Charité Clinical Journal Club (English) by Fred Luft - 28.11.2018

The N Engl J Med image shows a cast structure and we are asked to identify the cast as: portal vein, left bronchial tree, femoral vein, hepatic artery, or right bronchial tree. A knowledge of human gross anatomy would be of use here. Peanut allergy, for which there are no approved treatment options, affects patients who are at risk for unpredictable and occasionally life-threatening allergic reactions. In a phase 3 trial, investigators screened participants 4 to 55 years of age with peanut allergy for allergic dose-limiting symptoms at a challenge dose of 100 mg or less of peanut protein (approximately one third of a peanut kernel) in a double-blind, placebo-controlled food challenge. Participants with an allergic response were randomly assigned, in a 3:1 ratio, to receive AR101 (a peanut-derived investigational biologic oral immunotherapy drug) or placebo in an escalating-dose program. We learn that in young individuals, a desensitization is possible. Acute gastroenteritis develops in millions of children in the United States every year, and treatment with probiotics is common. However, despite universal enthusiasm for probiosis, data to support the use of probiotics in this population are limited. Invesitgators conducted two prospective, randomized, double-blind trials involving children 3 months to 4 years of age with acute gastroenteritis who presented in pediatric emergency departments. Both trials were negative. Thus, there is no evidence that „probiosis“ is of value in the treatment of gastroenteritis in children. The anaplastic lymphoma kinase (ALK) gene can form a translocation with echinoderm microtubule-associated protein-like-4 (EML4) in about 5% of patients with non-small-cell lung cancer. The result can be treated with crizotinib, but a „next generation“ drug might be better. Brigatinib, a next-generation anaplastic lymphoma kinase (ALK) inhibitor, has robust efficacy in patients with ALK-positive non–small-cell lung cancer (NSCLC) that is refractory to crizotinib. The efficacy of brigatinib, as compared with crizotinib, in patients with advanced ALK-positive NSCLC who have not previously received an ALK inhibitor is unclear. We learn that brigatinib beats crizotinib. Under normal conditions, the phospho-inositol-3 kinase (PI3K) plays an integral role in translating extracellular growth signals into the intracellular actions that facilitate growth by coupling macromolecule biosynthesis with the initiation of cell-cycle progression. For instance, insulin relies on PI3K for its effects. The N Engl J Med review is about PI3K and its potential role in cancer and other non-communicable diseases. The case of the week concerns a young patient with a large 11 cm-diameter renal mass. Lorcaserin is a selective agonist of the 5-hydroxytryptamine 2C serotonin receptor (5-HT2C) that regulates appetite through hypothalamic activation of the anorexigenic pro-opiomelanocortin pathway. In the Lancet, we learn that an antibody against the 5-HT2C receptor could promote weight loss and decrease the progression to type-2 diabetes. A substantial proportion of patients with migraine does not respond to, or cannot tolerate, oral preventive treatments. Erenumab is a novel CGRP-receptor antibody with preventive efficacy in migraine. Lancet investigators assessed its efficacy and tolerability in patients with episodic migraine in whom previous treatment with two-to-four migraine preventives had been unsuccessful. Food producers are amongst the world’s most successful lobbyists. The world-wide Dairy industry is of course very interested in keeping consumption of milk products as high as possible. Dietary guidelines recommend minimizing consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, Salim Yussuf and associates aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. They discovered that the more dairy products consumed, the less strokes and myocardial infarction occurred. The list of sponsors for this study is extremely long and difficult to discern, including a grant from the Royal House of Saud. The Lancet reviews are on depression and hepatitis B, both important and well-covered topics. We close with an interactive case from N Engl J Med. I disagree with several of the authors’ points regarding diagnosis and treatment of hyponatremia.