Internal Medicine Alert
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Time of Day Affects the Probability of Antibiotic Initiation for Hospitalized Patients with Sepsis
In this retrospective cohort study of patients with hospital-onset sepsis, the probability of antibiotic initiation was lowest at shift changes and gradually declined overnight compared to during the day shift.
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Antibiotic Stewardship vs. Diagnostic Stewardship for Reducing Unnecessary Antibiotics in Asymptomatic Bacteriuria
A statewide quality study compared antibiotic stewardship to diagnostic stewardship for hospitalized patients with asymptomatic bacteriuria. It found that reducing urine cultures decreased unnecessary antibiotic prescribing better than antibiotic stewardship.
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The Natural History of Aortic Stenosis Revisited
A large multi-institution observational study of patients referred for Doppler echocardiography to assess for aortic stenosis has shown that discrepant measurements are not uncommon. When four-year all-cause untreated mortality is considered, the intermediate grades of aortic stenosis behave like the next highest level stenosis, which suggests that we should consider intervening earlier in moderate to severe stenosis.
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Aerobic Exercise Effective for Erectile Dysfunction
Exercising for 30 minutes or more three times a week is effective for improving erectile function.
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Zilucoplan Injection (Zilbrysq)
The U.S. Food and Drug Administration has approved a once-daily subcutaneously administered drug for the treatment of generalized myasthenia gravis in adult patients who are anti-acetylcholine receptor antibody positive. Zilucoplan is macrocyclic peptide that inhibits the cleavage of complement 5 (C5) to C5a and C5b.
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Brain Atrophy and Type 1 Diabetes
In a long-term longitudinal study of people with type 1 diabetes, excessive brain atrophy and cognitive dysfunction were noted compared to healthy controls. The investigators calculated that type 1 diabetes resulted in six years of accelerated brain aging and brain atrophy that was separate and distinct from Alzheimer’s disease.
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Shigella: The New Superbug?
Five percent of Shigella isolates in the United States in 2022 were extensively drug-resistant.
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Which Coronary Artery Calcium Score Signifies the Need for Secondary Prevention?
A large registry study of individuals without known cardiovascular disease but with known coronary artery computed tomography calcium scores showed those with an Agatston score higher than 300 are at risk of experiencing major cardiac events similar to patients with known cardiovascular disease over five years.
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Do We Overdiagnose Breast Cancer in Women 70 Years and Older?
Overdiagnosis of breast cancer from mammography is common in women age 70 years and older and increases with age. The use of mammography in women older than age 70 years does not reduce breast cancer deaths.
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How Many Steps a Day Will Improve Patients’ Longevity?
A systematic review and meta-analysis of studies of the association of step counts and cadence with all-cause mortality and cardiovascular events showed the benefits in these outcomes are statistically significant, at about 2,600 steps/day and peak at about 8,000 steps/day. Also, faster step cadence augments these benefits.