What’s new in medical literature
What's new in the medical literature?
Updated 3 October 2025
_________________________________________________________________________________
Autism spectrum disorder and Parkinson's disease
Studies in children and adults with autism spectrum disorder (ASD) suggest that ASD is associated with an increased risk for Parkinsonism or Parkinson's disease (PD). In an observational study including over 2.2 million adults (ages 29 to 42 years), the risk of PD was increased in individuals with ASD compared with those without ASD (0.05 versus 0.02 percent) [18]. The risk was independent of age at ASD diagnosis, preterm birth, or family history of PD, and was not fully explained by the use of antipsychotic medications. These findings suggest that individuals with ASD are at risk for and warrant ongoing monitoring for long-term neurologic conditions. (See "Autism spectrum disorder (ASD) in children and adolescents: Terminology, epidemiology, and pathogenesis", section on 'Parkinson's disease'.)
Azelastine nasal spray and COVID-19 prevention
Early clinical evidence suggests that azelastine, an over-the-counter antihistamine nasal spray, may prevent COVID-19 in healthy individuals. In a phase 2 randomized trial in 450 adults, azelastine reduced the incidence of SARS-CoV-2 infection compared with placebo spray over eight weeks (2.2 versus 6.7 percent) [53]. It also reduced infections with other respiratory viruses (eg, rhinovirus). Although these data are promising and azelastine was well tolerated, event rates were low, and additional data are needed from larger studies that include individuals with comorbidities to confirm whether this strategy should be routinely used for prevention. We do not actively discourage interested patients from trying it if tolerated, but we advise them that it is not a substitute for vaccination. (See "COVID-19: Epidemiology, virology, and prevention", section on 'Interventions with no or uncertain preventive role'.)
Benefits of exercise before and during hemodialysis
Few studies of patients on maintenance hemodialysis (HD) have compared the effects of intradialytic exercise with those of interdialytic exercise. In a crossover trial in which 25 patients with end-stage kidney disease (ESKD) were assigned in random order to conventional HD, HD with intradialytic exercise, or HD preceded by exercise, the timing of exercise did not materially affect exercise-induced reductions in myocardial stunning during dialysis, as determined by echocardiography-assessed left ventricular regional wall motion abnormalities [4]. These and other data suggest that exercise in patients with ESKD confers benefit regardless of setting, and that patients on HD should pursue an exercise regimen even in the absence of an established intradialytic exercise program. (See "Deconditioning and weakness in patients with chronic kidney disease (including those on dialysis)", section on 'Optimal exercise regimen'.)
Dalbavancin for Staphylococcus aureus bacteremia
Standard treatment of Staphylococcus aureus bacteremia consists of short-acting parenteral antibiotics administered at least daily over several weeks, requiring prolonged intravenous access. In a randomized trial, 200 patients with complicated S. aureus bacteremia (including 66 patients with methicillin-resistant infection) were treated with short-acting parenteral therapy until blood culture clearance and then given either dalbavancin (two infusions one week apart) or standard therapy (four to eight weeks of short-acting parenteral therapy) [2]. Clinical efficacy was comparable between the groups (72 versus 73 percent), with similar rates of adverse events. Based on these data, dalbavancin is an acceptable alternative regimen for treatment of S. aureus bacteremia; however, its use may be limited by cost and administrative logistics. (See "Clinical approach to Staphylococcus aureus bacteremia in adults", section on 'Route of administration'.)
Effects of systemic glucocorticoids on galactose-deficient IgA1 levels in IgA nephropathy
In patients with IgA nephropathy, systemic glucocorticoids reduce proteinuria and lower the short-term risk of end-stage kidney disease; however, the underlying mechanisms of their benefits remain unclear. In a secondary analysis of over 130 patients from the TESTING trial, systemic glucocorticoids reduced the levels of total IgA and pathogenic galactose-deficient IgA1 (Gd-IgA1) in a dose-dependent manner at six months compared with placebo [8]. The decline in Gd-IgA1 levels correlated with improvements in proteinuria but did not predict long-term kidney outcomes, and Gd-IgA1 levels rose in all groups by 12 months (after treatment discontinuation). These findings provide mechanistic insight into the benefits of systemic glucocorticoids in IgA nephropathy and further support their use in patients who have indications for immunosuppressive therapy. (See "IgA nephropathy: Treatment and prognosis", section on 'Choice of immunosuppressive therapy'.)
