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2 Minute Medicine Rewind November 10th, 2025
1. In this randomized clinical trial, combination therapy with diphenhydramine and sodium bicarbonate was associated with decreased vertigo compared to therapy with diphenhydramine alone.
Evidence Rating Level: 1 (Excellent)
Vertigo is characterized as a spinning sensation that is usually accompanied by nausea and vomiting, leading many patients to seek emergency care. In Taiwan, about 3% of adults experience vertigo, with frequent recurrences. In the emergency department (ED), the priority is to rule out serious central causes and alleviate symptoms quickly. Previous research has shown support for antihistamines; however, they often cause fatigue and increase fall risk, particularly in older adults. Another potential treatment option could be sodium bicarbonate, which is typically used to treat acidosis, but has shown potential to ease vertigo symptoms by improving inner ear blood flow and calming vestibular nerves. As such, this double-blinded randomized clinical trial compared sodium bicarbonate, antihistamines, and their combination for treating acute peripheral vertigo in the ED. Participants were randomized in a 1:1:1 ratio to receive either intravenous diphenhydramine (group A), sodium bicarbonate (group B), or both agents (group C). A total of 222 participants (mean [SD] age, 57.9 [17.6] years) were included in the study. Vertigo scores decreased by a mean (SD) of -4.4 (2.7), -5.1 (2.2), and -5.6 (2.1) in groups A, B, and C, respectively, with group C having significantly greater improvement than group A (P=.01). Fewer participants in group C required rescue therapy compared to group A (17.8% [13 of 73] vs 46.7% [35 of 75]; P<.001). Moderate lethargy was more frequently reported in the diphenhydramine groups (group A, 38.7% [29 of 75]; group C, 30.1% [22 of 73]) than in the sodium bicarbonate group (8.1% [6 of 74]; P<.001). Overall, in patients with acute peripheral, a combination of sodium bicarbonate and diphenhydramine provided greater symptom relief than diphenhydramine alone, and sodium bicarbonate alone was similarly effective while causing less lethargy.
Risk of Parkinson’s disease after human papillomavirus infection: a nationwide cohort study
1. In this cohort, Human papillomavirus (HPV) infection was associated with increased risk of developing Parkinson’s disease (PD), specifically in men.
Evidence Rating Level: 2 (Good)
Parkinson’s disease (PD) is a neurodegenerative disorder causing motor and non-motor symptoms, leading to reduced quality of life and increased mortality. The disease is mainly driven by the loss of dopamine-producing neurons and by abnormal protein aggregates, and is influenced by genetic and environmental factors. Viral infections such as hepatitis C and the Dengue virus have been shown to have a link with PD. Human papillomavirus (HPV) is a common sexually transmitted DNA virus that affects epithelial tissues; however, its impact on PD is unknown. This study aimed to investigate whether individuals diagnosed with HPV have an increased risk of developing PD compared to those without HPV. The study population comprised 80,318 individuals with prior HPV infection, 322,952 individuals without HPV as the primary control group, and 80,318 individuals with a history of acute respiratory infections (ARI) as the second control group. After accounting for CCI scores, patients with HPV infection were 25% more likely to develop PD than those without HPV infection compared to the general control group (HR=1.25, 95% CI=1.13-1.39) and the ARI control group (HR=1.20, CI=1.04-1.38). When stratified by sex, men with HPV infection had a significantly higher risk of PD, while women did not. For men, the risk was 1.48 times higher than the non-HPV control group and 1.31 times higher than the ARI control group. Overall, this retrospective cohort study found a link between HPV infection and the development of PD in men, highlighting the importance of public awareness and monitoring vulnerable populations.
Hearing Loss, Brain Structure, Cognition, and Dementia Risk in the Framingham Heart Study
1. In this cohort study, midlife hearing loss was linked with smaller brain volumes, faster decline in executive function, and a higher risk of developing dementia, particularly in those carrying the apolipoprotein E ε4 allele.
