Uterine fibroids are a common cause of heavy menstrual bleeding and pain. Combination therapy with once-daily oral gonadotropin-releasing hormone-receptor antagonist relugolix plus estradiol and norethindrone acetate in a 12-week course resulted in a significant reduction in bleeding in more than 70% of those in the therapy arms versus less than 20% for the placebo groups.

In the US, only two emergency contraceptive methods have been FDA approved: oral levonorgestrel and oral ulipristal acetate. However, the copper IUD appears to be an order of magnitude more effective than the approved methods and so copper IUD is often used. But women prefer the levonorgestrel IUD. This study looked to compare the two IUDs as emergency contraceptives. Among 711 women randomized to copper versus levonorgestrel IUDs, pregnancy rates were 1 in 317 in the levonorgestrel group and 0 in 321, equating to non-inferiority for the levonorgestrel IUD.

She has been treating her IBS with bismuth subsalicylate. Her symptoms include shortness of breath, nausea, and vomiting. On exam, the patient is confused. Laboratory testing showed primary anion-gap metabolic acidosis, primary respiratory alkalosis, and a salicylate level 25x greater than the normal upper limit.

Although the relationship between preceding viral illness and subsequent Guillain-Barre isn’t proven, it is a commonly observed pattern. The severity of GBS ranges from mild sensory disturbances to life-threatening loss of function requiring intubation.

A 63-year-old man is seen in the ER for new onset confusion. He has been taking codeine-guaifenesin as directed for a URI. Respirations are shallow and the rate is 10/min. Pupils are miotic and the patient is somnolent. Exam and vitals are otherwise normal. The confusion resolves with administration of naloxone. Why did this patient most likely have the drug reaction?

In a study of 37,887 men 50 to 60 years old, those with PSA of >= 3 ng/ml underwent MRI imaging of the prostate and were randomized to systematic biopsy plus targeted biopsy or MRI-targeted biopsy only. MRI-directed targeted biopsy reduced the risk of overdiagnosis by half but did delay detection of intermediate-risk tumors in a small proportion of patients.