Adult

Lumbar Belt for Nonspecific Low Back Pain: A Randomized Clinical Trial

Nathan Hinkle — Fri, 21 Aug 2026 05:00:00 +0000

Date Added:

August 21, 2026

Journal/Publication:

JAMA Network Open

Publisher:

The American Medical Association

Publication Date:

August 19, 2026

Issue:

Volume:

Pages:

1-13

URL:

Lumbar Belt for Nonspecific Low Back Pain: A Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

doi:10.1001/jamanetworkopen.2026.29793

Keywords

Nonspecific Low Back Pain

Randomized Clinical Trial

Adults

MeSH

low back pain

Adult

Surveys and Questionaires

RPR Commentary: Non-rigid lumbar support belts appear to reduce pain and disability in people with non-specific low back pain for at least 6 months. Not sure about the strength of the control. James W. Mold, MD, MPH

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Importance Nonspecific low back pain is highly prevalent and disabling. Most current guidelines state that evidence is insufficient to recommend lumbar belts for this condition.

Objective To determine whether a soft and extensible lumbar belt reduces functional disability and pain in patients with nonspecific low back pain.

Design, Setting, and Participants This multicenter, open-label, randomized clinical trial was conducted at 17 medical centers across France from February 26, 2021, to March 28, 2024. Participants were adults with nonspecific low back pain lasting 1 to 6 months. Data were analyzed from August 7, 2024, to June 18, 2025.

Interventions Patients were randomized using an interactive web response system to wear a nonrigid lumbar belt for 12 weeks in addition to usual care or to receive usual care without a device.

Main Outcomes and Measures The primary outcome was the between-group difference in mean change in the Oswestry Disability Index (ODI) score from baseline to week 12. Outcomes were assessed at baseline, week 4, and week 12; pain was also reported weekly using online questionnaires.

Results At total of 168 patients were randomized (mean [SD] age, 49.0 [13.7] years; 101 women [60.1%]), with 86 participants in the belt group and 82 participants in the usual care group. The primary analysis included 155 patients with at least 1 postrandomization assessment (81 patients in the belt group; 74 patients in the control group). ODI improvement from baseline to week 12 was greater in the belt group (change, −10.0 [95% CI, −13.0 to −7.0] points) than in the control group (change, −5.3 [95% CI, −8.6 to −2.1] points), with a between-group difference of −4.7 (95% CI, −8.4 to −0.9) points (P = .01). Reductions in pain at rest and during activity were also greater in the belt group, with between-group differences of −8.7 (95% CI, −16.1 to −1.3) points (P = .02) and −10.0 (95% CI, −18.3 to −1.6) points (P = .02), respectively. Over 12 weeks, medication use was lower in the belt group than in the control group (41 patients [50.6%] vs 50 patients [67.6%]; P = .03). No serious device-related adverse events occurred.

Conclusions and Relevance In this randomized clinical trial, adding a nonrigid lumbar belt to usual care resulted in improved pain and functional disability in patients with nonspecific low back pain lasting 1 to 6 months. These findings suggest that lumbar belts may be considered as a nonpharmacological option for symptom management.

Author/s:

Laurent Grange, Paul Calmels, Yves-Marie Pers, Guillaume Laustriat, Valerie Wieczorek, Nassima Saih, Mathieu De-Seze, Christelle Nguyen, Camille Daste, Isabelle Fayolle-Minon, Emmanuel Coudeyre, Francois Rannou

Hearing Aids for Adults With Mild to Moderate Hearing Loss

Nathan Hinkle — Tue, 04 Aug 2026 19:18:58 +0000

Date Added:

August 4, 2026

Journal/Publication:

Journal of the American Medical Association

Publisher:

The American Medical Association

Publication Date:

May 27, 2026

Issue:

Volume:

336

Pages:

334-335

URL:

Hearing Aids for Adults With Mild to Moderate Hearing Loss

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2026.4740

Keywords

MeSH

Hearing Loss, Sensorineural

RPR Commentary: What all primary care physicians should know about hearing aids in adults. James W. Mold, MD, MPH

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Hearing loss is defined as an impaired ability to hear sounds at thresholds considered to be normal. Projections based on audiometric data from the National Health and Nutrition Examination Survey estimate that by 2030, approximately 55 million US adults will have hearing loss, including 35 million with mild loss (25-40 dB) and nearly 20 million with moderate or greater loss (>40 dB).1 The most common cause of hearing loss among hearing aid users is bilateral sensorineural hearing loss due to cochlear hair cell or auditory nerve degeneration. Functional effects of hearing loss differ with severity. Mild hearing loss may affect the ability to understand speech in noisy environments; moderate or greater hearing loss affects the ability to have individual conversations in a quiet room.