High-dose influenza vaccine in older adults
Among patients ≥65 years, most studies comparing high-dose (HD) with standard-dose (SD) inactivated influenza vaccine have observed reductions in hospitalization with the HD vaccine, but sometimes the number of events was small. In a randomized trial among more than 100,000 adults ≥65 years in Spain, HD vaccine reduced hospitalization for influenza or pneumonia compared with SD vaccine (relative vaccine effectiveness 24 percent) [5]. In a similar trial among more than 330,000 adults ≥65 years in Denmark, hospitalization rates were similar between the groups (relative vaccine effectiveness 6 percent) [6]. While the Danish study did not detect a statistically significant difference, many subgroup analyses favored the HD vaccine. We continue to favor HD over SD vaccine for this patient group. (See "Seasonal influenza vaccination in adults", section on 'Patients 65 years and older'.)
Influenza vaccination in hospitalized patients with heart failure
In patients with heart failure, influenza virus infection can trigger decompensation; routine vaccination during hospital admission may improve clinical outcomes for such patients. In a cluster-randomized trial in China including 7771 adults hospitalized with moderate to severe heart failure during influenza season, patients were assigned to an influenza vaccination group or a control group that received usual care (in which only 21 percent of patients were vaccinated) [3]. Vaccination during hospital admission reduced all-cause mortality at 12 months (10 versus 12.8 percent) and readmission rates at 12 months (35.4 versus 40.5 percent). These findings highlight that hospital admission is an important opportunity for delivery of preventive care for patients with heart failure. (See "Seasonal influenza vaccination in adults", section on 'Patients with heart disease'.)
Intravenous immune globulin for chronic antibody-mediated rejection of the kidney allograft
Intravenous immune globulin (IVIG) and glucocorticoids are used to treat chronic antibody-mediated rejection (ABMR) of the kidney allograft based on observational data showing benefit; evidence from randomized trials has been lacking. In a recent open-label multicenter trial in 30 patients with biopsy-proven chronic ABMR who were randomly assigned to treatment with pulse methylprednisolone with or without IVIG, patients in the no IVIG group had a significant increase in histologic damage scores compared with those in the IVIG group [25]. Mean estimated glomerular filtration rate (eGFR), which was similar between the groups at diagnosis, declined more rapidly in the no IVIG group over two years; patient and allograft survival at 12 months were similar between the groups. These findings support our use of IVIG and glucocorticoids as initial therapy for kidney transplant recipients with chronic ABMR. (See "Kidney transplantation in adults: Prevention and treatment of antibody-mediated rejection", section on 'Treatment of chronic antibody-mediated rejection'.)
Long-term outcomes with rituximab in membranous nephropathy
Rituximab is considered a first-line immunosuppressive therapy for patients with primary membranous nephropathy (MN), but data on long-term outcomes are lacking. In a retrospective study of nearly 160 patients with MN treated with rituximab, 140 (88 percent) achieved complete or partial remission, while 12 percent did not respond to therapy [9]. Kidney survival was 95 and 87 percent at 5 and 10 years, respectively; over a median of 68 months, approximately 9 percent reached end-stage kidney disease. These findings provide additional support for the use of rituximab in patients with primary MN who have an indication for immunosuppressive therapy. (See "Membranous nephropathy: Treatment and prognosis", section on 'High or very high risk of progression'.)
Metformin does not reduce COVID-19 symptom duration
Some observational studies have found an association between metformin use and improved COVID-19 outcomes, but randomized trials have not demonstrated a clear benefit. In a new randomized trial of almost 3000 outpatients with mild to moderate acute COVID-19 infection (recruited between September 2023 and May 2024), those who received metformin had a similar time to sustained recovery compared with those who received placebo [4]. Emergency department and hospitalization rates were also similar; there were no deaths in either group. We do not use metformin in the treatment of acute COVID-19 infection since it does not appear to reduce symptom duration or risk of severe disease; whether it reduces the likelihood of post-COVID-19 conditions remains uncertain. (See "COVID-19: Evaluation and management of adults with acute infection in the outpatient setting", section on 'Therapies that we do not recommend'.)
