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Treatment of Acute Migraine With Ginger
Ginger extract has a long anecdotal history as a treatment for migraine headaches in traditional Chinese medicine. This well-designed study provides evidence that adding ginger to a standard nonsteroidal anti-inflammatory medication improves outcomes of migraine treatment by all measured parameters.
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Proceedings From the International Stroke Conference, Honolulu, February 2019
The following reviews of studies presented at the 2019 International Stroke Conference were written after my personal attendance at the presentations, followed by review of the simultaneous publications in The New England Journal of Medicine and The Lancet. All comments and opinions are solely those of this editor. — Matthew E. Fink, MD
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Lifestyle Modification for the Prevention and Reversal of Cardiovascular Disease
Lifestyle is a critical determinant of the common risk factors for cardiovascular disease (hypertension, diabetes, hyperlipidemia, and smoking) that have been well-known to predict disease outcomes. Lifestyle medicine can be used in conjunction with traditional medications to provide the best care to patients. Clinicians need to act now to prevent being overwhelmed with the eventual increase in coronary artery disease following the obesity/diabetes epidemic.
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Infectious Disease Alert Updates
Jump in Cocci Cases, Winter 2017; Who Knew the Ink Was Not Sterile? Homeless Population Requires Hepatitis A Vaccination
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IV to Oral Conversion of Antibiotic Therapy for Bacteremia Due to Enterobacteriaceae
Oral step-down antibiotic therapy (IV to oral conversion) is safe and effective in patients with bloodstream infection due to Enterobacteriaceae.
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Eravacycline (Xerava)
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Infection After Placement of Antibiotic Spacers in Prosthetic Joints
Researchers reviewed a case series of 51 patients who received retained “destination spacers” after resection of infected joint prostheses. The researchers noted a significant association between the presence of preoperative sinus drainage and re-infection. Longterm antimicrobial suppression after retention of a destination spacer did not result in significant prevention of re-infections.
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The Downsides of High Vancomycin Troughs: No Longer ‘Mississippi Mud,’ but Still Hazardous
A retrospective cohort study from a large healthcare system found that elevated vancomycin troughs were common and associated with a higher body mass index and reduced baseline renal function, and led to more acute kidney injury and a longer hospital length of stay.
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Pediatric Pneumonia — Evolving Diagnosis and Management
Tachypnea has long been considered to identify which children with acute fever and cough might benefit from antibiotic treatment, especially in resource-limited parts of the world. Now, with declining rates of vaccine-preventable infections with Haemophilus influenzae and pneumococcus, new data suggest that approximately 90% of febrile, tachypneic, coughing (but still well enough for outpatient treatment) preschoolers do fine without antibiotics.
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Left Ventricular Unloading During Venoarterial ECMO in Cardiogenic Shock
In a series of patients with cardiogenic shock, the use of venoarterial extracorporeal membrane oxygenation with a percutaneous left ventricular unloading device was associated with better-than-expected outcomes.