Internal Medicine
An alpha-blocker before trial without catheter raised voiding success by about a quarter in acute retention
A meta-analysis of eight trials supports a simple ward step for men in retention from prostatic enlargement; small airway dysfunction flagged asthma patients at higher exacerbation risk; and telehealth mindfulness helped back pain, though less than hoped.
Sibling comparison finds no link between prenatal paracetamol and autism or ADHD
A Hong Kong cohort of 700,000 mother-child pairs dissolves the paracetamol signal once families are compared with themselves; an updated review ranks weight loss across GLP-1 drugs; and GDF-15 predicts death far better than it diagnoses ischaemia.
Endoscopy within six hours did not improve outcomes in non-variceal upper GI bleeding
A meta-analysis of 10,785 patients found ultra-early endoscopy no better than endoscopy within 24 hours, even in high-risk bleeders; a potassium-competitive acid blocker lifted H. pylori eradication where clarithromycin resistance is documented; and a referral trial in prostate cancer improved cholesterol, not cardiac events.
VA/DoD lipid guideline adds a one-time Lp(a) test and combination therapy for very high risk
The updated guideline adopts PREVENT, adds coronary calcium and one-time lipoprotein(a), and moves secondary prevention towards statin plus ezetimibe or PCSK9 inhibition. Also: medically tailored meals cut heart failure admissions, ward surveillance technology remains unproven, and a consensus on POTS.
Most penicillin allergy labels are wrong, and a direct oral challenge can remove them on the ward
A JGIM review sets out how PEN-FAST and an oral challenge turn delabelling into routine inpatient work. Also: KDIGO's 2026 anaemia-in-CKD guideline, a hybrid CGM protocol that replaced half of ward fingersticks, why a low vitamin D rarely means osteomalacia, and the alcohol treatment gap in fatty liver.
An NT-proBNP over 20,000 on admission more often meant infection than heart failure
In 415 unselected admissions with extremely high NT-proBNP, infection was the main diagnosis in 60% and heart failure in 19%, and 6-month mortality was 64.5%. Also: AGA advice on MetALD, point-of-care PCR in nursing homes, and HEPA filters in care homes.
Fatty liver: one score earns its place for cirrhosis follow-up, none for liver cancer
An 853,000-patient VA cohort ranks nine risk scores for steatotic liver disease. Also: hospital-to-clinic linkage for alcohol use disorder, why the cirrhosis SBP cut-off misleads in malignant ascites, and meals after discharge.
Withholding the ACE inhibitor before surgery changed nothing across 638 patients
A randomised trial finds no difference in cardiovascular events, intraoperative hypotension or acute kidney injury whether angiotensin-axis blockers are continued or held for 24 hours before elective non-cardiac surgery. A new tobacco treatment guideline puts varenicline and combination nicotine replacement ahead of single-agent therapy, and half of hospitalists think asymptomatic inpatient hypertension should be left alone.