Pregnancy and risk of chronic kidney disease progression
Pregnancy can hasten the progression of chronic kidney disease (CKD), with the risk dependent upon the baseline glomerular filtration rate (GFR), proteinuria, and hypertension. A meta-analysis that included over 2900 pregnant patients with CKD found no significant difference in kidney function before versus after pregnancy in cohorts of patients with mild CKD (ie, ≤25 percent of patients having CKD stages 3 to 5) over a mean of 4.4 years [1]. However, post-pregnancy kidney function was significantly lower in cohorts with advanced CKD (ie, >25 percent of patients with CKD stages 3 to 5). These results support those of prior studies showing that while the risk of CKD progression is low in pregnant patients with mildly decreased GFR, those with low baseline GFR are at much higher risk for progression. (See "Pregnancy and contraception in patients with nondialysis chronic kidney disease", section on 'Effects of pregnancy on kidney disease'.)
Surgical management of spinal hemangioblastomas
Spinal cord hemangioblastomas are rare tumors with varied natural history and morbidity; multidisciplinary management aims to identify patients with progressive neurologic symptoms or enlarging tumors who may require surgical resection. In a multicenter retrospective study of 357 patients with sporadic (44 percent) or von Hippel-Lindau (VHL)-associated (56 percent) spinal hemangioblastoma, complete resection was achieved in 88 percent of cases [26]. Six-year local progression-free survival was 90 percent for sporadic tumors and 81 percent for VHL-associated tumors. Intramedullary location and preoperative bleeding were associated with worse functional outcomes. These data further inform the risks and benefits of surgery for spinal hemangioblastomas. (See "Hemangioblastoma", section on 'Surgery'.)
_________________________________________________________________________
Combined cardiorespiratory and resistance training for people with stroke Cochrane Library 24 September 2025
Combined training after stroke does not affect mortality or the incidence of secondary events at the end of intervention or end of follow‐up. Since these events are infrequent, conclusions cannot be drawn about any protective effect on mortality or secondary events. Small beneficial effects on physical fitness and blood pressure at the end of intervention may represent a reduced risk of secondary events, but this is very uncertain. Combined training may cause small improvements in fitness, disability, walking speed, and balance at the end of intervention. The small benefit observed for balance may be preserved after a follow‐up period. The evidence for these effects is of low or very low certainty. Combined training interventions were adhered to successfully without serious adverse events or adverse effects; the interventions were acceptable to and well tolerated by participants. Limited data at follow‐up restricts the conclusions we can draw about the retention of any benefits observed. Larger, well‐designed trials are needed to determine the optimal regimen for exercise prescription, the benefits, and long‐term effects.
Efficacy and safety of respiratory syncytial virus vaccines Cochrane Library 29 September 2025
RSV prefusion vaccines reduced RSV‐associated lower respiratory tract illness and acute respiratory illness in older adults. There may be little to no difference in serious adverse events (SAEs) related to vaccination in older adults. Maternal vaccination with RSV F protein‐based vaccines reduced medically attended RSV‐associated lower respiratory tract illness and severe cases in infants. There may be little to no difference in SAEs related to vaccination in mothers and infants. The evidence is very uncertain regarding the effects of RSV vaccine on women of childbearing age, and the effects of live‐attenuated RSV vaccines on infants and children; there may be little to no difference in SAEs related to vaccination.
Effectiveness of SARS‐CoV‐2 testing strategies inreducing COVID‐19 cases, hospitalisations, and deaths Cochrane Library 2 October 2025
The available data are of very low‐certainty. Only one of the 21 included studies reported hospitalisations or deaths; therefore, we cannot draw conclusions about the effects of testing strategy versus no testing on reducing hospitalisation and mortality. No studies evaluated other critical outcomes i.e. COVID‐19 cases avoided, and serious adverse events related to testing. Future research should aim for consistency and relevance by using clearly defined outcomes, preferably based on a standardised core outcome set. A qualitative evidence synthesis (QES) would help identify barriers and facilitators to routine SARS‐CoV‐2 testing in healthcare settings, which could help inform intervention development. The QES would explore factors affecting the implementation of routine testing, drawing on the perspectives of healthcare providers, patients, and other interest holders.
