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2 Minute Medicine Rewind January 26, 2026
1. Sleeve gastrectomy produces substantially greater and more durable weight loss than semaglutide over 12 months in patients with obesity.
2. Semaglutide is effective during treatment, but discontinuation frequently leads to clinically significant weight regain, highlighting the need for long-term treatment strategies.
Evidence Rating Level: 2 (Good)
In this prospective, non-randomized study, sleeve gastrectomy (SG) was compared with once-weekly semaglutide for weight loss and metabolic outcomes in adults with obesity over 12 months. Thirty-six patients underwent SG and thirty-five received semaglutide following shared decision-making. SG achieved significantly greater weight loss at all time points, with a mean 12-month total weight loss of 28.6% compared with 11.3% for semaglutide. BMI reduction was also substantially greater after SG. Both interventions improved metabolic parameters, but SG resulted in greater triglyceride reduction and HDL-cholesterol increase. Semaglutide produced meaningful short-term weight loss; however, among patients who discontinued therapy after 6 months, weight regain was common, with nearly one-third returning to baseline weight. The study concludes that SG offers superior and more durable weight loss, while semaglutide is effective during active treatment but requires ongoing use to maintain benefit.
Effect of fluoxetine on organ dysfunction and mortality in severe sepsis
1. Adjunctive fluoxetine significantly reduced vasopressor duration and ICU length of stay in patients with severe sepsis.
2. Fluoxetine improved organ dysfunction scores and metabolic recovery but did not significantly reduce short-term mortality.
Evidence Rating Level: 1 (Excellent)
Sepsis is a leading cause of intensive care unit morbidity and mortality, driven by a dysregulated host inflammatory and metabolic response that results in organ dysfunction and hemodynamic instability. Given emerging evidence that selective serotonin reuptake inhibitors have immunomodulatory and metabolic effects, this randomized controlled trial evaluated fluoxetine as adjunctive therapy in severe sepsis. This single-center, randomized, double-blind, placebo-controlled trial enrolled 46 adults with severe sepsis who were randomized 1:1 to receive fluoxetine 40 mg daily or placebo in addition to standard sepsis care. The primary outcome was duration of vasopressor dependence, with secondary outcomes including organ dysfunction scores, inflammatory biomarkers, lactate levels, ICU length of stay, and 28-day mortality. Patients receiving fluoxetine had a significantly shorter duration of vasopressor use compared with controls (6.2 vs. 7.9 days) and a reduced ICU length of stay. Fluoxetine was also associated with faster improvement in Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores, as well as lower lactate levels by days 7 and 10. Inflammatory markers, including tumor necrosis factor-alpha, interleukin-1, C-reactive protein, and procalcitonin, declined more rapidly in the fluoxetine group. There was no statistically significant difference in 28-day mortality between groups. Overall, fluoxetine appeared to improve hemodynamic recovery and organ dysfunction in severe sepsis without demonstrating a clear mortality benefit, supporting further investigation in larger multicenter trials.
1. Intravenous esketamine provides effective adjunctive analgesia after cesarean delivery while also reducing postoperative inflammation and mood-related complications.
2. Esketamine may be a useful component of multimodal postoperative management in obstetric anesthesia beyond pain control alone.
Evidence Rating Level: 1 (Excellent)
Postoperative pain following cesarean section is common and closely linked to inflammation, anxiety, depression, sleep disturbance, and central sensitization. This single-center, randomized, double-blind, placebo-controlled trial evaluated whether perioperative esketamine improves postoperative pain and related outcomes in women undergoing elective cesarean delivery under combined spinal-epidural anesthesia. One hundred term pregnant women were randomized to receive intravenous esketamine (0.5 mg/kg after cord clamping, followed by esketamine-containing patient-controlled intravenous analgesia) or placebo with standard opioid-based analgesia. The primary outcome was the maximum numeric rating scale pain score within 24 hours postoperatively. Secondary outcomes included pain at rest, with movement, and visceral pain at multiple time points, analgesic use, pressure pain threshold and tolerance, serum C-reactive protein, and rates of anxiety, depression, and sleep disorders. Ninety-eight participants completed the study. The esketamine group had significantly lower maximum pain scores within 24 hours and consistently lower rest, movement, and visceral pain scores at all assessed intervals. Time to first patient-controlled analgesia use was prolonged, and postoperative serum C-reactive protein levels were lower, indicating reduced inflammation. Esketamine was also associated with significantly lower rates of postoperative anxiety, depression, and sleep disturbance. There were no significant differences in hyperalgesia measures or adverse effects between groups. Overall, perioperative esketamine provided effective multimodal benefits after cesarean delivery.
