Questioning Medicine

Xin X, et al. Optimal exercise modalities and dosages for blood pressure reduction in adults with prehypertension and established hypertension: A network meta-analysis and dose–response relationship study. J Am Heart Assoc 2026 May 14; 15:e044003. DOI: 10.1161/JAHA.125.044003 .   Vosooney A, et al. Screening for Cervical Cancer: A Recommendation From the Women’s Preventive Services Initiative. Obs...

Jafari K, et al. Risk factors for pediatric deep neck infection revisit after emergency department discharge for pharyngitis or localized neck symptoms. Ann Emerg Med 2026 May; 87:605. DOI: 10.1016/j.annemergmed.2025.10.007 . In a “look-back” analysis of some 800 children admitted with deep neck infection, 18% had at least one ED discharge before admission. The most common discharge diagnoses were...

https://pubmed.ncbi.nlm.nih.gov/41903215/   Evolocumab to Reduce First Major Cardiovascular Events in Patients Without Known Significant Atherosclerosis and With Diabetes: Results From the VESALIUS-CV Trial   https://pubmed.ncbi.nlm.nih.gov/41769754/   Association between statin therapy as primary prevention and mortality in adults 50 years and older with chronic kidney disease without other indic...

https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70463   Angiotensin Receptor Blockers Versus Calcium Channel Blockers for First-Line Antihypertensive Therapy and Survival in Adults Aged 75Years or Older     https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0140673626003673?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673626003673%3Fshowall%3Dtrue&r...

Donato J, et al. Things We Do For No Reason™: Low salt diets for patients with acute heart failure. J Hosp Med 2026 Feb 4; [e-pub]. DOI: 10.1002/jhm.70278 . Some guidelines now recommend "normal sodium intake" for patients with acute and chronic HF, which means avoiding excessive sodium intake and staying under 4 to 5 g daily. https://academic.oup.com/eurjhf/article-abstract/26/4/730/8328801?redir...

432.  CME LECTURE-  Under Pressure, Blood Pressure

https://www.sciencedirect.com/science/article/abs/pii/S2665991326000342?via%3Dihub lancet rheumatology   A treat-to-target strategy versus symptom-driven management of gout in the Netherlands (GO TEST Overture): a multicentre, open-label, pragmatic, superiority, randomised controlled trial     The question on the table: Is chasing a serum urate level below six milligrams per deciliter worth the ef...

Let’s rewind to the early 2000s. Flip phones were cool, low-rise jeans were a crime, and the Women’s Health Initiative—WHI—dropped what became the medical equivalent of a headline: “Hormone Therapy Increases Risk!” The study looked at one very specific regimen: an oral pill with conjugated equine estrogens—yes, horse estrogens—and medroxyprogesterone acetate, or MPA, taken every day by women with...

— rivaroxaban versus apixaban. Yes, folks, this is The Battle of the Blood Thinners! And spoiler alert — one of them came out looking like the overachiever in a safety class... while the other probably needs a little extra padding on its report card. The Setup So here’s the story. For years, observational studies hinted that apixaban — we’ll call it “Api” because we’re friendly like that — might b...

Minocycline in Acute Ischemic Stroke (EMPHASIS trial) A multicenter, double-blind RCT in China studied 1,724 patients with acute ischemic stroke treated within 72 hours of onset. Patients received either a 4.5-day course of oral minocycline or placebo. Minocycline works by inhibiting microglial activation , which contributes to post-stroke inflammation. Primary outcome: 52.6% of minocycline patien...

Today, we're talking about Kawasaki disease-no, not the motorcycle company, though sometimes treating it does feel like trying to ride one at full speed through uncertainty. For decades, high-dose aspirin was basically the holy water of Kawasaki treatment. Eighty to a hundred milligrams per kilogram per day-because apparently, kids with vasculitis also needed a little side of tinnitus. But here's...

