Questioning Medicine

https://www.nejm.org/doi/full/10.1056/NEJMoa2405182?query=recirc_Semantic     Key Takeaways Extended Predictive Value of Biomarkers : High-sensitivity C-reactive protein (CRP), LDL cholesterol, and lipoprotein(a) levels were found to be predictive of cardiovascular events over a 30-year period. These markers contribute independently to long-term cardiovascular risk beyond traditional 10-year risk...

Desgagnés N et al. Use of albumin-adjusted calcium measurements in clinical practice. JAMA Netw Open 2025 Jan 21; 8:e2455251. ( https://doi.org/10.1001/jamanetworkopen.2024.55251 ) Overall, total calcium levels (just the ones we would get back on a basic cmp) correlated better with ionized calcium than did formula-corrected calcium levels. Formulas with stronger correlation than total calcium leve...

https://www.nejm.org/doi/10.1056/NEJMoa2416394 At 72 weeks, the mean percentage decrease in weight was significantly greater with tirzepatide than with semaglutide (20% vs. 14%). Gastrointestinal side effects occurred frequently in both groups but led to discontinuation of treatment in only 3% and 6% of participants in the tirzepatide and semaglutide groups, respectively. Injection-site reactions...

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832701 In this multisite trial, 800 adults who smoked 10 or more cigarettes daily (mean duration of smoking, ≈35 years) were randomized to 6 or 12 weeks of cytisinicline or to placebo. In the 6-week group,15% of cytisinicline recipients and 6% of placebo recipients were abstinent (defined by self-report and breath carbon monoxide &...

What does the evidence and the guidelines say about the use and testing of Vitamin D in kids

Aryee EK et al. Prevalence of obesity with and without confirmation of excess adiposity among US adults. JAMA 2025 Apr 17; [e-pub]. ( https://doi.org/10.1001/jama.2025.2704 ) The rate of obesity was 39.7% based on BMI and 39.1% based on excess adiposity. Among participants with obesity based on BMI, 98% also had excess adiposity; in other words, essentially the same individuals were considered as...

In an hour-by-hour analysis, patients we suspect to have asthma are significantly more likely to have positive bronchodilator responses early in the morning; with each passing hour before testing, there was small decrease (8%) in positive response. Patients also were more likely to have positive responses in the winter.  Knox-Brown B et al. Effect of time of day and seasonal variation on bronchodi...

Vitamin D and Adults and what you should do with Vitamin D

 a cme lecture on the outpatient management of COPD

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https://www.nejm.org/doi/full/10.1056/NEJMoa2405923?query=clinical-medicine   Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain.     Recent attempts to improve outcomes with intensified renin–angiotensin–aldoste...

Estimated 5-year incidence of recurrent VTE was similar in the reduced-dose and full-dose groups (2.2% and 1.8%). Estimated 5-year bleeding incidence was significantly lower with reduced-dose than with full-dose treatment (2.1% vs. 4.0% for major bleeding; 8.6% vs. 11.5% for clinically relevant nonmajor bleeding). Outcomes with apixaban and rivaroxaban were similar. Couturaud F et al. Extended tre...

https://www.nejm.org/doi/full/10.1056/NEJMoa2405404 NNT of 4! systemic metronid and topical clinda bid for one week

What Was Studied? The EMPA-KIDNEY trial followed 6,609 CKD patients at risk of disease progression. Participants were randomly assigned to receive empagliflozin (10 mg daily) or a placebo for a median of 2 years. After this ‘active’ phase, 4,891 patients entered a 2-year post-trial observational period where neither group received the trial drug, but doctors could prescribe open-label SGLT2 inhibi...

Metformin while not necessarily first line therapy for diabetes depending on the patients co-morbid conditions it is certainly highly ranked on the list of medications!   I know often metformin is stopped while coming into the hospital for fear of potentially lactic acidosis or an increase in AKI with contrast studies however this ‘belief’ is largely based on myth and misconception. Metformin's co...

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825813 Conclusions and Relevance   In this randomized clinical trial assessing simultaneous vs sequential administration of mRNA COVID-19 and IIV4 vaccines, reactogenicity was comparable in both groups. These findings support the option of simultaneous administration of these vaccines.

https://www.bmj.com/content/388/bmj-2024-081164 systematic review and meta-analysis on prehabilitation before surgery, published in the BMJ in February 2025.Prehabilitation aims to prepare patients for surgery through interventions like exercise, nutrition, and psychological support. This study looked at which prehabilitation components are most effective for improving key outcomes after surgery....

Mammograms

379. REPORT mammogram part 1

https://jamanetwork.com/journals/jama/article-abstract/2828218 DCIS is a non-invasive form of breast cancer, meaning the abnormal cells are contained within the milk ducts. For years, the standard treatment has been surgery, often followed by radiation and/or hormone therapy - the same treatments used for invasive breast cancer. But is this aggressive approach always necessary for low-risk DCIS? (...

Association of Duration of Recognized Hypertension and Stroke Risk: The REGARDS Study       (Transition Music - Short and subtle - 2 seconds)Host:    Hypertension is a well-known risk factor for stroke, but this study, led by Dr. George Howard and colleagues, asks a fascinating question: Does the duration of hypertension matter, even when blood pressure is managed?   (Transition Music - Short and...

Bloom CI et al. Association of dose of inhaled corticosteroids and frequency of adverse events. Am J Respir Crit Care Med 2025 Jan; 211:54. ( https://doi.org/10.1164/rccm.202402-0368OC )     Bloom and colleagues' study, published in the American Journal of Respiratory and Critical Care Medicine in January 2025, provides significant insights into the safety profile of inhaled corticosteroids (ICS)...