Cleveland Clinic Journal of Medicine

KEY POINTS The human gut microbiome is a complex and dynamic system that is susceptible to alterations from various factors; dysbiosis of this environment has clinical implications. FMT is a safe and effective option for the treatment and prevention of recurrent or refractory C difficile infection. Live biotherapeutic products facilitate standardized clinical application of microbiota restorative therapy.

KEY POINTS Attributing microscopic hematuria to a patient’s use of an antiplatelet or anticoagulation medication—without an appropriate workup—is imprudent. These 2 drug classes can unmask hematuria, sometimes revealing a sinister etiology; an algorithmic evaluation is warranted. Gross hematuria requires urgent computed tomography urography and urology referral.

KEY POINTS Patients with cancer are at a much higher risk of developing VTE than the general population. Low-molecular-weight heparin or direct oral anticoagulants are preferred over vitamin K antagonists. Direct oral anticoagulants are generally preferred, but caution is needed in patients at risk of bleeding.

A 55-year-old male presents to the emergency department with dysuria, fevers, and chills. His temperature is 38.3°C (101.8°F), blood pressure 75/46 mm Hg, and heart rate 113 beats per minute. Laboratory test results show a white blood cell count of 17.0 × 109/L (reference range 4.5–11.0) and serum lactate 4 mmol/L (> 2). Urinalysis shows 50 to 100 white blood cells per high-power field (0–3), as well as nitrites and leukocyte esterase.

The evolution of our understanding of human disease has been a remarkable journey, spanning centuries of scientific progress and shifting paradigms. Illness was originally attributed to the imbalance of bodily fluids or the involvement of evil humors and miasmas, concepts rooted in superstition and religious beliefs. Over centuries, a usually more scientific and technologically focused understanding of disease has emerged. The germ theory revolutionized our understanding of infections.

Low vs high dose of dexamethasone in COVID-19 Why not use a higher dose of dexamethasone? Dexamethasone 6 mg is equivalent to only about 30 mg of methylprednisolone. Would 12 mg be better than 6 mg? Two randomized controlled trials28,29 did not show a statistically significant benefit in terms of survival at 28 days in patients who received 12 mg compared with those who received 6 mg. Therefore, 6 mg of dexamethasone is still most commonly given.

RESHAPING THE CANON If we are to truly diversify the medical humanities curriculum, as we must, how should the canon be reshaped? One way would be to continue relying on narratives from conventional spaces, but with an intentional emphasis on voices from communities of people of color.

In recent years, the treatment of heart failure with reduced ejection fraction (HFrEF) has been revolutionized by collaborative efforts among healthcare practitioners, pharmaceutical industry leaders, and regulators regarding the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors.1 A series of cardiovascular outcome trials led to the discovery of powerful and broad cardiorenal benefits associated with this class of drugs, originally developed as noninsulin therapy for type 2 diabetes...

Presenters: Kathryn E. Wellen, PhD, Cholsoon Jang, PhD, Michael Karin, MD, and Mark A. Herman, MD Fructose consumption has been increasing over the past several decades and has been linked to increasing rates of several metabolic diseases in addition to hepatocellular carcinoma (HCC). Fructose metabolism was the focus of a symposium in which four presenters summarized the current knowledge with respect to the role of excess fructose consumption in metabolic disease.