Internal Medicine Alert
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Midazolam Nasal Spray (Nayzilam) CIV
Midazolam nasal spray should be prescribed to treat acute intermittent, stereotypic episodes of frequent seizure activity (acute repetitive seizures, seizure clusters) that are distinct from the patient’s usual seizure patterns.
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Physicians Cannot Agree on Who Benefits From ICU Care
The authors of a study randomizing U.S. critical care physicians to analyze hypothetical patient vignettes found that estimates of whether a patient would benefit from ICU care were widely dissimilar among those surveyed and influenced by factors unrelated to severity of illness.
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Does Hormone Therapy Increase the Risk of Alzheimer’s Disease?
The results of a large Finnish case-control study suggest that postmenopausal hormone therapy results in a 9-17% increase in the risk of Alzheimer’s disease. However, the small effect size, and likely confounding of use effect, does not provide strong evidence for a causal relationship.
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Neuropathy in Systemic Lupus Erythematosus
Systemic lupus erythematosus may be associated with a variety of neuropsychiatric syndromes, including peripheral neuropathy, mostly sensorimotor types. However, all parts of the peripheral and central nervous system may be affected; careful and repeated neurological evaluation is important.
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Sacubitril-Valsartan Reduces Functional Mitral Regurgitation
In patients with chronic heart failure and functional mitral regurgitation, sacubitril/valsartan was associated with greater reduction in mitral regurgitation compared to valsartan alone.
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Why Is the QRS Wide?
The ECG in the figure belongs to an older woman who called EMS because of new-onset chest pain. How might one interpret the tracing? Why is the QRS complex wide?
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Erdafitinib Tablets (Balversa)
Erdafitinib is the first FDA-approved targeted therapy for metastatic bladder cancer.
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The Promise and Perils of the Apple Heart Study
A large study with virtual enrollment of Apple Watch users helped illustrate the positive predictive value of wearable, pulse-based atrial fibrillation detection technology, as well as the ability to enroll and follow huge numbers of research subjects in a short period.
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How Safe Are New Medications for Type 2 Diabetes?
In recent years, new medications have been approved for the management of type 2 diabetes, generally after metformin is given. The FDA has reported 55 cases of Fournier’s gangrene in patients using SGLT2 inhibitors. These medications may not be worth the risk when lifestyle alternatives are available.
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Late Sunsets, Sleep Deprivation, and Adverse Outcomes
All living organisms have 24-hour circadian rhythms. A growing body of evidence shows that chronic disruption of this important rhythm may result in poor health outcomes. These negative consequences of disrupted circadian rhythms might be prevented by modifying work and sleep schedules.