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Are Epidural Steroid Injections Cost-Effective?
In a retrospective review of patients treated for low back pain and lumbar radiculopathy at the Cleveland Clinic, at three- and six-month follow-up, epidural steroid injections were no better than conservative therapies in quality of life measures or overall cost of medical care.
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Incidence of Cardiovascular Disease and All-Cause Mortality: Does the Type of Meat Consumed Matter?
Investigators found consuming more processed meat, unprocessed red meat, or poultry (but not fish) was closely connected to a higher risk for incident cardiovascular disease. Meanwhile, consuming processed meat or unprocessed red meat (but neither fish or poultry) was strongly associated with a higher risk of all-cause mortality.
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Heart Failure Confers Increased Risk of Venous Thromboembolic Events
In the Atherosclerosis Risk in Communities (ARIC) cohort, incident heart failure hospitalization with either preserved or reduced ejection fraction was associated with long-term increased risk of venous thromboembolic events.
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Role of Cardiac MRI in Recurrent Pericarditis
This multicenter study revealed cardiac MRI may be useful in the diagnosis of difficult pericarditis cases, especially if pericardial edema and late gadolinium enhancement are found. Pericardial thickening and elevated C-reactive protein were found to be predictive of recurrent pericarditis and other complications.
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Anatomic vs. Functional Testing in Older Coronary Artery Disease Patients
An analysis of the PROMISE trial by age showed that cardiovascular death or myocardial infarction was predicted by a positive stress test in patients with symptoms suggesting myocardial ischemia who were >age 65 years, but only CT angiography or a calcium score was predictive in symptomatic patients < age 65 years.
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Warfarin or DOACs for Atrial Fibrillation in Chronic Kidney Disease?
A large outpatient observational study of patients with atrial fibrillation and chronic kidney disease who were anticoagulated revealed that, compared to warfarin, direct oral anticoagulants exhibited less all-cause mortality and major bleeding with at least equivalent efficacy at preventing stroke.
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What Device-Detected Atrial Fibrillation Burden Reveals About Stroke Risk
In a retrospective analysis of electronic health record data matched with remote pacemaker and implantable cardioverter-defibrillator recordings of atrial fibrillation episodes, a threshold daily arrhythmia burden portending higher stroke risk was determined over a range of CHA2DS2-VASc scores.
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Infectious Disease Alert Updates
Urinary Fermentation Syndrome? Residential Legionellosis From Potable Water; Which Treatment for SARS-CoV-2 Is Best?
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Imipenem, Cilastatin, Relebactam (Recarbrio)
In July 2019, the Food and Drug Administration (FDA) approved imipenem, cilastatin, relebactam for the treatment of complicated urinary tract infections (cUTI), including pyelonephritis and complicated intra-abdominal infections (cIAI).
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Empiric Anti-MRSA Therapy in Pneumonia May Not Always Be a Good Idea
In a retrospective cohort study, 88,605 patients in the Veterans Administration system who were hospitalized with pneumonia were examined. Thirty-eight percent received empiric anti-methicillin-resistant Staphylococcus aureus (MRSA) treatment. Empiric anti-MRSA treatment was not associated with a reduction in mortality in any subgroup of patients studied and appeared to cause harm in many patients.