Setting the stage Picture this: your knee is like a three-room apartment. You've got a medial room, a lateral room, and a patellofemoral room. In isolated anteromedial osteoarthritis, just one room is trashed. The rest of the apartment still looks like something you'd put on a rental listing.   So surgeons have two choices:   Option A: Total knee arthroplasty, or TKA - bulldoze the entire apartmen...

Kalapura C, et al. Triptan initiation and cerebrovascular events in patients with migraine: A nationwide cohort study. J Am Heart Assoc 2026 Feb 17; 15:e043409. DOI: 10.1161/JAHA.125.043409 .     Today, we're talking triptans - those long-trusted migraine relievers - and a new study that asks a not-so-relaxing question: could they slightly raise the risk of ischemic stroke?   Let's break it down....

Li H-Y, et al. GLP-1 receptor agonists and risk of optic nerve or vision-threatening events in patients with type 2 diabetes or cardiometabolic diseases: A meta-analysis of randomized controlled trials. Diabetes Care 2026 Mar 1; 49:526. DOI: 10.2337/dc25-1929 . Heberer K, et al. New-onset nonarteritic anterior ischemic optic neuropathy and initiators of semaglutide in US veterans with type 2 diabe...

CME-- Discharge Questions Answered in 2025

Lin Z, et al. Antifibrotic drug finerenone restores fertility in premature ovarian insufficiency. Science 2026 Feb 5; 391:eadz4075. DOI: 10.1126/science.adz4075 .   Premature ovarian insufficiency is usually one of those diagnoses that shuts the door on fertility: ovarian function is lost before age 40, mature follicles are scarce to nonexistent, and we have no reliable way to turn things back on....

Stavropoulou E, et al. Reassessing the 2023 International Society for Cardiovascular Infectious Diseases Duke clinical criteria for infective endocarditis: Impact of excluding fever and updating diagnostic definitions. Clin Infect Dis 2025 Dec 31; [e-pub]. DOI: 10.1093/cid/ciaf737 .    Big takeaways About 35% of patients truly had IE. Fever showed up in 80% of patients both with and without IE, so...

we look at CODE LVO and what does being frail even mean????? vaccines may not help baby and antibiotics still don't help viral illness

CME song --Check the Lytes

CME - sodium, potassium, calcium

  10.1016/j.jaip.2025.07.005 .40675327 All of the videos were found to be useful or very useful, 99% were of moderate or high reliability, and 99% had moderate to excellent educational quality   Prostate-specific antigen levels among participants receiving annual testing. JAMA Oncol 2025 Nov; 11:1341 10.1001/jamaoncol.2025.3386 .40965920 PSA levels at or above 4.0 ng/mL fell below that threshold o...

Wolfe R, Broder JC, Zhou Z, et al. Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial. Eur Heart J. 12 Aug 2025. [Epub ahead of print]. https://pubmed.ncbi.nlm.nih.gov/40796244/   Donocan LE et al. Closed-loop insulin delivery in type 1 diabetes in pregnancy: The CIRCUIT randomized clinical trial. JAMA 2025 Oct 24; [e-pub]. ( https://doi.org/...

Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction - https://www.nejm.org/doi/full/10.1056/NEJMoa2504735?query=WB     McGuire DK et al. Oral semaglutide and cardiovascular outcomes in high-risk type 2 diabetes. N Engl J Med 2025 Mar 29; [e-pub]. ( https://doi.org/10.1056/NEJMoa2501006 )   Interactive Virtual Presence to Remotely Assist Parents With Car Seat Installation ht...

https://pubmed.ncbi.nlm.nih.gov/40767818/ This is a great example for students and residents to look and see that the abstract does not always match what the paper actually says

Efficacy and safety of Baxdrostat in uncontrolled and resistant hypertension compared to placebo in phase three when there are MRA available that are cheap and available A randomised trial of physical therapy for meniscal tear and knee pain discovers that home exercises are just as good as inperson physical therapy a Pragmatic trial of glucocorticoids for community acquired pneumonia that I don't...