Misoprostol for intrauterine device placement Cochrane Library 23 September 2025
Evidence from RCTs of women seeking routine IUD placement suggests that receiving misoprostol compared to placebo or no treatment makes little to no difference to pain during tenaculum placement or after IUD placement; and may make little to no difference to pain during IUD placement. Misoprostol may make little to no difference to reduced vasovagal reaction, improved providers' ease of placement, or reduced need for cervical dilation; and probably makes little to no difference to placement success, except for women with a recent failed IUD placement attempt, where misoprostol probably leads to a clinically meaningful increase in placement success. Misoprostol use probably leads to clinically important increases in harms, specifically preplacement abdominal pain or cramping and diarrhea. Misoprostol may increase patient satisfaction with the IUD placement procedure, but the evidence is very uncertain. The number of available RCTs did not support examining effect modifiers such as prior vaginal delivery status, misoprostol dose, or IUD type.
Omega‐3 fatty acid supplementation for distal symmetrical peripheral neuropathy in adults with diabetes mellitus Cochrane Library 24 September 2025
There are inadequate data to draw conclusions about the effects of omega‐3 PUFA supplementation on peripheral nerve impairment in adults with diabetes mellitus. There may be little to no benefit of oral omega‐3 PUFA treatment, compared to placebo or no treatment, for improving peripheral neuropathy symptoms or health‐related quality of life. While no harms of omega‐3 PUFA treatment are suggested, more data are needed to elucidate any potential risks.
Pharmacotherapies for cannabis use disorder Cochrane Library 30 September 2025
There is incomplete evidence for all the clinically‐important pharmacotherapies investigated and, for half of their outcomes, the quality of the evidence was low (44%) or very low (11%). Given the limited evidence of efficacy, those pharmacotherapies should still be considered experimental for treating cannabis use disorder. The greater withdrawal from treatment due to adverse effects seen with anticonvulsants and mood stabilisers may limit their therapeutic value.
Pharmacotherapy for mild hypertension Cochrane Library 24 September 2025
In people with untreated mild hypertension and no pre‐existing cardiovascular disease, initiation of antihypertensive monotherapy or step‐up therapy may not reduce all‐cause mortality, total cardiovascular events, or coronary heart disease compared to those who received placebo or no treatment. There may be a reduction in stroke, but possibly also an increase in withdrawal due to adverse effects (WDAEs).
Remote ischaemic conditioning for preventing and treating ischaemic stroke Cochrane Library 24 September 2025
There is moderate‐certainty evidence that remote ischaemic conditioning (RIC) compared to non‐RIC probably reduces recurrence of ischaemic stroke slightly, and low‐certainty evidence that RIC may result in a slight increase in excellent functional outcome (mRS 0–1). Evidence for improvement in National Institutes of Health Stroke Scale (NIHSS) scores is very uncertain due to risk of bias and imprecision. RIC demonstrated an acceptable harm profile with no increase in intracerebral haemorrhage or mortality; however, treatment‐related adverse events were more common. The certainty of evidence was limited by high risk of bias for blinding in most studies, incomplete outcome data in some studies, and imprecision in several outcomes. However, the generalisability of these findings may be limited because 79.3% of participants were from China, highlighting the need for further studies in diverse populations to confirm the results. The optimal timing, duration, and method of RIC administration require further investigation through large, high‐quality randomised trials with standardised protocols to establish definitive evidence for clinical practice. This updated analysis includes 16 new RCTs, and these findings highlight the need for ongoing research and careful consideration of study design and methodology in future investigations.
Resistance training for people with stroke Cochrane Library 24 September 2025
Resistance training does not affect mortality at the end of intervention or after follow‐up. We could not draw conclusions about resistance training effects on disability, secondary prevention of cardiovascular or cerebrovascular events or the risk of these because the data were inadequate. Resistance training probably increases muscle strength in the arms and legs, particularly on the unaffected side at the end of intervention. There was little or no effect on comfortable walking speed, possibly because the interventions were insufficiently task‐related to walking. However, there may be a small improvement in balance which persists at follow‐up. Resistance training interventions were adhered to without serious adverse events or adverse effects, but may not be acceptable to everyone. Inadequate data at follow‐up prevented conclusions about retention of benefits. Further well‐designed randomised trials are needed to determine the optimal exercise prescription, the benefits and long‐term effects.
Service delivery, behavioural, and self‐management interventions for adults with epilepsy Cochrane Library 24 September 2025
There is no high‐certainty evidence that service delivery, behavioural, and self‐management interventions improve seizure control or quality of life outcomes for adults with epilepsy. There were wide variations in the size of the effect estimate, depending on how outcomes were measured. Furthermore, there was significant clinical heterogeneity amongst the populations studied, types of interventions delivered, study setting, and study design, which limit interpretation of the currently available evidence and its overall applicability. Further research is needed from well‐designed studies using validated measures to assess long‐term improvement in outcomes important to adults with epilepsy.
