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Dual Antiplatelet Therapy: One-Size Doesn’t Fit All After PCI Written By: Dr. Janhvi Ajmera When someone gets a percutaneous coronary intervention (PCI), which involves the use of stents to open blocked arteries, doctors usually prescribe dual antiplatelet therapy (DAPT). This means taking two medications to prevent blood clots- aspirin and a P2Y₁₂ inhibitor (such as clopidogrel, ticagrelor, or prasugrel). The idea is to reduce the risk of heart attacks and stent clots. Sounds smart, but here’s the twist: recent trials suggest that how much benefit vs. risk you get from that combo highly depends on your individual risk profile. What New Studies Reveal Two big, recent trials presented at ESC 2025 are shedding light: TARGET-FIRST examined low-risk patients who had undergone “complete revascularization” (i.e., no residual clogged arteries after PCI). In them, stopping aspirin after just 1 month and continuing only the P2Y₁₂ inhibitor did not significantly increase ischemic events. But bleeding dropped by roughly half. But then there’s NEO-MINDSET, with a more typical group (older, more comorbidities, etc.). In that trial, stopping aspirin almost immediately didn’t meet the noninferiority margin. Sure, bleeding was less, but there was a modest increase in ischemic events (stroke, MI, etc.) beyond acceptable limits. Why It Matters for You These studies tell us: Personal risk stratification matters more than blanket rules. Not everyone benefits from long DAPT; for some, shorter or modified therapy may reduce bleeding without raising clot risks too much. Low-risk patients – those with complete revascularization, fewer comorbidities, and a stable situation, might do well with early de-escalation (i.e., stop aspirin early). High-risk patient – with MI, hypertension, diabetes, prior MI, etc, probably still need the usual longer DAPT combo, because their risk of ischemia may outweigh bleeding risk. Bleeding vs. Ischemic Trade-Off – It’s like walking a tightrope. Every medicine that reduces clot risk increases bleeding risk; so the sweet spot depends on how “bleed-prone” you are (age, kidney function, other meds, etc.). Practical Takeaway: What to Discuss With Your Cardiologist If you or someone you care about is on or considering DAPT after PCI: Ask what risk category you fall into: low vs high ischemic risk / bleeding risk. Check if “complete revascularization” was really achieved. Are there still blockages that weren’t treated? Find out which P2Y₁₂ inhibitor is being used (clopidogrel vs ticagrelor vs prasugrel), some are more potent (and riskier) than others. Ask whether a plan exists for reassessment: e.g., can you drop aspirin after 1 month, or do you need full DAPT for longer? Monitor follow-up closely: any signs of bleeding? Any symptoms of ischemia (new pain, unusual fatigue)? The Bottom Line DAPT is a powerful medicine. But “powerful” means it can help or hurt, depending on the patient. The latest evidence suggests moving away from “always DAPT for X months” toward personalized antiplatelet therapy: shorter durations, tailored drug choices, careful risk balancing. If you’re dealing with PCI recovery, use what these studies teach to have a smart, evidence-based conversation with your doctor, because your ideal DAPT duration might be very different from someone else’s. REFERENCES: Dual‐Antiplatelet Therapy After Percutaneous Coronary Intervention: How Short Is Too Short? | Journal of the American Heart Association https://share.google/bLrbOsBmo5YlFlGhj  New trial evidence on the use of blood thinners after coronary stenting https://share.google/O7vp8BxzJMmJ86q08  Source: European Society of Cardiology https://share.google/v2znHU7DArK5bOA1X

Emerging Trends in the 2025–2026 Residency Match: What Every Applicant Should Know Written By: Dr. Janhvi Ajmera As we gear up for Match 2026, several shifts are redefining the playing field for applicants. Whether you’re an IMG, US MD, or biomedical researcher supporting residency-bound peers, staying informed gives you a major strategic edge. 1. Research Experience: The New Differentiator With USMLE Step 1 now pass/fail, program directors are looking for other signals of academic drive. A survey of 885 residency PDs revealed that 41% are placing more weight on applicant’s research participation when granting interview invites. Why it matters:Research isn’t just “nice to have”, it can now be a deciding factor. Even if your Step scores are average, meaningful research can set you apart in review committees. 2. Home Program Advantage in Surgical Matches A 5-year study of nearly 13,000 applicants showed that those from institutions with home surgical residencies matched into surgical specialties at significantly higher rates (39.1%) compared to those without (22.3%). That’s a 1.76x advantage. Takeaway:Institutional affiliation matters, especially for competitive fields. If you’re planning a surgical path, consider strengthening your ties with your school’s home program or gaining access to similar networks. 3. Neurology: Fastest-Growing Specialty While internal medicine still boasts the most seats, neurology has seen a 30.4% growth in residency spots over the past four years (the fastest rate of growth by proportion). Why this stands out:More seats mean more opportunities, but don’t let that lure you into a passion-less specialty. Explore growth areas that align with interest, not just availability. 4. Mentorship & Coaching: Game-Changers in Residency Prep Strong informal mentorship, like chats with seniors or faculty and structured programs (academic coaching, career guidance) are gaining recognition as impactful tools for helping applicants navigate the match. These relationships foster confidence, specialty insight, and resilience. Pro move:It’s not just about doing more, it’s about connecting with people who see your potential, guide you toward meaningful research, and open doors through shared networks. 