Questioning Medicine

gabapentin may increase COPD exacerbations Benzo for ETOH might be long gone..guess what is going to replace it Anticoagulation after ablation.... what do you do with it? BBlocker in those with cirrhosis and varices

Clinicians should refer patients for liver transplant evaluation after any decompensation event —such as ascites or variceal bleeding— regardless of MELD score . After a first decompensation, 5-year mortality is 20–30% ; after a second, it rises to 80–90% . Refractory ascites carries a 50% 1-year mortality , and overt hepatic encephalopathy has a 25–40% 1-year mortality . After an initial variceal...

Study Summary: Emergent Carotid Stenting in Acute Stroke Thrombectomy A multicenter registry study in Catalonia (2017–2023) evaluated outcomes in 578 patients with acute ischemic stroke and tandem lesions (large-vessel occlusion plus extracranial carotid stenosis). Patients were divided into two groups: those who received emergent carotid artery stenting (E-CAS) and those who did not ( non-CAS )....

This massive meta-analysis of 484 randomized, double-blind, placebo-controlled trials (104,176 participants) quantified the blood pressure–lowering effects of major antihypertensive drug classes and their combinations. It introduces a new intensity-based classification system and an online calculator to predict BP-lowering efficacy based on drug, dose, and baseline BP. Study Design: 484 trials, 10...

Practice Pearls: “Skip Leg Day” (Sometimes) For PAD patients who can’t tolerate leg workouts, upper body aerobic training is a strong, evidence-backed alternative . It’s not just a workaround—it’s a workout. Citation Ahiskali GN, Demirel A, Yamikan H, Kutukcu EC. The Effects of Upper Extremity and Lower Extremity Aerobic Exercise Training in Patients with Peripheral Arterial Disease: A Systematic...

GLP1 drugs work but they likely need lifestyle modifications No convincing evidence GLP1 cause thyroid cancer in humans BUT contraindication if family history exist Stopping therapy usually results in weight gain Insurance coverage for weight loss is limited and variable  Semaglutide for type 2 diabetes max dose is 2.0 mg weekly Semaglutide for weight loss has a goal dose of 2.4 mg weekly Diagnose...

OMED COPD CME

All of these articles have been talked about on questioning medicine social media on tik tok and instagram but here is an update of my recent reading

Buelt, Andrew | 2:13 PM (1 hour ago) |  | to me https://jamanetwork.com/journals/jama/fullarticle/2833338   Conclusions and Relevance   These results support use of metformin for treatment of symptomatic knee osteoarthritis in people with overweight or obesity. Because of the modest sample size, confirmation in a larger clinical trial is warranted.         Lee S et al. Live zoster vaccination and...

https://www.nejm.org/doi/10.1056/NEJMoa2504544     During follow-up ranging from 12 to 52 weeks, fewer patients had severe exacerbations in the albuterol/budesonide group than in the albuterol group (5% vs. 9%). Patients in the albuterol/budesonide group had less than half the total exposure to systemic glucocorticoids as those in the albuterol group (mean, 23 vs. 62 mg per year).     Clinical Pra...

https://publications.aap.org/pediatrics/article/156/1/e2024070175/202234/Infant-Antibodies-After-Maternal-COVID-19?autologincheck=redirected   Objective: The study aimed to evaluate the kinetics and duration of maternally derived antibodies in infants up to 6 months old, following maternal COVID-19 vaccination during pregnancy or postpartum. Study Design: A prospective multicenter cohort study was...

https://www.nejm.org/doi/10.1056/NEJMoa2415879?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed   Key Findings: Classic Risk Factors: The five risk factors examined were hypertension, hyperlipidemia, underweight and overweight or obesity, diabetes, and smoking. These factors are estimated to account for about 50% of the global burden of cardiovascular disease. Li...

GLP1 might cause thyroid cancer in mice but the evidence is drastically lacking in humans Oral semaglutide is expensive for an NNT of 50 at 4 yrs Tiktok videos of skin care are a scam

https://jamanetwork.com/journals/jama/article-abstract/2834040 amiloride is realistically equal to spironolactone for resistant HTN https://journals.lww.com/ajg/abstract/2025/05000/higher_rate_of_spontaneous_bacterial_peritonitis.24.aspx prophalaxis antibiotics might not be needed https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2834317 If you got a friend in weight loss-- or...

https://www.jthjournal.org/article/S1538-7836(25)00109-6/fulltext Antithrombotic agents, like aspirin and anticoagulants, are essential for treating many cardiovascular conditions. However, a common side effect is bleeding, with extracranial bleeding—bleeding outside the brain and spinal cord—being quite prevalent. This study, a secondary analysis of the Aspirin in Reducing Events in the Elderly,...

https://jamanetwork.com/journals/jama/article-abstract/2834632 Summary The article examines the effectiveness and safety of zilebesiran, an RNA interference therapeutic agent, when used in combination with standard first-line antihypertensive drugs for patients with inadequately controlled hypertension. The phase 2, prospective, randomized, double-blinded trial was conducted over multiple internat...

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