Potential role of the endocannabinoid receptor antagonist rimonabant in the management of cardiometabolic risk: a narrative review of available data

The endocannabinoid system (ECS) is an endogenous physiological system composed of two cannabinoid receptors and several endogenous ligands. The ECS is intimately involved in appetite regulation and energy homeostasis, which makes it an intriguing target for pharmacological treatment of obesity, diabetes, and the metabolic syndrome. Rimonabant is the first cannabinoid receptor (CB-1) antagonist being studied and utilized to treat obesity (it is approved in Europe but is currently under review in the United States). Large randomized trials with rimonabant have demonstrated efficacy in treatment of overweight and obese individuals with weight loss significantly greater than a reduced calorie diet alone. In addition, multiple other cardiometabolic parameters were improved in the treatment groups including increased levels of high density lipoprotein cholesterol, reduced triglycerides, reduced waist circumference, improved insulin sensitivity, decreased insulin levels, and in diabetic patients improvement in glycosylated hemoglobin percentage. There was an increase in the adverse effects of depression, anxiety, irritability, and nausea in rimonabant-treated groups. This novel medication may become an important therapeutic option in the fight to reduce cardiovascular disease worldwide through its unique action on cardiometabolic risk

Genetic Confirmation of Clonal Spread of Candida auris from Southern to Northern Nevada

Candida auris is an emerging fungal pathogen characterized by high levels of antifungal drug resistance and hospital outbreaks in a global distribution. Since introduction to the United States, it has been identified most frequently in New York, Illinois, California, Florida, and Nevada. Its surge poses significant risk as a nosocomial infection with multi-drug resistance, with clades bearing resistance to fluconazole, micafungin, and amphotericin B. Within the state of Nevada, and specifically the greater Las Vegas area in the southern part of the state, there are ongoing outbreaks from clade I and clade III, with 1728 confirmed clinical cases identified as of January 2025. In northern Nevada, three clinical cases have been identified to date, with two occurring at our facility. Both patients had been hospitalized at facilities in Las Vegas, Nevada. The C. auris strains isolated from these two cases have been identified as belonging to clade III and demonstrate resistance to fluconazole. Genome sequencing of the C. auris isolates indicates close genetic identity to strains from the Las Vegas outbreak. These data indicate that the spread of these clonal isolates is due to hospitalization and subsequent patient relocation to northern Nevada, revealing the ongoing importance of screening for geographic spread

How we developed and piloted an electronic key features examination for the internal medicine clerkship based on a US national curriculum

<div><p></p><p><b>Background</b>: Key features examinations (KFEs) have been used to assess clinical decision making in medical education, yet there are no reports of an online KFE-based on a national curriculum for the internal medicine clerkship.</p><p><b>What we did</b>: The authors developed and pilot tested an electronic KFE based on the US Clerkship Directors in Internal Medicine core curriculum. Teams, with expert oversight and peer review, developed key features (KFs) and cases.</p><p><b>Evaluation</b>: The exam was pilot tested at eight medical schools with 162 third and fourth year medical students, of whom 96 (59.3%) responded to a survey. While most students reported that the exam was more difficult than a multiple choice question exam, 61 (83.3%) students agreed that it reflected problems seen in clinical practice and 51 (69.9%) students reported that it more accurately assessed the ability to make clinical decisions.</p><p><b>Conclusions</b>: The development of an electronic KFs exam is a time-intensive process. A team approach offers built-in peer review and accountability. Students, although not familiar with this format in the US, recognized it as authentically assessing clinical decision-making for problems commonly seen in the clerkship.</p></div