The US Department of Health and Human Services, in conjunction with the US Department of Agriculture, has released the latest update of its Dietary Guidelines (www.health.gov). The emphasis this time is on weight loss through calorie restriction and exercise. A low-fat intake is recommended; a low-carbohydrate diet is not. Fruits, vegetables and whole grains are encouraged. A review of Diet, Drugs and Surgery for Weight Loss appeared in the December 2003 issue of Treatment Guidelines from The Medical Letter.

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The investigational monoclonal antibody bebtelovimab (LY-CoV1404 – Lilly) has been granted an FDA Emergency Use Authorization (EUA) for IV treatment of mild to moderate COVID-19 in patients ≥12 years old who weigh ≥40 kg and are at high risk of progressing to severe disease, including hospitalization and death, and for whom alternative treatment options are unavailable or inappropriate. Bebtelovimab is active against the Omicron variant of SARS-CoV-2; sotrovimab (VIR-7831) is the only other monoclonal antibody currently available for treatment of COVID-19 that is active...

Anticoagulants are the drugs of choice for treatment and prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE). US guidelines for treatment of VTE were updated in 2020 and 2021.

A combination tablet containing estradiol and drospirenone (Angeliq - Berlex) recently became available for treatment of moderate to severe menopausal symptoms in women with an intact uterus. Since the last Medical Letter issue reviewing such devices,1 more continuous glucose monitoring (CGM) systems have become available. Five devices available now, and two expected to be marketed soon, are listed in the table on page 14. The FDA has approved continuous glucose devices only for the observation of glucose trends.

Atrial fibrillation (AF) is the most common arrhythmia in the world. Risk factor modification, anticoagulation, rhythm control, and rate control are the four pillars of its management. American College of Cardiology/American Heart Association (ACC/AHA) guidelines on management of AF were updated recently.

Onychomycosis is caused most commonly by Trichophyton rubrum or T. mentagrophytes. About 10% of all persons worldwide and 40% of those ≥60 years old are believed to have the disease. Risk factors include older age, diabetes, poor peripheral circulation, smoking, HIV infection, psoriasis, and immunosuppression. Left untreated, onychomycosis can cause nail plate destruction, ingrown nails, and (particularly in patients with diabetes) secondary infections. Guidelines on treatment of onychomycosis have been published.

Clostridioides (formerly Clostridium) difficile infection (CDI) is the most common infectious cause of healthcare-associated diarrhea in adults. Guidelines on management of CDI have recently been updated.

The CDC has reported that many states are experiencing a higher-than-usual incidence of pertussis this year. The highest incidence has been in infants, but the disease has also occurred in older children, adolescents, and adults. Thirteen pertussis-related deaths were reported through August 24; the majority of these were in infants <3 months old.

The Interruption of Anticoagulation section of our article on Treatment of Atrial Fibrillation cited the recommendations of the American College of Chest Physicians on perioperative management of antithrombotic therapy (JD Douketis et al. Chest 2022; 162:e207). A reader suggested that our general statement on when to discontinue an oral anticoagulant would have benefited from inclusion of the recommendations of the American College of Cardiology/American Heart Association (JA Joglar et al. Circulation 2024; 149:e1). Recommendations for periprocedural management of oral anticoagulant therapy...