Clinical Publication
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Repeated Head Trauma May Lead to Parkinsonism in Patients with CTE
Repeated head injury from years of contact sports play in men with confirmed chronic traumatic encephalopathy (CTE) may cause pathological changes in the substantia nigra that lead to parkinsonism in a subset of patients with CTE.
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Genetic Testing for Patients with Parkinson’s Disease
In this large scale, international study of Parkinson’s disease (PD) patients, approximately 15% of participants were found to have a positive PD-related genetic variant, most commonly in the GBA1 and LRRK2 genes.
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MRI-Guided Focused Ultrasound Thalamotomy for Treating Essential Tremor
This open-label study demonstrated the safety and efficacy of staged bilateral magnetic resonance imaging-guided focused ultrasound thalamotomy for bilateral essential tremor with excellent efficacy rates at one year. Most adverse events were mild, but greater real-world experience is needed to understand its true safety profile.
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A New Technique for Predicting Outcomes in Asymptomatic AS
An international study of patients with moderate or asymptomatic severe aortic stenosis has demonstrated that increased amounts of left ventricular fibrosis, as measured by cardiac magnetic resonance imaging, is associated with worse outcomes.
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PCI in TAVR Patients with Severe Coronary Lesions Shows Benefits
In this randomized trial of patients undergoing transcatheter aortic valve replacement (TAVR), with an average of one severe coronary stenosis, percutaneous coronary intervention in addition to TAVR reduced the incidence of the combined endpoint of all-cause mortality, myocardial infarction, and urgent revascularization at two years.
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Screening for Atrial Fibrillation in Older Adults
A two-week ambulatory electrocardiogram monitor in a large group of individuals 70 years of age or older with no history of atrial fibrillation (AF) showed a very low incidence of AF (4.4%), almost all of which was paroxysmal. In less than 2% of the subjects did it represent ≥ 2% of the monitoring time. However, some patients had hours of AF, raising a concern for thromboembolic risk.
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Biomarker Enhances Screening for Atrial Fibrillation
A large Swedish population study of screening for atrial fibrillation (AF) in 75-year-old individuals that was enhanced by N-terminal pro-B-type natriuretic peptide (NT-proBNP) stratification did not identify more AF cases or prevent thromboembolic outcomes compared to unscreened control subjects. However, a low NT-proBNP (< 125 ng/L) did identify individuals at low risk for AF and thromboembolic events in whom screening could be safely forfeited.
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A New Drug for Heart Failure with Preserved Ejection Fraction?
The addition of the nonsteroidal mineralocorticoid receptor antagonist finerenone to standard therapy reduced the incidence of recurrent heart failure and death compared to placebo in patients with heart failure and mildly reduced or preserved left ventricular ejection fraction and was generally well tolerated.
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Beyond the Symptoms: A Primary Care Approach to Depression Management
In the vast mosaic of primary care, depression often remains in the shadows, embedded in patient care but easily overlooked. Left unrecognized, the prognosis worsens and complicates the management of other chronic conditions. However, with timely identification and effective treatment, the course of depression can be altered significantly. A comprehensive understanding of this condition, coupled with effective treatment strategies, empowers the primary care physician to mitigate the potentially debilitating effects of this condition.
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Look for the Pattern
How would you interpret the two-lead rhythm strip shown in the figure? Hint: Is there a pattern?