Questioning Medicine

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?redirectedFrom=fulltext&login=trueLuo Y, et al. Measuring public preferences for statin therapy: Using the smallest worthwhile difference. JAMA Intern Med 2026 Feb 16; [e-pub]. DOI: 10.1001/jamainternmed.2025.7958. It's honestly kind of beautiful - and a little frustrating. But it's also a reminder that medicine isn't math; it's human. People don't just want statistics; they want clarity, control, and context. A one-percent drop means one thing on paper, and something very different when you're trying to remember if you already took today's pill. Kang J, et al. Aspirin versus clopidogrel for chronic maintenance monothera

432.  CME LECTURE-  Under Pressure, Blood Pressure

https://www.sciencedirect.com/science/article/abs/pii/S2665991326000342?via%3Dihublancet 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 effort? Or are we just torturing our patients with more lab draws and dose titrations than they actually need? What’s the Real Takeaway?So — is it worth chasing six? Probably yes, but let's keep expectations realistic.Think of it like aiming for LDL targets in dyslipidemia — specific numbers keep us intentional,The bottom line: when your gout patient agrees to start urate-lowering therapy,  don’t expect miracles overnight. Lower urate just tilts the odds for fewer flares — it doesn’t guarantee smooth sailing for every patient.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846208 HPV, Cytology, and Cotest Cervi

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 an average age of 63.Now, 63 is not “just hit menopause.” That’s about 12 years past menopause for most women. So we were basically taking a therapy usually started around 50, testing it in women in their early 60s, and then pretending that result applied to everyone, at every age, on every dose, with every type of hormone, in every form—patch, pill, gel, ring, cream, you name it.Imagine testing one fast-food burger in 63-year-olds and then announcing: “All food is dangerous. Consider only lettuce, and maybe not too much of that either.”Let’s do a quick myth-versus-reality lightning round.Myth: “All hormone therapy c

— 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 SetupSo here’s the story. For years, observational studies hinted that apixaban — we’ll call it “Api” because we’re friendly like that — might be gentler when it comes to bleeding compared to rivaroxaban — or “Riva,” who sounds like she’d stir drama on a reality show.But now, for the first time ever, we’ve got a head-to-head trial. Picture a randomized cage match… but with 2,800 patients who probably just wanted their deep vein thrombosis or pulmonary embolism treated quietly.These brave participants, average age 58, were split—half got apixaban, half got rivaroxaban. Researchers then followed them for three suspense-filled months.The Results (and the Punchline)Here’s the headline:Clinically relevant bleeding was twice as likely with rivaroxaban compared to apix

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 patients vs. 47.4% of placebo patients achieved good functional recovery (mRS 0–1) at 90 days (p=0.0061). Safety: No difference in adverse events. Practice impact: Clinicians are cautiously optimistic; further positive trials could lead to selective use of minocycline in AIS patients. 2. Tenecteplase for Basilar Artery Stroke (TRACE-5 trial)This phase 3 RCT in China tested IV tenecteplase given within 24 hours of ischemic basilar artery occlusion against standard medical care (both groups could undergo thrombectomy). Results: At 90 days, 38% of tenecteplase patients vs. 29% of controls had no or minimal disability (mR

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 the twist: new research says... maybe we didn't need all that aspirin after all.Researchers at one hospital decided to mix things up. First, they treated 300 kids with the traditional high-dose aspirin. Then they switched the policy and gave the next 200 kids low-dose aspirin-3 to 5 mg/kg/day. Everyone got IVIG, because we're not completely reckless. And the results? Drumroll please-no difference. That's right. About 20% of kids in both groups needed IVIG a second time, and their coronary arteries looked... equally fine. The median max Z-score was 1.6 in both groups. (For the non-cardiologists out there, that's comfor

