Neurology

Articles

• When to Administer the 13-Valent Pneumococcal Conjugate Vaccine: A Review of the ACIP Recommendations

  Recently revised guidelines no longer recommend the 13-valent pneumococcal conjugate vaccine for most healthy adults.

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• Why Was There Syncope?

  The 12-lead ECG in the figure was obtained from a middle-aged woman with syncope and hypotension but no chest pain. No long lead rhythm strip is available. What might be causing her syncope?

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• Omeprazole Magnesium, Amoxicillin, and Rifabutin Delayed-Release Capsules (Talicia)

  Talicia is indicated for the treatment of Helicobacter pylori infection in adults.

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• Urine Cultures: A Gateway to Antibiotic Overuse

  Inappropriate antibiotics use in nursing homes across North America continues driving antibacterial resistance and the risk of Clostridioides difficile infection in the elderly.

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• Consensus Position Statement on the Use of Testosterone in Women

  A task force of representatives from leading international societies issued guidance for appropriate prescribing of testosterone in women.

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• Sexually Transmitted Diseases in the United States — Not a Happy Picture

  Since reaching historically low rates, many sexually transmitted infections have re-emerged in the United States. Of particular concern is the continued emergence of antibiotic resistance in Neisseria gonorrhoeae.

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• Dual Antiplatelet Therapy Results in Increase in Serious Hemorrhages Following TIA or Minor Stroke

  The POINT trial showed a 25% reduction in the composite outcome of ischemic stroke, myocardial infarction, or ischemic vascular death in patients treated with clopidogrel plus aspirin for 90 days, immediately following a transient ischemic attack (TIA) or minor acute ischemic stroke. The investigators performed a secondary analysis and found the risk of major hemorrhages was low in both groups, although treatment with clopidogrel and aspirin together increased the risk of major hemorrhages over aspirin alone. Caution should be taken and very close observation of patients maintained when treating with dual antiplatelet therapies.

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• Smartwatches for the Diagnosis of Atrial Fibrillation

  The Apple Heart Study participants were people without atrial fibrillation who purchased a smart phone app and consented to monitoring using a smartwatch-based irregular pulse notification algorithm, which identified possible atrial fibrillation. If notification occurred, the person was mailed an electrocardiography (ECG) patch to be worn for seven days to confirm the findings first identified by the smartwatch. The age distribution of this group is different than the usual cohort at risk for atrial fibrillation: 52% were between the ages of 22 and 39 years of age, and only 5.9% were 65 years or older. A much more useful study would have included an older cohort that carries a higher risk of atrial fibrillation.

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• What Is the Optimal Blood Pressure for Secondary Prevention of Stroke?

  High blood pressure is the most prevalent and important risk factor for stroke, and great efforts have been made to reduce blood pressure for both primary and secondary stroke prevention. However, at this time, we do not have evidence to support a firm recommendation for optimal blood pressure management for secondary stroke prevention.

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• Patients With Stable Coronary Disease and Atrial Fibrillation Are Best Treated With Rivaroxaban, Alone

  Optimal antithrombotic therapy for stroke prevention in patients with atrial fibrillation continues to evolve.Monotherapy with rivaroxiban was noninferior to combination therapy for the primary efficacy endpoint.

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