Evidence Rating Level: 1 (Excellent)
Age-related hearing loss has been linked by studies as a major risk factor for dementia, with several others noting the association between age-related hearing loss and poorer cognition. This study, using data from the Framingham Heart Study (FHS) Offspring Study, a 3-generational cohort study, examined the link between hearing loss with a multitude of brain outcomes, including those measured by MRI and neuropsychological ones. The presence of the apolipoprotein E (APOE) ε4 allele was used to evaluate the association and the value of hearing loss as a predictive risk factor for dementia. 1656 participants were studied and examined by certified audiologists for Pure Tone Averages (PTA), with patient histories obtained. A large spectrum of cognitive tests was run to link brain outcomes. The study found links between hearing loss and decline in brain function, with increasing PTA thresholds linearly associated with a greater increase in white matter hyperintensity volume (β [SE], 0.02 [0.01]; P = .048) and a greater decline in TMT-B minus TMT-A performance (β [SE], −0.02 [0.01]; P = .02). 12.7% of patients from a sample developed dementia, with a higher risk shown for those with any hearing loss (HR, 1.71; 95% CI, 1.01-2.90; P = .045). Those who did not use hearing aids showed a slightly elevated risk compared to those who did (HR, 1.72; 95% CI, 1.02-2.91; P = .04), with the primary risk being seen in APOE ε4 carriers (HR, 2.82; 95% CI, 1.11-7.16; P = .03). Overall, any more than a slight hearing loss showed 70% increase in dementia risk. The links between the two may be due to isolation or decreases in brain connectivity. Hearing loss can thus be seen to not just affect quality of life, but also brain health.
Hysterectomy Status and Outcomes in Patients With Grade 1, Stage IA Endometrioid Adenocarcinoma
1. In this cohort study, patients with early-stage, low-grade endometrial cancer who did not undergo hysterectomy, specifically those from racial and ethnic minorities or age extremes, had significantly higher risks of death from endometrial cancer, cardiovascular disease, and all-cause mortality, compared to those who did.
Evidence Rating Level: 2 (Good)
For patients with presumed early-stage, low-grade endometrial cancer, standard treatment is hysterectomy with bilateral salpingo-oophorectomy and lymph node evaluation, yielding a 5-year survival of 95%. Some patients, such as those willing to preserve their fertility or who are medically inoperable, may receive medical management instead, typically with progestin-based therapy, with surgery recommended after childbearing. Prior data on outcomes for patients who do not undergo surgery are limited. Thus, the study aimed to compare patient characteristics and outcomes in those with grade 1, stage IA endometrioid adenocarcinoma who did or did not undergo hysterectomy, examining cancer-specific survival, cardiovascular disease (CVD) deaths, and overall mortality by surgery status and age. A total of 27,331 patients with grade 1, stage IA endometrioid adenocarcinoma met the inclusion criteria for analysis (S1), including 26,984 (98.7%) who underwent hysterectomy and 347 (1.3%) who did not. Among patients 18-49 years, non-Hispanic White patients were least likely to undergo hysterectomy (2.8%) compared with Hispanic (4.9%), Asian or Pacific Islander (4.0%), and Black patients (8.2%) (P<.001). There were several reasons why patients did not undergo a hysterectomy, with the most common being not recommended by the clinician (42.1%). Over a median follow-up of four years, deaths from endometrial cancer were rare, occurring in 0.8% of all patients. However, those who did not undergo hysterectomy had significantly higher mortality across all categories, with higher rates of endometrial cancer-related death (4.2% vs 1.2%), CVD (7.8% vs 2.1%) and all-cause mortality (23% vs 8.2%) compared to those who underwent surgery. Overall, in a cohort of patients with low-grade, stage IA endometrioid adenocarcinoma, not undergoing surgery was associated with increased risk of mortality.
Risk of cardiovascular mortality in patients with gastric cancer
1. In this cohort of patients with gastric cancer, there was a significantly higher risk of cardiovascular death compared with the general population.
Evidence Rating Level: 2 (Good)
Gastric Cancer (GC) remains the fifth highest in both prevalence and mortality for types of cancer worldwide, with a 5-year survival rate of 25%. Among these patients, cardiovascular disease (CVD) accounts for 5.9% of mortalities, owing to CVD and GC sharing many risk factors, as well as many GC treatments being cardiotoxic. This study aims to show estimates of CVD mortality risk in GC patients compared to the general population. 41,083 GC patients from the Surveillance, Epidemiology, and End Results (SEER) registry were examined, with 2,288 deaths attributed to CVD (mortality rate: 1.91 per 100 person-years), a higher rate than the general population (mortality rate: 0.50 per 100 person-years) (IRR 1.46, 95% CI 1.40–1.52). Patients who underwent radiotherapy, which has a known association with inflammation, had an increased CVD risk. Higher risk was seen at the first month after diagnosis (IRR 11.52, 95% CI 9.97–13.31), likely owing to a combination of stresses, GC being thrombosis-prone, surgery risks and some first-line regimens’ cardiotoxicity. The risk decreased with age (IRR declining from 3.03 at age 40 to 1.25 at age 80), suggesting that early cardiovascular intervention may be particularly beneficial. The population-based cohort study helps limit selection and recency bias; however, it is limited in being able to adjust for CVD risk factors. Overall, the links between CVD and GC show the need for a multidimensional assessment between the two, with prioritized interventions at certain points showing potential.
Image: PD
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