Internal Medicine Alert
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Low BNP Levels in Up to 16% of Heart Failure Patients
In patients with clinical heart failure and low B-type natriuretic peptide levels, the authors found these patients usually are young and obese, with higher ejection fraction and better renal function.
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How to Safely Open Schools in the Time of COVID-19
Multiple COVID-19 transmission clusters were identified in a Georgia school district, with educators often the index cases. The CDC has provided recommendations for safely opening schools.
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COVID-19 Long-Haulers May Show Signs of Chronic Fatigue, Myalgic Encephalitis
Many patients with COVID-19 will go on to develop persisting symptoms that resemble those of myalgic encephalitis/chronic fatigue syndrome, regardless of symptoms experienced at viral onset.
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Is There Bundle Branch Block?
Try to interpret the ECG in the figure without the benefit of any clinical information. What do you see?
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When Aortic Stenosis Is Almost Severe: What Happens Next?
A study of patients with normal flow, low gradients, normal left ventricular systolic function but with calculated aortic valve areas <1.0 cm2 showed that about half of them progressed to severe aortic stenosis during the 25-month median follow-up period.
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Race Correction in Clinical Calculations: Is It Time to Reconsider?
Many clinical calculators use race as a predictive variable to assess risk for outcomes. Although most tools assume a genetic disposition for these outcomes, other factors, such as health disparities and other potential confounders, are more likely to be the underlying reasons for any race-related differences in outcomes.
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Is There Right Ventricular Strain or Acute Pulmonary Embolism?
The ECG in the figure was obtained from a middle-age woman who presented with new dyspnea. Is the T wave inversion in the inferior leads a reflection of right ventricular “strain” from acute pulmonary embolism? If not, what else might cause these ECG findings?
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Auditory Startle Response as a Predictor of Recovery from Coma
Preserved habituation of the auditory startle response, performed bedside, indicates intact cortical structures and cortico-cortical white matter tract connections. Preservation of this reaction in patients with unresponsive wakefulness can help distinguish the vegetative state from minimally conscious state and may even predict eventual awakening.
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Teprotumumab-trbw Injection (Tepezza)
Teprotumumab should be prescribed to treat thyroid eye disease.
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What Kind of AV Block?
The ECG in the figure was obtained from a young adult who presented to the emergency department with dizziness, a near syncopal episode, and chest discomfort. Does this ECG suggest AV block is the cause of his symptoms?