Author/s:

Karina C. De Sousa, De Wet Swanepoel

Adult Male Hypogonadism: A Review

Megan George — Fri, 29 May 2026 19:35:04 +0000

Date Added:

May 29, 2026

Journal/Publication:

JAMA

Publication Date:

May 28, 2026

URL:

Adult Male Hypogonadism: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.8526

Keywords

hypogonadism

Androgens

Erectile Dysfunction

prostate-specific antigen

Sex Hormone-Binding Globulin

MeSH

Prostate-Specific Antigen

Sex Hormone-Binding Globulin

Testis

Testosterone

A review of current knowledge on adult male hypogonadism. James W. Mold, MD, MPH

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Importance Male hypogonadism is a clinical syndrome of signs and symptoms of testosterone deficiency and consistently low morning serum testosterone concentrations. The prevalence of hypogonadism due to hypothalamus, pituitary, or testes pathology is less than 1%, and the prevalence due to obesity (body mass index ≥30) is from 2% to 8%.

Observations The most common signs and symptoms of hypogonadism are decreased libido, decreased spontaneous erections, and small testes. Primary hypogonadism is characterized by deficient testicular production of testosterone despite elevated luteinizing hormone (LH) concentrations. The most common cause of primary hypogonadism is Klinefelter syndrome (≥2 X chromosomes and 1 Y chromosome), which affects 2 in 1000 men and is frequently undiagnosed. Secondary hypogonadism is caused by hypothalamic or pituitary dysfunction and is characterized by low testosterone concentrations and low or inappropriately normal LH and follicle-stimulating hormone (FSH) concentrations. The most common permanent causes of secondary hypogonadism are head and neck radiation and severe head trauma. The most common potentially reversible causes of secondary hypogonadism are obesity, severe illness, and medication use (opioids, corticosteroids, checkpoint inhibitors, and medications that cause hyperprolactinemia). Testing for hypogonadism is reserved for men with signs and symptoms of androgen deficiency. Hypogonadism is confirmed if an individual’s serum testosterone concentration is less than 264 to 300 ng/dL in at least 2 fasting samples collected between 7 and 10 am and measured with an accurate and external quality-controlled assay. Assessment of calculated free testosterone concentration derived using total testosterone and sex hormone–binding globulin (SHBG) concentrations is necessary for men with obesity, diabetes, and other conditions that cause low serum SHBG concentrations. Patients diagnosed with hypogonadism should have serum FSH and LH concentrations measured to distinguish primary from secondary hypogonadism. For men with obesity-induced hypogonadism, the recommended first-line management is weight loss. In men with obesity, weight loss of at least 5% typically increases serum total testosterone concentration significantly, and weight loss is associated with improved physical function, libido, and erectile function. Men with permanent hypogonadism, or those unable to discontinue medications that cause hypogonadism, may be treated with testosterone. The testosterone formulation (injection, gel, or pill) and dosage should be individualized with monitoring of serum testosterone concentration, hematocrit percentage, and possibly prostate-specific antigen concentration.

Conclusions and Relevance Primary hypogonadism affects less than 1% of men, whereas secondary hypogonadism due to obesity (body mass index ≥30) occurs in 2% to 8%. First-line treatment for obesity-induced hypogonadism is weight loss. Testosterone therapy should be initiated for men with permanent hypogonadism or those who are unable to discontinue medications that cause hypogonadism.

Author/s:

Bradley D. Anawalt, Kim M. O’Connor, Mathis Grossmann

Hearing Aids for Adults With Mild to Moderate Hearing Loss

Megan George — Fri, 29 May 2026 19:31:08 +0000

Date Added:

May 29, 2026

Journal/Publication:

JAMA

Publication Date:

May 27, 2026

URL:

Hearing Aids for Adults With Mild to Moderate Hearing Loss

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.4740

Keywords

PMID (1):

42201716

MeSH

Hearing Loss, Sensorineural

Hair Cells

Auditory Perception

Social Isolation

A review of hearing aids, types, characteristics, benefits, and limitations in adults with mild to moderate hearing loss. James W. Mold, MD, MPH

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Untreated hearing loss is associated with social isolation that can reduce quality of life.2 A meta-analysis of 5 randomized trials (825 adults with mild to moderate hearing loss) that compared those not receiving hearing aids with those who received hearing aids that amplified sounds via air conduction had improved ability to discriminate sound and speech and hearing-related quality of life based on Hearing Handicap Inventory for the Elderly,2 which quantifies self-perceived functional and emotional hearing handicap (such as negative feelings and psychological distress from communication problems). The Hearing Handicap Inventory for the Elderly scores (lower scores indicate less handicap; scale, 0-100) improved by −26.5 (95% CI, −42.2 to −10.8) points with hearing aids, exceeding the minimal clinically important difference of 18.7 points.2

Amplification with hearing aids is the primary treatment for hearing loss, but use is limited. Traditional Medicare does not cover hearing aids, and coverage for associated services remains limited. In a nationally representative cohort using data from the National Health and Aging Trends Study, hearing aid use among US adults aged 71 years and older with hearing loss was 29.2% in 2021, including 14.4% among those with mild loss and 45.3% among those with moderate hearing loss.3 Although reasons for nonuse were not directly assessed, lower-income individuals, along with those who have milder degrees of hearing loss, are less likely to use hearing aids.3 Until recently, hearing aids in the US could only be obtained through licensed hearing care professionals such as audiologists. However, since October 2022, the US Food and Drug Administration has allowed adults to buy hearing aid devices without a medical examination, prescription, or professional fitting. This regulatory change has enabled over-the-counter (OTC) direct-to-consumer hearing aids, with potential to broaden access.