Single‐incision versus conventional multi‐incision laparoscopic appendicectomy for suspected uncomplicated appendicitis Cochrane Library 19 September 2025
There is low‐to‐moderate certainty evidence that single‐incision laparoscopic appendicectomy is comparable to conventional laparoscopic appendicectomy in terms of complications, length of hospital stay, return to normal activities, and postoperative pain in the first 24 hours. The disadvantage of single‐incision laparoscopic appendicectomy (SILA) may be a higher conversion rate, but SILA is probably associated with better patient cosmetic satisfaction.
Synchronised approach for intrauterine insemination in subfertile couples Cochrane Library 23 September 2025
There is insufficient evidence to determine whether there is any difference in effectiveness between different methods of synchronisation of ovulation and insemination.
________________________________________________________________________________
Atopic eczema in under 12s: diagnosis and management National Institute for Health and Care Excellence (UK) Updated 22 September 2025
This guideline covers diagnosing and managing atopic eczema in children under 12. It aims to improve care for children with atopic eczema by making detailed recommendations on treatment and specialist referral. The guideline also explains how healthcare professionals should assess the effect eczema has on quality of life, in addition to its physical severity.
Colonoscopy: Clinical Care Standard Australian Commission on Safety and Quality in Health Care Updated September 2025
About 1 million colonoscopies are performed in Australia annually. The Colonoscopy Clinical Care Standard describes the safe, appropriate and high-quality use of colonoscopy.
Deprescribing in older people: a clinical practice guideline The University of Western Australia 16 September 2025
This deprescribing guideline was developed in response to the growing need to provide guidance for optimising medication regimes in older people to reduce adverse outcomes and their treatment burden. It represents a collaborative partnership between consumers, carers, healthcare professionals and researchers.
_________________________________________________________________________________
Changes in patient management after preoperative MRI for newly diagnosed breast cancer: a multicentre prospective observational study MJA 24 September 2025
The known: Preoperative breast MRI has higher sensitivity than conventional imaging, but little evidence confirms which patient subgroups are likely to benefit.
The new: MRI was most frequently requested for women with dense breasts. There was an absolute increase in mastectomy of 13 percentage points following MRI, and increases were seen for all subgroups except women aged ≥ 70 years and those for whom neoadjuvant therapy was already planned. The majority of changes in surgery plans (85%) were potentially justified by the final pathology findings.
The implications: MRI for selected women where conventional imaging is suboptimal may improve surgical planning and thus afford better outcomes. MRI is less likely to change outcomes in older women.
Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations MJA 21 September 2025
Main recommendations:
- This article summarises the recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine HCC surveillance in the form of six-monthly ultrasound scans, with or without α-fetoprotein testing.
- People with liver cirrhosis and a non-HCC-related life expectancy of greater than six months are recommended to receive routine HCC surveillance.
- People with chronic hepatitis B virus infection who do not have liver cirrhosis are recommended to receive routine HCC surveillance if they have a family history of HCC, are Aboriginal or Torres Strait Islander peoples, or have an Asian, Pacific, or sub-Saharan African background, with varying start ages recommended for each group.
- People with stage 3 non-cirrhotic liver fibrosis (F3) may be recommended to receive routine HCC surveillance based on individual risk assessment, or otherwise monitored for progression to cirrhosis.
Non-technical errors associated with deaths in surgical care, Australia, 2012–2019, by surgical specialty (Australian and New Zealand Audit of Surgical Mortality): a retrospective cohort study MJA 23 September 2025
The known: Non-technical errors contribute to the deaths of patients receiving surgical care in Australia.
The new: The frequency of fatal non-technical errors differs between surgical specialties. However, it is high for the five specialties with the largest numbers of surgical care-related deaths (general, cardiothoracic, orthopaedic, vascular, and neurosurgery) and did not change markedly during 2012–2019.
The implications: General improvements in non-technical skills are required to avert avoidable deaths among people receiving surgical care in Australia. Specialty-specific interventions could target certain identified problems, but systemwide strategies should receive priority.
The first live term birth following uterus transplantation in Australia MJA 22 September 2025
The known: In Australia, the options for women with uterine factor infertility who wish to have children are adoption and surrogacy. Both options are limited by legal, availability, and ethical barriers.
