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Family Medicine - Adult Cardiovascular Medicine

International validation of the Canadian Syncope Risk Score (June 2022)


Multiple risk stratification tools have been developed to avoid expensive unnecessary admissions for syncope, but none are universally accepted. The Canadian Syncope Risk Score (CSRS) has been validated in several sites across Canada and recently validated in an international, multicenter cohort that included over 2200 adults who presented to an emergency department (ED) with syncope.2 In nearly 1400 patients classified as low-risk by the CSRS, only 1 percent had a serious clinical event or required a procedure at 30 days. A multivariate regression analysis of the nine individual items of the CSRS found that ED clinician gestalt for the classification of syncope (eg, cardiac syncope, vasovagal syncope, or other) had similar accuracy compared with the entire CSRS. This supports our recommendation that risk stratification tools should be used to assist clinical judgment but cannot replace it.


Allergy and Immunology - Asthma and COPD

Risk factors for thunderstorm asthma (July 2022)


"Thunderstorm asthma" refers to asthma exacerbations that occur in the hours after a thunderstorm, especially storms occurring during pollen seasons. The mechanism appears to involve rupture of water-logged pollen grains, which releases allergenic debris that is swept up by strong cross currents and deposited in concentrated form at ground level. In a multicenter study of adults with a past diagnosis of thunderstorm asthma and/or seasonal allergic rhinitis, risk factors for thunderstorm asthma included higher pollen-specific immunoglobulin E levels, eosinophil counts, fractional exhaled nitric oxide levels, and asthma that was not optimally controlled.3 Clinicians should be aware that thunderstorms can precipitate asthma and counsel patients with pollen allergies and asthma to avoid the outdoors during and after thunderstorms occurring during pollen seasons.


Dermatology - Other Dermatology

Guidelines for pregnancy and childbirth in patients with epidermolysis bullosa (June 2022)


Limited evidence from small case series suggests that women with epidermolysis bullosa (EB) can have successful pregnancies and deliveries. Consensus-based guidelines that provide recommendations for improving the preconception, pregnancy, childbirth, and postpartum management of women affected with EB have been recently published.4 They provide detailed guidance for the care of patients with EB who desire to plan a pregnancy. Main recommendations include engaging a multidisciplinary team early during pregnancy, preparing a birth plan, offering vaginal birth as the preferred mode of delivery, and providing modified skin care during labor (eg, padding monitoring equipment) to minimize skin trauma.


Family Medicine - Prevention

Low-dose aspirin for primary cardiovascular disease prevention (June 2022)


Low-dose aspirin may prevent cardiovascular disease (CVD) in some patients but also increases the risk of bleeding. The 2022 United States Preventive Services Task Force (USPSTF) statement concluded that among people 40 to 59 years of age with a >=10 percent risk of CVD over the next ten years, there is a small potential benefit of low-dose aspirin.1 The USPSTF did not recommend starting low-dose aspirin in persons over 60 years without heart disease. We believe the decision to prescribe aspirin for primary prevention should be made by the patient and their provider after discussing individual risks and benefits.


1. Davidson KW, Barry MJ, et alUS Preventive Services Task Force Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577. [Context Link]


2. Zimmermann T, du Fay de Lavallaz J, Nestelberger T, et al International Validation of the Canadian Syncope Risk Score: A Cohort Study. Ann Intern Med. 2022;175(6):783. Epub 2022 Apr 26. [Context Link]


3. Douglass JA, Lodge C, Chan S, et al Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study. J Allergy Clin Immunol. 2022;149(5):1607. Epub 2021 Nov 11. [Context Link]


4. Greenblatt DT, Pillay E, Snelson K, et al Recommendations on pregnancy, childbirth and aftercare in epidermolysis bullosa: a consensus-based guideline. Br J Dermatol. 2022;186(4):620. Epub 2021 Nov 25. [Context Link]


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