Author/s:

Karina C. De Sousa, De Wet Swanepoel

Prepregnancy Care and Counseling: A Review

Megan George — Wed, 22 Apr 2026 20:08:17 +0000

Date Added:

April 22, 2026

Journal/Publication:

JAMA

Publication Date:

April 20, 2026

URL:

Prepregnancy Care and Counseling: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.2888

Keywords

Pregnancy

Prepregnancy

Family Planning Services

Maternal Health

Gestational Diabetes

maternity

PMID (1):

42008245

MeSH

Diabetes, Gestational

Family Planning Services

Maternal Health

Pregnancy Outcome

Guideline recommendations for counseling women who plan to become pregnant. James W. Mold, MD, MPH

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Importance Prepregnancy care and counseling optimize maternal health before conception to improve outcomes for mothers and infants. In the US, 66.4% of reproductive-aged women have at least 1 modifiable risk factor for adverse pregnancy outcomes.

Observations For all individuals desiring pregnancy, recommended interventions include folic acid supplementation; cessation of tobacco, alcohol, cannabis, and opioids; immunizations against hepatitis B virus, varicella, and rubella; and screening for syphilis and HIV. Folic acid use before pregnancy is associated with reduced fetal neural tube defects (relative risk [RR], 0.67; 95% CI, 0.52-0.87). Maternal tobacco smoking is associated with increased risks of stillbirth (summary RR [sRR], 1.46; 95% CI, 1.38-1.54), neonatal death (sRR, 1.22; 95% CI, 1.14-1.30), and perinatal death (sRR, 1.33; 95% CI, 1.25-1.41). Screening for and treatment of syphilis and HIV prior to and during pregnancy decrease rates of fetal and neonatal infection. Prepregnancy immunizations against hepatitis B virus, varicella, and rubella decrease neonatal infection and mortality. Individuals using tobacco, alcohol, cannabis, and opioids should receive counseling and treatment prior to pregnancy (eg, buprenorphine or methadone for opioid use disorder). For individuals with chronic disease, routine health examinations and contraceptive care in the year before conception can optimize pregnancy timing and are associated with decreased risk of severe maternal morbidity. Compared with planned pregnancies, unintended pregnancies are associated with increased risk of postpartum depression (15.7% vs 9.6%; adjusted odds ratio [aOR], 1.51; 95% CI, 1.40-1.70), preterm birth (9.4% vs 7.7%; aOR, 1.21; 95% CI, 1.12-1.31), and low infant birth weight (7.3% vs 5.2%; aOR, 1.09; 95% CI, 1.02-1.21). Weight loss prior to conception is recommended for individuals with a body mass index of 25 or greater because overweight and obesity are associated with increased risk of gestational diabetes, gestational hypertension, and cesarean delivery. Among patients with pregestational diabetes (type 1 or 2), hemoglobin A1c of less than 6.5% is associated with a decreased risk of fetal anomaly compared with hemoglobin A1c of 6.5% or greater. Cardiovascular complications such as hypertension and heart failure occur in 15% of pregnancies and are more common among those with preexisting cardiovascular disease. These patients should receive counseling on maternal and neonatal risk, monitoring, and medication management by specialists in cardiology and maternal fetal medicine.

Conclusions and Relevance Prepregnancy counseling and care reduce maternal morbidity and neonatal morbidity and mortality. Primary care–based discussion of reproductive goals, immunizations, screening for infections and substance use, and risk-reducing interventions such as folate supplementation can optimize outcomes in individuals contemplating pregnancy.

Author/s:

Kylie M. Cooper, Linda M. Szymanski, Paru S. David

Diagnosis and management of bronchiectasis

Megan George — Wed, 22 Apr 2026 20:03:10 +0000

Date Added:

April 22, 2026

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

June 19, 2017

URL:

Diagnosis and management of bronchiectasis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.160830

Keywords

MeSH

A concise review of the diagnosis and management of patients with bronchiectasis. James W. Mold, MD, MPH

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Bronchiectasis is a chronic, debilitating respiratory condition that affects people of all ages. It is most prevalent in women and those older than 60 years, and prevalence is increasing. Patients have daily excessive sputum and associated symptoms, recurrent chest infections and impaired health-related quality of life. In North America, management guidelines are lacking. This review discusses best evidence to guide the long-term management of non–cystic fibrosis bronchiectasis in adults, focusing on the two most common single-entity types of bronchiectasis in adults: idiopathic and postinfectious bronchiectasis (Box 1). Table 1 lists all the types of bronchiectasis by cause.

