#420 Recap Extravaganza: 2023 Highlights and Top Stories
Dec 25, 2023
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The podcast covers a range of interesting topics including menopause therapy, hemochromatosis, hematuria management, diabetes updates, xylazine overdose and withdrawal, primary aldosteronism, resistant hypertension, delirium, AKI risk, statin therapy in HIV patients, inpatient heart failure management, kratom use implications, and effectiveness of RSV vaccines.
Primary aldosteronism should be evaluated in patients with difficult-to-control blood pressure.
Recognizing the symptoms of xylazine overdose is crucial in identifying and treating patients affected by this emerging trend.
Prompt identification and management of underlying causes of delirium are critical to prevent future cognitive decline.
Deep dives
Primary Aldosteronism: A Common Cause of Resistant Hypertension
Primary aldosteronism is the most common cause of resistant hypertension and should be evaluated in patients with difficult-to-control blood pressure. Initial diagnostic testing should include measurement of morning plasma renin activity (PRA) or plasma renin concentration (PRC) and plasma aldosterone concentration. Avoid overuse of beta blockers as fourth-line agents for hypertension management.
Xylazine Overdose and Withdrawal: A Concerning Trend
Xylazine, an animal sedative, has been mixed into the fentanyl supply and has caused Narcan-resistant opioid overdoses. Recognizing the symptoms of xylazine overdose, such as anxiety, is crucial. Timely testing and management are essential in identifying and treating patients affected by this emerging trend.
Delirium: A Harbinger of Cognitive Decline
Delirium is associated with inflammation and neurodegeneration in the brain, and prolonged or severe delirium can increase the risk of cognitive decline and dementia. Prompt identification and management of underlying causes of delirium are critical to prevent future cognitive decline.
Pitavastatin vs. Sufimostat: Comparative Analysis in Acute Kidney Injury
Results of the Acorn trial showed no difference in acute kidney injury risk between patients treated with pitavastatin or sufomostat, suggesting that combination therapy with vancomycin is not associated with an increased risk of AKI. This trial supports the use of pitavastatin as an alternative to sufomostat in patients requiring antibiotic therapy.
Impagliflozin improves clinical outcomes in patients with acute decompensated heart failure
The M. Pulse trial showed that initiating impagliflozin in patients hospitalized with acute decompensated heart failure improves clinical outcomes. Patients who received impagliflozin had a 36% higher likelihood of experiencing clinical benefit at day 90, with symptom improvement starting as early as 15 days.
Kratom use and potential implications
Kratom, a substance that has gained popularity, has psychoactive properties and is being used recreationally and to mitigate opioid withdrawal symptoms. Case series have reported patients being treated for Kratom use disorder, and it is important for healthcare providers to be aware of this substance when taking a patient's social history.
Join us as we recap various topics discussed throughout the year, including hormonal and non-hormonal therapy for menopause symptoms, hemochromatosis, evaluation and management of hematuria, updates in diabetes management (insulin, GLP1 agonists, SGLT2 inhibitors, hypoglycemia), xylazine overdose and withdrawal, primary aldosteronism, resistant hypertension, delirium, and its implications, the ACORN trial on AKI risk with pip-tazo vs. cefepime, the REPRIEVE trial on statin therapy in patients with HIV, inpatient heart failure management, the implications of kratom use, and the effectiveness of RSV vaccines. Plus, Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), Nora Taranto (@norataranto), and Matt Watto (@doctorwatto) share their picks of the year and take a moment to reflect on their gratitude for the fans and the opportunity to work on Curbsiders.
Our team needed a break so we did not make CME for this episode.
Show Segments
Time Stamps are for Patreon (Ad-Free) Version
00:00 Introduction and Overview
09:42 Hormonal and Non-Hormonal Therapy for Menopause Symptoms
14:20 Understanding Hemochromatosis
19:24 Evaluation and Management of Hematuria
25:00 Updates in Diabetes Management
29:35 Xylazine Overdose and Withdrawal
35:35 Primary Aldosteronism
39:36 Resistant Hypertension
44:12 Delirium and its Implications
46:29 The Acorn trial and AKI risk
49:47 HIV trial: Reprieve
51:11 Updates in hospital medicine
56:00 Kratom and its implications
59:11 RSV vaccines and their effectiveness
01:05:38 Reflections and Gratitude
Credits
Written, Produced, and Hosted by: Nora Taranto MD, Rahul Ganatra MD, MPH; Matthew Watto MD, FACP; Paul Williams MD, FACP
Cover Art: Matthew Watto MD, FACP
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Transcript Disclaimer
We've included a a free AI-generated transcript which has not been corrected by a human for accuracy or completeness. Please consider this a starting point for further research and consultation. We disclaim any liability for damages or losses resulting from this content.
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