Internal Medicine
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Does the Physical Exam Help?
You are given the electrocardiogram (ECG) in the figure and told that the patient is a young man in his 20s who presents with acute dyspnea. The physical exam is remarkable for tachypnea, cyanosis, and clubbing of the extremities. How would you interpret the rhythm? Do the noted physical exam findings help in your assessment of the rhythm?
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Sulopenem Etzadroxil and Probenecid (Orlynvah)
The U.S. Food and Drug Administration has approved a combination of sulopenem and probenecid for the treatment of uncomplicated urinary tract infections.
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Epilepsy and Cardiovascular Events
This large prospective cohort study found that older adults with a lifetime history of epilepsy were more likely to experience cardiovascular events (CVEs), and that enzyme-inducing antiseizure medications (EIASMs) may account for a significant portion of this risk. The findings suggest a potential causal link between epilepsy treated with EIASMs and CVE, highlighting the need for careful medication selection in epilepsy management.
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Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis
In a pragmatic, open-label, randomized trial conducted at 15 hospitals in the Netherlands, two days of postoperative intravenous antibiotics for complex appendicitis was found to be noninferior to five days in terms of infectious complications and mortality within 90 days.
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DOACs Can Safely Be Started Early After Atrial Fibrillation-Associated Stroke
In ischemic stroke associated with atrial fibrillation, early restart of anticoagulation with apixaban one to three days after ischemic stroke, compared to late restart (seven to 14 days), resulted in no significant differences between the groups in the primary outcome — a composite endpoint including recurrent ischemic stroke, symptomatic intracranial hemorrhage, and systemic embolism.
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Migraines: Which Came First, the Chocolate or the Craving?
Knowledge of the differentiation between the triggers for a potential migraine attack and the prodromal symptoms of an initiated migraine attack reveals strategies that decrease migraine disability. Recognition of migraine triggers allows for a modification of behavior to avoid precipitating an attack. Recognition of common migraine prodromal symptoms creates an early time window when rapid treatment enhances the therapeutic intervention’s efficacy.
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Exploring the Benefits of Time-Restricted Eating and Nutritional Counseling
In a randomized trial, adding time-restricted eating (limiting eating to an eight- to 10-hour window) to standard nutritional counseling improved hemoglobin A1c, glycemic control, and other markers of cardiometabolic health when compared to standard treatment alone.
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Twice-Yearly Subcutaneous Lenacapavir Injection Prevents HIV Infection
Subcutaneous injection of lenacapavir every 26 weeks had 100% efficacy in preventing human immunodeficiency virus (HIV) infection in a high-risk population.
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Validation of the New American Heart Association’s PREVENT Equations
An analysis of the accuracy of the new American Heart Association PREVENT Equations for predicting 10-year cardiovascular disease mortality in the National Health and Nutrition Examination Survey population has shown excellent discrimination with only modest underprediction and supports its use vs. the pooled cohort equation, which is the current standard.
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Combatting the Resurgence of Syphilis
Syphilis has continued its upward trend, reaching the highest number of cases in the United States in 2023 since the 1950s. There was a brief dip in cases during the first few months of social isolation with COVID, but, overall, cases have doubled since 2015. It is obvious the current approach of testing those who present with symptoms or other sexually transmitted infections is not sufficient.