Author/s:

Maeve P. Smith

2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Megan George — Tue, 31 Mar 2026 13:32:45 +0000

Date Added:

March 31, 2026

Journal/Publication:

JACC

Publication Date:

March 13, 2026

URL:

2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.jacc.2025.11.016

Keywords

Proliferating Cell Nuclear Antigen

PMID (1):

41824590

MeSH

Proliferating Cell Nuclear Antigen

Updated (2026) Guidelines for management of dyslipidemia. James W. Mold, MD, MPH

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Aim: The "2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia" retires and replaces the "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol."

Methods: A comprehensive literature search was conducted from October 2024 to December 2024 to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Structure: The focus of this clinical practice guideline is to address the evaluation, management, and monitoring of individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a).

Keywords: ACC/AHA clinical practice guideline; HDL; LDL; anticholesteremic agents; atherosclerosis; atherosclerotic disease; cardiovascular disease; cardiovascular diseases; cholesterol; drug interactions; dyslipidemia(s); hydroxymethylglutaryl-CoA reductase inhibitors; hypercholesterolemia; hyperlipid(a)emia/s; hyperlipoproteinemia type II; hypertriglyceridemia; hypolipidemic agents; lipids; lipoprotein(a); primary prevention; risk adjustment; risk assessment; risk factors; simvastatin; statin(s); triglycerides.

Author/s:

Roger S. Blumenthal, Pamela B. Morris, Mario Gaudino, Heather M. Johnson, Timothy S. Anderson, Vera A. Bittner, Ron Blankstein, LaPrincess C. Brewer, Leslie Cho, Sarah D. de Ferranti, Eugenia Gianos, Ty J. Gluckman, Kristen F. Gradney, Ijeoma Isiadinso, Donald M. Lloyd-Jones, Joel C. Marrs, Seth S. Martin, Kellie H. McLain, Laxmi S. Mehta, Samia Mora, Wudeneh M. Mulugeta, Pradeep Natarajan, Ann Marie Navar, Carl E. Orringer, Tamar S. Polonsky, Harmony R. Reynolds, Joseph J. Saseen, Michael D. Shapiro, Daniel E. Soffer, Sheila A. Tynes, Chloé D. Villavaso, Salim S. Virani, John T. Wilkins

Female pattern hair loss

Megan George — Wed, 04 Mar 2026 18:14:15 +0000

Date Added:

March 4, 2026

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

March 2, 2026

URL:

Female pattern hair loss

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.251058

Keywords

Female Pattern Hair Loss

Hair Loss

Alopecia

PMID (1):

41771564

MeSH

Female Pattern Hair Loss

Polycystic Ovary Syndrome

Adrenal Gland Neoplasms

Alopecia

A concise summary of the key features and management of female pattern hair loss. James W. Mold, MD, MPH

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Female pattern hair loss (FPHL) is a common, nonscarring hair-loss disorder. Prevalence of FPHL increases with age; 12% of females will have symptoms by age 29 years, 25% by age 50 years, and 41% to 50% at age 70 years and older. Risk factors include genetics and endocrinological diseases (e.g., polycystic ovarian syndrome, adrenal hyperplasia, ovarian or adrenal tumours).

Author/s:

Eric McMullen, Ammar Saed Aldien, Cathryn Sibbald, Jeffrey Donovan

The association between medication use and vitamin B12 deficiency in the elderly population: a cross- sectional study

Megan George — Mon, 09 Feb 2026 16:51:18 +0000

Date Added:

February 9, 2026

Journal/Publication:

BMC Geriatrics

Publication Date:

February 3, 2026

URL:

The association between medication use and vitamin B12 deficiency in the elderly population: a cross- sectional study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1186/s12877-026-07040-6

Keywords

Vitamin B 12 Deficiency

PMID (1):

41634610

MeSH

Vitamin B 12 Deficiency

Perhaps patients who are taking metformin should be routinely put on oral B12 and then monitored, James W. Mold, MD, MPH

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Background
Vitamin B12 deficiency is common in the elderly population and can cause severe complications. The use of certain medication has in previous studies been associated with vitamin B12 deficiency in the general population. To identify elderly patients at risk for vitamin B12 deficiency due to medication use, we evaluated the association between medication use and vitamin B12 deficiency in the elderly population.

Methods
Hospitalized geriatric patients 65 years of age or over with a serum vitamin B12 measurement within one week of the admittance date were included. Patients were classified as either B12 normal (258–635 pmol/L) or B12 deficient (< 148 pmol/L). Upon hospital admission patients’ medication use was verified. The association between vitamin B12 deficiency and the use of antacid, antiepileptic, antidiabetic, lipid lowering and other medication was evaluated by univariate and multivariate analyses.

