It may be worth starting metformin immediately on diagnosis of DM, without waiting to see whether dietary treatment works. One study found that starting metformin within three months of diagnosis was associated wtih a reduced rate of monotherapy failure a year later, compared to starting metformin later in the first year.
I don’t know that anyone would have the courage to advise a woman to continue HRT after an MI, but, interestingly, women who do so don’t seem to have any greater a rate of repeat infarction than women who don’t. Not enough data to draw firm conclusions one way or the other, according to this article (BMJ 2012;344:e1802).
Despite the dangers of polypharmacy, it may not be a good idea to withdraw antidepressants in patients with dementia and neuropsychiatric symptoms, even if they don’t have a depressive disorder. A small RCT has shown an increase in depressive symptoms in patients who do so compared to patients who don’t (BMJ 2012;344:e1566).
Bell’s palsy in a child? Check blood pressure – it can be caused by severe hypertension, which in turn can be caused by renal artery stenosis.
Although acupuncture does work for migraines, it doesn’t work much better than placebo – about a day less spent affected over a 3 – 4 month period.
The word on aspirin for primary prevention of cardiovascular disease is now a definite ‘No’, or at least until the next study comes along. This is partly because other forms of primary prevention such as statins are now decreasing the risk enough to leave less for aspirin to do. NNT is now clearly less than NNH with severe bleeds. (According to a totally different article appearing serendipitously in the same issue of Pulse, it’s also an occasional cause of angioedema.)