Welcome to the  7^TH Edition of The Clinical Chronicle!

From FIT screening outpacing colonoscopy in participation to anti-CD20 drugs showing lasting MS control at 7+ years, this edition brings clarity to complex clinical choices. We examine how metabolic syndrome increases young-onset dementia risk by 24%, why post-ERCP pancreatitis rates haven’t budged in two decades, and the unchanged survival edge between IO and IV access in cardiac arrest.

As phthalates in plastics are linked to 350,000 heart deaths and cannabis use raises dementia odds, we separate correlation from causation. Meanwhile, fecal therapy via colonoscopy proves safe and 95% effective for recurrent C. diff, and FDA expands TAVR for asymptomatic aortic stenosis with a 50% lower risk of death, stroke, or hospitalization.

Stay informed. Stay prepared.

Featured Story

Sapien 3 TAVR Gets FDA Approval for Asymptomatic Severe Aortic Stenosis.

Urgent Need to Change Clinical Practice vs Watchful Waiting?

The FDA has approved the Sapien 3 transcatheter aortic valve replacement (TAVR) system, including the Ultra and Ultra Resilia devices, for treating asymptomatic severe aortic stenosis, expanding its use beyond symptomatic patients for the first time.

The landmark EARLY TAVR trial, which enrolled 901 patients over age 65 with severe AS, low surgical risk, and preserved LVEF, showed that early TAVR halved the risk of death, stroke, or unplanned cardiovascular hospitalization compared to watchful waiting 26.8% vs 45.3% over a median 3.8 years (HR 0.50; 95% CI: 0.40–0.63).

Additionally, 1 in 4 patients in the watchful waiting group required valve replacement within the first 6 months, and 87% underwent it during follow-up, often after becoming symptomatic unexpectedly.

Current guidelines recommend monitoring every 6–12 months for asymptomatic patients, but the data signal an urgent need to reassess this approach. Experts advocate for early heart team evaluation, emphasizing that proactive treatment can improve outcomes and reduce unpredictable clinical deterioration.

However, surgical AVR may still be preferable in younger patients with bicuspid valves or complex anatomy, where long-term durability is a key consideration.

Source: BUSINESSWIRE

In Focus

Scientists Investigate 'Ozempic Blindness' as Vision Loss Reported with Weight Loss Drugs

Rare Risk or Red Flag?

A new study in JAMA Ophthalmology reports rare cases of sudden vision loss in patients taking Ozempic, Wegovy, Zepbound, and Mounjaro. Of nine patients, most developed NAION( Non Arteritic Anterior Ischemic Optic neuropathy) , a serious condition caused by reduced blood flow to the optic nerve. Others experienced optic nerve swelling or retinal damage.

Experts believe this may be linked not to the drugs directly, but to the rapid correction of high blood sugar, which has previously been associated with eye damage.

While these events are extremely rare, doctors urge patients to monitor for vision changes and consult their physician promptly. Gradual dose increases may help reduce risk.

These findings don’t outweigh the benefits of GLP-1/GIP drugs—but highlight the need for close monitoring and further research.

Source: JAMA Ophthalmology

Blood Clot Prevention in Fracture Patients: Aspirin Matches LMWH.

Oral Aspirin as Effective as LMWH in Preventing Serious Clots, Even in High-Risk Groups?

A subanalysis of the PREVENT CLOT trial involving 12,211 orthopedic trauma patients found no significant difference between oral aspirin (81 mg twice daily) and injectable low-molecular-weight heparin (LMWH, 30 mg twice daily) in preventing pulmonary embolism, proximal deep vein thrombosis (DVT), or bleeding complications across 11 high-risk subgroups.

Three subgroups who received aspirin showed higher rates of distal DVT compared to LMWH: those with head injury and AIS >2 (5.5% vs 1.1%, P=0.02), thoracic injury with AIS >2 (2.2% vs 0.8%, P=0.04), and severe trauma with ISS >16 (3.3% vs 1.6%, P=0.03). However, these differences were not statistically significant after adjusting for multiple comparisons (P<0.0001).

In contrast, aspirin was associated with lower mortality in certain subgroups. Among patients with head injury (AIS >2), mortality was 0.5% with aspirin vs 3.7% with LMWH (P=0.03), and among those with spine injury (AIS >2), mortality was 0% with aspirin vs 6% with LMWH (P=0.04). Nonetheless, there was no overall mortality difference across all subgroups (P=0.63).

