Internal Medicine
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Fulminant Clostridioides difficile Infection: Hold the IV Metronidazole?
The combination of oral vancomycin and intravenous metronidazole is not superior to vancomycin alone in the treatment of fulminant infection due to Clostridioides difficile.
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What Is the Risk of Joint Prosthesis Infection Resulting From Bacteremia?
The risk of periprosthetic joint infection resulting from bacteremia depends on the organism.
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Preventing Readmissions and Optimizing Outcomes for Staphylococcus aureus Bacteremia: Still a Long Journey Ahead
Using a population-based database, investigators found that the rate of readmission within 30 days following hospitalization for S. aureus bacteremia was high (22%) and resulted in high cost to the healthcare system.
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Sports-Related Concussion
Media coverage of professional athletes experiencing irreversible damage after repeated brain trauma and of the underreported rates and risks of pediatric concussion have heightened awareness surrounding head injury in sports and recreation. Concussion is now known to be a significant public health issue, with high rates of emergency department visits and hospitalizations. Much of the current concern surrounding concussions revolves around recognition, early diagnosis, treatment modalities, return-to-play, and prevention of recurrent concussions.
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Predicting the Progression of Chronic Aortic Regurgitation
A large database observational study of patients with chronic aortic mild or moderate regurgitation (AR) largely due to bicuspid aortic valve or aortic root dilatation showed that it was largely an indolent disease, with only 20% progressing to moderately severe AR in five years.
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Perioperative Management of Direct Oral Anticoagulants
A simple protocol for managing atrial fibrillation patients on direct oral anticoagulants perioperatively was shown to produce low levels of major bleeding and thromboembolism for 30 days postoperatively.
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CRT Nonresponders Experience Poor Outcomes, Warrant More Aggressive Management
The ADVANCE CRT registry revealed a significant minority of patients fail to respond to cardiac resynchronization therapy, conferring a worse prognosis.
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Is the Physical Exam an Anachronism in Heart Failure?
In the PARADIGM-HF trial, signs of congestion during physical exam were related to outcomes and the improved outcomes observed with valsartan/sacubitril vs. enalapril.
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CABG vs. PCI for Left Main Disease at 5 Years
Five years after randomizing 1,905 patients with left main disease to coronary artery bypass grafting or percutaneous coronary intervention, researchers found no significant difference in the primary composite outcome of death, stroke, or myocardial infarction.
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Why Was There Syncope?
The 12-lead ECG in the figure was obtained from a middle-aged woman with syncope and hypotension but no chest pain. No long lead rhythm strip is available. What might be causing her syncope?