Internal Medicine Alert – May 15, 2025

Manual Maneuvers for the Treatment of Benign Positional Vertigo

Benign positional vertigo is a challenge to treat. This clinical trial from investigators in South Korea demonstrated modest efficacy in resolving posterior canal-related vertigo with a head-shaking maneuver that is easily performed in an office setting.

Can Anti-Amyloid Antibody Treatment Delay the Clinical Onset of Alzheimer’s Disease?

In this open-label extension of the dominantly inherited Alzheimer’s disease gantenerumab trial (DIAN-TU), long-term continuous amyloid clearance over eight or more years in asymptomatic carriers of autosomal dominant Alzheimer’s mutations showed potential to delay symptom onset and slow progression. Shorter duration or partial clearance did not yield measurable clinical benefit, suggesting that only sustained, near-complete amyloid removal may have disease-modifying effects.

Antibiotics for Asymptomatic Bacteriuria: Using Urinalysis to Improve Stewardship

A cohort study found that in patients receiving antibiotics for a urinary tract infection, a urinalysis with pyuria and/or nitrituria identified 40% more cases of unnecessary antibiotic use compared to asymptomatic bacteriuria.

The Effect of High-Dose Vitamin D on Clinically Isolated Syndrome and MS

This study by Thouvenot et al evaluated the effectiveness of high-dose vitamin D treatment on clinically isolated syndrome and early multiple sclerosis as monotherapy and reported a reduced incidence of new disease activity compared to the control group.

Paxlovid: Is It Still Worth the Cost?

Paxlovid is one of the most effective antivirals developed during the COVID-19 years, demonstrating significant reductions in hospitalization and death in higher-risk persons, as well as the time to viral elimination. However, it does not shorten the duration of symptoms, and there is little evidence that Paxlovid reduces the risk of developing long COVID symptoms.

Vimseltinib (Romvimza) Capsules for TGCT

The U.S. Food and Drug Administration has approved vimseltinib for the treatment of tenosynovial giant cell tumor for which surgical resection is not desirable.

And Then What Happens?

You are consulted on the electrocardiogram (ECG) in the figure — but without the benefit of any clinical information. This tracing was assessed as showing AFib (atrial fibrillation) with a controlled ventricular response. Do you agree?