https://pubmed.ncbi.nlm.nih.gov/40443569/

Candida hypertension guidelines start with Polly pill

https://pubmed.ncbi.nlm.nih.gov/40562047/

Once weekly insulin equal to once daily insulin

https://www.jwatch.org/na58924/2025/06/26/new-single-pill-three-drug-combination-hypertension?query=etoc_jwhospmed&jwd=000020154104&jspc=HOS&cid=DM2406155_Subscriber&bid=-1280218728

FDA-approved new triple Polly pill

https://pubmed.ncbi.nlm.nih.gov/40517008/

For carpal tunnel syndrome I do keep giving steroid injections

https://www.acpjournals.org/doi/10.7326/ANNALS-24-03933

AI is only is good is information that we put into it

https://www.bmj.com/content/389/bmj-2024-082007

You can fast however you want but it is all about the same in the end

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 at least in maintaining weight loss

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 to explore how clinically significant extracranial bleeding affects the development of functional disability in otherwise healthy older adults.

What did the researchers find?

Summary of Findings:

• Incidence of Bleeding: Out of nearly 19,000 participants, about 2.9%, or 547 individuals, experienced clinically significant extracranial bleeding.
• Functional Independence Impact: Those who experienced such bleeding had a more than two-fold increase in the risk of developing dependence on activities of daily living, or ADLs. Specifically, the hazard ratio for ADL dependence was 2.46, indicating a significant association.
• Types of Bleeding: Both gastrointestinal (GI) bleeding and other non-GI extracranial bleeding showed similar risks, with hazard ratios of 2.29 and 2.68 respectively. Importantly, these associations held true whether participants were on aspirin or a placebo.

Strengths of the Study:

1. Large Sample Size: With nearly 19,000 participants, the study provides robust data.
2. Rigorous Data Collection: Bleeding events were meticulously documented and adjudicated by medical professionals.
3. Comprehensive Analysis: The detailed follow-up and frequent assessments allowed for thorough monitoring of participants' health outcomes over several years.

Weaknesses of the Study:

1. Granular Data Absence: Specific details about hospitalization, such as length of stay or the number of transfusions, were not available.
2. Data Collection Frequency: Bleeding events were assessed continuously, whereas ADL dependence was assessed biannually. This discrepancy could lead to challenges in pinpointing the exact onset of functional dependence relative to bleeding events.

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 international sites with patients treated with either indapamide, amlodipine, or olmesartan. The primary outcome measured was the change in 24-hour mean ambulatory systolic blood pressure (SBP) at three months.

Key findings from the study showed that a single subcutaneous dose of zilebesiran significantly reduced 24-hour mean ambulatory and office SBP at three months compared to placebo, across all background treatments. This indicates that zilebesiran can be an effective adjunctive treatment to standard oral antihypertensive therapies, providing sustained blood pressure control.

Strengths

1. Innovative Approach: The use of RNA interference to target hepatic synthesis of angiotensinogen introduces a novel mechanism to control blood pressure.
2. Methodological Rigor: The study used a double-blinded, placebo-controlled design across multiple international sites, enhancing the reliability and generalizability of the results.
3. Significant Findings: The results indicated significant reductions in SBP with zilebesiran, especially when added to indapamide and amlodipine, showing its potential effectiveness as an additive therapy.
4. Well-Tolerated: Despite instances of hyperkalemia, hypotension, and acute kidney failure, most events were mild and resolved without the need for medical intervention, highlighting a favorable safety profile for zilebesiran.

Weaknesses

1. Short Duration: The study's follow-up period was limited to six months. Long-term efficacy and safety of zilebesiran need to be evaluated in future studies.
2. Sample Size and Specificity: The study's sample size might be insufficient to capture rare adverse events, and the exclusion of patients with high cardiovascular risk might limit the applicability of the results to broader, real-world populations.
3. EIght Background Therapies: Although the study included three commonly used antihypertensive drugs, the varying responses could indicate the need for more comprehensive studies including other first-line therapies.

https://www.nejm.org/doi/full/10.1056/NEJMoa2405182?query=recirc_Semantic

Key Takeaways

1. 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 estimates.
2. Study Design and Population:
   • The study enrolled 27,939 initially healthy U.S. women who were followed for 30 years.
   • The primary endpoint was the occurrence of a first major adverse cardiovascular event, including myocardial infarction, coronary revascularization, stroke, or death from cardiovascular causes.
3. Predictive Strength of Biomarkers:
   • Among the biomarkers, high-sensitivity CRP showed the strongest association with future cardiovascular events (hazard ratio for top quintile: 1.70).
   • LDL cholesterol and lipoprotein(a) also significantly predicted risk, albeit to a slightly lower degree (hazard ratios: 1.36 and 1.33, respectively). NOT STATIN WITH CRP
4. Implications for Clinical Practice:
   • Combining all three biomarkers may offer the best method for identifying high-risk individuals who might benefit from early intervention. YOU HAVE TO PROSPECTIVELY VALIDATE THIS
   • The study supports extending cardiovascular prevention strategies beyond traditional risk assessments.
   • Lifestyle and pharmacologic interventions should target multiple pathways, including lipid levels and inflammation.

Key Limitations

1. Study Population:
   • The study cohort predominantly consisted of female health professionals who are mostly White (94%), which may limit generalizability.
   • The results may not extend to males or more diverse populations without further studies.
2. Absence of Repeated Measures:
   • Biomarkers were measured only at baseline without repeated measures over time.
   • This limits the ability to observe changes in biomarker levels and their association with risk over time.
3. Statin Use Data:
   • Increasing use of statins over the study period was not thoroughly considered in initial analyses, and detailed data on adherence and duration are lacking.
   • Sensitivity analyses attempted to account for this by censoring data at the time of first statin prescription, but residual confounding may be present.

Concerns with Study Design

1. Cohort Composition:
   • The study's focus on health professionals might have led to better access to healthcare and healthier lifestyle choices, potentially skewing outcomes.
   • Non-White participants were underrepresented, raising concerns about the applicability of findings to more diverse groups.
2. Single Time Point Measurement:
   • Only baseline biomarker levels were used for long-term prediction, which may not account for variability and changes in risk factors over time.

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 levels were either complex (e.g., requiring blood pH measurement) or derived locally (i.e., not generalizable). Many formulas overestimated calcium at low calcium levels; the Payne formula misclassified 41% of patients, whereas the total calcium level only misclassified 25% of patients.

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 were more common with tirzepatide than with semaglutide (9% vs. <1%) but didn't cause participants to stop treatment.