Clinical
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Tacrolimus for Treatment of Myasthenia Gravis
A large observational study performed in Korea suggests that tacrolimus is an effective immunomodulating, steroid-sparing medication for the treatment of myasthenia gravis.
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Prediction of Survival After Cardiac Arrest Using Pupillometry
Automated infrared pupillometry holds promise as a quantitative, reproducible measure that aids in determining neurological prognosis after cardiac arrest and coma.
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Distinguishing Ischemic from Non-ischemic Cardiomyopathy Clinically
SYNOPSIS: This cardiac catheterization-based study of patients with newly diagnosed reduced left ventricular ejection fraction of unknown etiology showed that 15% had ischemic cardiomyopathy and they could be identified by clinical characteristics and an ECG-based risk score.
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B-type Natriuretic Peptide Is Less Useful in Elderly Patients with Dyspnea
SYNOPSIS: Among patients ≥ 80 years of age presenting with acute dyspnea, B-type natriuretic peptide level was not useful for differentiating cardiac vs. respiratory etiologies when added to a model of clinical predictors.
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Sepsis Management: What We Think We Know
SYNOPSIS: In the Protocolized Resuscitation in Sepsis Meta-Analysis (PRISM), 3,723 patients’ outcomes from the ProCESS, ARISE, and ProMISe randomized, controlled trials of early goal-directed therapy (EGDT) were evaluated. EGDT did not result in better outcomes than usual care and was associated with higher costs. The authors of a second study looked at outcomes of 49,331 patients with sepsis treated in New York from April 2014 to June 2016. More rapid completion of the three-hour sepsis bundle and antibiotic administration (but not rapid bolus administration of IV fluids) was associated with reduced in-hospital mortality.
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Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis
SYNOPSIS: A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.
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Going Wireless: Combining the Subcutaneous ICD With a Leadless Pacemaker
A system incorporating an entirely subcutaneous implantable cardioverter defibrillator that can command a novel leadless anti-tachycardia pacemaker unidirectionally showed success and promise in an early, short-term animal trial.
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Alcohol Septal Ablation in Younger HCM Patients: Should We Relax Guidelines?
Current guidelines recommend surgical myectomy over septal ablation for younger hypertrophic cardiomyopathy patients. A new study bridges part of the data gap, showing safety and efficacy of the procedure in young patients.
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Early Diuretic Administration Associated With Improved Survival in Acute Heart Failure Patients
Among patients presenting to the ED with acute heart failure, those who received the first dose of intravenous furosemide within 60 minutes of arrival demonstrated lower in-hospital mortality compared to those receiving the first dose after 60 minutes.
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Prevention of Myocardial Infarction in Atrial Fibrillation Patients
A large observational study showed that the primary prevention of myocardial infarction and stroke in patients with atrial fibrillation is better with vitamin K antagonists alone as compared to aspirin alone and dual therapy.