Internal Medicine
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WHO: Corticosteroids OK for Children with Multisystem Inflammatory Syndrome
International group updates guidelines for treating young patients with this rare-but-serious COVID-19-related complication.
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Is This Wellens’ Syndrome?
The ECG in the figure is from a young adult man known to have a bicuspid aortic valve. He presented to the ED following a presyncopal episode. The patient has not experienced chest pain recently. Does this patient have Wellens’ syndrome?
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Eculizumab for Refractory Myasthenia Gravis
Eculizumab, a monoclonal antibody that inhibits the C-5 complement terminal complex formation, is a safe and effective treatment for generalized myasthenia gravis with acetylcholine receptor auto-antibodies, even after failed treatment with other immunosuppressive regimens.
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Varenicline Nasal Spray (Tyrvaya)
Varenicline nasal spray is indicated to treat the signs and symptoms of dry eye disease.
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Intensive Blood Pressure Lowering Does Not Affect Small Vessel Disease Progression
Intensive blood pressure lowering was not associated with worsening but did not demonstrate any benefit in this population over standard blood pressure management.
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Infections Before Age 20 Years Increase the Risk of Multiple Sclerosis
The relationship between childhood infections and the risk of multiple sclerosis is supported by increasing evidence. Using the Swedish Total Population Register, researchers found that patients diagnosed with infection in adolescence showed an increased risk of multiple sclerosis, even after exclusion of infectious mononucleosis, pneumonia, and central nervous system infection.
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Environmental Shedding of MRSA Far Greater Than From Multidrug-Resistant Gram-Negative Bacilli
An observational cohort study showed shedding of methicillin-resistant Staphylococcus aureus by colonized patients outside hospital rooms or during outpatient clinic visits occurred more often than in those colonized by multidrug-resistant gram-negative bacilli.
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Gene and Substrate Therapy for Neurogenetic Disease: A Combined Approach to Treat Mitochondrial Myopathy
A combined adenoviral-mediated gene therapy plus substrate therapy delivered to a mouse model of thymidine kinase 2 (TK2) deficiency, manifested most often as a fatal mitochondrial myopathy in infants and children, rescued TK2 activity and prolonged animal lifespan, thus indicating a promising therapeutic approach for affected patients.
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TSPO PET Imaging for Monitoring Natalizumab-Associated Progressive Multifocal Leukoencephalopathy
Authors of a recent study evaluated inflammatory activity in multiple sclerosis patients who developed natalizumab-associated progressive multifocal leukoencephalopathy (PML) using translocator protein positron emission tomography (TSPO PET) for imaging of microglia. They demonstrated that TSPO PET can monitor PML longitudinally.
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COVID-19 Vaccination, Pregnancy, Lactation, and Fertility
Vaccination rates are notably low among pregnant women. Clinicians should underscore the safety of vaccination and the risks of natural infection, particularly in pregnancy and in patients with underlying comorbidities.