The new: The first live birth after uterus transplantation in Australia confirms that it could be a solution for women with uterine factor infertility who wish to have children with whom they are biologically related.
The implications: Uterus transplantation is a new reproduction alternative for women with uterine factor infertility. Further research and regulation are important for refining surgical procedures and assessing surgical risks, immunosuppression effects, obstetric complications, costs, and benefits, as well as the long term medical and psychological effects.
The forgotten pandemic: Hong Kong influenza in Australia (1968–1970) MJA 29 September 2025
Australia's ability to manage future pandemics will depend not only on robust scientific and health care systems but also on fostering public trust and resilience, especially when balancing scientific uncertainty with the need for decisive action. By learning from these experiences, Australia can better anticipate and mitigate the complex social, economic and health impacts of future global health emergencies. _________________________________________________________________________________
Australian experts first to describe potentially fatal magic mushroom toxidrome MJA Insight 22 September 2025
An Australian MD, and a mycologist, have been the first to publish a study on Wood-lover’s Paralysis, a rare toxidrome associated with ingesting species of ‘magic mushrooms.’ InSight+ spoke with the researchers, who say the medical community needs to know about WLP. Wood-lover’s Paralysis (WLP) is an extremely rare, but potentially fatal, toxidrome causing unpredictable muscle weakness.
First-of-its-kind online tool revolutionises hypertension treatment MJA Insight 29 September 2025
A new online blood pressure calculator could help overcome the inadequacies of hypertension treatment in Australia. A first-of-its-kind new online tool could revolutionise how high blood pressure is treated. The Blood Pressure Treatment Efficacy Calculator is built on data from nearly 500 randomised clinical trials of more than 100,000 people.
It’s OK to use paracetamol in pregnancy. Here’s what the science says about the link with autism MJA Insight 29 September 2025
United States President Donald Trump has urged pregnant women to avoid paracetamol except in cases of extremely high fever, because of a possible link to autism. Paracetamol – known as acetaminophen or by the brand name Tylenol in the US – is commonly used to relieve pain, such as back pain and headaches, and to reduce fever during pregnancy. Australia’s Therapeutic Goods Administration today re-affirmed existing medical guidelines that it’s safe for pregnant women to take paracetamol at any stage of pregnancy.
Older Australians collect an average of 31 PBS scripts a year – new research MJA Insight 22 September 2025
Australians are living longer than ever before. While this is broadly good news, ageing well comes with a range of challenges. As people grow older, they’re more likely to develop multiple chronic conditions, including heart disease, diabetes, high blood pressure, and cognitive problems such as dementia. These conditions often mean people need to take more medications. Around one in three Australians aged over 70 take five or more different medications. While these can be important, and even lifesaving, managing multiple medications can become a major challenge in itself. We wanted to understand more about how older Australians use medications. In a new study, we looked at ten years of national data from the Pharmaceutical Benefits Scheme (PBS), which subsidises medications for eligible Australians.
Social media for doctors: your comments and messages count as your content MJA Insight 29 September 2025
Even casual online interactions can carry professional risk. _________________________________________________________________________________
Atypical diabetic neuropathies BMJ 29 September 2025
Diabetes is one of the most common conditions in the world and is associated with a broad range of adverse effects in multiple organ systems. Roughly half of all patients with diabetes will develop a typical distal, symmetric polyneuropathy, but several other atypical peripheral nerve conditions can also occur. Treatment induced neuropathy of diabetes is an acute and severely painful small fiber neuropathy that occurs in association with a precipitous drop in glycated hemoglobin levels. Radiculoplexus neuropathies include lumbosacral, cervical, and thoracic forms in which pain and weight loss are followed by weakness and sensory loss in the distribution of a single anatomical region. The underlying process is a monophasic inflammatory microvasculitis that does not seem to respond to immunomodulatory therapy. By contrast, monophasic cranial mononeuropathies are caused by non-inflammatory microvascular ischemia and present acutely followed by slow improvement. Patients with diabetes are also at increased risk for compressive neuropathies, particularly of the median, ulnar, and peroneal nerves. Finally, several lines of evidence indicate increased prevalence of chronic inflammatory demyelinating polyneuropathy (CIDP) in patients with diabetes, although definitive diagnosis of CIDP is often challenging in the setting of concurrent diabetes. This review presents in-depth discussions of these atypical diabetic neuropathies.
