Internal Medicine
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Treatable Causes of Rapidly Progressive Dementias
Many cases of rapidly progressive dementia are caused by prion diseases and have no effective treatments. But, with the greater awareness of the presentation for autoimmune encephalitis, these disorders make up an increasing percentage of presenting cases and can be aggressively and successfully treated. The STAM3P score helps to identify potentially treatable cases of this disorder.
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Apixaban Dose in Atrial Fibrillation Patients with Chronic Kidney Disease
A large nationwide health systems database study comparing 5 mg apixaban vs. 2.5 mg twice daily in patients with stage 4/5 chronic kidney disease not on dialysis shows that the 5 mg dose increases the risk of bleeding compared to 2.5 mg without any improvement in the risk of stroke, systemic emboli, or death.
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Slow-Wave Sleep and Risk of Dementia
In this long-term observational study of sleep efficiency in the Framingham Heart Study population, researchers found a strong correlation between a decline in duration of slow-wave sleep during aging and the risk of incident dementia from all causes. However, a direct cause-and-effect relationship cannot be determined from this observational study.
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Peak SARS-CoV-2 Viral Loads Delayed
In an effort to characterize the hypothetical utility of rapid COVID-19 antigen kits, the authors of this study examined cycle threshold values in symptomatic adults infected with SARS-CoV-2 relative to the onset of symptoms.
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Who Benefits Most from Tirzepatide Among Patients with Type 2 Diabetes?
Females, patients of white or Asian race, younger patients, and those taking metformin benefit the most from treatment with tirzepatide.
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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.