Cardiology
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Surgical Management of Infective Endocarditis
SOURCES: Chu VH, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: A prospective study from the international collaboration on endocarditis. Circulation 2015;131:131-140; Erbel R. The new strategy in infective endocarditis: Early surgery based on early diagnosis: Are we too late when early surgery is best? Circulation 2015;131:121-123. -
Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes
Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.1 To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.
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Intravenous Fluids in Patients With Acute Heart Failure
MONOGRAPH: Volume overload is a hallmark of acute heart failure. In hospitalized patients, intravenous loop diuretics are the most common treatment for decongestion.
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Internal Medicine [ALERT]
The United States Preventive Services Task Force (USPSTF) gave a level B recommendation in support of annual low-dose computed tomography (LDCT) to screen for lung cancer in appropriate risk groups. The USPSTF decision was largely based on the National Lung Screening Trial (NLST), a mega-trial (n = 53,454) in the United States that randomized subjects to annual LDCT or chest X-ray. The primary endpoint of the study was lung cancer mortality, and all-cause mortality was a secondary endpoint. Inclusion criteria included at least a 30-pack/year history of smoking (if stopped within 15 years), ability and willingness to complete follow-up for abnormal findings, and absence of problematic comorbidities that might otherwise compromise long-term survival.
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Human Papillomavirus 9-valent Vaccine, Recombinant (Gardasil® 9)
The FDA has approved a 9-valent human papillomavirus (HPV) vaccine. The new vaccine covers five more types of HPV than the previous vaccine and protects against 90% of the HPV strains that cause cervical cancer.1 The new vaccine is marketed by Merck as Gardasil®9.
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Liraglutide Preserves Beta Cell Function — Well, Kind of…
SYNOPSIS: Fifty-one patients with type 2 diabetes of 2.6 +/- 1.9 years duration and an A1C of 6.8 % completed 4 weeks of intensive insulin therapy in order to eliminate glucose toxicity which is injurious to pancreatic beta cells. Thereafter, patients were randomized to receive daily subcutaneous liraglutide or an equivalent volume of placebo. Serial assessments of beta-cell function following oral glucose tolerance testing was performed at 12 week intervals for 48 weeks. Patients using liraglutide noted a rebust enhancement of beta cell function which was sustained over the course of the trial, yet lost within two weeks after stopping treatment.
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Clinical Briefs
The Heavy Emotional Costs of Rosacea, Treatment Choices Among the PDE5 Inhibitors, and Screening Asymptomatic Diabetics with CT angiography
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Ombitasvir, Paritaprevir, and Ritonavir, Dasabuvir Tablets (Viekira™ Pak)
The FDA has approved the fourth new product for the treatment of chronic hepatitis C (HCV) infection since November 2013. The latest is a four fixed-drug combination (3-DAA) that includes paritaprevir, a nonstructure 3/4A protease inhibitor, ombitasvir, an inhibitor of the NS5A replication complex, and copackaged with dasabuvir, a nonnucleoside NS5B polymerase inhibitor. The plasma levels of paritaprevir is boosted with ritonavir, a CYP3A inhibitor to permit once-daily dosing. The combination is marketed by AbbVie, Inc. as Viekira Pak.
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Can Intracardiac Echo Be Used as a Substitute for Transesophageal Echo Prior to Atrial Fibrillation Ablation?
This article originally appeared in the January 2015 issue of Clinical Cardiology Alert.
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Should Metformin Use In Patients With Chronic Kidney Disease Be Expanded?
SYNOPSIS: Expansion of the metformin label to include patients with mild-to-moderate kidney disease is appropriate.