Internal Medicine Alert
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Coronary CT Angiography in Patients with Type 2 MI
In an observational, single-center study of patients with type 2 myocardial infarction who underwent coronary computed tomography (CT) angiography, researchers reported fewer than half had a significant anatomic stenosis (50% or greater), but only 26% had a hemodynamically significant lesion by CT fractional flow reserve.
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Atorvastatin vs. Rosuvastatin in Patients with Coronary Artery Disease
A large trial of moderate doses of rosuvastatin vs. atorvastatin in patients with coronary artery disease has shown that both drugs are equivalent at reducing major adverse cardiovascular and cerebral events, but rosuvastatin is associated with higher rates of new-onset diabetes and cataract surgery.
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To Activate the Cath Lab?
The ECG in the figure was recorded on a patient with new chest pain that began one hour earlier. How would you interpret this ECG? Should the catheterization lab be activated, given the history and this ECG?
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Tirzepatide Injection (Zepbound)
The U.S. Food and Drug Administration has approved tirzepatide for chronic weight management. The drug previously was approved for the treatment of type 2 diabetes under the trade name Mounjaro.
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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.