1. Children and adolescents with chronic medical conditions have a significantly higher risk of invasive pneumococcal disease, particularly those who are immunocompromised or have multiple comorbidities.
2. These findings support strengthening pneumococcal vaccination strategies for older children and adolescents with chronic medical conditions who remain vulnerable despite routine early childhood immunization.
Evidence Rating Level: 2 (Good)
This retrospective cohort study evaluated the risk of pneumococcal disease among individuals younger than 19 years with chronic medical conditions (CMCs) in Japan. Using the JMDC longitudinal insurance claims database, the authors analyzed data from over 12.2 million children and adolescents between 2006 and 2022 to compare rates of invasive pneumococcal disease (IPD) and non-bacteremic pneumonia, acute otitis media, or sinusitis (NBP/AOM/sinusitis) in those with versus without CMCs. Seventeen predefined CMCs were identified using ICD-10 codes, and outcomes were assessed annually. Adjusted incidence rate ratios were estimated using multivariable Poisson regression models controlling for age and sex. Children with at least one CMC had substantially higher rates of IPD and NBP/AOM/sinusitis compared with healthy peers. The risk of IPD increased markedly with the number of CMCs, with particularly high incidence rate ratios among immunocompromised individuals and those with two or more CMCs. Infants and younger children with immunocompromising conditions demonstrated the highest absolute IPD rates. In contrast, while NBP/AOM/sinusitis risk was elevated in children with CMCs, the magnitude of risk did not increase substantially with additional comorbidities. Elevated risks persisted across vaccine eras and during the COVID-19 period. The authors conclude that children and adolescents with CMCs represent a high-risk population for pneumococcal disease and may benefit from expanded and targeted pneumococcal vaccination strategies beyond early childhood.
Long-Term Recovery, Morbidity, and Mortality After Maternal Ischemic Stroke
1. Most women experience good functional recovery after maternal ischemic stroke.
2. Long-term mortality and neurologic morbidity remain significantly higher than in women without pregnancy-related stroke.
3. Vocational outcomes are adversely affected, with higher rates of disability pension use among survivors.
Evidence Rating Level: 2 (Good)
Maternal ischemic stroke is a rare but serious complication of pregnancy and the postpartum period, yet its long-term prognosis has been insufficiently characterized. This nationwide retrospective cohort study examined long-term mortality, morbidity, functional recovery, and vocational outcomes among women with a history of maternal ischemic stroke in Finland. Using national health registers, the authors identified women who experienced ischemic stroke during pregnancy or within the postpartum period between 1987 and 2016 and compared them with age-matched women without pregnancy-related stroke. Mortality and long-term morbidity outcomes were assessed using hospital discharge diagnoses, medication data, and cause-of-death registries. Functional recovery was evaluated using modified Rankin Scale scores, and vocational status was assessed through employment and disability pension records. Women with maternal ischemic stroke had significantly higher long-term mortality and increased rates of neurologic and cardiovascular morbidity compared with controls. Despite this, most survivors achieved good functional recovery, with the majority demonstrating favorable functional outcomes. However, women with prior maternal ischemic stroke were more likely to experience persistent neurologic deficits and were less likely to be fully employed, with higher rates of disability pension use. The authors conclude that although functional recovery after maternal ischemic stroke is often favorable, affected women face increased long-term mortality, morbidity, and vocational challenges, underscoring the need for long-term follow-up and multidisciplinary support.
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