Neurology
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Migraine With Aura, Stroke Risk, and Biomarkers
The authors of a longitudinal cohort study of twins found no increased stroke risk related to migraine overall, but there was a modestly increased risk for stroke related to migraine with aura. Familial factors and vascular biomarkers associated with migraine with aura may explain its correlation with vascular disease.
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Procalcitonin to Guide Antibiotic Therapy for Acute Respiratory Infections
The authors of this meta-analysis reviewed patient-level data on 6,708 patients from 26 randomized studies that examined procalcitonin-directed antibiotic therapy for acute respiratory tract infections. They found a 1% reduction in mortality and a 2.4-day reduction in antibiotic exposure for the procalcitonin-directed therapy groups. How procalcitonin can be incorporated into routine clinical practice, in what settings, and whether it is cost-effective are still unclear.
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How Would You ‘Date’ This Infarct?
The ECG in the figure was obtained from a 48-year-old man who presented to the ED with a three-day history of chest discomfort. It clearly shows evidence of infarction. How would you “date” the infarct?
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Clinical Briefs
In this section: A new Parkinson's treatment, type 2 diabetes treatment, and morphine for dyspneic acute heart failure patients.
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Zoster Vaccine Recombinant Adjuvanted (Shingrix)
Shingrix is indicated for the prevention of herpes zoster in adults ≥ 50 years of age.
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Fecal Microbiota Testing
Researchers have determined that persons with diabetes or inflammatory bowel disease — or people who have received recent antibacterial therapy — may exhibit very different microbiota profiles. Unfortunately, no one really knows what these differences mean in terms of your overall health.
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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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Can Medical Therapy Improve Functional Mitral Regurgitation?
Among patients who presented with heart failure with reduced ejection fraction and severe functional mitral regurgitation, mitral regurgitation improved in 38% of patients with medical management. Improvement in mitral regurgitation was associated with increased survival.
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Neurologic Complications of Checkpoint Inhibitors
Anti-programmed death 1 antibodies (checkpoint inhibitors) have become a mainstay in the treatment of many types of cancers, and now are known to cause frequent neuromuscular adverse effects that can cause severe disability or death if not recognized or treated promptly.
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Systemic Immune Activation and the Course of Amyotrophic Lateral Sclerosis
Activation of the immune system has been recognized in patients with amyotrophic lateral sclerosis, and immune activation may influence the course of the disease and the speed of progression.