Background: Dexmedetomidine, an alpha-2 agonist commonly used as a sedative agent in mechanically ventilated patients, has been associated with drug-induced fever. Concern for fever may prompt diagnostic evaluation and empiric antimicrobial therapy, potentially leading to unnecessary health care utilization. Objective: This pilot study aimed to evaluate if dexmedetomidine use in mechanically ventilated medical intensive care unit (ICU) patients was associated with increased escalation of care compared with alternate sedative agents. Methods: This single-center, retrospective, matched cohort study included patients 18 years or older who were admitted to the medical ICU and required a sedative agent to facilitate mechanical ventilation. Patients receiving dexmedetomidine were matched 1:1 with patients receiving alternate sedative agents. The primary outcome was the composite outcome of initiation of diagnostic evaluation and/or antimicrobial escalation (IDEA). Results: A total of 150 patients were included (75 per group). Most patients were male (68%), and 45% had a primary diagnosis of respiratory failure. The primary outcome, IDEA, occurred in 53 patients (71%) receiving dexmedetomidine and 51 patients (68%) receiving alternate sedatives ( P = .723). Fever occurred in 24 patients (32%) receiving dexmedetomidine compared with 17 patients (23%) receiving alternate sedatives. Median ICU length of stay was longer in the dexmedetomidine group (5 [interquartile range, IQR 1-8] vs 4 [IQR 1-5] days; [ P = .002]). In-hospital mortality occurred in 14 patients (19%) receiving dexmedetomidine and 24 patients (32%) receiving alternate sedative ( P = .060). Conclusions: There was no statistically significant difference between escalation of care in the use of dexmedetomidine versus other sedatives in ICU patients.
Objective: Review the pharmacology, efficacy, and safety of lecanemab, a humanized immunoglobulin gamma 1 (IgG1) monoclonal antibody, for the treatment of early Alzheimer’s disease (AD). Data Sources: Comprehensive search of Embase, PubMed, International Pharmaceutical Abstracts, Cochrane CENTRAL, Scopus, Web of Science, and Google Scholar were conducted from inception through December 2025. Study Selection and Data Extraction: Phase I-III clinical trials, systematic reviews, and meta-analyses evaluating lecanemab pharmacology, pharmacokinetics, efficacy, and safety were included. Product labeling was reviewed to supplement clinical data. Data synthesis: In the phase III Clarity AD trial, patients were randomized 1:1 to lecanemab 10 mg/kg every 2 weeks or placebo. The primary endpoint was change from baseline in Clinical Dementia Rating Sum of Boxes (CDR-SB) score at 18 months. Lecanemab demonstrated a mean change of 1.21 versus 1.66 with placebo (difference, −0.45; 95% CI, −0.67 to −0.23; P < .001). Secondary endpoint, amyloid burden via positron emission tomography (PET) scans ( n = 698) showed −55.48 centiloids with lecanemab versus 3.64 with placebo (difference −59.12 centiloids; 95% CI, −62.64 to −55.6; P < .001). Additional endpoints included changes in ADAS-cog 14, ADCOMS, and ADCS-MCI-ADL scores favoring lecanemab over placebo. Lecanemab was well tolerated; infusion site reactions occurred in 26.4%. Amyloid-related imaging abnormalities (ARIA-E) occurred in 12.6% of participants. Conclusion: Compared to placebo, lecanemab demonstrated statistically significant slowing of cognitive decline on CDR-SB and secondary endpoints, including amyloid burden reduction. However, its clinical benefit must be weighed against ARIA risk and substantial financial burden. Current evidence supports its use in carefully selected patients with early AD under close supervision.
