Category: Physicians

Family Physicians

Bleeding risk following systemic fluconazole or topical azoles in patients with atrial fibrillation on apixaban, rivaroxaban or dabigatran

Background Bleeding safety in relation to use of systemic fluconazole and topical azoles among patients with atrial fibrillation treated with apixaban, rivaroxaban or dabigatran is insufficiently explored, despite clinical relevance and several reports suggesting associations.Methods Using nationwide, Danish registers we identified patients with atrial fibrillation initiated on apixaban, rivaroxaban or dabigatran from 2012–2018. We investigated associations between bleeding incidents, and systemic fluconazole or topical azole treatment using a case-crossover design with 30-day exposure windows and reported odds ratios (OR) with 95% confidence intervals (CI).

Mistaken Identity: Many Diagnoses are Frequently Misattributed to Lyme Disease

Lyme disease is the most common vector-borne infection in North America and Europe, commonly caused by one of three pathogenic genospecies of the spirochete Borrelia 1 2. Borrelia burgdorferi sensu stricto is transmitted solely in North America, mostlyby the tick Ixodes scapularis. The infection typically causes dermatologic, musculoskeletal, neurologic, and cardiac illnesses. Both under- and over-diagnosis of Lyme disease have been well described3 4 5. While antibiotic therapy resolves symptoms for most infected patients, some are left with persistent subjective problems such as pain, fatigue or brain fog that may fall within the proposed entity post-treatment Lyme disease syndrome 6.

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