Suspect encephalitis, start aciclovir, keep the specific PCR

The edition in brief

Encephalitis: a joint European Academy of Neurology and ESCMID guideline considered 16 questions and made two GRADE recommendations — start intravenous aciclovir as soon as encephalitis is suspected, and do not replace pathogen-specific cerebrospinal fluid PCR with multiplex panels. It could not recommend for or against corticosteroids in proven HSV encephalitis, and added 13 good practice statements. Fibromyalgia: a network meta-analysis of 151 trials and 32,592 participants found low-certainty evidence that SNRIs, noradrenaline reuptake inhibitors, gabapentinoids and sodium oxybate may help some patients, but no drug reached a clinically important pooled effect on pain, physical or mental health. Responder analyses suggested 111 to 202 more per 1,000 achieving 30% pain relief with some agents. Pulmonary hypertension after PE: in the CTEPH-DETECT quasi-cluster trial of 400 patients, an electronic alert to their physicians raised echocardiography from 17.5% to 32.5% and pulmonary hypertension detection from 5.0% to 10.5%; no new chronic thromboembolic pulmonary hypertension was diagnosed. Low-risk chest pain with anxiety: in PACER, 375 patients discharged from the emergency department improved on all three arms, and peer-supported internet CBT improved anxiety scores by 1.22 points more than primary care referral, with larger effects in severe anxiety.