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Quinacrine is highly effective in the treatment of giardiasis that is recalcitrant to initial therapy with other agents, but patients must be warned about neuropsychiatric effects.
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A nationwide cohort study of adults in Denmark found that proton-pump inhibitor (PPI) use was associated with a moderately increased risk of community-associated Clostridioides difficile infection, and the risk remained elevated up to one year after PPI treatment had stopped.
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Primary amebic meningoencephalitis is a rarely diagnosed worldwide disease associated with exposure to fresh water that causes highly lethal, rapidly progressive central nervous system infection but may be treatable in some cases, necessitating maintenance of a high index of suspicion in appropriate cases.
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Fidaxomicin is preferred over vancomycin for both initial and recurrent cases. Bezlotoxumab is recommended in many cases of recurrent infection and initial infection in patients at high risk of recurrence.
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The occurrence of myocarditis after receipt of COVID-19 mRNA vaccines is most frequent in young males and generally is benign, with rapid resolution with only supportive care. Careful analysis indicates that the benefit of vaccination outweighs the risk in all groups for whom the vaccine is recommended — including young males.
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Multisystem inflammatory syndrome in children (MIS-C) can be a devastating post-COVID-19 complication, but treatment seems effective. High-dose steroids and intravenous immune globulin (IVIG) are commonly used, although new studies give conflicting findings as to whether it is best to use both treatments together.
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The MENDS2 trial found that dexmedetomidine, when used for light sedation, had outcomes similar to those for propofol.
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These two trials had disparate findings with respect to interleukin-6 inhibition, with REMAP-CAP showing a benefit and COVACTA showing none.
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In this retrospective analysis of COVID-19 patients hospitalized with cytokine storm, the use of corticosteroids combined with tocilizumab was associated with superior survival when compared to no immunomodulatory treatment; a combination of corticosteroids and anakinra; or corticosteroids, tocilizumab, or anakinra alone. Patients who received corticosteroids, either alone or in combination with anakinra, also experienced lower hospital mortality compared to no treatment.
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In a randomized trial of patients with atrial fibrillation, left atrial appendage occlusion during elective cardiac surgery was associated with lower rates of ischemic stroke or systemic embolism after 30 days.
