Internal Medicine Alert – December 15, 2024

Migraines: Which Came First, the Chocolate or the Craving?

Knowledge of the differentiation between the triggers for a potential migraine attack and the prodromal symptoms of an initiated migraine attack reveals strategies that decrease migraine disability. Recognition of migraine triggers allows for a modification of behavior to avoid precipitating an attack. Recognition of common migraine prodromal symptoms creates an early time window when rapid treatment enhances the therapeutic intervention’s efficacy.

DOACs Can Safely Be Started Early After Atrial Fibrillation-Associated Stroke

In ischemic stroke associated with atrial fibrillation, early restart of anticoagulation with apixaban one to three days after ischemic stroke, compared to late restart (seven to 14 days), resulted in no significant differences between the groups in the primary outcome — a composite endpoint including recurrent ischemic stroke, symptomatic intracranial hemorrhage, and systemic embolism.

Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis

In a pragmatic, open-label, randomized trial conducted at 15 hospitals in the Netherlands, two days of postoperative intravenous antibiotics for complex appendicitis was found to be noninferior to five days in terms of infectious complications and mortality within 90 days.

Epilepsy and Cardiovascular Events

This large prospective cohort study found that older adults with a lifetime history of epilepsy were more likely to experience cardiovascular events (CVEs), and that enzyme-inducing antiseizure medications (EIASMs) may account for a significant portion of this risk. The findings suggest a potential causal link between epilepsy treated with EIASMs and CVE, highlighting the need for careful medication selection in epilepsy management.

Sulopenem Etzadroxil and Probenecid (Orlynvah)

The U.S. Food and Drug Administration has approved a combination of sulopenem and probenecid for the treatment of uncomplicated urinary tract infections.

Does the Physical Exam Help?

You are given the electrocardiogram (ECG) in the figure and told that the patient is a young man in his 20s who presents with acute dyspnea. The physical exam is remarkable for tachypnea, cyanosis, and clubbing of the extremities. How would you interpret the rhythm? Do the noted physical exam findings help in your assessment of the rhythm?