Results
Of the 7132 patients included in the study, 532 (7.5%) had vitamin B12 deficiency and 3433 (48.1%) patients had normal vitamin B12 concentrations. Metformin use was significantly and independently (adjusted OR 2.5; 95% CI 1.7–3.6) associated with a dose-dependent higher risk of vitamin B12 deficiency. The use of other medication evaluated in this study was not associated with vitamin B12 deficiency.

Conclusions
Metformin use is significantly associated with vitamin B12 deficiency in the elderly, and this risk rises with higher metformin doses. Monitoring and timely start of vitamin B12 supplementation along with the lowest possible metformin dose are essential to prevent complications.

Author/s:

Monique P H Tillemans, Thijs J Giezen, Toine C G Egberts, Kees J Kalisvaart

Management of Premenstrual Disorders

Megan George — Mon, 09 Feb 2026 14:12:26 +0000

Date Added:

February 9, 2026

Journal/Publication:

JAMA

Publication Date:

February 4, 2026

URL:

Management of Premenstrual Disorders

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.26054

Keywords

Premenstrual Dysphoric Disorder

Luteal Phase

menstruation

Affective Symptoms

PMID (1):

41637081

MeSH

Premenstrual Dysphoric Disorder

A review of what we know and think about how to help women with premenstrual disorders. James W. Mold, MD, MPH

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Premenstrual disorders encompass a spectrum of cyclic affective and physical symptoms that interfere with daily functioning, occurring during the luteal phase and resolving with or immediately following menstruation. Premenstrual disorders may be caused by fluctuations of estrogen in the luteal phase, leading to dysregulation of serotonin, increased sensitivity to changes in the progesterone metabolite allopregnanolone, or both. Diagnosis can be made based on symptom assessment with daily ratings for at least 2 consecutive menstrual cycles, such as the Daily Record of Severity of Problems.1,2 Affective symptoms include lability (mood swings, sudden sadness or tearfulness, sensitivity to rejection), irritability or anger, depressed mood, and anxiety or tension. Physical symptoms include difficulty concentrating, lethargy or fatigue, appetite changes, sleep disturbances, breast tenderness, joint pain, and abdominal bloating.

Premenstrual syndrome (PMS) is characterized by the cyclic occurrence of any of these affective or physical findings during the premenstrual period and affects approximately one-quarter of menstruating individuals. Premenstrual dysphoric disorder (PMDD) is more severe than PMS and less common (affecting 2%-5% of females). Based on the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5), the diagnosis of PMDD requires at least 5 symptoms, including at least 1 affective symptom and 1 physical symptom, the week before menses. Symptoms of PMDD substantially decrease or resolve the week after menses.1,2 Treatment choices are based on the timing and severity of symptoms and patient goals such as desire for contraception.

Author/s:

Rebeca Ortiz Worthington, Lindsey M Eastman, Jason T Alexander

Exacerbation risk in patients with bronchiectasis receiving DPP-1 inhibitors vs placebo: A meta-analysis of RCTs

Megan George — Tue, 03 Feb 2026 14:17:01 +0000

Date Added:

February 3, 2026

Journal/Publication:

Respiratory Medicine

Publication Date:

January 31, 2026

URL:

Exacerbation risk in patients with bronchiectasis receiving DPP-1 inhibitors vs placebo: A meta-analysis of RCTs

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.rmed.2025.108607

Keywords

Bronchiectasis

DPP-1 inhibitor

Dipeptidyl-peptidases and tripeptidyl-peptidases

meta-analysis

PMID (1):

41443427

MeSH

Bronchiectasis* / drug therapy

Bronchiectasis* / physiopathology

Dipeptidyl-Peptidase IV Inhibitors* / therapeutic use

Disease Progression

Forced Expiratory Volume / drug effects

Randomized Controlled Trials as Topic

GLP-1 inhibitors appear to benefit patients with bronchiectasis apart from their weight reduction effect. James W. Mold, MD, MPH

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Background: No therapies have been approved to alter bronchiectasis progression. Dipeptidyl peptidase-1 (DPP-1) inhibitors, which target neutrophil serine protease activation, are under investigation as potential disease-modifying agents.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing DPP-1 inhibitors versus placebo in patients with non-cystic fibrosis bronchiectasis. PubMed, Cochrane, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, and ICTRP were searched from inception until April 26, 2025. Primary outcomes included time to first exacerbation and proportion of patients remaining exacerbation-free. Secondary outcomes included post-bronchodilator % Forced Expiratory Volume in 1 s (FEV1), Quality of Life-Bronchiectasis (QoL-B) questionnaire scores, and rate of adverse events. Time-to-event outcome was analyzed using Kaplan-Meier (KM)-estimated individual patient data (IPD), whereas random-effects meta-analyses were performed for remaining outcomes.