Diagnosis and management of multidrug resistant tuberculosis BMJ 25 September 2025
What you need to know
- Universal drug susceptibility testing is key for early diagnosis of drug resistant tuberculosis (TB) and should be offered to all people with bacteriologically confirmed TB; rapid molecular diagnostic tests used as an initial di(eagnostic investigation can simultaneously detect Mycobacterium tuberculosis and drug susceptibility early.
- Treatment of people with multidrug resistant TB or rifampicin resistant TB with shorter oral regimens based on bedaquiline results in improved treatment success with better tolerability.
- Conduct monthly clinical and laboratory assessments (including sputum smear and culture) for people who are being treated for multidrug resistant TB or rifampicin resistant TB to monitor the treatment response and promptly detect and address adverse events.
- Refer people for evaluation and initiation of TB preventive treatment if they have been in contact with people with multidrug resistant TB.
First mammography screening participation and breast cancer incidence and mortality in the subsequent 25 years: population based cohort study BMJ 24 September 2025
This study shows that first screening non-participants represent a large population at long term risk of dying from breast cancer, providing an opportunity for targeted interventions to improve adherence to screening and thereby decrease mortality risk.
Use of new CORE risk score to predict 10 year risk of liver cirrhosis in general population: population based cohort study BMJ 29 September 2025
The CORE model, based on a flexible modelling approach and using biomarkers easily accessible in primary care, outperforms FIB-4 when predicting liver related outcomes in the general population and could be a novel means to stratify patients at risk for liver disease in the general population.
_________________________________________________________________________________
Adaptive vs monthly support for weight-loss maintenance: A randomized clinical trial JAMA 22 September 2025
These findings suggest provision of extended care on an adaptive vs static schedule did not reduce weight regain; however, the successful maintenance of clinically-meaningful weight loss in both conditions supports the role of extended care for weight-loss maintenance.
Cognitive behavioral therapy for insomnia in people with chronic disease: A systematic review and meta-analysis JAMA 22 September 2025
These findings suggest that CBT-I is an acceptable and efficacious intervention for managing insomnia in chronic disease populations, supporting its use as a first-line treatment across diverse patient groups.
Cumulative cardiovascular health score through young adulthood and cardiovascular and kidney outcomes in midlife JAMA 2 October 2025
These findings suggest that a higher cumulative cardiovascular health (CVH) score from 30 to 40 years of age was associated with markedly lower risks of cardiovascular disease (CVD) and kidney events in midlife, highlighting the importance of sustained primordial prevention efforts throughout early life.
Management of severe refractory Asthma JAMA 1 October 2025
Patients with severe refractory asthma benefit from management of comorbidities and environmental triggers and access to asthma specialists to optimize medications, including prescription of biologics.
Parental mental disorders and offspring mortality up to middle age JAMA 24 September 2025
The findings of this study emphasize the importance of providing support for families with parents with mental disorders; further studies are needed to investigate whether such support may reduce the risk of premature death in affected offspring.
Population-level effectiveness and herd protection 17 years after HPV vaccine introduction JAMA 29 September 2025
In this study, population-level effectiveness and herd protection were robust 17 years after HPV vaccine introduction, even in sexually experienced adolescent girls and young women at relatively high risk for HPV who may not have received the full vaccination series.
Suicide interventions for youths: A systematic review JAMA 29 September 2025
This systematic review found that the current evidence on available interventions targeting youths at heightened risk of suicide is uncertain. Medication, neurotherapeutics, and emerging therapies remain unstudied among this population. The limited evidence base calls for the development of novel, developmentally and trauma-informed treatments, as well as multilevel interventions to target the increasing suicide risk among youths.
Sunburn and cutaneous squamous cell carcinoma: A meta-analysis JAMA 24 September 2025
This meta-analysis supports an association between painful, blistering, and/or severe sunburns and cSCC.
_________________________________________________________________________________
Hypertonic Saline or Carbocisteine in Bronchiectasis NEJM 28 September 2025
In participants with bronchiectasis, neither hypertonic saline nor carbocisteine significantly reduced the mean incidence of pulmonary exacerbations over a period of 52 weeks.
Monoclonal Gammopathy of undetermined significance NEJM 1 October 2025
Key Points
- Monoclonal Gammopathy of Undetermined Significance
- Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma-cell disorder present in approximately 5% of the general population over the age of 50 years.
