Clinical Publication
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Efgartigimod for Seronegative Myasthenia Gravis
In an uncontrolled, open-label series of patients with myasthenia gravis, double antibody-negative patients responded to immunosuppressive therapies in a similar manner as do those with antibodies to acetylcholine receptors (AChR) or muscle-specific tyrosine kinase. However, when treating myasthenia patients with a specific agent (efgartigimod) that blocks AChR antibodies at the level of endothelial cells, double antibody-negative patients do not respond as well.
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Usefulness of the Physical Examination in the Concussed Patient
This article suggests that certain specific physical examination findings may be helpful in evaluating and monitoring patients with sports-related concussion using oculovestibular responses and balance tests.
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Intensive Lifestyle Interventions May Prevent and Ameliorate the Symptoms of Alzheimer’s Disease
Recent clinical studies support the benefit of intensive lifestyle interventions, which should include a plant-based diet, exercise, stress management, and avoidance of smoking and alcohol, for the prevention of Alzheimer’s disease.
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Non-Marine Envenomations in the United States
Envenomations can be caused by many different species, both marine and non-marine. The presentation can range from minor skin irritation to anaphylaxis, systemic illness, organ failure, and even death. Knowing which species are endemic to the area, and what the presentations of medically important envenomations will look like, can aid in recognition and timely treatment, especially when the bite or sting was unwitnessed. This article will give an overview of medically important non-marine envenomations in the United States, including their clinical manifestations, treatment, and disposition.
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Cardioversion in Obese Patients
A multicenter, single-blind, randomized clinical trial of dual vs. single defibrillator shocks for cardioverting obese patients with atrial fibrillation showed that dual defibrillation was significantly more effective without any increase in adverse events.
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Are Women with Atrial Fibrillation Still at Higher Risk of Ischemic Stroke?
A Finnish national database study of newly diagnosed atrial fibrillation from 2007-2018 has shown that the independent association of ischemic stroke risk with female sex initially was high but trended downward to nonsignificant at the end of the study. This has implications for the risk stratification of atrial fibrillation patients regarding oral anticoagulation therapy.
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Insights from the Apixaban vs. Aspirin for Subclinical Atrial Fibrillation Trial
An analysis of the ARTESiA trial of apixaban vs. aspirin for stroke prevention in subclinical atrial fibrillation by CHA2DS2VASc score has shown that the benefits of apixaban outweigh the risk of major bleeding at scores > 4 and the opposite is true at scores < 4.
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Empagliflozin Post-Acute Myocardial Infarction
A prespecified further analysis of the EMPACT-MI trial has shown that patients within two weeks of an acute myocardial infarction who are at risk for heart failure who receive empagliflozin compared to placebo have significantly fewer episodes of heart failure hospitalizations over a median follow-up of 18 months.
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Impella Scores a Big Win in Infarct-Related Cardiogenic Shock, but with Big Caveats
In this randomized controlled trial of patients presenting with ST-elevation myocardial infarction and cardiogenic shock, use of the Impella microaxial flow pump resulted in improved survival but also higher adverse safety events compared with standard care.
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Furosemide for the Management of Postpartum Hypertension
Current evidence does not support the effectiveness of furosemide in reducing the mean arterial pressure within 24 hours before discharge from delivery hospitalization or before starting antihypertensive medications, compared to a placebo.