Results: 2523 patients from four RCTs were included, of whom 1689 (66.9 %) received DPP-1 inhibitors. Compared with placebo, DPP-1 inhibitors prolonged the time to first exacerbation (HR 0.79; 95 % CI: 0.71 to 0.88) and increased the proportion of patients remaining exacerbation-free (RR 1.33; 95 % CI 1.12 to 1.58). A slower decline in post-bronchodilator % FEV1 was observed (MD 1.1 %; 95 % CI 0.05 to 2.15), but no difference in QoL-B scores (MD 1.35; 95 % CI -0.72 to 3.42). The safety profile of DPP-1 inhibitors was acceptable and comparable to placebo. Moderate certainty was found across endpoints.

Conclusions: DPP-1 inhibitors prolong time to first exacerbation and reduce exacerbation rates in patients with bronchiectasis, with an acceptable safety profile. These findings support their potential as a disease-modifying strategy.

Registration: PROSPERO (CRD420251042542).

Keywords: Bronchiectasis; DPP-1 inhibitor; Dipeptidyl-peptidases and tripeptidyl-peptidases; Meta-analysis; Randomized controlled trials; Systematic review.

Author/s:

Giulia Carvalhal, Júlia Moreira Diniz, Larissa Calixto Hespanhol, David Curi Barbosa Izoton Cabral, Jafar Aljazeeri

Ann Arbor Guide to Triaging Adults With Suspected Urinary Tract Infection for In-Person and Telehealth Settings

Megan George — Mon, 02 Feb 2026 15:48:55 +0000

Date Added:

February 2, 2026

Journal/Publication:

Consensus Statement Infectious Diseases

Publication Date:

January 29, 2026

URL:

Ann Arbor Guide to Triaging Adults With Suspected Urinary Tract Infection for In-Person and Telehealth Settings

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2025.56135

Keywords

urinary tract infections

Triage

Urinalysis

telemedicine

PMID (1):

41609831

MeSH

Anti-Bacterial Agents* / therapeutic use

practice guidelines as topic

Urinary Tract Infections* / diagnosis

Urinary Tract Infections* / drug therapy

Guidance regarding how to triage adults with symptoms of urinary tract infection. I'm not sure it applies well to older women who may have UTI-like symptoms related to atrophic changes in the urethra. James W. Mold, MD, MPH

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Importance: Urinary tract infection (UTI) is common in ambulatory care settings and the primary reason for antibiotic prescribing. Despite several guidelines focused on the type and duration of antibiotics prescribed for treating UTI, there is limited outpatient guidance on how to best triage patients with presumed UTI.

Objective: To assess the appropriateness of different triage and management recommendations involving empiric antibiotics, urine testing strategies, and visit types and how these recommendations vary by patient sex, age, presenting symptoms, and clinical history.

Evidence review: Using the RAND/UCLA Appropriateness Method, a 13-member multidisciplinary panel (physicians, advanced practice providers, and nurses) performed a scoping review of the literature publications from 2009 to June 2024 and rated the appropriateness of 136 clinical scenarios (48 for women, 49 for men, and 39 scenarios not specific to sex) with up to 9 management strategies per scenario for a total of 1094 scenarios. For each scenario, experts rated the appropriateness of empiric treatment, types of urine testing, and triage to visit type (in-person, virtual, or none) as appropriate (ie, benefits outweigh risks), inappropriate, or of uncertain appropriateness. Appropriateness ratings were summarized into 2 groups: nonpregnant adult women and adult men.

Findings: Major recommendations based on symptoms included (1) same-day in-person evaluation if symptoms were concerning for pyelonephritis, complicated cystitis, or urinary obstruction; (2) a visit if additional nonurinary symptoms were present (ie, diarrhea, genital discharge, or cough); (3) neither urine testing nor empiric treatment solely due to a change in urine color or appearance without other bladder (cystitis) symptoms; (4) empiric treatment without testing or a visit, for women, if there were new classic cystitis symptoms of dysuria, urinary frequency, urgency, or suprapubic pain without risks for antibiotic resistance; (5) urinalysis with culture (ideally reflexed to culture) before taking first antibiotic dose for women at risk of antibiotic resistance (eg, recent antibiotic treatment for UTI or recurrent UTIs) and all men; and (6) empiric treatment considered for patients with barriers to obtaining timely urine testing or visits.

Conclusions and relevance: The appropriateness of empiric antibiotics, urine testing, and different clinical evaluation options were defined for adults presenting with concerns for UTI in common ambulatory triage settings, including telehealth. These criteria for ambulatory triage of suspected UTI symptoms in adults are anticipated to help standardize and improve the appropriateness of empiric antibiotic prescribing, urine testing, and visit type triage.

Author/s:

Jennifer Meddings, Kristin Chrouser, Karen E. Fowler

Restless Legs Syndrome: A Review

Megan George — Wed, 28 Jan 2026 18:57:15 +0000

Date Added:

January 28, 2026

Journal/Publication:

JAMA

Publication Date:

January 21, 2026

URL:

Restless Legs Syndrome: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.23247

Keywords

Restless Legs Syndrome

sleep

quality of life

methadone

MeSH

Restless Legs Syndrome

A review of what we think we know about restless legs syndrome. James W. Mold, MD, MPH

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Importance Restless legs syndrome (RLS) is a sleep-related movement disorder that affects approximately 3% of US adults to a clinically significant extent and can cause substantial sleep disturbance.