- MGUS is characterized by the presence of detectable monoclonal (M) proteins, which are identical copies of intact immunoglobulins, immunoglobulin light chains, or both that are secreted by the clonal plasma cells.
- MGUS is asymptomatic but can progress to cancer — specifically, multiple myeloma, Waldenström’s macroglobulinemia, or solitary plasmacytoma — at a rate of 1% per year.
- A variety of systemic disorders, referred to collectively as monoclonal gammopathy of clinical significance (MGCS), can develop as a result of the secreted monoclonal immunoglobulin in persons with MGUS.
- The diagnosis of progression to cancer or MGCS usually requires histopathological confirmation to ensure that the clinical problem is attributable to the plasma-cell disorder.
- No therapy is needed for MGUS, and the schedule for clinical follow-up is dictated by underlying risk stratification.
Sotatercept for Pulmonary Arterial Hypertension within the first year after diagnosis NEJM 30 September 2025
Among adults with pulmonary arterial hypertension who had received the diagnosis less than 1 year earlier, the addition of sotatercept to background therapy resulted in a lower risk of clinical worsening than placebo.
_________________________________________________________________________________
Dietary polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in patients with COPD Nutrition & Metabolism 30 September 2025
Higher dietary PUFA intake is associated with lower all-cause and cardiovascular mortality among COPD patients, suggesting that increasing dietary PUFA, particularly from plant sources, may help reduce COPD-related mortality risk.
Early C-reactive protein reduction predicts survival in COVID-19 severe pneumonia treated with glucocorticoids BMC Pulmonary Medicine 30 September 2025
In patients with COVID-19-related severe pneumonia receiving low-dose glucocorticoid treatment, even early reductions in CRP levels, together with other meaningful clinical traits, predict survival, representing a possible biomarker to guide personalized interventions.
Early prediction of bloodstream infections in ICU patients using machine learning methods based on routine laboratory parameters BMC Infectious Diseases 29 September 2025
Machine learning (ML)-based models using only routine laboratory tests from the first ICU day can effectively identify patients at increased risk of Bloodstream infections (BSIs).
Granisetron for prevention of postoperative shivering in surgical patients: a systematic review and meta-analysis BMC Anesthesiology 30 September 2025
Our meta-analysis and TSA demonstrated that granisetron administration significantly reduced the incidence of shivering in patients undergoing surgery. While evidence regarding the general effect of granisetron on shivering is extensive, future studies should focus on determining the optimal dosage.
Informed consent processes with First Nations peoples undergoing surgery or invasive procedures: a scoping review BMC Medical Ethics 29 September 2025
Evidence suggests that consent forms are often signed by patients who are not fully informed. For First Nations people, this is aggravated by language barriers, culturally different understanding of health and racism leading to coercion. Better assessment of informed consent processes with First Nations people, training and ongoing quality improvement are required to identify and address gaps. Partnership with First Nations people is required to enhance current guidelines and to develop strategies to ensure true informed consent.
Oxandrolone for burn patients: a systematic review and updated meta-analysis of randomized controlled trials from 2005 to 2025 World Journal of Emergency Surgery 29 September 2025
Oxandrolone demonstrates clinical utility in burn management by significantly reducing surgical burden, shortening hospitalization, and enhancing anabolic recovery; lean mass.
Physical, cognitive, and mental health impacts of Omicron reinfection in patients with original SARS-CoV-2 infection: a community-based observational study BMC medicine 30 September 2025
The results suggest that reinfection may be a risk factor for long COVID conditions. These findings provide information for the clinical management and healthcare services of long COVID and SARS-CoV-2 reinfection and highlight the importance taking necessary action to prepare for a future pandemic.
Reducing surgical site infections in patients undergoing pancreatic resection: a quality improvement initiative BMJ open quality 29 September 2025
What is already known on this topic
- Although surgical site infections (SSIs) are a significant source of morbidity in patients undergoing pancreaticoduodenectomy, these can be reduced with properly dosed piperacillin–tazobactam (pip–tazo).
What this study adds
- Although pip–tazo alone can significantly reduce rates of SSI, using a ringed wound protector in high-risk patients with preoperative biliary stenting may be a synergistically effective strategy.
How this study might affect research, practice or policy
- Ringed wound protectors should be used in conjunction with properly dosed pip–tazo as standard practice for patients undergoing pancreaticoduodenectomy.
_________________________________________________________________________________