geoffrey modest medical blogs

  Contrary to several current guidelines, prescribing beta-blockers in patients with acute MI and preserved ejection fraction does not seem to provide any benefit (see MI nl EF beta block not help NEJM2026 in dropbox, or DOI: 10.1056/NEJMoa2512686 ) Details : -- this study is a preplanned meta-analysis of five prior open-label trials that randomly assigned patients with a recent myocardial infarction, no other indications for beta-blocker therapy, and a left ventricular ejection fraction (LVEF) of at least 50% to receive either beta-blocker therapy or no beta-blocker therapy:     -- the REBOOT study (Treatment with Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction): 6459 patients     -- the REDUCE-AMI study (Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction): 4967 patients     -- the BETAMI study (Norwegian Beta-Blocker Treatment after Acute Myocardial Infarction in Revascularized P...

  A recent article reviewed the resurgence of tetanus in the US that is associated with inadequate tetanus vaccine administration: see tetanus resurgence JAMA2026 in dropbox, or doi:10.1001/jama.2026.9347 A few background issues: -- tetanus is ubiquitous in nature -- clinical tetanus develops in humans when the spores of the Clostridium tetani bacteria germinate in anaerobic environments; the spores release the tetanus toxin tetanospasmin     -- the typical scenario is having a contaminated or deep wound providing anaerobic conditions     -- the diagnosis of tetanus is a clinical one: there are no diagnostic tests that support or rule out tetanus -- this toxin affects the sympathetic nervous system by interfering with the release of neurotransmitters, resulting in sustained muscular contraction and spasms -- this effect involves many different muscles, leading to respiratory failure from chest wall spasms, diaphragmatic dysfunction, laryngospasm and airway obs...