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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.
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Combination Therapy of MRSA Bacteremia Was Not Beneficial in a Randomized Clinical Trial
In a randomized clinical trial conducted at 27 hospitals in four countries, researchers found that the addition of an antistaphylococcal beta-lactam to vancomycin or daptomycin (99% received vancomycin) did not lead to improved outcomes in MRSA bacteremia. The trial was stopped early because of safety concerns, including a higher risk of acute kidney injury in the combination group.
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Quantifying the Risk of SARS-CoV-2 Transmission in the United States
In the United States, the rate of symptomatic transmission of SARS-CoV-2 to contacts was only 0.45%, but was 10.5% in household contacts; there were tertiary symptomatic transmissions. However, since only symptomatic individuals underwent testing, the actual overall rate of transmission with or without resultant symptomatic illness is likely to be higher.
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Pharmacotherapy Considerations for COVID-19
This article provides a brief summary of selected pharmacotherapy options proposed for COVID-19.
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17P to Prevent Recurrent PTB in Singleton Gestations: The PROLONG Study
In this large, double-blind, placebo-controlled, international trial, pregnant women at risk for preterm birth (PTB) between 16-36 weeks gestational age were randomized to an intramuscular weekly injection of either 17-hydroxyprogesterone caproate (17P) or placebo. There was no difference in rates of PTB or neonatal morbidity between these two groups. In comparison to the Meis trial published in 2003, the findings of the PROLONG trial question the use of intramuscular 17P injection as the cornerstone of PTB prevention.
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Vaginal Dryness: The Keystone Symptom of Postmenopausal Sexual Dysfunction?
In a large, cross-sectional, multicenter study in Italy that evaluated factors predictive of sexual dysfunction, vaginal dryness correlated independently and negatively with each Female Sexual Function Index domain.