The American journal of medicine
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Cocaine is associated with acute cardiovascular complications, but the long-term cardiovascular risks of cocaine use are poorly understood. We examined the association between cocaine use disorders and long-term cardiovascular morbidity in women. ⋯ Women with cocaine use disorders have a high risk of cardiovascular hospitalization up to 3 decades later. Substance use reduction and cardiovascular risk surveillance may help reduce the burden of cardiovascular disease in women with cocaine use disorders.
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Asymptomatic bacteriuria is a common clinical condition that often leads to unnecessary treatment. It has been shown that incidence of asymptomatic bacteriuria increases with age and are more prominent in women than men. In older women, the incidence of asymptomatic bacteriuria is recorded to be more than 15%. ⋯ Furthermore, unnecessary treatment is often associated with unwanted consequences including but not limited to increased antimicrobial resistance, Clostridioides difficile infection, and increased health care cost. As a result, multiple antibiotic stewardship programs around the US have implemented protocols to appropriately reduce unnecessary treatment of asymptomatic bacteriuria. It is important to appropriately screen and treat asymptomatic bacteriuria only when there is evidence of potential benefit.
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Differentiating patients with type 1 and type 2 myocardial infarction (MI) and acute non-ischemic myocardial injury continues to be a problem for many clinicians. Type 1 MI is the most easily defined. It involves the rise and fall of blood troponin measurements (only falling values if the patient arrives late) with an appropriate clinical observation consistent with myocardial ischemia. ⋯ The clinical scenarios leading to type 2 MI and non-ischemic myocardial injury are, however, often fraught with greater degrees of uncertainty. In addition, therapy for these latter 2 entities is poorly defined. This review will present 3 patient scenarios that should help clinicians understand the difference between these 3 entities as well as possible therapeutic interventions.
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Angiotensin receptor blockers (ARBs), which are commonly used antihypertensives, have been proposed to lower the risk of Parkinson disease by reducing oxidative stress based on animal and in vitro studies. Thus, this study aimed to test this association in patients with newly diagnosed hypertension. ⋯ ARB treatment was associated with a statistically important reduction of Parkinson disease risk in patients with newly diagnosed hypertension. Therefore, ARB may constitute an effective neuroprotective strategy to lower Parkinson disease risk in such patients.
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Current pulmonary embolism treatment options rely heavily on anatomical clot location. However, anatomical location does not necessarily determine adverse outcomes; rather, clinical severity is secondary to the degree of perfusion impairment. Dual-energy computed tomography pulmonary angiogram (DE-CTPA) can map perfusion at the time of pulmonary embolism diagnosis. Single-photon emission computed tomography ventilation-perfusion scans allow for perfusion tracking similar to DE-CTPA. ⋯ Intermediate-risk pulmonary embolism often has large initial clot burden that predicts residual pulmonary vascular obstruction. Residual pulmonary vascular obstruction is associated with increased risk of death, recurrent thrombus, and chronic thromboembolic pulmonary hypertension. Clot removal via thrombectomy may decrease the prevalence of residual pulmonary vascular obstruction by improving lung perfusion. We found that mechanical thrombectomy increased lung perfusion immediately and at follow-up assessments.