Internal Medicine
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Antithrombotic Treatment for Atrial Fibrillation After Acute Coronary Events
An analysis of the AUGUSTUS trial comparing a P2Y12 inhibitor plus four combinations of double or triple therapy with apixaban, aspirin, and a vitamin K antagonist in patients with atrial fibrillation and a recent acute coronary event or percutaneous coronary intervention has shown that a P2Y12 inhibitor plus apixaban exhibited the lowest rate of major adverse events and major bleeding events.
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Screening for Atrial Fibrillation in Older Adults
A two-week ambulatory electrocardiogram monitor in a large group of individuals 70 years of age or older with no history of atrial fibrillation (AF) showed a very low incidence of AF (4.4%), almost all of which was paroxysmal. In less than 2% of the subjects did it represent ≥ 2% of the monitoring time. However, some patients had hours of AF, raising a concern for thromboembolic risk.
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A New Drug for Heart Failure with Preserved Ejection Fraction?
The addition of the nonsteroidal mineralocorticoid receptor antagonist finerenone to standard therapy reduced the incidence of recurrent heart failure and death compared to placebo in patients with heart failure and mildly reduced or preserved left ventricular ejection fraction and was generally well tolerated.
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Early Bird or Night Owl: Who’s Mentally Sharper?
A large cross-sectional analysis of adults aged 53-86 years found that people with normal sleep durations while being “night owls” often scored higher on cognitive tests than “early bird” types.
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Lebrikizumab-lbkz Injection (Ebglyss)
The U.S. Food and Drug Administration has approved a humanized monoclonal antibody that targets interleukin-13 for the treatment of moderate-to-severe atopic dermatitis.
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Metformin Reduces SARS-CoV-2 Viral Load in Outpatients with COVID-19
A randomized, placebo-controlled clinical trial of outpatients with COVID-19 found that metformin reduced SARS-CoV-2 viral load 3.6-fold compared to placebo, while ivermectin and fluvoxamine showed no benefit.
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Blood Biomarker for the Diagnosis of Alzheimer’s Disease
In this population-based study of patients in Sweden with cognitive complaints, mild cognitive impairment, and dementia, the use of blood biomarkers, specifically, phosphorylated tau 217 and amyloid-beta 42/40 ratios, improved the diagnostic accuracy for pathological Alzheimer’s disease in primary care patients as well as patients seen by dementia specialists.
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Treatment Direction After Unsuccessful Attempts at Smoking Cessation
This randomized trial found that, for patients unable to stop smoking after six weeks of treatment, increasing the dose of either varenicline or combination nicotine replacement therapy (CNRT) or switching from CNRT to varenicline, leads to an increased likelihood of success.
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Diagnostic Uncertainty in Community-Acquired Pneumonia
A national retrospective cohort study from the Veterans Administration found a high rate of diagnostic discordance for patients admitted and discharged for community-acquired pneumonia (CAP). Improvement in the diagnosis of CAP is needed.
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Look for the Pattern
How would you interpret the two-lead rhythm strip shown in the figure? Hint: Is there a pattern?