Diagnostics
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How Did Paralytic Polio Re-Emerge in the U.S.?
Most outbreaks globally are attributed to vaccine-derived polio, or type 2. Cases of the type 2 form of polio stem from the large-scale, global use of the oral polio vaccine, a solution that contains a live (but weakened) virus.
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Those Anterior T Waves
The ECG in the figure was obtained from a man in his 60s who was seen in the field for new chest pain. How might one interpret this tracing?
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Measure Stroke Risk with Asymptomatic Severe Carotid Artery Stenosis
A community-based, retrospective, observational study of patients with asymptomatic severe carotid artery stenoses showed the crude stroke risk over five years was about 5%. Patients whose stenoses progress to high grade or start at that severity were at the highest risk for stroke.
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COVID-19 and Headache
Headache is a common feature of acute COVID-19 infection, as well as a long-standing feature of “long COVID” after recovery from the acute infection. Treatment is symptomatic, based on the characteristics of the headache syndrome.
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Be Careful About Informed Consent if Pelvic Exams Happen While Patients Are Under Anesthesia
Incorporate explicit discussions with patients about pelvic exams conducted while patients are under anesthesia. These discussions should occur during consent processes for gynecologic procedures. Specifically, patients would be told about the potential for medical student involvement in these exams.
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The Value of Stress Testing in Patients with Known Coronary Artery Disease
A comparison of adenosine stress single-photon emission CT, PET, and MRI in stable patients with known coronary artery disease (CAD) showed PET to be more sensitive for detecting invasive fractional flow reserve-identified ischemic lesions. However, the sensitivity was disappointing. Patients with known CAD and new symptoms should be referred directly to invasive coronary angiography.
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COVID-19 Rebound
Symptomatic and virologic recrudescence after treatment of patients with COVID-19 with Paxlovid occurs in a tiny percentage of patients and generally is mild and self-limited.
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COVID-19: Duration of Shedding of Transmissible Virus
Patients with COVID-19 were found, by culture, to shed replication-competent virus after an initial PCR test for median durations of four to five days.
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Provocative Testing with Intracoronary Acetylcholine as Part of Cardiac Catheterization Evaluation
In this systematic review and meta-analysis of invasive coronary provocation testing, intracoronary acetylcholine was found to be a safe procedure, with low rates of major complications.
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New Details Emerge About Acute Flaccid Myelitis, Cases Could Surge This Year
Researchers uncovered evidence indicating enterovirus D68 directly infects neurons in the spinal cord, prompting an immune response that leads to the limb weakness that is characteristic of acute flaccid myelitis. Investigators shed important light on the disease process that takes place in children who develop this polio-like illness. This is progress that can help lead to better treatments.