Setting the stagePicture 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 apartment and rebuild it. Option B: Medial unicompartmental knee arthroplasty, or UKA - fix the one bad room and leave the rest alone. Previous work suggested that partial knees can actually hold up pretty well when only that medial compartment is involved. But we needed a high-quality, double-blind, multicenter randomized trial to really settle the argument-because if there's anything surgeons love more than power tools, it's being right. The Danish showdownEnter Denmark, land of bicycles, universal healthcare, and apparently, a lot of unicompartmental knees. UKA is done more often there than in many other countries, which means

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. Researchers analyzed data from 870,000 adults with migraine and no previous vascular events. The median age was 40, and about three-quarters were women. The team compared those who started triptans with those who didn't, adjusting carefully for age, health, and baseline risk factors. Here's the headline number: over roughly seven years, people who started triptans had an ischemic stroke rate of 3.4 per 1000 person-years, compared to 1.7 per 1000 for nonusers. That's an absolute risk difference of just 0.17% per year, or, in practical terms, about one additional stroke for every 588 people treated annually. So yes - there's

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 diabetes. JAMA Ophthalmol 2026 Feb 12; [e-pub]. DOI: 10.1001/jamaophthalmol.2025.6262.Noh Y, et al. Glucagon-like peptide 1 receptor agonists and risk of nonarteritic anterior ischemic optic neuropathy in patients with type 2 diabetes. Diabetes Care 2026 Feb 17; [e-pub]. DOI: 10.2337/dc25-2577.    Nonarteritic anterior ischemic optic neuropathy is the kind of diagnosis that makes every clinician's stomach drop: sudden, often permanent vision loss, and not much we can do about it. It has always been rare, but a growing body of work is now pointing to a possible link with one of the most widely discussed drug classes in medic

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. In most textbooks, that's the end of the story. A group in Hong Kong is now asking a different question: what if the problem isn't just the follicles, but the neighborhood they live in? In aged mice, they found that the ovarian stroma becomes fibrotic and stiff, and that this mechanical stiffness itself seems to suppress follicle maturation. Loosen up the stroma, and previously dormant follicles begin to wake up. To turn that concept into something clinically relevant, the team screened nearly 1,300 drugs that are already approved for other human uses, looking for agents that could activate follicles in mice. Ten made

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 it did not help distinguish them. Dropping fever from the criteria actually made them better:   Sensitivity improved: 77% (no-fever) vs 74% (standard). Specificity improved a lot: 80% vs 49%. "Possible IE" shrank from 39% to 17%, meaning fewer gray-zone cases. Only 0.4% of patients without IE were incorrectly labeled as having IE.  Both are widely used and both can work for regular (non-crusted) scabies. The SCRATCH trial: who won?In the SCRATCH trial from France, researchers treated about 1000 people in 300 households with confirmed scabies. Each household was randomized to: Whole-body 5% permethrin cream on days 0 an

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.2025.07.005.40675327All 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.2025.3386.40965920PSA levels at or above 4.0 ng/mL fell below that threshold on the next annual test 30% of the time. 10.1016/S2665-9913(25)00250-4.During 10 years of follow-up, patients in the PKA and TKA groups did not differ significantly in pain, function, or quality of lifehttps://www.nejm.org/doi/full/10.1056/NEJMoa2508026?query=TOCAmong patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, https://www.nejm.org/doi/full/10.1056/NEJMoa2509907?query=TOCIn this trial, a high-dose inactivated influenza vaccine did not result in a significantly lower incidence of hospitalization for influenza

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) https://jamanetwork.com/journals/jama/fullarticle/2822766 https://onlinelibrary.wiley.com/doi/full/10.1002/art.24894?msockid=3f10fb6c3d086e4c32e2ede23c9e6fbc https://pubmed.ncbi.nlm.nih.gov/41118187/ https://pubmed.ncbi.nlm.nih.gov/41115754/  https://pubmed.ncbi.nlm.nih.gov/41138956/ 

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/41077424/  Effectiveness of high-dose influenza vaccine against hospitalisations in older adults (FLUNITY-HD): an individual-level pooled analysis  https://pubmed.ncbi.nlm.nih.gov/41115437/ 

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