Clinical
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Cardiac and Paracardiac Structure in the SUMMIT Trial
A cardiac magnetic resonance imaging study in a subgroup of the patients in the SUMMIT trial of tirzepatide in patients with heart failure with preserved ejection fraction has demonstrated that patients treated with tirzepatide had reduced left ventricular mass and paracardiac adipose tissue compared to placebo-treated patients, which may partially explain the reduction in heart failure events observed in the main SUMMIT trial.
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A New Treatment for Heart Failure with Preserved Ejection Fraction
A recent randomized, placebo-controlled trial of the long-acting glucagon-like peptide-1 receptor agonist tirzepatide in patients with heart failure with preserved left ventricular ejection fraction who have obesity, diabetes, and one other weight-related comorbidity has shown that tirzepatide not only reduces the symptoms of heart failure, but reduces the incidence of worsening heart failure events.
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Endometrial Cancer: An Update to Classification Using Molecular Features
The classification of endometrial cancer is evolving, transitioning from histological subtypes to molecular profiling. Four key molecular subtypes (POLE ultramutated, MSI unstable, p53 mutant, and NSMP) guide prognosis and treatment. The integration of molecular features into staging highlights their clinical relevance for improving diagnostic accuracy and therapeutic strategies.
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Adverse Outcome Predictors in Pregnancies Complicated by SLE
A prior history of lupus nephritis, active systemic lupus erythematosus (SLE) at conception, secondary antiphospholipid syndrome, and chronic hypertension are critical predictors of adverse pregnancy outcomes in women with SLE.
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Twelve-Month Contraceptive Prescriptions: Do They Make a Difference?
In this national retrospective cohort study of patients on Medicaid, states with 12-month hormonal contraceptive supply policies increased their 12-month dispensing by only 4.39% compared to the pre-policy period. The majority of this increase was contributed by the state of California.
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Individualizing Opioid Prescriptions After Cesarean Delivery
A multicenter, randomized controlled trial of 5,521 participants who underwent uncomplicated cesarean deliveries found that an individualized opioid prescription protocol (IOPP) with shared decision-making was noninferior to a fixed prescription regarding the proportion of participants experiencing moderate to severe pain one week post-discharge, while significantly reducing the number of opioid tablets prescribed at discharge (median of 14 tablets vs. 20 tablets, P < 0.001).
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Does the Physical Exam Help?
You are given the electrocardiogram (ECG) in the figure and told that the patient is a young man in his 20s who presents with acute dyspnea. The physical exam is remarkable for tachypnea, cyanosis, and clubbing of the extremities. How would you interpret the rhythm? Do the noted physical exam findings help in your assessment of the rhythm?
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Sulopenem Etzadroxil and Probenecid (Orlynvah)
The U.S. Food and Drug Administration has approved a combination of sulopenem and probenecid for the treatment of uncomplicated urinary tract infections.
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Epilepsy and Cardiovascular Events
This large prospective cohort study found that older adults with a lifetime history of epilepsy were more likely to experience cardiovascular events (CVEs), and that enzyme-inducing antiseizure medications (EIASMs) may account for a significant portion of this risk. The findings suggest a potential causal link between epilepsy treated with EIASMs and CVE, highlighting the need for careful medication selection in epilepsy management.
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DOACs Can Safely Be Started Early After Atrial Fibrillation-Associated Stroke
In ischemic stroke associated with atrial fibrillation, early restart of anticoagulation with apixaban one to three days after ischemic stroke, compared to late restart (seven to 14 days), resulted in no significant differences between the groups in the primary outcome — a composite endpoint including recurrent ischemic stroke, symptomatic intracranial hemorrhage, and systemic embolism.