Internal Medicine Alert
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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?
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Decitabine and Cedazuridine Tablets (Inqovi)
Inqovi should be prescribed to treat adults with myelodysplastic syndromes.
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Cheyne-Stokes Respiration in Heart Failure
A comprehensive cardiorespiratory study of stable systolic heart failure patients showed Cheyne-Stokes breathing in the awake, upright position is related to hypercapnia and is independently associated with a higher risk of cardiac death.
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Risks of Hookah Smoking
An average hookah contains as much tobacco as 20 filtered cigarettes. The nicotine hit from a hookah is every bit as real and as addictive as smoking cigarettes. The temperature of the smoke when heated electronically in newer hookahs, rather than by older charcoal versions, may be cidal to lung cells.
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High Lateral Infarction, or Something Else?
The ECG in the figure was obtained from a man with new onset palpitations. What is the probable cause of his symptoms? Is there high lateral infarction, or is something else accounting for the Q waves in leads I and aVL?