Internal Medicine
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Telestroke Consultation Increases Rate of Thrombolysis and Reduces Mortality
Real-time video conferencing between the patient, a remotely located stroke specialist, and the bedside healthcare provider in a hospital emergency department is referred to as “telestroke.” However, there are little data comparing its benefit with in-person evaluation and treatment for hospitals that do not have in-hospital stroke specialists 24 hours per day, seven days per week.
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Intensive Lowering of Blood Pressure Does Not Affect the Progression of Small Vessel Disease
Small vessel disease of the brain accounts for 20% to 25% of all ischemic strokes and is a common cause of vascular cognitive impairments. The major risk factor for small vessel disease is hypertension. Targeting a systolic blood pressure of 120 mmHg to 125 mmHg has been recommended, but this has not been confirmed as effective in preventing stroke or long-term cognitive impairment in these patients.
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Pregnancy-Associated Stroke Is Increasing in Frequency
Stroke during pregnancy or the puerperium is a rare event but accounts for a considerable part of maternal morbidity and mortality. The incidence has been increasing in all countries, particularly in wealthy industrialized countries, where pregnancy is being delayed considerably and other cardiovascular risk factors have taken on greater importance.
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Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis
This retrospective study of autologous hematopoietic stem cell transplantation in patients with active relapsing remitting multiple sclerosis or progressive multiple sclerosis showed efficacy in relapse rate reduction and on magnetic resonance imaging and disability outcomes during a median post-transplant follow-up of about two years. There were risks, including death, associated with the treatment.
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Diagnostic Utility of CSF Alpha-Synuclein
This observational study investigated whether the cerebrospinal fluid (CSF) α-synuclein (α-syn) real-time quaking-induced conversion (RT-QuIC) assay, applied to 289 CSF samples, accurately identified patients with mild cognitive impairment (MCI) caused by probable Lewy body (LB) disease. RT-QuIC identified patients with MCI-LB against cognitively unimpaired controls with 95% sensitivity, 97% specificity, and 96% accuracy and showed 98% specificity in neuropathologic controls, indicating that CSF α-syn RT-QuIC is a robust biomarker for prodromal dementia with Lewy bodies.
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Surgical Approaches to Decompression in Degenerative Lumbar Spondylolisthesis
A multicenter, randomized, noninferiority trial of people with symptomatic lumbar stenosis and single-level spondylolisthesis who were refractory to conservative treatment found no significant difference between outcomes in those who underwent decompression surgery with instrumented fusion vs. decompression surgery without fusion.
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Adverse Effects of Electronic Cigarettes on the Disease-Naïve Oral Microbiome
A robust metagenomic comparison study of the effects of electronic cigarettes on oral microbiomes suggested the unique aerosol component of electronic cigarettes poses increased risk to development of oral cavity disease.
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Aftermath of COVID-19 in Adults
This review of investigations centered on long-term effects following acute COVID-19 illness in adults illustrates an evolving understanding of the aftermath of this viral infection.
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Electronic Cigarette Use and Risk of Lung Injury
Electronic cigarette use has increased rapidly. Although vaping may aid with stopping cigarette smoking, cases of severe pulmonary disease and several deaths related to vaping have been reported.
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Infectious Disease Alert Updates
Pyrethroids losing activity against mosquitoes; Resistance erodes standard treatment for pneumonia; and homelessness and COVID-19.