Faster troponin pathways did not shorten emergency stays across 110,000 presentations

The edition in brief

An individual participant data meta-analysis of five randomised trials (110,933 presentations) found the guideline-recommended 0/1 h troponin pathway did not shorten emergency department stays or clearly raise direct discharge compared with 0/3 h, and its safety estimate was imprecise (death or new type 1 MI 0.8% vs 1.0%, OR 0.83, CI 0.45–1.53), with large heterogeneity between systems. A Brazilian adaptive trial in 399 adults with long COVID fatigue found fluvoxamine 100 mg twice daily modestly improved fatigue scores at 60 and 90 days; metformin was inconclusive. TRIUMPH-2 found retatrutide, a triple GIP–GLP-1–glucagon agonist, reduced weight by 12–19% at 80 weeks in adults with obesity and type 2 diabetes, against 5% with placebo, with more gastrointestinal effects and discontinuation at higher doses. The pearl covers when acute sinusitis needs antibiotics. The practice-changer is the ACP guideline: hormone therapy first-line for menopausal vasomotor symptoms, SNRIs second, and SSRIs, gabapentin or neurokinin antagonists third.