Comparing the Use of Physiotherapy, Shockwave Therapy, Prolotherapy, and Platelet-Rich Plasma for Chronic Lateral Epicondylitis: A Prospective, Randomized Controlled Trial With 2-Year Follow-up.
A prospective randomized controlled trial with a 2-year follow-up compared outcomes of four treatments—physiotherapy, extracorporeal shockwave therapy (ESWT), prolotherapy, and platelet-rich plasma (PRP)—for chronic lateral epicondylitis (tennis elbow. Results showed that PRP produced the highest patient-reported symptom scores (SSS) and significantly greater functional gains, followed by prolotherapy; both outperformed ESWT and physiotherapy. All groups improved more than the minimal clinically important difference in DASH (Disabilities of the Arm, Shoulder and Hand) scores, but PRP and prolotherapy demonstrated larger improvements. These findings suggest PRP and prolotherapy may offer superior long-term nonsurgical options for managing chronic lateral epicondylitis. Full Access: QxMD
Clinical Practice Guideline: Adult Sinusitis Update
This article provides an updated clinical practice guideline for adult sinusitis, outlining the rationale, purpose, and 14 key action statements to assist clinicians in implementing the recommendations effectively. It serves as a streamlined roadmap to enhance evidence-based care for adult patients presenting with sinusitis. The 14 developed recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Full Access: AAO-HNSF
‘Natural’ Isn’t Always Safe: Reframing Herbal-Induced Liver Injury
Herbal supplements—commonly marketed for detox or immune support—are not inherently safe and are an increasingly recognized cause of liver injury. Over 80,000 such products are sold in the U.S. without FDA approval, making them a high-risk, poorly regulated source of liver toxicity. Supplements like turmeric, green tea extract, kava, and black cohosh have been implicated; turmeric, for example, may cause autoimmune-like liver injury, especially when co-administered with piperine. Data from the U.S. Drug-Induced Liver Injury Network (DILIN) shows that supplement-related cases of liver injury have jumped from 7% to 20% of all cases between 2004 and 2013. Full Access: Medscape
Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections – A Phase 2 Randomized Clinical Trial
In a randomized, double-blind, placebo-controlled phase 2 trial involving 450 healthy adults, regular use of azelastine nasal spray significantly reduced the risk of SARS-CoV-2 infection—only 2.2% of participants in the azelastine group contracted the virus compared to 6.7% in the placebo group. The spray also delayed the time to infection, shortened the duration of antigen test positivity, and reduced symptomatic cases. Safety profiles were similar between groups. These findings suggest azelastine may serve as a safe, over-the-counter option for pre-exposure prophylaxis, though larger, multicenter studies are needed to confirm its effectiveness. The study’s limitations include a modest sample size, single-center design, and potential unblinding due to the nasal spray’s taste, which may limit generalizability and introduce bias. Additionally, the sensitivity of rapid antigen testing could have underestimated asymptomatic infections. Full Access: JAMA