Questioning Medicine – Détails, épisodes et analyse

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Questioning Medicine

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Fréquence : 1 épisode/12j. Total Éps: 360

Join Andrew on a medical rollercoaster as we ask a medical question and answer it based on recent published papers.

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Données mises à jour le 04/07/2026

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https://www.clinicalkey.com/#
14 partages
https://www.atsjournals.org/doi/full/10.1164/rccm.202402-0368OC
4 partages
https://www.umms.org/ummc/pros/physician-briefs/orthopedics/hip/mortality-in-hip-fracture-patients
4 partages

https://doi.org/10.1016/S0140-6736
2 partages
https://doi.org/10.1210/clinem/dgae290
2 partages

https://pmc.ncbi.nlm.nih.gov/articles/PMC11755353/
4 partages
https://www.ncbi.nlm.nih.gov/pubmed/31189511
2 partages
https://www.ncbi.nlm.nih.gov/pubmed/31265456?dopt=Abstract
2 partages

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Liste des épisodes récents, avec titres, durées et descriptions.

Episode 398: 406. Update of Medical Articles

Épisode 398

mercredi 27 août 2025 • Durée 29:58

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

Episode 397: 405. 4 New Medical Articles That Are Deceiving

Épisode 397

vendredi 1 août 2025 • Durée 19:00

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 nationwide, South Korean study. Eur Heart J 2025 May 5; [e-pub]. (https://doi.org/10.1093/eurheartj/ehaf230)

In a new South Korean study, researchers evaluated nearly 1.3 million people (age ≥50) who were entered into a nationwide database. In an analysis adjusted for numerous confounders and with an average follow-up of 6 years, people who received a VZV vaccine had significantly lower risk (by ≈25%) for overall adverse cardiovascular events, heart failure, cerebrovascular disorders, ischemic heart disease, thrombotic disorders, and arrhythmias.

https://pubmed.ncbi.nlm.nih.gov/40658956/

Conclusion: Findings indicate that VNPs were more effective than NRT for smoking cessation in this population. Given the challenges for cessation among these socially disadvantaged populations, VNPs present a promising treatment option for this priority group.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0326804

We did not find that haloperidol was arrhythmogenic or increased mortality in these largely short-duration trials. Further research to clarify actual clinical outcomes related to QTPmeds is important to inform safe prescribing practices.

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Episode 396: 404. albuterol/budesonide, DOAC in 4 Days, Statins for AAA

Épisode 396

jeudi 24 juillet 2025 • Durée 12:03

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 the use of an as-needed combination of albuterol and budesonide in reducing severe asthma exacerbations in patients with mild asthma who are inadequately controlled by SABA alone. This aligns with current recommendations by the Global Initiative for Asthma (GINA), which advocates for an inhaled corticosteroid plus a fast-acting bronchodilator as rescue therapy across all treatment steps for patients aged 12 years and older.

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0140673625004398?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673625004398%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F

Clinical Recommendation: The findings support the practice of initiating DOAC treatment within 4 days of an acute ischemic stroke in patients with atrial fibrillation, as it reduces the risk of early recurrent ischemic stroke without increasing hemorrhagic complications. This challenges the traditional approach of delaying anticoagulation to avoid potential bleeding risks.

Episode 395: 403. COVID Maternal Booster And Cervical Self Swabs

Épisode 395

mardi 22 juillet 2025 • Durée 10:28

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 conducted across nine U.S. academic sites, enrolling infants born to mothers vaccinated with 2- (n=280) or 3-dose (booster) monovalent mRNA vaccines during pregnancy (n=202) or postpartum (n=36).
Primary Outcomes:
- Antibody Levels: Significantly higher geometric mean titers (GMTs) of binding and neutralizing antibodies (nAb) were observed at birth and 2 months in infants of mothers who received a booster dose during pregnancy compared to those who received 2 doses or were vaccinated postpartum.
- Sustained Antibody Levels: Higher titers against the vaccine strain persisted up to 6 months in infants of boosted mothers, although not for the Omicron BA.1 and BA.5 variants.

https://pubmed.ncbi.nlm.nih.gov/40478588/

Objective:
- The study aimed to determine if mailed self-collection kits for CCS, with or without additional patient navigation, could improve screening participation compared to standard telephone reminders.

Episode 394: 402. Cardiovascular Risk Factors, Zilebesiran, Shared Decision Making

Épisode 394

vendredi 18 juillet 2025 • Durée 15:05

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.
Lifetime Risk Estimates:
- Among individuals free of these risk factors at age 50, the lifetime risk of cardiovascular disease was 13% for women and 21% for men.
- For those with all five risk factors, the lifetime risk jumped to 24% for women and 38% for men.
Significance of Risk Factor Modification:
- Adjusting certain risk factors during midlife, particularly managing hypertension and quitting smoking, led to the most significant gains in life expectancy free of disease.
- For instance, controlling hypertension between ages 55 and 60 yielded the most additional life-years free of cardiovascular disease.
- Quitting smoking during the same period was associated with the most additional life-years free of death from any cause.

https://jamanetwork.com/journals/jama/fullarticle/2834632

Study Design:
- This was a phase 2, randomized, double-blinded trial with participants enrolled from 150 sites across 8 countries. The study spanned from January 2022 to June 2023, with analyses completed by March 2024.

Episode 393: 404. 3 quick articles you might want to know about (oral semaglutide, tiktok, and GLP1 thyroid cancer)

Épisode 393

mercredi 25 juin 2025 • Durée 12:30

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

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Episode 392: 403. 3 Papers, 1 Podcast - One Guideline Changer

Épisode 392

lundi 16 juin 2025 • Durée 14:11

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

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Episode 391: 402. Functional disability after clinically significant extracranial bleeding: a secondary analysis of ASPREE

Épisode 391

jeudi 5 juin 2025 • Durée 07:45

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:

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

Weaknesses of the Study:

Granular Data Absence: Specific details about hospitalization, such as length of stay or the number of transfusions, were not available.

Episode 390: 401. Add-On Treatment With Zilebesiran for Inadequately Controlled Hypertension

Épisode 390

mercredi 4 juin 2025 • Durée 08:46

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

Innovative Approach: The use of RNA interference to target hepatic synthesis of angiotensinogen introduces a novel mechanism to control blood pressure.
Methodological Rigor: The study used a double-blinded, placebo-controlled design across multiple international sites, enhancing the reliability and generalizability of the results.
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.
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

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.

Episode 389: 400. CRP, Lipoprotein A, LDL for cardiac risk assessment

Épisode 389

jeudi 29 mai 2025 • Durée 09:37

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 estimates.
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.
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
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

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