Observations Restless legs syndrome is characterized by an overwhelming urge to move the limbs, typically the legs, often accompanied by unpleasant limb sensations (eg, achiness, tingling). Symptoms, provoked by immobility, are relieved while moving and are typically present or most severe in the evening or at night. Restless legs syndrome symptoms may lead to difficulty falling asleep, staying asleep, or returning to sleep. According to population-based studies, approximately 8% of US adults experience RLS symptoms of any frequency annually and 3% experience moderately or severely distressing symptoms at least twice weekly. Patients with RLS have impaired quality of life and elevated rates of cardiovascular disease (29.6% with coronary artery disease, stroke, or heart failure), depression (30.4%), and suicidal ideation or self-harm (0.35 cases/1000 person-years). Restless legs syndrome is common among patients with multiple sclerosis (27.5%), end-stage kidney disease (24%), and iron deficiency anemia (23.9%); during pregnancy and especially in the third trimester (22%); with peripheral neuropathy (eg, diabetic, idiopathic; 21.5%); and with Parkinson disease (20%). Other risk factors include family history of RLS, northern European descent, female sex (2:1 vs male sex), and older age (RLS prevalence of 10% in adults ≥65 years). Restless legs syndrome is diagnosed based on clinical history; polysomnography is not recommended for diagnosis. Iron supplementation with ferrous sulfate (325-650 mg daily or every other day) or intravenous iron (1000 mg) should be initiated for serum ferritin level less than or equal to 100 ng/mL or transferrin saturation less than 20%. If possible, medications associated with RLS, including serotonergic antidepressants, dopamine antagonists, and centrally acting H1 antihistamines (eg, diphenhydramine), should be discontinued. Gabapentinoids (eg, gabapentin, gabapentin enacarbil, pregabalin) are first-line pharmacologic therapy. In randomized clinical trials, approximately 70% of patients treated with gabapentinoids had much or very much improved RLS symptoms vs approximately 40% with placebo (P < .001). Dopamine agonists (eg, ropinirole, pramipexole, rotigotine) are no longer recommended as first-line medications due to the risk of augmentation, an iatrogenic worsening of RLS symptoms, which has an annual incidence of 7% to 10% with these medications. Patients who do not improve with first-line treatment or have augmented RLS often benefit from low-dose opioids (eg, methadone 5-10 mg daily).

Conclusions and Relevance Restless legs syndrome affects approximately 3% of adults and can have negative effects on sleep and quality of life. Initial management includes cessation of exacerbating medications, as well as iron supplementation for patients with low-normal iron indices. If medication therapy is indicated, gabapentinoids are first-line treatment.

Author/s:

John W. Winkelman, Benjamin Wipper

Gastric Cancer: A Review

Megan George — Mon, 12 Jan 2026 17:08:24 +0000

Date Added:

January 12, 2026

Journal/Publication:

JAMA

Publication Date:

January 7, 2026

URL:

Gastric Cancer: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.20034

Keywords

Helicobacter Infections

abdominal pain

MeSH

Stomach Neoplasms

adenocarcinoma

Helicobacter Infections

A review of what we know currently about gastric cancer. James W. Mold, MD, MPH

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Importance Globally, 968 350 new cases and 659 853 deaths from gastric cancer were reported in 2022. In the US, 30 300 new cases and 10 780 deaths were estimated in 2025.

Observations Gastric cancer is more common in men, and the median age at diagnosis is 68 years. Most gastric cancers (>90%) are adenocarcinomas. Worldwide, 85% of cases arise from the stomach body or antrum and 15% from the cardia. In the US, more than 90% of patients diagnosed with gastric cancer present with symptoms such as weight loss and abdominal pain. At presentation, approximately 13% have localized disease (limited to the stomach), 15% to 25% have locally advanced disease, defined as a tumor that has spread to regional lymph nodes, and 35% to 65% have metastatic disease. Helicobacter pylori infection is a treatable risk factor associated with 90% of gastric body and antrum cancers globally. Additional modifiable risk factors include smoking, alcohol, obesity, and salt intake. In countries with high incidence such as Japan and Korea, routine endoscopic screening beginning at age 40 years is associated with improved survival. Diagnosis is made by endoscopic biopsy. Patients with localized gastric cancer are treated with surgical resection and have a 5-year relative survival rate of 75% with treatment. Patients with more advanced-stage disease should receive gastrectomy, perioperative chemotherapy with 5-fluorouracil, oxaliplatin, and docetaxel and immunotherapy (durvalumab). Metastatic or unresectable disease may be treated with chemotherapy, immunotherapy, and/or targeted therapy depending on biomarkers, including programmed cell death ligand 1 (PD-L1), human epidermal growth factor receptor 2 (ERBB2; formerly HER2 or HER2/neu), and claudin-18, isoform 2 (CLDN18.2). For PD-L1–expressing gastric cancer, adding immune checkpoint inhibitors, such as nivolumab and pembrolizumab, is associated with an additional 3 months of survival when compared with chemotherapy alone. For gastric cancers overexpressing the ERBB2 or CLDN18.2 proteins, the addition of trastuzumab or zolbetuximab, respectively, is associated with an additional 3 to 4 months’ survival. Early supportive care focusing on symptom management and on nutritional and psychosocial support is associated with 3 months of survival benefit. Less than 10% of patients with metastatic gastric cancer survive more than 5 years.

