Internal Medicine Alert
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More Reports of Severe Group A Streptococcal Infection
Around the world, rates of severe illness caused by group A Streptococcus are rising. Possible explanations for the increase include immunity-altering, post-pandemic changes in exposure to respiratory pathogens and the emergence of new pathogenic M strains of Streptococcus.
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Glyceryl Trinitrate Topical Gel (Eroxon)
Eroxon can be recommended to treat adult men (age 18 years and older) with erectile dysfunction.
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Timing of Anticoagulation Administration Following Atrial Fibrillation-Associated Stroke
A prospective, blinded, randomized study of early vs. later administration of oral anticoagulation after ischemic stroke in patients with atrial fibrillation calibrated by cerebral imaging showed no significant difference in 30-day outcomes.
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Researchers Report on the Efficacy of the Subcutaneous Implantable Cardioverter-Defibrillator
An FDA-mandated post-approval study of the subcutaneous cardioverter-defibrillator system in a real-world population revealed excellent safety and efficacy over five years.
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Oral Penicillin Challenge vs. Skin Testing: Diagnosing Low-Risk Patients with Reported Penicillin Allergy
In a comparison of direct oral penicillin challenge in low-risk patients to skin testing followed by oral challenge, researchers reported no significant differences. Direct oral penicillin challenge appears to be a safe and effective way to delabel a penicillin allergy.
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Nonhormonal Treatment for Menopausal Vasomotor Symptoms: A Phase III Study of Fezolinetant
More than 500 women with moderate to severe menopausal vasomotor symptoms received either 45 mg of fezolinetant, 30 mg fezolinetant, or placebo. Both fezolinetant doses significantly reduced the frequency and severity of menopausal symptoms at four and 12 weeks of treatment vs. placebo.
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Syncope and Complete AV Block?
The rhythm strip shown in the figure was recorded from a patient with syncope. It was interpreted as consistent with complete AV block. Do you agree with that interpretation?
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Zuranolone Capsules (Zurzuvae)
Zuranolone can be prescribed to treat postpartum depression.
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The Degree of Pyuria Can Help Determine Urinary Tract Infection in Elderly Women
Elderly women with a urinary tract infection recorded a higher median number of urinary leukocytes compared to uninfected controls, including those with asymptomatic bacteriuria. For 264 leukocytes/µL, the sensitivity and specificity of microscopy were 88%. Using the standard pyuria threshold of 10 leukocytes/µL gave a specificity of 36% and a sensitivity of 100%.
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Treating Psychotic Symptoms Among Alzheimer’s Disease Patients
In a meta-analysis of several large treatment trials of patients with Alzheimer’s disease, Parkinson’s disease, and dementia with Lewy bodies, cholinesterase inhibitors demonstrated a small but statistically significant benefit in alleviating psychotic symptoms.