5. Ranking Psychology and Matching Odds: What Research Reveals A recent empirical study reveals something intriguing: applicants rejected from their first-choice programs are much less likely to match into their second-ranked choice. Experts attribute this partly to the psychological pressure around ordering ROLs strategically. The study even suggests using randomized rank lists to reduce manipulation and enhance fairness. Smart strategy:Rank with clarity and confidence. Don’t let perceived ranking tactics cloud genuine preference, your first choices should be exactly that: what you truly want. 6. Emergency Medicine & Primary Care: Shifting Demand Patterns Emergency Medicine is rebounding from past unfilled cycles, with MD students increasingly returning to the field. However, proposed changes (like switching to a 4-year training track starting 2027) might reshape future competitiveness. Primary Care specialties— including family medicine, internal medicine, and pediatrics, continue growing, driven by systemic demand and matched by supportive institutional training efforts. Insights:If you’re passionate about patient-centered care, now is a particularly opportune time to pursue primary care pathways. EM may fluctuate, keep an eye on evolving timelines.   What This Means for You Move Strategy Highlight meaningful research Use your work to stand out, don’t just tick boxes. Build mentorship ties early Whether informal or formal, support systems matter. Think critically about rankings Rank programs based on alignment, not pressure-induced judgments. Plan specialty around growth areas Neurology and primary care are expanding, align your application accordingly. Leverage institutional strengths Have access to home programs? Use them wisely. If not, build equivalent support systems.   Final Thoughts The residency match process continues evolving. As benchmarks shift, your success will depend not just on credentials, but on strategy, relationships, and adaptability. Research, mentorship, and thoughtful application design are no longer optional— “they’re essential”. ____________________________________

By Aida Feda Vanderpuye, MD, MPH Candidate

Pregabalin & Heart Failure Risk: What Every Clinician Should Keep in Mind Written By: Dr. Janhvi Ajmera When a Common Painkiller Raises Uncommon Concerns Medicine evolves with every publication. What we once considered safe can quickly shift under the weight of new data. A recent JAMA Network Open study is the latest reminder: pregabalin, widely prescribed for neuropathic pain and seizures, may significantly raise the risk of heart failure in older adults. Involving more than 240,000 Medicare beneficiaries aged 65–89 years with noncancer chronic pain, the study found that patients starting pregabalin faced a 48% higher risk of developing heart failure compared with those prescribed gabapentin. For patients with a prior history of cardiovascular disease, the risk jumped to 85%. It’s a potential practice-changing signal. Why This Matters Older adults often sit at the intersection of multiple vulnerabilities: chronic pain, diabetes, hypertension, and existing heart disease. For them, every new medication can tip the balance between stability and crisis. Pregabalin binds strongly to the α2δ calcium channel subunit, which may promote sodium and water retention. In a patient with compromised cardiac reserve, this can accelerate fluid overload and trigger heart failure. What begins as leg swelling or shortness of breath can escalate quickly into hospitalization. In other words, the very drug intended to relieve suffering may quietly add to it. Practical Takeaways for Clinicians Reconsider first-line choices: Gabapentin, though less potent, may be a safer alternative for older patients with cardiovascular risk. Start low, go slow: If pregabalin is required, use the lowest dose possible and reassess frequently. Monitor early warning signs: New edema, rapid weight gain, or shortness of breath should prompt immediate review. Explore non-drug therapies: Physical therapy, CBT, mindfulness, and integrative strategies like yoga and breathing practices, which can reduce dependency on high-risk medications. The Bigger Picture Pregabalin is not alone in this spotlight. Other widely used pain medications, including NSAIDs and COX-2 inhibitors, carry well-documented cardiovascular risks. In older adults juggling multiple prescriptions, the combined effect of polypharmacy can double or even triple cardiovascular events. This underscores a central truth: safe prescribing is not about the drug alone, it’s about the patient, their context, and evolving evidence. What Future Research Is Needed? Mechanistic: How does pregabalin trigger fluid retention and heart failure at the molecular and physiological level? Dose-response relationship: Is there a threshold dose at which CVD risks rise, and whether lower doses are safer for specific populations? Comparative safety: How does pregabalin’s risk profile compare to other commonly used agents for neuropathic pain, such as duloxetine or tricyclic antidepressants? Non-drug interventions: Can structured nonpharmacological strategies (yoga, mindfulness-based stress reduction, or CBT) reduce reliance on pregabalin in high-risk groups? Outcomes: Beyond Medicare data, what do international cohorts reveal about pregabalin’s long-term safety? Addressing these gaps is essential not only for clinical safety but also for guiding rational prescribing and future guidelines. FAQs on Pregabalin and Heart Failure Risk 1. Is pregabalin safe for all elderly patients? Not necessarily. Older adults, especially those with prior cardiovascular disease, appear at higher risk for heart failure when taking pregabalin. Risk-benefit assessment is crucial. 