Browse Internal Medicine Articles by Topic

Live Longer: Substitute in Whole Grains

When adjusted for possible confounding variables, this analysis of U.S. men and women found an association between higher whole grain intake and lower mortality from all causes, including cardiovascular disease, but no association for cancer mortality.

The Disruptive Effects of Tablet Readers on Sleep Patterns

The use of light-emitting tablet devices prior to bedtime negatively impacts sleep patterns through disturbances in circadian rhythms.

Corticosteroids in Severe Community-Acquired Pneumonia: The Controversy Continues

Treatment failure in hospitalized patients with severe community-acquired pneumonia (CAP) is associated with an excessive inflammatory response and worse outcomes. Torres and colleagues sought to determine the effect of corticosteroids in patients with severe CAP and a significant inflammatory response. In this multicenter, randomized, double-blind, placebo-controlled trial, 120 severe CAP patients with C-reactive protein (CRP) levels >150 mg/L were randomized to receive either an IV methylprednisolone bolus of 0.5 mg/kg every 12 hours or placebo. Treatment began within 36 hours of hospital admission and lasted for 5 days. Severe CAP was defined as two out of the three minor criteria independently associated with severity including PaO₂ /FiO₂ < 250, multilobar involvement, and systolic blood pressure < 90 mmHg, or one out of two major criteria, including a requirement for mechanical ventilation or septic shock.¹ Risk class V for the Pneumonia Severity Index was also considered severe CAP.² The primary outcome was early or late treatment failure. Early treatment failure was defined as the development of shock, need for mechanical ventilation not present at baseline, or death within 72 hours of treatment. Late treatment failure was defined as radiographic progression, persistence of severe respiratory failure, development of shock, need for invasive mechanical ventilation not present at baseline, or death between 72 hours and 120 hours after treatment.

Neuromuscular Blockade and Successful Endotracheal Intubation

Previous studies have shown the utility of neuromuscular blocking agents for endotracheal intubation in the operating room and emergency department. However, airway management in the ICU often involves unplanned, emergent intubations under suboptimal conditions. This study asked whether NMBAs improved first attempt success of intubations in the ICU. Additionally, these authors asked whether succinylcholine or rocuronium improved first attempt success and the effects of NMBA on intubations using video laryngoscopy.

Does Functional Ability Prior to an ICU Admission Influence Outcomes in Older Adults?

The impact of an older person’s functional status prior to experiencing hospitalization for a critical illness is difficult to determine. Given that ICU admission is generally an unplanned event, obtaining prospective evaluations of function prior to a critical illness or injury is almost impossible. Most evidence to date has utilized proxy reports for a patient’s functional status to determine what, if any, pre-ICU disability may have on an older adult’s outcomes after hospitalization for a critical illness or injury.

Assessment, Prevention, and Treatment of Delirium in the ICU

A review of the latest Society of Critical Care Medicine clinical practice guidelines.

Neurologic Disease and Criminal Behavior – A Medicolegal Conundrum

Patients with frontotemporal dementia, primary progressive aphasia, and Huntington’s disease exhibited antisocial and/or criminal behavior.

Urinary Tract Infection

MONOGRAPH: More than 8 million medical visits per year are for the chief complaint of UTI and the diagnosis accounts for 100,000 admissions annually.

Clinical Briefs

Clinical Briefs on topics such as: Chronobiology and Insulin Glargine, Dual Add-on Therapy for Type 2 Diabetes When Metformin is Not Enough, and Might Long-term Dual Antiplatelet Therapy Be Better? Not

Are Atrial Premature Complexes Benign?

Atrial premature complexes (APCs) are commonly observed on routine ECGs and believed to be harbingers of atrial fibrillation, especially in patients with cardiovascular disease. However, little is known about the long-term prognosis of APCs in the general population. Thus, these investigators from Japan analyzed the database of a large community-based cohort from 1993 to 2008 to determine the risks of APCs seen on the subjects’ baseline ECGs.