Internal Medicine Alert – November 15, 2025

Acupuncture to Treat Low Back Pain in Older Adults

A multisite, three-arm, parallel-group randomized clinical trial of older adults in the United States with chronic low back pain found improvement in both pain and disability with the addition of acupuncture treatment compared to usual medical care alone.

Potential Benefit of Glyburide in Moderate-Volume Acute Ischemic Stroke

An exploratory analysis of the CHARM trial suggests intravenous glyburide may improve outcomes in large hemispheric stroke patients with infarct volumes < 125 mL, particularly alongside thrombectomy, reducing edema, mortality, and the need for decompressive surgery, and highlighting a potential neuroprotective role.

COVID-19 Rebound: To Retreat or to Re-Treat

Re-treatment of non-immunocompromised patients with mild-moderate COVID-19 rebound with nirmatrelvir/ritonavir provided no significant benefit.

Recombinant Herpes Zoster Vaccine in a Medicare Population

Receipt of adjuvanted recombinant herpes zoster vaccine was effective in individuals older than 64 years of age and maintained its efficacy in immunocompromised individuals. Added benefit accrued from receipt of the second vaccine dose, even if its administration was delayed.

Paltusotine (Palsonify) Tablets

The U.S. Food and Drug Administration has approved paltusotine, the second oral (after octreotide), but first once-daily formulation for the treatment of acromegaly in adults.

The History Matters!

How would you interpret today’s 12-lead electrocardiogram and long lead V1 rhythm strip if the history was that of an older adult with known coronary disease? Would your interpretation change if, instead, the patient was a younger adult with a known history of severe congenital heart disease, having been operated on a number of times as a child?