These results are consistent with the original PREVENT CLOT trial findings, which established aspirin as noninferior to LMWH for preventing 90-day all-cause mortality, nonfatal pulmonary embolism, and bleeding. Rates of DVT were slightly higher with aspirin, but both treatments were effective in reducing overall clot burden.

Given its oral administration, lower cost, and greater patient preference, aspirin offers a compelling alternative to LMWH, particularly for the 10–20% of orthopedic trauma patients without insurance. While some small subgroup differences were observed, they were not statistically robust. Researchers emphasized that the conservative statistical corrections might have masked potential differences, representing a limitation of the study.

Source: American Academy of Orthopaedic Surgeons

Colonoscopy-Based Fecal Therapy Safe and Highly Effective for Recurrent C. Diff.

New Study Supports Targeted Delivery of Rebyota.

Delivering fecal microbiota transplant (FMT) via colonoscopy using Rebyota (live-jslm) significantly prevented recurrent Clostridium difficile (C. diff) infection in a recent phase IIIb trial, with 95% of patients remaining recurrence-free at 8 weeks. The treatment showed a favorable safety profile, with only mild gastrointestinal adverse events reported.

Promising Efficacy and Safety

The single-arm study enrolled 41 adults across 12 sites, all of whom had recurrent C. diff and completed standard antibiotic therapy. A single 150 mL dose of Rebyota was administered into the right colon via colonoscopy following bowel prep. The treatment was well tolerated, with adverse events including bloating, constipation, diarrhea, and flatulence reported in only 9.8% of participants during the 8-week follow-up. Additional AEs noted over six months were mostly mild GI or infectious in nature, with two serious events deemed unrelated to the intervention.

Colonoscopic Administration Shows Practical Advantages

Although Rebyota is FDA-approved for rectal use, investigators noted that colonoscopic delivery allows for targeted placement and assessment of colonic mucosa. All patients opted for colonoscopy, reflecting strong patient preference. Physician feedback was overwhelmingly positive, supporting potential for easier integration into GI practice. However, the study design limits conclusions about route superiority, and long-term outcomes beyond 8 weeks are still pending.

Source: Digestive Disease Week(DDW)

Next in Practice

SCCM Guidelines Endorse Family-Centered ICU Care.

Liberal Family Presence and Psychosocial Support.

The Society of Critical Care Medicine (SCCM) released updated guidelines in March 2025 emphasizing a family-centered approach in adult intensive care units (ICUs). Based on robust evidence, the SCCM now strongly recommends liberal caregiver and family presence, including participation during rounds and even resuscitation. The guidelines also advocate for tangible support systems—such as dedicated family spaces, ICU diaries, caregiver education resources, and access to psychological, spiritual, and bereavement support.

Communication and Collaborative Involvement Encouraged

The SCCM issued a conditional recommendation for enhanced communication tools for both caregivers and ICU clinicians, reflecting the growing need for shared decision-making and emotional support. These changes aim to mitigate the burden of post-intensive care syndrome-family (PICS-F), promoting better outcomes for both patients and their loved ones. The guidelines reinforce that families are not just visitors—they’re integral to care.

Source: SCCM

4x Greater Risk of Dementia Within 5 Years.

New Study Links Cannabis Use to Higher Dementia Risk.

A major study in JAMA Neurology found that adults aged 45+ who sought ER or hospital care for cannabis-related issues had a significantly higher risk of developing dementia. Within five years, 5% of cannabis users were diagnosed with dementia, compared to 3.6% of other ER patients and 1.3% in the general population. Among hospitalized users, the risk was 72% higher than nonusers.

The data, drawn from over 6 million Canadians, showed that ER visits for cannabis surged fivefold between 2008–2021 nearly 27-fold for seniors. Most cannabis users in the study had medical visits due to addiction, mental health issues, or poisoning linked to cannabis.

While the study does not prove causation, the findings highlight a strong correlation, particularly in those with heavy or problematic use. By contrast, cannabis users had a 31% lower dementia risk than those hospitalized for alcohol use, showing substance-specific differences.

With cannabis also linked to heart issues, early death, and mental decline, experts urge caution—especially for older adults and those with cognitive risk factors.

Source: JAMA

Evidence at a glance

Plastics and Heart Disease: Are Phthalates Putting Millions at Risk?

New Study Estimates 350,000 Heart Deaths Linked to Plastic Chemicals.

A major study from NYU suggests that exposure to phthalates—chemicals used in plastics—may have contributed to over 350,000 cardiovascular deaths worldwide in 2018 among adults aged 55–64. These chemicals are found in food containers, cosmetics, and even air, raising concerns about their health impact.

