Internal Medicine
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Weighing the Harms and Benefits of E-cigarettes
So far, studies evaluating whether e-cigarettes are less harmful than traditional cigarettes remain mostly inconclusive.
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Hypoglycemia Increases Cardiovascular Risk in Patients With Type 1 and Type 2 Diabetes
This is a retrospective analysis of data from the UK Clinical Practice Research Datalink which includes 265,868 insulin-treated patients age > 30 years diagnosed with diabetes between 2001 and 2007. 3260 were diagnosed with T1DM and 10,422 had T2DM. During a median follow-up of 5 years for type 1 diabetes patients and 4.8 years for those with type 2 diabetes, hypoglycemia was experienced by 573 (18%) and 1463 (14%) of patients, respectively. Compared with patients who did not experience hypoglycemia, the hazard ratio (HR) for CV events among T1DM patients who experienced hypoglycemia was 1.51 (not significant) and 1.61 for those with and without a history of CVD. For T2DM patients, the respective HRs were 1.60 and 1.49. The median time interval between the first hypoglycemia event and the first CV event was 1.5 years for all diabetes patients. Thus, hypoglycemia increases the risk of both CV and all-cause mortality in patients with diabetes.
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Influenza, 2014-2015 — Something Old, Something New, and a Mismatch
By early January, influenza activity had reached epidemic proportions in large parts of the United States, despite prior vaccination.
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REM Behavior Disorder as a Predictor of Parkinson’s Disease
Here are the results of a carefully executed study of REM behavior disorder patients compared to controls and those with Parkinson’s disease.
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The Devalued Body: Symptoms of BPD in Mental Health and Medical Settings
Borderline personality disorder is a complex dysfunction often caused by childhood trauma and it may result in your patients harming themselves.
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Risk of Stroke with Intracardiac Devices and Patent Foramen Ovale
After some case reports of stroke due to electrophysiology (EP) device thrombosis in patients with a patent foramen ovale (PFO), concern has been raised about the risk of stroke with intracardiac devices in patients with known PFO. Thus, these investigators from the Cleveland Clinic did a retrospective database study of 2921 echocardiography-detected PFO patients and categorized them as having an EP device (231) or not.
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Late Tricuspid Regurgitation After Heart Valve Surgery
Due to the success of left heart valve disease surgical corrections, patients may experience late tricuspid regurgitation.
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Coronary Stents and Noncardiac Surgery
Contemporary data suggest that approximately one in every five patients will require non-cardiac surgery within two years of coronary stent implantation.
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Spironolactone & the Potential Benefit for HFPEF Patients
No treatment has been shown to improve outcomes in heart failure with preserved ejection fraction.
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Revascularization for Isolated Proximal LAD Disease: PCI is Easiest, but is it Best?
Among patients with obstructive coronary disease requiring revascularization, guidelines would suggest a clear preference for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) only in certain defined subsets, including those with left main disease and in diabetics with multi-vessel disease. Patients with isolated proximal LAD disease represent a unique high-risk subset of those with single-vessel disease, in that the size of the affected territory and associated ischemic risk makes CABG a viable option. In fact, U.S. guidelines currently assign a slight advantage to CABG with a left internal mammary graft to the left anterior descending (LAD) for such patients, rating this as a IIa indication vs a IIb recommendation for PCI. This is despite a relative paucity of data on this subset of patients, at least using contemporary treatments. In fact, of the nine randomized, controlled trials forming the basis for 17 published studies examining this question, most are quite small, and all but one were performed using bare-metal stents; the single small RCT incorporating drug-eluting stents (DES) used first-generation devices that are no longer part of the treatment landscape.