Clinical
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Community-Acquired Pneumonia: Sputum Gram Stains Are Helpful After All!
Researchers analyzed the diagnostic accuracy and yield of sputum Gram stain (SGS) in community-acquired pneumonia across 24 studies of 4,533 adult patients in a meta-analysis. SGS was specific for the diagnosis of Streptococcus pneumoniae and Haemophilus influenzae infection.
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Strep Testing — We Can Do Better
Testing for streptococcal pharyngitis in children younger than 3 years of age is rarely helpful and results in unnecessary costs. Quality improvement efforts can be effective in systematically reducing non-indicated testing.
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Sexually Transmitted Diseases in the United States — Not a Happy Picture
Since achieving historic lows, the rates of many sexually transmitted infections has been increasing in the United States. The problem is highlighted by the continued emergence of antibiotic resistance in Neisseria gonorrhoeae.
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Temperature Trajectories to Find Sepsis Subphenotypes
The authors of this study used development and validation cohorts to retrospectively identify temperature trajectories over the first 72 hours from presentation in the setting of sepsis. Patients presenting with hyperthermia that resolved quickly (within the first 24 hours) had lower mortality compared to those with slow resolution or those presenting with hypothermia.
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Vasopressin Use in Septic Shock
Current management of septic shock includes early administration of intravenous fluids, antimicrobial agents, and vasopressor support. While norepinephrine is recommended as the first-line vasopressor for septic shock in the 2016 Surviving Sepsis Campaign guidelines, vasopressin is a second-line vasopressor option that may be added.
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A Review of Atrial Fibrillation and Current Therapeutic Strategies: Part 1
This two-part series presents a review of the current evidence on atrial fibrillation. The first part includes its definition, classification, risk factors, comorbidities, evaluation, and acute management of newly diagnosed patients. The second part will focus on long-term management, including risk factor modification, rate and rhythm control measures, stroke risk stratification, and anticoagulation management.
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Cardiac Arrest in Takotsubo Syndrome
Investigators sought to determine whether secondary prevention interventions could reduce the mortality rate of takotsubo patients with cardiac arrest.
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Safety of Carvedilol for Cocaine Users
The use of beta-blockers in cocaine users is controversial, and there are few data on their use in cocaine-associated heart failure. This prospective, observational, registry study of cocaine-associated heart failure patients showed that carvedilol is safe and effective in such patients.
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Planning Therapy for Severe Tricuspid Regurgitation
A retrospective study of moderate to severe secondary tricuspid valve regurgitation showed that right ventricular systolic dysfunction (but not dilatation alone) is predictive of all-cause mortality.
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Predicting Chemotherapy Cardiotoxicity
Administering trastuzumab after a course of anthracycline therapy for breast cancer can result in cardiac toxicity. Serial echocardiograms in this study showed that a lower initial left ventricular ejection fraction before anthracycline therapy and the amount of decrease in ejection fraction after the anthracycline course are predictive of subsequent trastuzumab cardiac toxicity.