújo, J. C., Paiva, H. C., Faara, P. M. M., et al. Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy. A Case Report. Lasers in Surgery and Medicine. 2026; 58(2): 70-73. Published: February, 2026. DOI: 10.1002/lsm.70091
Oral Itraconazole Versus Oral Voriconazole for Treatment-Naive Patients With Chronic Pulmonary Aspergillosis in India (VICTOR-CPA Trial)
Voriconazole was not superior to itraconazole for treating chronic pulmonary aspergillosis and was associated with a significantly higher incidence of adverse events. Our findings support the continued use of itraconazole as the preferred therapy for chronic pulmonary aspergillosis, although voriconazole remains a reasonable alternative. The choice between the two agents should be guided by factors such as patient tolerance, drug availability, and cost considerations.
Summary
A Single-Centre, Open-Label, Randomised, Controlled, Superiority Trial
[Posted 28/Feb/2026]
AUDIENCE: Infectious Disease
KEY FINDINGS: Voriconazole was not superior to itraconazole for treating chronic pulmonary aspergillosis and was associated with a significantly higher incidence of adverse events. Our findings support the continued use of itraconazole as the preferred therapy for chronic pulmonary aspergillosis, although voriconazole remains a reasonable alternative. The choice between the two agents should be guided by factors such as patient tolerance, drug availability, and cost considerations.
BACKGROUND: Both itraconazole and voriconazole are used to treat chronic pulmonary aspergillosis. However, treatment success with itraconazole is only around 65-70%. Voriconazole, with its lower minimum inhibitory concentrations and better oral bioavailability, might offer improved outcomes, but no head-to-head comparison has been conducted to date. We aimed to evaluate whether oral voriconazole is superior to itraconazole in treating chronic pulmonary aspergillosis.
DETAILS: This single-centre, prospective, open-label, superiority trial was conducted at the chest clinic of a tertiary care hospital in Chandigarh, India. We enrolled treatment-naive adults aged 18 years or older with chronic cavitary pulmonary aspergillosis or chronic fibrosing pulmonary aspergillosis. We excluded those who denied consent, received any antifungal azoles for more than 3 weeks in the previous 6 months, or had other forms of aspergillosis. Participants were randomly assigned 1:1 to receive 200 mg twice daily of oral itraconazole or oral voriconazole for 6 months, using a computer-generated randomisation sequence with variable block sizes (4-8). Participants, staff administering the interventions, clinical outcome assessors, and data analysts were not masked to treatment assignment; a radiologist masked to clinical details and treatment allocation evaluated chest images. The primary outcome was the proportion of participants achieving a favourable response (clinical and radiological stability or improvement) at 6 months in the modified intention-to-treat population, which included all participants who received at least one dose of the allocated treatment. The safety analyses (a secondary outcome) were also performed in the modified intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT04824417) and is complete. Between April 15, 2021, and May 31, 2024, 150 individuals were screened, and 116 were randomly assigned to receive itraconazole (n=58) or voriconazole (n=58). Of the 116 participants, 74 (64%) were men, 42 (36%) were women, and the mean age was 45.9 years (SD 14.4). All participants received at least one dose of the study drug and were included in the primary analysis. The proportion of participants achieving a favourable response at 6 months was similar in both groups (69% [40 of 58] receiving voriconazole vs 67% [39 of 58] receiving itraconazole; absolute risk reduction -0.02 [95% CI -0.2 to 0.15], p=0.84). Voriconazole was associated with significantly more treatment-related adverse events than itraconazole (55% [32 of 58] of participants receiving voriconazole vs 34% [20 of 58] receiving itraconazole, p=0.025). There were four deaths, all in the voriconazole group; none were directly attributable to the treatment.
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Source: Sehgal, I. S., Agarwal, R., Dhooria, S., et al. Oral Itraconazole Versus Oral Voriconazole for Treatment-Naive Patients With Chronic Pulmonary Aspergillosis in India (VICTOR-CPA Trial): A Single-Centre, Open-Label, Randomised, Controlled, Superiority Trial. The Lancet Infectious Diseases. 2026; 26(3): 239-249 Published: March, 2026. DOI: 10.1016/S1473-3099(25)00537-7.
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