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MERCURI-2 Trial: Dapagliflozin Dramatically Reduced AKI After Cardiac Surgery
Acute kidney injury remains one of the most frequent complications following cardiac surgery and is associated with prolonged hospitalization, greater morbidity, and worse long-term outcomes. Given the growing evidence that SGLT2 inhibitors have kidney-protective effects in chronic cardiovascular and renal disease, investigators have begun asking whether these benefits might extend into the perioperative setting. The…
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MARCH Trial: Carbocisteine and Hypertonic Saline in Acute Respiratory Failure
Patients receiving invasive mechanical ventilation frequently develop thick or difficult-to-clear respiratory secretions. Mucolytic agents such as carbocisteine and nebulized hypertonic saline are commonly considered to improve secretion clearance, but high-quality evidence supporting their routine use in critically ill ventilated patients has been limited. The MARCH trial, published in the New England Journal of Medicine in…
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ARISE FLUIDS Trial: Early Vasopressors vs More Fluids in Septic Shock
For decades, intravenous fluids have been a cornerstone of early septic shock management. However, growing concern about fluid overload has led clinicians to question whether vasopressors should be started earlier, allowing patients to receive less intravenous fluid. The ARISE FLUIDS trial, published in the New England Journal of Medicine in 2026, directly tested these two…
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Amyotrophic Lateral Sclerosis (ALS): Clinical Features, Diagnosis, and Management
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that affects the motor neurons responsible for voluntary movement. Degeneration of both upper motor neurons (UMNs) and lower motor neurons (LMNs) leads to progressive muscle weakness, atrophy, impaired mobility, bulbar dysfunction, and eventually respiratory failure. Although ALS remains a life-limiting disease, earlier recognition, multidisciplinary care, respiratory…
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ADVANCE OUTCOMES Trial: Ralinepag Reduces Clinical Worsening in Pulmonary Arterial Hypertension
A new phase 3 trial published in The Lancet suggests that ralinepag, an oral once-daily selective prostacyclin IP receptor agonist, can substantially reduce the risk of clinical worsening in patients with pulmonary arterial hypertension (PAH) already receiving contemporary background therapy. The ADVANCE OUTCOMES trial evaluated whether adding ralinepag to existing PAH treatment could improve long-term…
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Rheumatoid Arthritis: Symptoms, Diagnosis, and Long-Term Management
Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints but can also involve the lungs, heart, eyes, skin, and other organs. Unlike osteoarthritis, which is largely related to mechanical wear and tear, rheumatoid arthritis is driven by persistent inflammation of the synovial lining of the joints. Early recognition matters. Without treatment,…
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Right Heart Catheterization and Swan-Ganz Hemodynamic Assessment
A clinician-focused review of right heart catheterization and Swan-Ganz catheterization, including indications, catheter positioning, pressure waveforms, cardiac-output measurement, pulmonary hypertension classification, shock profiles, complications, and common interpretation errors. Right heart catheterization, or RHC, provides direct measurement of right-sided and pulmonary hemodynamics. It remains the reference standard for confirming pulmonary hypertension, differentiating pre- from post-capillary physiology,…
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Amyloidosis: Recognition, Diagnosis, and Treatment Clinical Cheat Sheet
Amyloidosis comprises a heterogeneous group of disorders characterized by extracellular deposition of misfolded proteins as amyloid fibrils. The clinical phenotype depends on the precursor protein, the organs involved, and the extent of tissue deposition. The most important systemic forms encountered in clinical practice are immunoglobulin light-chain amyloidosis, or AL amyloidosis; transthyretin amyloidosis, or ATTR amyloidosis;…
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Hemodialysis: Indications, Prescription, Vascular Access, and Clinical Monitoring
Hemodialysis is an extracorporeal kidney replacement therapy that removes accumulated solutes and excess extracellular fluid while correcting selected electrolyte and acid-base abnormalities. Blood is circulated through a dialyzer containing a semipermeable membrane, across which solutes are cleared primarily by diffusion and fluid is removed by ultrafiltration. Although conventional maintenance hemodialysis is often delivered three times…