2. Should pregabalin be avoided altogether? No. Pregabalin still has a role, particularly in refractory neuropathic pain or seizure management. But clinicians should prescribe cautiously, monitor closely, and consider safer alternatives when possible. 3. How does pregabalin compare to gabapentin? Gabapentin was associated with a lower risk in this study. While less potent, it may be preferable for patients with high cardiovascular risk. 4. What signs should patients and providers watch for? Leg swelling, rapid weight gain, shortness of breath, and fatigue may indicate fluid overload. Early detection can prevent progression to heart failure. 5. Are there non-drug options for chronic pain? Yes. Cognitive behavioral therapy, physiotherapy, yoga, and mindfulness are increasingly validated as adjuncts to pain management, particularly in older populations. Final Word For clinicians, IMGs, and researchers, this study is a reminder that there are no “routine prescriptions” in medicine. Every drug is a double-edged sword, and for older adults, pregabalin may tip the scales toward harm. The takeaway is’nt panic, but perspective. Reassess your prescribing habits, remain vigilant, and let emerging evidence guide safer, more holistic care. Because at the heart of medicine, whether in practice or research, is a single question: Are we truly helping the patient in front of us? REFERENCE https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837132#google_vignette  ________________________________________

Menopause Management: A Modern Clinical Roadmap Written By: Dr. Janhvi Ajmera Menopause is a universal milestone, but for many women, it doesn’t come quietly. Hot flashes, night sweats, disrupted sleep, and mood swings can turn daily life into a challenge and sometimes for years. For physicians, the task is clear but meticulous: how do we ease symptoms without exposing patients to unnecessary risks? A recent JAMA review reframes this conversation by offering a structured, evidence-backed approach. But clinical guidelines are only as powerful as the way we apply them. Let’s unpack what this means for real-world practice and research. Symptom Burden: More Than Just Hot Flashes Nearly 8 in 10 women report vasomotor symptoms (VMS). For many, it’s more than discomfort; sleep disruption fuels fatigue, mood instability, and cardiovascular risk factors. The clinical fork in the road is straightforward: Mild symptoms → tolerable, no significant impact → reassure and avoid overtreatment. Moderate to severe symptoms → interfering with daily life → treatment is justified, often transformative. It sounds simple, yet underdiagnosis and undertreatment are global challenges. The Safety Lens: First, Do No Harm Hormone therapy (HT) is not for everyone. Before prescribing, clinicians must screen for red flags: History of breast cancer or estrogen-sensitive tumors Liver disease or impaired liver function Previous stroke, myocardial infarction, or thromboembolic disease When contraindications are present, HT is off the table. When they’re absent, the door to therapy opens, but still with careful weighing of risks and benefits. Hormone Therapy: The Right Patient, The Right Window For the right candidate, HT can be life-changing. Best outcomes are seen in: Women under 60 years old Within 10 years of menopause onset Without elevated risk for breast cancer or cardiovascular disease Treatment choices include: Estrogen-only therapy (for women with hysterectomy) Estrogen plus progestogen or bazedoxifene (for women with an intact uterus) The guiding principle? Lowest effective dose, regularly reassessed. Route of administration (oral vs transdermal) should be personalized. Beyond Hormones: The Nonhormonal Toolkit Not all patients can or want to use HT. Fortunately, the nonhormonal armamentarium is growing, and clinical trial data are reassuring. Evidence-backed alternatives include: SNRIs/SSRIs (e.g., venlafaxine, desvenlafaxine, escitalopram) Lifestyle strategies: structured exercise, weight management, cooling techniques, mindfulness-based interventions For some, these are not just substitutes, they’re first-line solutions that respect safety and patient choice. Clinical Pearls for Physicians   Individualize always — menopause is a shared physiology but a unique experience for every patient. Don’t under-treat — severe VMS can erode quality of life and exacerbate comorbidities if left unmanaged. Think long-term — revisit treatment regularly; menopause care is a continuum, not a one-time prescription. Research Horizons: Where Science Must Go For biomedical researchers, menopause care represents an under-explored frontier. Key unanswered questions include: The molecular mechanisms behind hot flashes and thermoregulation Precision biomarkers to predict who benefits most from HT Safer nonhormonal agents with fewer side effects Longitudinal outcomes of early vs delayed HT initiation This is where the next decade of translational science can directly transform millions of lives. Final Word Menopause isn’t a pathology, but poorly managed symptoms can feel like one. With evidence-based use of hormone therapy, nonhormonal alternatives, and personalized care, physicians can empower women to navigate this transition with strength rather than struggle. Science and compassion must walk hand in hand. Menopause care isn’t only about reducing symptoms; it’s also about restoring quality of life. REFERENCE: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2833235?resultClick=1