Internal Medicine
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Extreme Weather and Infectious Diseases: What Will Follow Hurricanes Harvey and Irma?
Among the dangers faced after a severe weather event is an increased risk of various infections.
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Zika Virus Disease: A Primer for the Primary Care Physician
Zika virus disease is a global issue, but with the recent hurricanes and flooding in Texas and Florida, mosquito-borne illnesses may become more prevalent. This article discusses the latest recommendations for the prevention of Zika viral disease, the populations and regions still at increased risk, and the latest and most promising research being conducted to develop a Zika virus vaccine and treatment.
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Anomalous Coronary Arteries Discovered in Middle-aged Individuals
Anomalous origin of coronary arteries from the opposite sinus are encountered more frequently in middle-aged subjects evaluated for coronary artery disease using CT angiography.
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Natriuretic Peptide-guided Therapy Does Not Improve Systolic Heart Failure Outcomes
Among high-risk patients with heart failure and reduced ejection fraction, a strategy of titrating medical therapy to a target natriuretic peptide level was not associated with improvements in hospitalization or survival.
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Rate-controlled Atrial Fibrillation as a Reversible Cause of Cardiomyopathy
In patients with persistent but rate-controlled atrial fibrillation and left ventricular systolic dysfunction of otherwise uncertain etiology, catheter ablation to restore sinus rhythm can result in significant improvement or normalization of ejection fraction.
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Is a Dabigatran Reversal Agent Effective?
A pragmatic clinical study of idarucizumab for counteracting the effects of the oral anticoagulant dabigatran showed rapid and complete reversal of its effects in patients with major bleeding or urgent surgery, without any adverse safety concerns.
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RE-DUAL Deals Another Blow to Triple Therapy
In this trial of post-percutaneous coronary intervention patients with atrial fibrillation, dual antithrombotic therapy with dabigatran and a P2Y12 inhibitor showed lower rates of bleeding but similar ischemic and thrombotic outcomes compared to a triple therapy regimen with warfarin.
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Angiotensin II Raises Blood Pressure in Patients with Vasodilatory Shock
Infusion of recombinant angiotensin II improved blood pressure control in patients with vasodilatory shock already receiving conventional vasopressors.
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Spontaneous Breathing Trials and Occam’s Razor
Different ventilator modes used for a spontaneous breathing trial affected a patient’s work of breathing (WOB) variously and differed regarding WOB measured after extubation. The clinical relevance of these differences is uncertain.
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Intensive Care Enteral Nutrition in 2017
Enteral nutrition, defined as any method of feeding that uses the gastrointestinal (GI) tract (including oral feeding), usually refers to the delivery of nourishment to the GI tract through a tube. Nutrition is of utmost importance for patients suffering from a critical illness, and EN is a mainstay of nutrition in the ICU. Malnutrition and nutritional risk are common in patients admitted to the ICU. The presence of critical illness causes the body to enter a catabolic state, putting patients at risk of development or worsening of malnutrition. The Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition have published and revised joint guidelines to offer evidence-based recommendations for how best to feed critically ill patients.