Background: Vancomycin and linezolid are commonly used for empiric treatment of methicillin-resistant Staphylococcus aureus (MRSA), but differences may influence the preferred agent. Vancomycin requires individualized dosing and drug monitoring, possibly delaying initiation. Linezolid offers fixed dosing, and potentially lower costs, which may improve time to first dose. This study compares clinical, operational, and cost outcomes associated with empiric vancomycin and linezolid use. Methods: This single-center, retrospective chart review included a convenience sample of 100 hospitalized adults receiving more than 1 dose of empiric vancomycin or linezolid, stratified by level of care (intensive care unit [ICU] vs non-ICU). The primary endpoint was 30-day all-cause mortality. Secondary endpoints included time to first dose, adverse events, therapy changes, treatment duration, length of stay (LOS), cost, and vancomycin dosing characteristics. Results: A convenience sample of 100 patients (50 per group) was analyzed. Thirty-day all-cause mortality was 22% with vancomycin versus 12% with linezolid ( P = .183). No statistically significant differences were observed in time to first dose (2.03 ± 1.51 hours vs 1.6 ± 1.66 hours, P = .180). No statistically significant difference was detected in therapy changes, treatment duration, hospital/ICU LOS, treatment failure, and adverse events. Vancomycin had a higher medication cost ($46.59 vs $29.52, P = .012). Patients receiving vancomycin had an average of 2.8 levels, requiring a median of 54.6 hours to reach therapeutic range, maintaining it for 29.5% of treatment duration. This study is limited by its retrospective design and small sample size. Conclusion: No statistically significant differences in clinical outcomes were detected between patients receiving empiric linezolid and vancomycin. Linezolid was associated with lower drug acquisition cost.
Background: Chromium picolinate has been studied as an adjunct to improve glycemic indices in ambulatory type 2 diabetes mellitus, but its role in critically ill patients is unknown. Objective: To evaluate whether chromium picolinate supplementation was associated with reduced insulin requirements without worsening glycemic control in critically ill adults with type 2 diabetes mellitus. Methods: We conducted a single-center retrospective pre-post cohort study of adult intensive care unit patients with type 2 diabetes mellitus or hemoglobin A1c ≥6.5% who received insulin and at least 4 consecutive chromium picolinate doses between July 2022 and January 2023. Patients served as their own controls during 24-hour pre- and post-chromium periods. The primary outcome was change in total daily insulin dose. Secondary outcomes included proportion of measured glucose values within 140 to 180 mg/dL, acute kidney injury, hypoglycemia, and exploratory Sequential Organ Failure Assessment-2 change. Results: Among 91 screened patients, 45 met the inclusion criteria. Median total daily insulin dose decreased from 76.3 U/d (interquartile range [IQR], 40.1-96.9) before chromium to 40.0 U/d (IQR, 20.5-65.6) after chromium; the Hodges-Lehmann paired difference was −23.0 U/d (95% CI, −33.25 to −14.25; P < .0001). Proportion of measured glucose values within target did not differ significantly. No post-intervention hypoglycemia was observed, and 2 patients met the study-defined acute kidney injury criterion. Interpretation is limited by the retrospective design and absence of a concurrent control group. Conclusions: Chromium picolinate supplementation was associated with lower insulin requirements without worsening glycemic control. These hypothesis-generating findings require confirmation in prospective controlled studies.
Introduction: Breast cancer is the most prevalent cancer among women worldwide with a higher probability of diagnosis in the postmenopausal years. Aromatase inhibitors (AIs) block the aromatase enzyme responsible for converting androgens into estrogens in the peripheral tissues, which become the main source for estrogen production in this population. Estrogen plays a key role in promoting vasodilation and inhibiting vascular injury and atherosclerosis development. Reduced levels can contribute to adipocyte hyperplasia, insulin resistance, and dyslipidemia, all of which are risk factors for atrial fibrillation. Patient Case: We describe the case of a 71-year-old postmenopausal female who presented to the emergency department with shortness of breath and was subsequently diagnosed with new-onset atrial fibrillation. This case report aims to evaluate whether there is a potential correlation between the initiation of an AI and the development of atrial arrhythmias. Discussion: While existing data suggest an association between AI use and atrial fibrillation, there lacks an elaborate understanding of the temporal relationship between the 2. This case highlights a potential association between AI therapy and unusually rapid-onset atrial fibrillation, demonstrating the need for further research and increased clinical awareness when managing patients receiving these treatments.
