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Fever in the Newly Returned Traveler

Fever in the newly returned traveler is both a broad and fascinating diagnostic challenge. This area is particularly relevant to work in the emergency department (ED), especially in densely populated cities and regions with large immigrant populations.

Carotid Artery Stenting: The New Treatment Standard for Asymptomatic Carotid Stenosis?

CREST-2 demonstrates that, in asymptomatic carotid stenosis, carotid artery stenting modestly reduced four-year stroke risk compared with intensive medical management, whereas carotid endarterectomy did not.

A Potential Treatment for Progressive Multifocal Leukoencephalopathy

Fingolimod-associated progressive multifocal leukoencephalopathy in a 67-year-old woman with secondary progressive multiple sclerosis (MS) was treated off-label with tenofovir alafenamide fumarate (TAF), resulting in rapid radiologic improvement and clearance of John Cunningham virus (JCV) from cerebrospinal fluid. Although MS activity emerged after fingolimod withdrawal, TAF was well tolerated and the close temporal association with JCV clearance suggests a potential antiviral effect warranting further study.

The IMPACT Tool Helps Guide Management of Incidental Meningiomas

In a large international, multicenter, retrospective cohort, the imaging-based IMPACT tool accurately predicted progression risk of incidental meningiomas and effectively stratified patients into low-, medium-, and high-risk groups at initial diagnosis.

A Randomized Trial of Shunting for Idiopathic Normal-Pressure Hydrocephalus

In this randomized, double-blind, placebo-controlled trial, investigators demonstrated that ventriculoperitoneal shunt surgery produces a clinically meaningful improvement in gait (but not in cognition or urinary symptoms) at three months in carefully selected patients with idiopathic normal-pressure hydrocephalus.

Spirituality: The Missing Pillar of Whole-Person Care

Spirituality is a critical yet often overlooked component of whole-person care. Evidence shows that attending to patients’ spiritual needs can improve coping, reduce anxiety and depression, and enhance satisfaction with care, while also strengthening the therapeutic relationship. Importantly, integrating spiritual care also supports clinician well-being by reconnecting providers with purpose and mitigating burnout, making it beneficial for both patients and practitioners.

Defining Normal Ascending Aorta Size by Imaging

Two large biobank studies of the relationship between various imaging measurements of ascending aorta size normalized to several body size metrics have shown that ascending aorta area/height performs best for predicting adverse aortic events.

Total Steps vs. How You Get Them and the Risk of Cardiovascular Events

In a large U.K. Biobank study of subjects who performed a one-week determination of steps/day, those who achieved < 8,000 steps/day were categorized by the duration of their step acquisition periods and were followed for a mean of eight years. All-cause mortality and the development of cardiovascular disease (CVD) were greater in those with short step acquisition periods (< 5 minutes) as compared to those with longer periods (> 15 minutes). Thus, longer step acquisition bouts are more effective in reducing mortality and CVD in those with less-than-ideal total daily step counts.

Value of Natriuretic Peptide Measurements in HFpEF

A pooled analysis of four trials of drug therapy for heart failure with preserved ejection fraction (HFpEF) patients has shown that, although the risk of adverse outcomes is higher with increasing baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, the effect is attenuated at higher body mass index levels, such that lower NT-proBNP cutoffs for risk-stratifying obese patients need to be developed.

Who Needs Antithrombotic Therapy After Atrial Fibrillation Ablation?

An international trial of rivaroxaban vs. low-dose aspirin started one year or more after successful atrial fibrillation catheter ablation has shown no significant differences in a composite outcome of stroke, systemic embolism, or covert cerebral emboli by head magnetic resonance imaging and no differences in major bleeding but shows an increase in clinically relevant minor bleeding with rivaroxaban.