Researchers estimate that 13% of heart-related deaths in this age group may be tied to phthalate exposure. However, the findings are based on statistical models, not direct cause-and-effect data. The study used prior datasets to link phthalate levels in bodily fluids with death rates, but it couldn’t fully account for lifestyle or social factors that also influence heart health.

Though not definitive, the research adds to growing evidence that phthalates may disrupt hormones and affect cardiovascular function. The U.S. EPA is currently reviewing several phthalates, including DEHP, the focus of this study.

Since exposure can happen through food, skin, or air, experts recommend reducing plastic use by choosing glass or steel containers and phthalate-free personal care products. More research is underway to see if lowering exposure can reduce health risks because plastics may be doing more harm than we thought.

Source: TheLancet

Anti-CD20 Therapies for MS: Long-Term Data Reveal Enduring Protection.

New 7 and 9 Year Data Show Ocrelizumab and Ofatumumab Strongly Reduce Disease Activity, Especially When Started Early.

Anti-CD20 therapies like ocrelizumab (Ocrevus) and ofatumumab (Kesimpta) continue to show impressive long-term benefits in people with relapsing multiple sclerosis (MS), according to new research presented at the 2025 American Academy of Neurology (AAN) meeting. Both drugs help suppress inflammation and reduce brain lesions but now, years of follow-up confirm they also delay disability progression and maintain safety over time.

Ofatumumab’s 7-Year Findings:
In a new analysis from the ALITHIOS study, patients who started ofatumumab early especially those newly diagnosed and previously untreated were significantly more likely to remain disability-free after 7 years. Compared to those who initially received teriflunomide, these patients experienced fewer events of confirmed disability worsening (CDW) and progression independent of relapse activity (PIRA). Lead researcher Dr. Gabriel Pardo emphasized that first-line use of ofatumumab provided stronger and more sustained protection, with no new safety concerns reported.

Ocrelizumab’s 9-Year Biomarker Data:
Ocrelizumab’s long-term data also continue to impress. New results from the OBOE extension study showed that after 4.5 years, the drug maintained its biological impact on key markers of inflammation in the cerebrospinal fluid (CSF)—such as neurofilament light chain, soluble TREM2, and CD19+ B cells. These changes, first seen within 12 weeks of treatment, remained stable through 240 weeks. Importantly, clinical benefits like reduced relapse rates and slower brain volume loss—initially proven in the OPERA trials—were sustained, especially in patients who started ocrelizumab early.

Why It Matters:
These long-term findings reinforce a key message: starting high-efficacy anti-CD20 therapies early can significantly improve outcomes in relapsing MS. Both ofatumumab and ocrelizumab offer powerful, lasting control of disease activity with consistent safety profiles—providing strong scientific backing for early, aggressive treatment strategies in MS management.

Source: NEUROLOGY

Metabolic Syndrome in Midlife May Trigger Early Dementia.

Could Your Metabolic Health Be Accelerating Brain Aging?

A large Korean study of nearly 2 million adults with an average age of 49 found that metabolic syndrome was linked to a 24% increased risk of young-onset dementia diagnosed before age 65. The risk was especially notable for vascular dementia and Alzheimer’s disease, and grew with each additional metabolic abnormality present.

Strikingly, the elevated risk was more pronounced among women, non-obese individuals, those who abstain from alcohol, and people with depression. These findings suggest a potential dose-response effect, where each metabolic component hypertension, obesity, diabetes, dyslipidemia adds to dementia risk.

Researchers stress that early lifestyle changes, healthy eating, regular exercise, weight management, and smoking cessation could lower risk. While genetics and other unmeasured factors may play a role, this study underscores the importance of metabolic health in midlife as a critical window for dementia prevention.

Source: NEUROLOGY

FIT Screening Boosts Colorectal Cancer Participation Without Compromising Survival

A major trial from Spain has confirmed that inviting people to do a fecal immunochemical test (FIT) results in higher colorectal cancer screening participation compared to colonoscopy—39.9% vs. 31.8%, respectively. Importantly, FIT was noninferior to colonoscopy for preventing colorectal cancer deaths over a 10-year period.

In the COLONPREV trial, which followed over 57,000 individuals aged 50-69, both screening methods showed similar outcomes for cancer incidence and all-cause mortality. The absolute 10-year risk of dying from colorectal cancer was nearly identical: 0.22% for colonoscopy, 0.24% for FIT.

