Articles related to Internal Medicine

A 75-y-o man is found to have an INR of 8.5 on routine monitoring. There is no evidence of bleeding, and he is otherwise well. He is instructed to stop warfarin. His hemoglobin comes back normal. What is the best next step in managing him: intervention or observation?

When tested at 32 weeks gestation, fetuses whose mothers ate carrots reacted with smiles, while those whose mothers ate kale showed crying faces. And those reactions became more expressive as the fetuses mature.

In the 5-year, multi-center, randomized, controlled GRADE trial (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study), insulin glargine and liraglutide were about 13% more effective than glimepiride in keeping HbA1c lower than 7.0%, and 30% more effective than sitagliptin.

Palliative care (PC) can help reduce emergency department use, hospitalizations, and symptom burden across a spectrum of diseases. To assist clinicians in keeping their expertise current, the authors reviewed and summarized the top PC articles of 2020. The analysis included 28 PC intervention trials for heart failure, chronic obstructive pulmonary disease, and dementia.

Gabapentin has been increasingly used as part of a multimodal analgesia regimen to reduce opioid use in perioperative pain management. In this cohort study of 237,872 adults aged 65 years or older, perioperative gabapentin users had significantly increased risk of delirium, new antipsychotic use, and pneumonia compared with nonusers after major surgery.

An 18-year-old man comes to you for a sports physical. He is asymptomatic, with no limitation in his exercise capacity. He has a history of exercise-induced bronchospasm for which he takes a budesonide-formoterol inhaler. He does not smoke, drink alcohol, or use any drugs. There is no family history of cardiac disease or sudden death. What’s the next appropriate test?