Internal Medicine Alert
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What Kind of Block?
The electrocardiogram in the figure was obtained from an older adult who presented for evaluation of syncope. What kind of atrioventricular (AV) block is present? Or is the rhythm something other than an AV block?
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Nipocalimab-aahu Injection (Imaavy)
The U.S. Food and Drug Administration has approved a neonatal Fc-receptor (FcRn) blocker for the treatment of generalized myasthenia gravis. Nipocalimab-aahu is a recombinant human immunoglobulin G1 lambda monoclonal antibody directed at FcRn with high affinity and selectivity.
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TIA Is Associated with Accelerated Cognitive Decline
The study investigators looked at data from a prospective study of 30,239 Black and white community-dwelling persons aged 45 years or older with cognitive evaluations over the phone every other year until 2022. The researchers documented patients who had transient ischemic attack (TIA) or stroke, and demonstrated that persons who had TIA had a cognitive decline trajectory similar to those patients who had a definite diagnosis of stroke.
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Looking Beyond LDL in Cardiovascular Risk Screening for Women
In a 30-year prospective study of nearly 28,000 initially healthy U.S. women, baseline levels of high-sensitivity C-reactive protein, low-density lipoprotein cholesterol or lipoprotein(a) independently and additively predicted major cardiovascular events.
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Measles Outbreaks in the United States
Several measles outbreaks have been active in the United States, with more than 1,000 cases reported already in 2025. Most outbreaks begin as unvaccinated individuals in the United States come into contact with an infected individual who has recently arrived after international travel. Vaccination is effective, but current U.S. vaccine coverage rates are below the 95% rate considered necessary to provide herd immunity.
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Atrasentan Tablets (Vanrafia)
The U.S. Food and Drug Administration has approved atrasentan, the first selective endothelin A receptor (ETAR) antagonist to reduce proteinuria in adults with immunoglobulin A nephropathy. It was approved under accelerated approval based on surrogate outcome. Continued approval may be contingent on verification of clinical benefit in a confirmatory clinical trial. Atrasentan is distributed by Novartis Pharmaceuticals Corporation as Vanrafia.
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Vasectomy Follow-Up Rates: How Good Are They?
In this retrospective cohort study of 2,567 patients at a single institution, 42.1% of men did not follow up at all after vasectomy for semen analysis. Of those with spermatozoa on the initial testing post-vasectomy, 43.3% of men failed to return for repeat testing.
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Best Long-Term Antiplatelet Monotherapy Post-PCI
In a multicenter, randomized, open-label trial of clopidogrel vs. aspirin monotherapy in patients post-percutaneous coronary intervention (PCI) who had been on dual antiplatelet therapy for the recommended period, those randomized to clopidogrel showed fewer major cardiovascular or cerebral events over a two-year follow-up period than those on aspirin without an increase in bleeding events.
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Does Thoracentesis Speed Recovery from Heart Failure?
An unblinded, multicentered, randomized trial of patients with acute heart failure hospital admissions and significant pleural effusions showed that early thoracentesis, in addition to recommended medical therapy, did not reduce mortality or length of stay, or increase days alive out of the hospital for 90 days. However, it was relatively safe and could be employed in selected persistently symptomatic patients with very large effusions.
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Stroke Risk in Patients with New AFib During Unrelated Hospitalization
In a Canadian administrative database study of patients who developed atrial fibrillation during a hospitalization for other reasons, researchers followed the patients for one year to ascertain the risk of subsequent stroke. The incidence of stroke in those not anticoagulated generally was below the 2% per year threshold recommended for treatment with anticoagulants. However, in those with a CHA2DS2-VA score ≥ 5 (sex not included based on new data) and in those admitted for cardiac medical problems, the 95% confidence intervals of stroke risk did cross 2%. Thus, selected patients may be candidates for anticoagulation.