While colonoscopy may offer greater risk reduction per protocol, researchers emphasize that FIT’s greater acceptability and ease make it a powerful tool for population-wide screening. The study suggests that patient preference matters—and that less invasive tests can be just as life-saving when participation increases.

This evidence supports broader use of FIT in global screening programs, especially in settings where access or adherence to colonoscopy is limited.

Source: TheLancet

Intraosseous vs. Intravenous Access in Cardiac Arrest.

Does vascular access method impact survival and recovery in out-of-hospital cardiac arrest?

A systematic review and meta-analysis of three randomized clinical trials, which included 9,332 adult patients with out-of-hospital cardiac arrest, compared the effectiveness of initial vascular access via intraosseous (IO) versus intravenous (IV) routes. The primary outcome was 30-day survival, while secondary outcomes included favorable neurological outcome and return of spontaneous circulation (ROSC).

The analysis showed that IO access did not significantly improve 30-day survival (odds ratio 0.99, 95% CI 0.84–1.17) or favorable neurological outcomes at 30 days or hospital discharge (odds ratio 1.07, 95% CI 0.88–1.30). However, IO access was associated with a lower likelihood of achieving sustained ROSC (odds ratio 0.89, 95% CI 0.80–0.99), suggesting that IV access may offer better outcomes in terms of circulation recovery.

Despite IO access being easier to establish when IV access is challenging, these findings indicate that IO access may not provide superior survival benefits and might even reduce the chances of sustained ROSC, highlighting the importance of IV access when possible during advanced cardiac life support.

Source: RESUSCITATION JOURNAL

Trends in Post-ERCP Pancreatitis: Rates Remain Stable Despite Advancements.

A systematic review of over two million patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between 2000 and 2024 revealed that the rates of post-ERCP pancreatitis remained consistent throughout the study period. The overall incidence of PEP was found to be 4.6% in all patients and 6.5% in first-time patients. These rates showed little fluctuation, indicating that despite advances in technology, such as improved cannulation techniques and the implementation of preventive strategies like hydration protocols and pharmacological interventions, there has been no substantial decline in the incidence of this complication.

One possible explanation for this stability could be the non-modifiable anatomical factors, particularly the proximity of the pancreatic orifice to the biliary orifice. This anatomical feature may contribute to a higher risk of pancreatic injury during the procedure, which could make it difficult to lower the rates of PEP further.

Interestingly, the findings suggest that while technical advancements have made ERCP procedures safer and more effective in many ways, the occurrence of post-procedural pancreatitis remains a persistent challenge. As a result, future research is needed to explore additional preventive strategies and interventions that could further reduce the incidence of PEP, improving patient outcomes and safety in ERCP procedures.

Source: GASTROJOURNAL

Resident’s Radar

The Hidden Crisis: Suicide and Mental Health Struggles Among Young Doctors.

The tragic suicide of Dr. Nakita Mortimer shines a light on the mental health challenges young doctors face.

Dr. Nakita Mortimer, an anesthesiology resident, tragically died by suicide in 2023, after experiencing the intense pressures of her medical residency. Despite her leadership role and efforts to improve conditions for residents, the long hours, stress, and isolation proved overwhelming.

Her death highlights a broader issue: the mental health crisis among young doctors. A 2024 Physicians Foundation survey found that 23% of residents have contemplated self-harm, and 20% know a peer who has considered suicide. This reflects the strain of 67-hour weeks and 28-hour shifts common in residency, contributing to high rates of depression, research shows a fivefold increase in depression in the first year of residency.

Financial pressures add to the burden, with average first-year residents earning $60,000 while carrying $200,000 in debt. Despite some hospitals providing mental health support, many residents still face stigma around seeking help, fearing it could harm their careers.

Corey Feist, co-founder of the Dr. Lorna Breen Heroes' Foundation, advocates for removing mental health-related questions from doctor licensing applications to reduce stigma. Still, only 34% of residents feel comfortable seeking mental health support.

Nakita’s death has sparked calls for change. Programs like Montefiore have increased support, including an 18% salary increase to ease financial pressures. Experts like Dr. Mary Klingensmith from ACGME stress the need to make residency programs more supportive, allowing residents to seek help without fear.

Upcoming Events & Deadlines

1. American Thoracic Society (ATS): 16 - 21 May, 2025 - SanFrancisco

2. CHEST: 19-22 October, 2025 - Chicago

3. American Diabetes Association (ADA) : June 6 - 10, 2025 - San Francisco

4. IDWeek 2025 : October 8 - 12, 2025 - Philadelphia