Blog

Under the Radar

Reading Time: 8 Minutes

Clinician using a tablet

Published May 9, 2026

Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Once a month, we'll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

Good morning and happy Mother's Day weekend! For years, research has illuminated how a first pregnancy brings lasting changes to the brain. But a second pregnancy? Historically, it's received about as much attention as a second child's baby book—well-intentioned, but often sparse. That's changing.

A new, small study comparing brain scans of first- and second-time mothers, alongside nonpregnant controls, found that each pregnancy leaves its own neurologic signature. First pregnancies showed stronger changes in networks linked to self-reflection and social processes. By a second pregnancy, those shifts were more subtle, with greater changes in attention and sensory processing—useful when simultaneously feeding a newborn and determining whether the silence in the next room should be enjoyed or investigated.

The maternal brain—evidence that the second time around isn't just hand-me-down biology.

 

Stronger Flu Shots, Lower Alzheimer Risk?

INFECTIOUS FINDINGS

Maybe you already knew the CDC recommends a higher dose flu vaccine for adults over 65. Paul Schulz, MD, did not. The UTHealth Houston neurologist and senior author of this study admitted he was "stunned" to learn a stronger option even existed. So, he did what researchers do best: turned the surprise into a study, asking whether flu shot strength influences Alzheimer disease risk.

Not all flu shots are created equal

The story actually began in 2022, when Schulz and his team reported that flu vaccination was linked to a lower risk of Alzheimer disease in older adults. That finding caught the attention of a public health department, which posed a simple follow-up: Does dose matter? As Schulz dug in, he uncovered an under-the-radar update: The CDC preferentially recommends enhanced flu vaccines for adults >65 to offset age-related immune decline, including a high-dose formulation with four times the standard antigen load.

To determine whether vaccine dose influences Alzheimer risk, the team analyzed data from nearly 200,000 adults aged 65 and older, comparing high-dose and standard-dose recipients. The difference stood out. Building on earlier findings of a 40% reduction in Alzheimer risk with standard flu vaccination, the high-dose version was associated with a nearly 55% reduction. The effect hit even harder in women, suggesting patient-specific factors may further influence this protective benefit. Despite notable limitations—retrospective design, modest follow-up, and lack of mortality data—the findings point to a potentially meaningful dose–response relationship.

Key takeaways

Flu vaccine dose may influence Alzheimer risk. In practice, however, supply and awareness gaps mean not all eligible adults receive the higher dose formulation. For clinicians, that means continuing to emphasize vaccination while also steering patients toward the option that may offer broader protection. This year's unforgiving flu season may have reinforced that first part, as "optional" lost some credibility.

For more education on dementia, check out this CME activity: Understanding Dementia: Characterization, Diagnosis, and Patient Care

A Mango a Day Keeps Diabetes Away?

DIABETES DIGEST

Suggesting a sugar-rich mango to someone with prediabetes may seem as mismatched as pitching off-the-rack to Miranda Priestly. Tropical fruits can pack upwards of 30 grams of natural sugar, making them seem off-limits. But that logic unravels when you consider the "whole-fruit matrix." So researchers asked: Could mangoes—nature's answer to dessert—help slow the silent slide from prediabetes to diabetes?

Hitting the sweet spot

To answer this question, researchers launched a small prospective trial that forced a direct comparison: A daily mango vs a calorie-matched granola bar in adults with prediabetes over 24 weeks. At the end of the study, the mango group achieved significantly lower fasting glucose and greater insulin sensitivity, while maintaining stable HbA1c, in contrast to rising levels in the control group. Participants in the mango group also showed a significant increase in fat-free mass, albeit in a small sample.

Welcome to the matrix

Why does a fruit with nearly 30 grams of sugar not trigger blood glucose chaos? The answer lies in the fruit's matrix—a combination of fiber, water, and bioactive compounds that slows glucose absorption and regulates its impact. Instead of flooding the bloodstream, fruit glucose is absorbed gradually, with built-in controls that prevent sharp spikes.

Key takeaways

Not all sources of sugar act as metabolic kryptonite to people with diabetes. Study co-author Raedeh Basiri says, "It is not just the sugar content that matters, but the overall food context." Peel back the layers, and mango reveals a finely coordinated mix of fiber, water, and bioactive compounds that slow and regulate sugar delivery. Rather than focusing solely on restriction, this study suggests a more nuanced approach—one that includes certain sweet foods rather than automatically excluding them. Yes, the study was funded by the National Mango Board—hardly a disinterested party—but the main message cuts through the bias: The impact of sugar depends on the company it keeps.

For more education on diabetes, check out this CME activity: Starting Medications for T2DM: When Metformin Isn't the First Choice

Allergic to Penicillin? Probably Not
SPECIAL CONTRIBUTOR—FRANK DOMINO, MD

So, what's the drug of choice when a patient with a dental infection says they had a penicillin allergy as a kid?

Most likely … it's still penicillin, not clindamycin.

About 10% of the US population believes they have a penicillin allergy, but the true prevalence is likely <1%. Most "allergies" are actually side effects or childhood rashes, or have waned over time.

The PEN-FAST rule can help risk-stratify using three criteria:

  • Five years or less since reaction (2 points)
  • Anaphylaxis or angioedema ORSevere skin reaction (2 points)
  • Treatment required for reaction (1 point)

You can calculate the score here. If a patient scores 0 points, the risk of a true penicillin allergy is <1% and you can try an oral challenge with penicillin; if they score 1–2 points, the risk is ~5%—still low, but possibly worth referring them for an oral challenge someplace where epinephrine is available.

So why not just give clindamycin?

Clindamycin has one of the highest risks forClostridioides difficile infection (CDI) among commonly used antibiotics and can significantly disrupt the gut microbiome. A recent study showed that a single course can alter a patient's microbiome for years, with other studies showing it carries roughly a 1-in-1,000 risk of CDI. All the more reason to avoid it when safer alternatives exist.

If you're avoiding penicillin, cephalexin (or even azithromycin) is a reasonable alternative, but you should also refer the patient for drug allergy testing to prevent this from happening again.

Key takeaways

Most patients labeled "penicillin allergic" aren't truly allergic. Taking a minute to risk-stratify suspected IgE-mediated reactions can help you use first-line therapy and avoid higher risk alternatives like clindamycin. When in doubt, refer for formal allergy testing so this doesn't follow the patient forever.

 

 

Interested in more healthcare news? Here are some other articles we don't want you to miss:

Morning Report is written by:

  • Alissa Scott, Author
  • Aylin Madore, MD, MEd, Editor
  • Margaret Oliverio, MD, Editor
  • Ariel Reinish, MD, MEd, Editor
  • Emily Ruge, Editor

Did You Enjoy This Issue of Morning Report?

Absolutely! | For the most part | Not at all

Click above, or share your feedback via email. Drop us an email at morningreport@pri-med.com to let us know how we're doing.
Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

Enjoying Morning Report? Share It with Colleagues!

Is Morning Report for you? It is if you're someone who needs quick-hitting, accurate medical news—but with some flair.

You don't just need to know about the latest metabolism study—you also need to know how it parallels an Alanis Morissette hit. If you're reading about acupuncture treatment, you need us to skip the needle puns and get straight to the point. We keep things simple, but when we do get into the scientific weeds, we always remind you to check for ticks.

Subscribe to receive Morning Report directly in your inbox the first Saturday of every month.