Internal Medicine Alert
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L-methylfolate for Bipolar Disorder
L-methylfolate improves some symptoms in major depression in people with type 1 bipolar disorder.
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Studies Find Cognitive Decline Reversible, Even if Patients Are ApoE4 Positive
Insulin resistance is associated with cognitive decline and Alzheimer’s disease. Patients who are positive for the apolipoprotein E4 gene are at increased risk for Alzheimer’s disease. This risk may be reversed by treating insulin resistance.
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Clinical Briefs
In this section: considering cardiorespiratory fitness and mortality; searching for answers on knee osteoarthritis; and comprehensive treatment for atopic dermatitis.
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Abemaciclib Tablets (Verzenio)
Abemaciclib is indicated in combination with fulvestrant for the treatment of women with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced or metastatic breast cancer with disease progression following endocrine therapy.
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Cardiac Stenting No Better Than Aggressive Medical Management for Stable Angina and Single Vessel Disease
Investigators conducted the first blinded, randomized trial comparing percutaneous coronary intervention with medical management.
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Migraine With Aura, Stroke Risk, and Biomarkers
The authors of a longitudinal cohort study of twins found no increased stroke risk related to migraine overall, but there was a modestly increased risk for stroke related to migraine with aura. Familial factors and vascular biomarkers associated with migraine with aura may explain its correlation with vascular disease.
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Procalcitonin to Guide Antibiotic Therapy for Acute Respiratory Infections
The authors of this meta-analysis reviewed patient-level data on 6,708 patients from 26 randomized studies that examined procalcitonin-directed antibiotic therapy for acute respiratory tract infections. They found a 1% reduction in mortality and a 2.4-day reduction in antibiotic exposure for the procalcitonin-directed therapy groups. How procalcitonin can be incorporated into routine clinical practice, in what settings, and whether it is cost-effective are still unclear.
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How Would You ‘Date’ This Infarct?
The ECG in the figure was obtained from a 48-year-old man who presented to the ED with a three-day history of chest discomfort. It clearly shows evidence of infarction. How would you “date” the infarct?
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Clinical Briefs
In this section: A new Parkinson's treatment, type 2 diabetes treatment, and morphine for dyspneic acute heart failure patients.
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Zoster Vaccine Recombinant Adjuvanted (Shingrix)
Shingrix is indicated for the prevention of herpes zoster in adults ≥ 50 years of age.