Episode 414: 421. Scabies and DUKE criteria

Episode 414: 421. Scabies and DUKE criteria

Stavropoulou E, et al. Reassessing the 2023 International Society for Cardiovascular Infectious Diseases Duke clinical criteria for infective endocarditis: Impact of excluding fever and updating diagnostic definitions. Clin Infect Dis 2025 Dec 31; [e-pub]. DOI: 10.1093/cid/ciaf737.

Big takeaways

  • About 35% of patients truly had IE.
  • Fever showed up in 80% of patients both with and without IE, so it did not help distinguish them.
  • Dropping fever from the criteria actually made them better:

  • Sensitivity improved: 77% (no-fever) vs 74% (standard).
  • Specificity improved a lot: 80% vs 49%.
  • "Possible IE" shrank from 39% to 17%, meaning fewer gray-zone cases.
  • Only 0.4% of patients without IE were incorrectly labeled as having IE.




Both are widely used and both can work for regular (non-crusted) scabies.

The SCRATCH trial: who won?

In the SCRATCH trial from France, researchers treated about 1000 people in 300 households with confirmed scabies. Each household was randomized to:

Whole-body 5% permethrin cream on days 0 and 10, or

Oral ivermectin (weight-based) on days 0 and 10.

They then checked who was cured at day 28.

Here's what they found:

Household cure rates

Permethrin: 88% cured

Ivermectin: 72% cured

Translation: For every 6 households treated with permethrin instead of ivermectin, one extra household was fully cured (NNT 6).

Index (main) patient cure rates

Permethrin: 92%

Ivermectin: 77%

That's one extra person cured for about every 7 treated with permethrin instead of ivermectin (NNT 7).

Side effect

Skin irritation-type reactions: 14% with permethrin vs 10% with ivermectin.

So permethrin wins on cure, with a small trade-off in local skin reactions.

Jaksot(385)

Episode 407: 415. Do Air Filters Lower Blood Pressure?

Episode 407: 415. Do Air Filters Lower Blood Pressure?

https://pubmed.ncbi.nlm.nih.gov/40767818/This is a great example for students and residents to look and see that the abstract does not always match what the paper actually says

12 Marras 20259min

Episode 406: 414. Resistant Hypertension, Physical Therapy, Steroids for Pneumonia

Episode 406: 414. Resistant Hypertension, Physical Therapy, Steroids for Pneumonia

Efficacy and safety of Baxdrostat in uncontrolled and resistant hypertension compared to placebo in phase three when there are MRA available that are cheap and availableA randomised trial of physical ...

3 Marras 202515min

Episode 405: 413. 4 Articles to Scare You-- COPD, Cirrhosis, ETOH, and Ablation

Episode 405: 413. 4 Articles to Scare You-- COPD, Cirrhosis, ETOH, and Ablation

gabapentin may increase COPD exacerbationsBenzo for ETOH might be long gone..guess what is going to replace itAnticoagulation after ablation.... what do you do with it?BBlocker in those with cirrhosis...

31 Loka 202518min

Episode 404: 412. Liver Transplant - The One Referral I Doubt You Are Doing Correctly

Episode 404: 412. Liver Transplant - The One Referral I Doubt You Are Doing Correctly

Clinicians should refer patients for liver transplant evaluation after any decompensation event—such as ascites or variceal bleeding—regardless of MELD score. After a first decompensation, 5-year mort...

24 Loka 20257min

Episode 403: 411. Gabapentin and Emergency Carotid Artery Stenting in Stroke

Episode 403: 411. Gabapentin and Emergency Carotid Artery Stenting in Stroke

Study Summary: Emergent Carotid Stenting in Acute Stroke ThrombectomyA multicenter registry study in Catalonia (2017–2023) evaluated outcomes in 578 patients with acute ischemic stroke and tandem lesi...

22 Loka 202510min

Episode 402: 410. When You Shouldn't Double Down But Instead Hit for Another

Episode 402: 410. When You Shouldn't Double Down But Instead Hit for Another

This massive meta-analysis of 484 randomized, double-blind, placebo-controlled trials (104,176 participants) quantified the blood pressure–lowering effects of major antihypertensive drug classes and t...

16 Loka 20258min

Episode 401: 409. The Effects of Upper Extremity and Lower Extremity Aerobic Exercise Training in Patients with Peripheral Arterial Disease:

Episode 401: 409. The Effects of Upper Extremity and Lower Extremity Aerobic Exercise Training in Patients with Peripheral Arterial Disease:

Practice Pearls: “Skip Leg Day” (Sometimes)For PAD patients who can’t tolerate leg workouts, upper body aerobic training is a strong, evidence-backed alternative. It’s not just a workaround—it’s a wor...

14 Loka 20257min

Episode 400: 408. CME Obesity and MASH

Episode 400: 408. CME Obesity and MASH

GLP1 drugs work but they likely need lifestyle modificationsNo convincing evidence GLP1 cause thyroid cancer in humans BUT contraindication if family history existStopping therapy usually results in w...

27 Syys 20251h 2min

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