Internal Medicine
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Palliative Care and Ethical Considerations in the COVID-19 ICU
The COVID-19 pandemic has created an ICU environment different from what we have ever seen in our lifetimes that has deep palliative care and ethical repercussions.
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Is Isolated Diastolic Hypertension a Disease?
An analysis of three large prospective databases showed the 2017 American College of Cardiology/American Heart Association revised definition of isolated diastolic hypertension as > 80 mmHg rather than the previous definition of > 90 mmHg resulted in a 5% higher prevalence of diastolic hypertension. This was not significantly associated with cardiovascular disease outcomes.
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What to Do with Large Pericardial Effusions
An observational study of patients with chronic, large, hemodynamically insignificant, C-reactive protein-negative, idiopathic pericarditis in which the majority were treated by pericardiocentesis or surgical drainage showed most patients treated conservatively remained stable. The invasive approach did not reveal an etiology for the effusions.
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Achieving AV Synchrony Without Wires
In the MARVEL 2 prospective study of patients with atrioventricular block treated with a leadless ventricular pacemaker, atrial sensing via an accelerometer-based algorithm was largely successful in establishing atrioventricular synchronous pacing.
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Who Benefits from Primary Prevention ICDs?
Long-term follow-up of SCD-HeFT did not show any benefit in installing implantable cardioverter-defibrillator devices in patients with New York Heart Association class III symptoms or nonischemic cardiomyopathy.
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Valve-in-Valve TAVR for Failed Surgical Prostheses: Short-Term Advantages, Long-Term Unknowns
This large retrospective study of patients undergoing reintervention for failed bioprosthetic aortic valves showed better short-term outcomes with valve-in-valve transcatheter aortic valve replacement vs. redo surgical aortic valve replacement.
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Antibiotic Stewardship: Who’s Responsible?
A joint Pew/AMA survey about resistance and prescribing habits sheds light on provider attitudes and the work ahead.
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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?
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Fostemsavir Extended-Release Tablets (Rukobia)
Fostemsavir is indicated, with other antiretrovirals, to treat HIV-1 infections in heavily treatment-experienced adults with multidrug-resistant HIV-1 infections who are failing current regimens.
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COVID-19 and Steroids: Is There a Consensus?
A study of adults admitted with COVID-19 pneumonia revealed risk factors associated with developing acute respiratory distress syndrome (ARDS) and progression from ARDS to death included older age, neutrophilia, organ dysfunction, and coagulation derangement.