Internal Medicine
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Newly Recognized Rickettsial Infection in Eastern Central China
Fifty-six of 733 patients in China who were evaluated for suspected Severe Fever with Thrombocytopenia Syndrome (SFTS) were shown by polymerase chain reaction (PCR) to be infected with Candidatus Rickettsia tarasevichiae (CRT). Fever, myalgia, cough, gastrointestinal symptoms, and hemorrhagic manifestations were common. Rash was rarely seen, and eschar was observed in 16% of cases. Thrombocytopenia, leukopenia, and abnormal LFTs were commonly observed. Co-infection with SFTS virus was seen 66% of patients, and eight patients died.
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Screening for Clostridium difficile Carriers at Hospital Admission Reduces Subsequent C. difficile Infections
Patients admitted to a single hospital were screened for C. difficile carriage and those found to be positive were placed in contact isolation. This led to a significant decrease in hospital-acquired C. difficile infections.
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Evaluation of Amoxicillin Allergy in Children
The majority of children in this study were nonallergic. Provocative challenges should be conducted in an appropriate medical setting.
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Skin Infections in Student Athletes
Among high school and college athletes, skin infections are most common in wrestlers and football players. Bacterial infections predominate. Up to 22% of wrestlers are colonized with methicillin-resistant Staphylococcus aureus sometime during the season.
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Early Adverse Events Post-PCI Carry Greatest Mortality Risk
About one in eight patients undergoing successful PCI will suffer MI, stent thrombosis or a clinically relevant bleeding event within two years.
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Predictors of Functional Status in Heart Failure with Preserved Ejection Fraction
In a retrospective cohort of patients presenting with heart failure with preserved ejection fraction, functional impairment was primarily driven by body mass index, diastolic dysfunction, and pulmonary vascular disease. New York Heart Association functional class, right ventricular dysfunction, and natriuretic peptide levels were the strongest predictors of death or heart failure hospitalization.
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Does Fludrocortisone Work in Vasovagal Syncope?
A multicenter, randomized, double-blind, controlled trial of fludrocortisone at a range of doses in patients with recurrent vasovagal syncope showed an overall trend toward reduced syncope, which was statistically significant in those who achieved the 0.2 mg daily dose.
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Management of Oral Anticoagulation in Atrial Fibrillation Patients with Worsening Renal Function
Approximately 25% of atrial fibrillation patients in a large trial comparing rivaroxaban to warfarin developed worsening renal failure during follow-up. Those treated with rivaroxaban had less embolic events, but equal bleeding events compared to those on warfarin.
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Take Two, and Call Me in the Morning?
In a real-world population of atrial fibrillation patients at moderate to high risk of stroke, more than one-third were treated with aspirin as opposed to an oral anticoagulant. Those with conditions related to coronary heart disease were more likely to be treated with aspirin.
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Ticagrelor vs. Aspirin for Secondary Stroke Prevention — About the Same!
Ticagrelor was not found to be superior to aspirin in reducing the rate of stroke, myocardial infarction, or death within 90 days, but there was a trend toward a reduced rate of ischemic stroke, that did not reach statistical significance.