Amboss | One-Minute Telegram️

🔻As we celebrate reaching the 💯th edition of the One-Minute Telegram, we'd like to thank our dedicated readers over the past four years. We hope that every issue has not only enriched your practice and studies but offered some well-deserved breaks. Your One-Minute Telegram team, Medical editors •  T. Barak, MD, MSc, DTM&H •  J. Jan, MD •  A. Lemoine, MD •  C. Moreno del Castillo, MD, MSc •  M. Overland, MD •  D. Randle, MD •  R. von Simson, MBBS, MSc, DLSTHM, MRCEM Copy editors •  A. Willis, MSc •  L. Toocaram, PhD 🎁For amazing Amboss Offers join us here

❓A 48-year-old woman with a history of hypertension and hyperlipidemia reports fever, chills, purulent nasal drainage, severe facial pain, and headache for the past 10 days. Two weeks ago, she saw her primary care provider for symptoms of fever, chills, malaise, sore throat, and a mild headache and was diagnosed with a viral syndrome. On physical examination, her vital signs are normal with the exception of a temperature of 38.9°C. She has boggy nasal mucosa, marked facial tenderness, and mild erythema of the pharynx. Laboratory investigations, including a complete blood count and comprehensive metabolic panel, are within normal limits. She has no known drug allergies. In addition to symptomatic therapy, which one of the following treatments is most appropriate for this patient ❓ 🔄Amoxicillin–clavulanate 875 mg by mouth twice daily for 5 to 7 days 🔄No antibiotic therapy is necessary 🔄Azithromycin 500 mg by mouth for one dose, followed by 250 mg by mouth once daily for 4 days 🔄Trimethoprim–sulfamethoxazole 160/800 mg twice daily for 3 to 7 days 🔄Levofloxacin 500 mg by mouth once daily for 5 to 7 days ✅Please check the first comment for the answer.👇

⏺#3: Blood pressure management in undifferentiated stroke: one size does not fit all 10-second takeaway The optimal management of blood pressure during acute stroke is unclear. In this study, ambulance-delivered rapid reduction of elevated blood pressure in patients with undifferentiated stroke did not improve functional outcomes overall, but was associated with better outcomes in patients with hemorrhagic stroke and worse outcomes in those with ischemic stroke. Quickly determining whether a stroke is hemorrhagic or ischemic remains a critical first step in stroke management. 🔹That was just a summary. The full text is in the first comment.👇

⏺#2: Less is more with low-risk prostate cancer 10-second takeaway Active surveillance is a recommended management strategy for most patients with favorable-risk prostate cancer (i.e., low-risk and very low-risk prostate cancer), but many clinicians remain fearful of undertreating cancer and choose more aggressive treatments, increasing the risk of unnecessary iatrogenic complications. In this long-term study of protocol-directed active surveillance of favorable-risk prostate cancer, half of the participants had no disease progression or treatment; in the other half, late disease progression and treatment were not associated with worse outcomes than earlier treatment. Clinicians and patients should feel comfortable choosing active surveillance as a strategy to manage favorable-risk prostate cancer. 🔹That was just a summary. The full text is in the first comment.👇

⏺#1: Shining a light on vitamin D supplementation 10-second takeaway Vitamin D supplementation and laboratory testing for 25(OH)D levels are common in the US due to the association between low vitamin D status and many diseases, but causal links have not been established for most diseases. The new clinical practice guideline from the Endocrine Society recommends against routine 25(OH)D testing and that empiric vitamin D supplementation should only be used in individuals who are aged 1–18 years or ≥ 75 years, are pregnant, or have high-risk prediabetes. These recommendations do not apply to individuals with established indications for vitamin D testing or supplementation. 🔹That was just a summary. The full text is in the first comment.👇

💠One-Minute Telegram | #100, June 2024 The One-Minute Telegram is a journal club for busy doctors, with the latest research distilled down to just one minute. AMBOSS has acquired NEJM Knowledge+, the self-assessment board exam prep question bank for internal medicine, pediatrics, and family medicine, from NEJM Group. Scroll down for a complimentary NEJM Knowledge+ question!🫰

✍️Medical editors •  C. Moreno del Castillo, MD, MSc •  T. Barak, MD, MSc, DTM&H Copy editor •  A. Willis, MSc Best wishes Your Amboss Team 🎁For amazing Amboss Offers join us here

💠#3: Early initiation of dapagliflozin during hospitalization for AHF 10-second takeaway Hospital management of acute heart failure (AHF) includes rapid decongestion and optimization of guideline-directed medical therapy. Previous trials demonstrated improved intermediate and long-term outcomes with the initiation of SGLT2 inhibitors at the end of hospitalization. In the DICTATE-AHF trial, initiation of dapagliflozin within 24 hours of admission for hypervolemic AHF did not improve dose-based diuretic efficiency but was associated with lower cumulative loop diuretic doses, improved diuresis and natriuresis, and a higher likelihood of early hospital discharge compared to usual care. These findings suggest that initiation of dapagliflozin on the first day of hospitalization for AHF is safe and may enhance diuresis. 🔹That was just the summary , full text in the first comment👇

💠#2: Acetaminophen for sepsis? 10-second takeaway Cell-free hemoglobin levels are elevated in the serum of critically ill patients with sepsis and are associated with the development of organ dysfunction. Acetaminophen is known for its antipyretic and antiinflammatory effects and can block hemoglobin-induced oxidative damage. This study found that in patients with sepsis, IV acetaminophen was safe but did not significantly increase the number of days patients were alive and free of organ support compared to placebo. Results did not differ in patients with high baseline cell-free hemoglobin levels. 🔹That was just the summary , full text in the first comment👇

💠1: Specialized care of newly diagnosed asthma and COPD leads to better outcomes 10-second takeaway Many individuals with chronic obstructive pulmonary disease (COPD) or asthma remain undiagnosed and untreated. In this trial, a strategy for early diagnosis and pulmonologist-directed treatment of individuals with respiratory symptoms reduced health care visits for respiratory illness and improved patients' respiratory health compared to early diagnosis and usual care. Early diagnosis and specialized care of asthma and COPD may reduce the burden on patients and health care systems. 🔹That was just the summary , full text in the first comment👇