Internal Medicine Alert
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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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Are SGLT2 Inhibitors Effective for HFpEF Patients Without Diabetes?
After comparing empagliflozin to placebo for patients with heart failure and preserved left ventricular ejection fraction, researchers found no differences in the significant reduction of the primary outcome of cardiovascular death or heart failure hospitalization over 36 months based on whether patients were diabetic.
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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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Novavax COVID-19 Vaccine, Adjuvanted (NVX-CoV2373)
Novavax is authorized to be administered to patients age 18 years and older for active immunization to prevent COVID-19 caused by SARS-CoV-2.
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Rivaroxaban Monotherapy for Atrial Fibrillation in Coronary Artery Disease Patients
For patients with atrial fibrillation and stable coronary artery disease, rivaroxaban monotherapy was superior to dual therapy for preventing thrombotic and bleeding events and was associated with a lower mortality rate.
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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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Inflammatory Foods Could Accelerate Brain Aging
In the Framingham Offspring cohort of subjects, those with a higher index of inflammatory foods recorded smaller brain volume, less grey matter.
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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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What Do You Think Happened?
You are asked to interpret the tracing in the figure without the benefit of any history. What do you think happened? How acute are these findings?