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TFP #267 – Serology, Serology: How Accurate and Prevalent Art Thou?

Clinical Question:  What is the role of serology testing in the COVID-19 pandemic? Bottom Line:  IgM and IgG antibodies may reveal an individual’s recent (after ~2 weeks) exposure to COVID-19. How long serology remains positive and whether antibodies confer immunity to subsequent infection is unknown. Many different tests exist, each with different accuracy. Current evidence…

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TFP #266 – Exercise-induced osteoarthritis: Running into problems?

Clinical Question:  Does running increase the risk of developing osteoarthritis? Bottom Line:  Based on low-quality observational data, running likely does not increase the risk of developing osteoarthritis, except possibly in elite athletes. Additionally, recreational running may be associated with lowering the risk of knee osteoarthritis. Exercise is one of the most effective treatments for reducing…

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TFP #265 – “Does baby know best?”: Benefits and harms of baby-led weaning for transitioning to solid foods

Clinical Question: What impact does baby-led weaning have on infant growth, iron intake, and choking? Bottom Line:  Transitioning infants to solid foods using a baby-led weaning approach (with parental education) results in up to 0.7kg less weight gain at 12 months than traditional spoon feeding. This is of unknown clinical significance. There is no difference in…

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TFP #264 – From theory to reality: ACEi, ARB, and COVID-19

Clinical Question: Do angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) increase the risk of catching, or severity of infection with, COVID-19? Bottom Line: Despite initial theoretical suggestions that ACEi and ARB are harmful, four observational studies have since found no association between COVID-19 infection or severity of disease and ACEi/ARB. One cohort study with…

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TFP #263 – Finding COVID – How Good is the Test to Detect it?

Clinical Question: What is the chance of obtaining an incorrect result with the polymerase chain reaction (PCR) test for COVID-19? Bottom Line: If the PCR COVID-19 test is positive you have COVID-19 (specificity ~100%). Small Canadian studies suggest the test will detect COVID-19 ~80-90% of the time (sensitivity), although estimates range from ~50%-90%. Collection technique, anatomical sample…

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TFP #262 – Who let the Gout Out? Targeting Uric Acid Levels in Treating Gout

Clinical Question:  To prevent gout recurrence, should we dose urate lowering therapies (like allopurinol) to target uric acid levels? Bottom Line: Best evidence finds that increasing doses of allopurinol to achieve a specific serum urate target (example <360 μmol/L) does not reduce gout flares, pain, or function, compared to standard allopurinol dosing. Febuxostat increases cardiovascular and…

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TFP #261 – Antivirals for COVID-19

Clinical Question: Do treatments such as remdesivir or other anti-virals change patient outcomes in COVID-19 patients? Bottom Line: To date, published RCTs have not demonstrated benefit of treating COVID-19 patients with remdesivir, lopinavir-ritonavir or oseltamivir.  There are signals of potential benefits from one interim analysis of remdesivir and non-statistically different results, but more research is needed. Full publication of studies…

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TFP #260 – Are there tools to help assess dyspnea virtually?

Clinical Question: Are there any techniques (like the Roth Score) to augment a typical history when assessing dyspnea/pneumonia over the phone or by video? Bottom Line: Unfortunately, no specific technique, including the Roth Score, is reliable in assuring dyspneic patients are not at risk and safe to stay home. Furthermore, no studies have evaluated dyspnea assessment in…

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TFP #259 – Unmasking the evidence around masks for healthcare workers

Clinical Question: Is there a difference between mask types in preventing viral respiratory infections for healthcare workers? Bottom Line: In healthcare workers; Surgical masks and respirators (N95) appear to provide similar protection against viral infections, with N95 masks having slightly lower, but not statistically different, infection rates in the wearer (~1-2%).  Cloth masks are less effective than…

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TFP #258 – Stealth style transmission? Covert data on COVID-19

Clinical Question: What is the evidence for asymptomatic transmission of COVID-19 (including those who will remain asymptomatic and those who are early and not symptomatic yet)? Bottom Line: Transmission of COVID-19 can occur in people who are currently asymptomatic. Case reports suggest this occurs in 6-13% of cases, although modelling suggests this might be higher. The importance of…

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TFP #257 – A rushed introduction to an uninvited guest

Clinical Question: COVID-19: What are the presenting symptoms, clinical course, and risk factors for mortality? Bottom Line: Cough and fever are the most common symptoms. Differences in testing and reporting of cases limit prognostic estimations. At minimum, 80% of cases are clinically mild. Of those hospitalized in North America, ~25% will require ICU admission. Risk factors for…

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TFP #256 -Hydroxychloroquine with or without azithromycin for COVID-19

Clinical Question: Is hydroxychloroquine (with or without azithromycin) effective in treating COVID-19? Bottom Line: One nonrandomized study found that more hydroxychloroquine/azithromycin patients tested negative for virus at days 3 and 6 but clinical outcomes were not reported. One unblinded randomized trial showed no effect from hydroxychloroquine on viral or clinical outcomes. Without further evidence, hydroxychloroquine is not…

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