Is Physical Exam a Lost Art? A Resident's Perspective.

The word clinical derives from the Greek klinikos, meaning "at the bedside, reflecting medicine's roots in human observation and presence. While a detailed history is foundational, a thoughtful physical examination remains critical for guiding diagnosis and comprehensive care. Yet modern clinical practice, driven by time constraints and reliance on technological advancements, has reduced the physical exam to a perfunctory ritual.

The clinical significance of thrombocytopenia in sepsis and septic shock: a systematic review and meta-analysis.

Background: Thrombocytopenia (TCP) is a common finding in critically ill patients that has been linked to a worse prognosis. Specifically, sepsis is a major risk factor for TCP. Several observational studies have examined the prognostic role of TCP and its correlation with clinical outcomes in patients with sepsis.

Forgotten Deficiency: A Case Series Highlighting Atypical Presentations of Scurvy in the 21st Century.

Scurvy, caused by vitamin C deficiency, is increasingly recognized in contemporary clinical practice, particularly among vulnerable populations. Despite its historical association with maritime exploration, scurvy persists in patients with malnutrition, alcoholism, psychiatric disorders, and limited access to fresh produce. This report presents two cases of scurvy diagnosed in a low socioeconomic urban setting, emphasizing the diverse and atypical manifestations of this condition.

Autoimmune hemolytic anemia in COVID-19 patients: A systematic review of 105 cases on clinical characteristics and outcomes.

Background: COVID-19 has been linked to autoimmune hemolytic anemia (AIHA), a rare but serious condition causing red blood cell destruction. This systematic review examines the clinical characteristics, management, and outcomes of AIHA in COVID-19 patients.

Methods: A systematic search of PubMed, CINAHL, and Scopus identified 85 studies encompassing 105 patients.

Clinical outcomes in patients with autoimmune hepatitis and primary biliary cholangitis overlap syndrome in the United States.

Background: There is evidence of overlap between autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC), two autoimmune hepatobiliary diseases. This retrospective analysis aimed to investigate extra-hepatic auto-immune diseases and compare outcomes of hospitalized patients with AIH-PBC overlap with AIH and PBC. We hypothesize that there are differences in rates of major adverse liver outcomes (MALO's) when comparing these groups.

Epidemiology and management of massive, sub-massive, and non-massive pediatric pulmonary embolism: a systematic reviews.

Objective: To evaluate the current evidence on the diagnosis, management, and outcomes of pediatric pulmonary embolism (PE) across varying severity classifications, including massive, submassive, and non-massive presentations.

Methods: A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, Web of Science, and Cochrane databases up to February 17, 2024.

Clinical decision support systems for heart failure management optimization: A systematic review and meta-analysis of randomized controlled trials.

BackgroundHeart failure (HF) patients are frequently rehospitalized shortly after discharge. Telemonitoring and Clinical decision support systems (CDSS) health alert follow-up may reduce the mortality and hospitalization in HF patients following discharge.MethodologyWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trial until May 2024.

Reevaluating STEMI: The Utility of the Occlusive Myocardial Infarction Classification to Enhance Management of Acute Coronary Syndromes.

Background: The current classification of acute myocardial infarction (AMI) into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) has limitations in identifying patients with acute coronary occlusion (ACO) who do not exhibit classic ST-elevation. Emerging evidence suggests that a reclassification to "Occlusive Myocardial Infarction" (OMI) may enhance diagnostic accuracy and therapeutic interventions.

Methods: A comprehensive review of the literature was conducted, focusing on the pathophysiology, electrocardiographic (EKG) patterns, and management of ACO.

Sex-specific differences in infective endocarditis: A systematic review and meta-analysis of clinical profiles and management outcomes.

Background: Infective endocarditis (IE) presents significant morbidity and mortality, with potential sex differences in clinical profile and outcomes. This is the first meta-analysis that aims to compare the clinical profile and outcomes of IE between males and females.

Methods: We conducted a meta-analysis of nine studies evaluating the clinical profile and outcomes of IE in males versus females extracted from PubMed, EMBASE, SCOPUS, and Cochrane databases up to 1st of Jan 2024.

Diagnostic value of CT scans in pediatric patients with acute non-traumatic altered mental status: a systematic review and meta-analysis.

Background: Computed tomography (CT) scans are widely used for evaluating children with acute atraumatic altered mental status (AMS) despite concerns about radiation exposure and limited diagnostic yield. This study aims to assess the efficacy of CT scans in this population and provide evidence-based recommendations.

Methods: A systematic review was conducted according to PRISMA guidelines.

Rotational Atherectomy Followed by Modified (Cutting or Scoring) Balloon Versus Plain Balloon Before Drug‑Eluting Stent Implantation for Calcified Coronary Lesions: A Meta-Analysis.

Coronary calcification is a major factor leading to stent under-expansion, and subsequent adverse events. This meta-analysis aimed to evaluate the short and long‑term outcomes of rotational atherectomy (RA), followed by modified balloon (cutting or scoring) (MB) versus plain balloon before drug‑eluting stent implantation for calcified coronary lesions. We searched PubMed, Web of Science (WOS), Scopus, and the Cochrane Library Central Register of Controlled Trials (CENTRAL), from inception until 30 January 2024.

Optimal Antithrombotic Regimen After Cryptogenic Stroke: A Systematic Review and Network Meta-Analysis.

Although several antithrombotic strategies have been investigated for the management of cryptogenic strokes, ie, ischemic strokes without known etiologies, an optimal antithrombotic strategy for cryptogenic strokes is unknown. We aim to assess oral antithrombotic agents' comparative efficacy and safety after cryptogenic stroke to identify an optimal treatment.A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Embase Cochrane, Scopus, and Web of Science until February 2024.

Targeting Apolipoprotein C-III for the Management of Severe Hypertriglyceridemia: Current Research and Future Directions.

Hypertriglyceridemia is characterized by elevated triglyceride levels in the blood, which increases the risk of cardiovascular disease and pancreatitis. This condition stems from multiple factors including lifestyle choices, genetics, and conditions such as diabetes and metabolic syndrome. Apolipoprotein C-III (APOC3), a protein for lipid metabolism, hinders enzymes necessary for breaking down triglycerides and thus plays a key role in hypertriglyceridemia.

Concomitant hiatal hernia repair with transoral incisionless fundoplication for the treatment of refractory gastroesophageal reflux disease: a systematic review.

Background: Transoral incisionless fundoplication (TIF) is safe and effective in select patients with hiatal hernias ≤ 2 cm with refractory gastroesophageal reflux disease (GERD). For patients with hiatal hernias > 2 cm, concomitant hiatal hernia (HH) repair with TIF (cTIF) is offered as an alternative to conventional anti-reflux surgery (ARS). Yet, data on this approach is limited.

COVID-19 vaccine-associated vasculitis: A systematic review.

Objectives: Post-COVID-19 vaccine-associated vasculitis stands as one of the most serious side effects attributed to COVID-19 vaccines. This complication encompasses diverse manifestations which vary in presentation and severity. Moreover, it can impact patients across all age groups, with a notably elevated incidence in the elderly.