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Trends in stroke over the past 50 years: The Framingham StudyA significant reduction in the age-adjusted incidence of stroke in men and women and 30-day mortality in men was shown in a community-based cohort study with biennial assessment of vascular risk factors and active surveillance for incident stroke over the past 50 years. Lifetime risk, severity of stroke, and 30-day mortality in women were stable. Increased life expectancy results in an increase in lifetime risk. This increased longevity is balanced by improvements in risk factor management, yielding no significant change.
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Newborn with Facial MarksThis newborn was noted to have these facial lesions at time of birth. On further exam there is some erythema on the nape of the neck. The parents indicate that the color seems to be more or less prominent at various times. The pregnancy and delivery were otherwise uncomplicated.
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Management of Acute GI Bleeding in Primary Care: An UpdateUpper gastrointestinal bleeding is a common medical emergency that continues to be a significant cause of morbidity and mortality. It requires rapid and appropriate intervention to control the associated hemodynamic instability and prevent continued or recurrent bleeding. Etiology is the key to prognosis. Lower gastrointestinal bleeding usually ceases spontaneously but may also result in hemodynamic instability or symptomatic anemia. Recognizing the signs and symptoms of upper versus lower gastrointestinal bleeding is crucial for prompt and appropriate treatment.
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Revascularization in patients 75 years or older with diabetes mellitus and angina pectorisWe analyzed the results of the Trial of Invasive Versus Medical Therapy in the Elderly with Chronic Coronary Artery Disease (TIME) in which invasive treatment was compared with optimized medical treatment in patients with chronic angina aged 75 years and older. Patients with diabetes had higher mortality than nondiabetic patients, but revascularization improved overall survival similarly in diabetic and nondiabetic patients.
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Initiating treatment for chronic heart failureStandard congestive heart failure treatment begins with an angiotensin-converting enzyme (ACE) inhibitor to which a beta-blocker is added once the target dose of the ACE inhibitor has been reached. We compared morbidity and mortality between standard treatment and treatment using the reverse sequence, that is, the beta-blocker bisoprolol was given to patients first, followed by the ACE inhibitor enalapril. Results showed that both sequence strategies were safe and effective, with a survival trend in favor of the bisoprolol-first strategy.
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Community-acquired MRSA pericarditisOnly 2 cases of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pericarditis have been reported in the English literature. Over the last 15 years, CA-MRSA has emerged as an increasingly common pathogen that is genetically and epidemiologically different from hospital-acquired MRSA (HA-MRSA).
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Assessing and Treating Complex MigraineProper diagnosis and treatment requires that physicians and patients understand the symptoms and clinical presentation of this complicated migraine condition.
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Hyperglycemia and platelet function in diabetic patients: Relevance to acute myocardial ischemia and infarctionDiabetic patients with acute coronary syndromes are at higher risk for mortality, even if they have ST-segment elevation myocardial infarction. Diabetic patients with unstable angina/non–Q-wave infarction have impaired platelet responsiveness to nitric oxide, a physiological anti-aggregating autocoid. The extent of this impairment depends on the degree of hyperglycemia. Rapid correction of hyperglycemia with infused insulin restores responsiveness to nitric oxide, thus ameliorating platelet dysfunction.
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Chronic diuretic use and increased mortality and hospitalization in heart failureDiuretic use is associated with activation of neurohormones and disease progression in heart failure. Yet, diuretics are commonly prescribed, although little is known about their long-term effects. We performed a study based on propensity score matching, which indicated that in subjects with ambulatory, chronic, mild-to-moderate heart failure, diuretic use was associated with increased mortality and hospitalization. These findings call into question the wisdom of using long-term diuretic therapy in heart failure patients who are asymptomatic or minimally symptomatic.
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Creatine kinase-MB elevation following coronary artery bypass graft surgery: What is its significance and should it be measured in all patients?In their study consisting of coronary artery bypass graft (CABG) patients recruited from 4 major trials, Mahaffey found that creatine kinase-myocardial band (CK-MB) elevations following CABG surgery are independently associated with an increased risk of mortality in patients with non–ST-segment elevation acute coronary syndromes, especially if the peak CK-MB level is > 5 x the upper limit of normal (ULN).
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HIV in Prison: How Inmates and Partners Are at RiskPrisons are breeding grounds for STIs, including HIV. What can fix that?
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The EMR as a Catalyst for QualityThe EMR has long promised a brave new world in which clinical information is synthesized, individualized, and seamlessly delivered to the frontline clinician.
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The Logistics of Getting to HaitiIdentifying the needs of the Haitians who were affected by the earthquake, finding a place to stay and work, and getting there would be impossible for us without the help and coordinated efforts of many people.
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Atorvastatin pretreatment in early percutaneous coronary interventionAccording to results of the Atorvastatin for Reduction of Myocardial Damage During Angioplasty-Acute Coronary Syndromes (ARMYDA-ACS) trial, short-term pretreatment with high-dose atorvastatin prior to percutaneous coronary intervention improves clinical outcome in subjects with unstable angina and non-ST-segment elevation myocardial infarction. These findings support the upstream administration of high-dose statins in subjects with acute coronary syndrome treated with an early invasive strategy.
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Are Hillary Clinton and Donald Trump Healthy Enough to be President?Will our next president be medically fit? And how much is the public entitled to know about candidates’ personal health?
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FDA Approves Adamis' Cheaper Alternative to EpiPenAdamis developed a single-dose epinephrine pre-filled syringe to treat anaphylaxis.
