Introduction Commotio cordis (CC), or concussion of the heart, is typically characterized by a sudden impact to the chest wall precipitating ventricular fibrillation arrest. There have been very few documented cases of atrial fibrillation (AF) resulting from this mechanism. A relative consensus exists in the crucial nature of the timing of a blow at the vulnerable ventricular repolarization in the cardiac cycle, with suggestion of the impact occurring during atrial repolarization, triggering paroxysmal atrial fibrillation.Case Presentation We present the case of a 17-year-old male patient who sustained two significant chest wall blows over the course of 8 months with initial electrocardiogram evidence of both atrial and ventricular irritability, subsequently developing AF, which did not spontaneously resolve.Conclusions Although the focus of CC has been management of immediate and lethal ventricular arrhythmias, atrial arrhythmias such as atrioventricular block, atrial flutter, or AF can occur from abnormal depolarization or occult damage to the conduction system. Detection of these rhythms may be delayed due to lack of initial collapse. Clinicians in the emergency department need to consider the possibility of late complications even in patients who do not exhibit immediate ventricular arrhythmia.
Introduction/Aims Guidelines for the management of chronic inflammatory demyelinating polyneuropathy (CIDP) recommend corticosteroids, intravenous immunoglobulin (IVIg), or plasma exchange for first-line therapies and subcutaneous immunoglobulin (SCIg) as a maintenance option. Literature on clinical experience with SCIg in CIDP maintenance therapy is limited. This study outlines practical approaches to SCIg transition and management optimization, considering the varying dosing recommendations in prescribing information and clinical guidelines.Methods This retrospective, multicenter study analyzed anonymized patient medical records from eight US centers. Patients with CIDP who transitioned to SCIg were included, and clinical practices regarding SCIg therapy management were analyzed.Results These 20 cases presented practical and clinical considerations for successful SCIg transition and maintenance. Switching decisions were guided by patient-physician assessment of treatment goals, benefits, and risks. The most common reason for switching (70%) was preference for site of care. Eight patients (40%) transitioned to a dose equivalent to their baseline IVIg dose. Overall, 12/19 patients (63%) remained stable following transition. Relapse-free rates were higher in patients who transitioned to a higher (67%) or lower (75%) than baseline dose versus those who received an equivalent dose (50%). All relapsed patients restabilized after increasing their SCIg dose. The final mean (SD) SCIg dose was 0.32 (0.15) g/kg/week. SCIg was well tolerated; 11 patients (55%) reported better tolerance versus IVIg.Discussion These patient cases provide practical guidance for SCIg therapy in CIDP maintenance, emphasizing individualized dosing strategies, ongoing monitoring, and patient-centered engagement. The findings help inform clinical decision-making to optimize long-term therapeutic outcomes.
Heart failure (HF) management is well-defined for reduced ejection fraction (HFrEF) but less so for mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF). This meta-analysis evaluates the impact of Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, on cardiovascular and renal outcomes in these patient populations. A systematic search in PubMed and Embase identified randomized controlled trials (RCTs) on Finerenone’s cardiovascular and renal effects. Three RCTs were included—FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF—encompassing 19,027 participants. Primary outcomes included cardiovascular death, HF hospitalization, and renal failure. Secondary outcomes focused on safety and adverse events like acute kidney injury and hyperkalemia. Meta-analyses were performed using hazard ratios (HR), confidence intervals (CI), and Relative Risk (RR). Finerenone was associated with a 20
The optimal duration of antibiotic therapy for Gram-negative bacteremia sourced from urinary tract infections (UTI) remains uncertain. We performed a systematic review and meta-analysis comparing short-course (approximately 7 days) versus prolonged-course (approximately 14 days) antibiotic therapy in this population. We systematically searched PubMed, Embase, and ClinicalTrials.gov through 26 April 26 2025. Studies were included if they compared 7-day versus 14-day antibiotic therapy in Gram-negative bacteremia with ≥ 65