Conclusions and Relevance Approximately 30 300 new cases of gastric cancer are diagnosed annually in the US. Localized gastric cancer is treated with gastrectomy, and locally advanced disease is treated with surgery and chemoimmunotherapy. For patients with unresectable or metastatic gastric cancer, chemotherapy with immune checkpoint inhibitors and targeted therapies such as trastuzumab or zolbetuximab improves survival by several months.

Author/s:

Anuj Kishor Patel, Nilay S. Sethi

Metabolic Dysfunction–Associated Steatotic Liver Disease in Adults: A Review

Megan George — Tue, 11 Nov 2025 14:43:19 +0000

Date Added:

November 11, 2025

Journal/Publication:

JAMA

Publication Date:

November 10, 2025

URL:

Metabolic Dysfunction–Associated Steatotic Liver Disease in Adults: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.19615

Keywords

liver disease

steatotic liver disease

MASLD

Steatohepatitis

PMID (1):

41212550

MeSH

Glucagon-Like Peptide-1 Receptor Agonists

semaglutide

cardiovascular diseases

prevalence

diabetes mellitus

diabetes mellitus, type 2

Prediabetic State

liver cirrhosis

A review of metabolic dysfunction–associated steatotic liver disease in adults. James W. Mold, MD, MPH

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Importance Metabolic dysfunction–associated steatotic liver disease (MASLD) includes a range of liver conditions, progressing from isolated steatosis (characterized by fat accumulation in the liver without inflammation) to metabolic dysfunction–associated steatohepatitis (MASH), which involves fat accumulation and inflammation in the liver. The presence of MASLD is associated with increased morbidity and mortality due to liver-related complications, hepatocellular carcinoma, cardiovascular disease, and certain extrahepatic cancers.

Observations The most common chronic liver disease worldwide, MASLD affects approximately 30% to 40% of the general adult population globally (with varying prevalence across continents), including approximately 60% to 70% of individuals with type 2 diabetes and approximately 70% to 80% of those with obesity. It is typically diagnosed based on an ultrasonographic finding of hepatic steatosis, along with at least 1 of 5 features of the metabolic syndrome (abdominal overweight or obesity, prediabetes or type 2 diabetes, hypertension, elevated level of plasma triglycerides, and low level of high-density lipoprotein cholesterol) for women who consume less than 140 g/wk of alcohol (<2 standard drinks/d) and for men who consume less than 210 g/wk (<3 standard drinks/d) and have no other known causes of steatosis such as use of a particular medication (eg, corticosteroids, tamoxifen, or methotrexate), hepatitis C, or iron overload. Other risk factors for MASLD include older age (≥50 years) and male sex (male:female ratio approximately 2). The Fibrosis-4 index (a scoring system incorporating age, serum levels of aspartate aminotransferase and alanine aminotransferase, and platelet count) and vibration-controlled transient elastography (a noninvasive imaging technique) are commonly used to stage hepatic fibrosis in patients with MASLD. Cardiovascular disease is the leading cause of death, followed by certain extrahepatic cancers (primarily gastrointestinal, breast, and gynecologic cancer) and liver-related complications, including cirrhosis, hepatic decompensation (ascites, hepatic encephalopathy, or variceal bleeding), and hepatocellular carcinoma. First-line treatment of MASLD involves behavioral modifications (including hypocaloric low-carbohydrate and low-fat diets, physical exercise, and avoidance of alcohol) and management of type 2 diabetes, obesity, hypertension, and hyperlipidemia. Bariatric surgery should be considered for patients with MASLD and a body mass index greater than 35. Resmetirom (a liver-directed, thyroid hormone receptor β-selective agonist) and subcutaneous semaglutide (a glucagon-like peptide-1 receptor agonist) are conditionally approved by the US Food and Drug Administration (FDA) for the treatment of adults with MASH who have moderate to advanced fibrosis.

Conclusions A highly prevalent condition among adults worldwide, MASLD is associated with liver-related complications, hepatocellular carcinoma, cardiovascular disease, and certain extrahepatic cancers. First-line treatment includes behavioral modifications, including a weight-reducing diet, physical exercise, and avoidance of alcohol. Resmetirom and semaglutide are conditionally FDA-approved medications for the treatment of adults with MASH and moderate to advanced fibrosis.

Author/s:

Herbert Tilg, Salvatore Petta, Norbert Stefan, Giovanni Targher