Questioning Medicine

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/10.1001/jama.2025.19578)

http...

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 https://pubmed.ncbi.nlm.nih.gov/410...

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 think you ca...

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 b...

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).

Key Findings:

• Favorable o...

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, 104,176 participa...

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 Review. J Vasc S...

• 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 dos...

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 cardiovascular outcomes: A nati...

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 Practice: This study supports ...

https://publications.aap.org/pediatrics/article/156/1/e2024070175/202234/Infant-Antibodies-After-Maternal-COVID-19?autologincheck=redirected

1. 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.
2. Study Design:
   • A prospective multicenter cohort study was conducte...

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:

1. 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.
2. Lifetime Risk Estimates:...

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 at...

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, or ASPREE trial, aimed ...