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Current guidelines recommend limiting the rate of correction in patients with severe hyponatremia to avoid severe neurologic complications such as osmotic demyelination syndrome (ODS). However, published data have been conflicting. We aimed to evaluate the association between rapid sodium correction and ODS in patients with severe hyponatremia.

Introduction: Inclisiran is a novel drug that employs ribonucleic acid (RNA) interference to lower the levels of the proprotein convertase subtilisin/kexin type 9 (PCSK9) protein. It has demonstrated a significant reduction in LDL cholesterol levels compared to a placebo. We aim to comprehensively evaluate the safety of using Inclisiran in patients with dyslipidemia and ASCVD or an ASCVD risk equivalent. Methods: Four electronic databases, namely, Pubmed/MEDLINE, Web of Science, Embase, and ClinicalTrials.gov, were searched from inception to June 2024 to identify relevant randomized controlled trials (RCTs) comparing safety profiles of Inclisiran and the control group. The outcomes investigated were all-cause mortality, major adverse cardiovascular events (MACEs), injection-site adverse events, new-onset or worsening type 2 diabetes mellitus (T2DM), and nasopharyngitis. The effect estimates of outcomes were assessed using the risk ratio (RR) with a 95% confidence interval (CI). Random-effects meta-analysis was conducted using the restricted maximum likelihood method. Subgroup analysis was performed based on different dosing regimens. Results: The study included 7 RCTs, enrolling 4790 patients (age 63.8 ± 9.7 years, 33.2% females) who received Inclisiran. Compared to the control group, Inclisiran use did not yield a significant effect on all-cause mortality (RR, 0.92; 95% CI, 0.54 to 1.54; I2 = 0%), MACEs (RR, 0.98; 95% CI, 0.82 to 1.17; I2 = 0%), nasopharyngitis (RR, 1.10; 95% CI, 0.83 to 1.45; I2 = 0%), and T2DM (RR, 1.02; 95% CI, 0.85 to 1.21; I2 = 0%). However, Inclisiran use demonstrated a significant increase in injection-site adverse events (RR, 6.50; 95% CI, 3.20 to 13.20; I2 = 29%). Conclusions: Inclisiran use significantly increased injection-site reactions, with no increase in mortality, T2DM, or nasopharyngitis. It demonstrates a generally favorable safety profile, making it a promising option for lipid management in individuals at high cardiovascular risk, such as those with ASCVD or equivalent conditions. While it effectively improves dyslipidemia, decision-makers should be aware of an increased incidence of injection-site reactions, which, though typically mild, warrant consideration in clinical practice. Further trials are required to assess the safety of Inclisiran, particularly the association of the severity of injection-site adverse events over longer treatment durations. [ABSTRACT FROM AUTHOR]

Acute recurrent myopericarditis, characterized by the occurrence of a new myopericarditis event following a symptom‐free interval of 4–6 weeks, is relatively rare lacking definitive guidelines for management. Understanding its prevalence, causes, and optimal management is challenging due to limited data and insufficient guidelines. This case outlines the diagnostic work‐up and different management modalities for recurrent myopericarditis. A 44‐year‐old African American man with a past medical history of myopericarditis a year ago presented with fever and chest pain for 4 days. The patient was found to have elevated troponin, CRP, and ESR; pericardial effusion along with a Coxsackie A virus titer of 1:800, suggestive of Coxsackie A virus–induced recurrent myopericarditis. The patient responded well to colchicine and a tapering dose of ibuprofen, achieving significant resolution in the pericardial effusion. Recurrent myopericarditis caused by Coxsackie A virus is a relatively rare phenomenon. New onset myopericarditis can be caused by various factors such as infections, autoimmune disorders, neoplasms, metabolic issues, trauma, and drugs, with recurrence rates of 15%–50% in pericarditis patients. Coxsackie A virus is an important and rare etiology of recurrent myopericarditis due to its unique immune evasive traits. The treatment modalities guided by definitive guidelines for recurrent pericarditis can be applied in recurrent myopericarditis with significant resolution of symptoms. Although there are no specific guidelines for managing recurrent myopericarditis, using approaches designed for recurrent pericarditis has shown promising results, and the immune evasive nature of Coxsackie A virus underscores the need for further research to improve our understanding and treatment of this condition. [ABSTRACT FROM AUTHOR]

We read the article entitled 'Mechanical versus bioprosthetic valves in chronic dialysis: a systematic review and meta-analysis' by Kim and colleagues, (1) with great interest. The authors attempted to address [...]

Summary: There are limited data on the optimal choice of anticoagulation in multiple myeloma (MM) patients receiving immunomodulatory drugs (IMiDs). We conducted a propensity score‐matched cohort study using the TriNetX database to compare the efficacy and safety of factor Xa inhibitors and warfarin in this patient population. Compared to warfarin, factor Xa inhibitors had a similar risk of deep vein thrombosis (hazard ratio [HR]: 1.11 [95% CI: 0.50–2.46]) or pulmonary embolism (HR: 1.08 [95% CI: 0.59–2.00]). There were no differences in the risk of gastrointestinal or intracranial bleeding. Factor Xa inhibitor‐treated patients had lower all‐cause mortality (HR: 0.56 [95% CI: 0.36–0.86]) compared with warfarin. These data suggest that factor Xa inhibitors had similar safety and efficacy compared with warfarin for MM patients on IMiDs. [ABSTRACT FROM AUTHOR]

Simple Summary: Proton pump inhibitors (PPIs) are frequently used in many patients with advanced breast cancer who are being treated with cyclin-dependent kinase inhibitors. In this study, our aim was to determine if there is an association between the use of PPIs and the effectiveness of cyclin-dependent kinase inhibitors, specifically Palbociclib and Ribociclib. We conducted a systematic review and meta-analysis through which to address this clinical question and found that the use of Palbociclib resulted in a lower survival rate for both overall and progression-free survival. However, the concurrent use of PPIs and Ribociclib did not lead to a decrease in the survival rates. Therefore, for cases in which advanced breast cancer patients require the use of PPIs, it may be reasonable to consider using Ribociclib. There have been many clinical questions regarding whether the use of proton pump inhibitors (PPIs) could deteriorate the effects of cyclin-dependent kinase inhibitors (CDKIs) in HR+/HER2- advanced breast cancer patients. We performed a systematic review and meta-analysis of this clinical question, including studies enrolling HR+/HER2- metastatic breast cancer patients treated with CDKIs (Palbociclib or Ribociclib) and reporting at least one comparative survival outcome, either overall survival (OS) or progression-free survival (PFS), between concomitant PPI users and non-users. Eight studies met the eligibility criteria, with a total of 2584 patients included (PPI users: 830, PPI non-users: 1754), demonstrating that concomitant PPI use was associated with significantly higher risks of all-cause mortality (HR = 2.03; 95% CI, 1.49 to 2.77; I2 = 0%) and disease progression (HR = 1.75; 95% CI, 1.26 to 2.43; I2 = 59%) in breast cancer patients taking Palbociclib. In contrast, there were no significant survival impacts of PPIs on Ribociclib (HR = 1.46; 95% CI, 0.91 to 2.34; I2 = 36%). Additionally, there was no significant difference in the risk associated with CDKI dose reduction due to drug toxicity (RR = 1.12; 95% CI, 0.97 to 1.29). Therefore, when HR+/HER2- advanced breast cancer patients require the use of PPIs, it may be reasonable to consider using Ribociclib. [ABSTRACT FROM AUTHOR]