Staying #Up2Date 🚨

1. Asymptomatic hypertension (HTN) in the hospital

The American Heart Association is one of the first organizations to provide guidance on asymptomatic elevated inpatient BP.

• Ensure accurate BP assessment with appropriate cuff size, identify reversible causes (e.g., stress, pain, sleep deprivation, withdrawal), and note common offending agents (e.g., fluida, NSAIDs, steroids, stimulant medications).

• Avoid treatment of asymptomatic elevated inpatient BP (including asymptomatic markedly elevated BP, i.e., SBP/DBP ≥180/110 mm Hg) in most situations.

• If choosing to treat markedly elevated inpatient BP without evidence of target-organ damage, start by resuming the patient's home oral BP meds. 

2. Atrial fibrillation (AF) and stable coronary artery disease (CAD)

Anticoagulation for patients with AF and stable CAD remains unclear. The EPIC-CAD trial compared edoxaban monotherapy with anticoagulation plus clinician-selected antiplatelet monotherapy in 1,040 patients with AF and stable CAD. At 12 months, edoxaban monotherapy reduced nonfatal major and clinically relevant non-major bleeding without excess risk for ischemic events (the primary composite outcome was 7% in edoxaban monotherapy vs. 16% in dual therapy group; HR 0.44).

3. Herpes zoster virus (VZV) and dementia 

Chronic neuroinflammation from viral infections has been linked to vascular dementia and Alzheimer’s. In this study, a multi-variable analysis of patients who received either the original live-virus VZV vaccine (Zostavax), the current recombinant vaccine (Shingrix), an influenza vaccine, or the tetanus–diphtheria–pertussis (Tdap) showed the following: in the 6 years after VZV immunization, patients who got the VZV vaccine had ≈20% lower risk for developing vascular dementia or AD compared to those who got the flu or Tdap vaccines only.

From Congestion To Conception

How commuting could impact reproductive health

What happened: A new study has linked traffic noise and pollution to infertility in men and women 🤯 

Why it’s interesting: A Danish study published in the BMJ found that infertility was 24% greater for men who were exposed to 2.5 levels of particulate matter found in traffic pollution. Women, who had exposure to traffic noise at 10.2 decibels higher than average, had a 14% increased risk. Researchers studied participants aged 30-45 over a 5-year period who were trying to get pregnant.

In Canada, 1 in 6 adults will be affected by infertility in this lifetime. The public already knows how noise and air pollution can be linked to diseases like cardiovascular health — but discovering its connection to infertility could change the argument.

But: Having this information can help couples trying to conceive, yet data linkage isn’t the most effective way to look at fertility. The main issue with the study: major assumptions about its participants, like what time they were at home vs. on the road. The study is unprecedented. Some say having actual measures of exposures instead of estimations are needed to help understand how pollution affects people. 

Bottom line: Understanding how the environment can affect the human body is fascinating. Still, clinics advise those worried about their fertility to speak to their physician, or contact Fertility Matters Canada for more information.

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Hot Off The Press

1: 🏥 A Canadian study has found that an AI tool called Chartwatch reduced unexpected hospital deaths by 26% since its 2020 launch. The system, in St. Michael’s Hospital, Toronto, monitors patient data in real-time, flagging potential deterioration earlier, allowing for quicker interventions. More trials are needed to confirm its efficacy in other settings.

2: 💊 In the US, pharma giants like Pfizer and Eli Lilly are diving into direct-to-consumer (DTC) services to bypass intermediaries, lower costs, and gain valuable consumer data. This shift lets them promote their own drugs, while offering teleheath and delivery services. Experts warn it could further fragment healthcare.

3: 🦍 Self-medicating gorillas could offer clues for future drug discoveries. Scientists studying wild gorillas have discovered that they consume plants that are also used by local healers. Lab tests revealed that these plants have strong medicinal properties, including antibacterial effects against drug-resistant strains.

4: 👶🏽 A new study has revealed that hair and skin products are exposing children to endocrine-developing chemicals, such as phthalates, which might interfere with hormone development. Experts are calling for greater regulation to protect vulnerable populations from these chemicals.

5: 📟️ Pagers aren’t only interrupting us on call: yesterday hundreds of them exploded in a coordinated attack on Hezbollah by Israel, causing 9 deaths including an 8 year old girl. Hezbollah ditched phones that could allow Israel to track them earlier this year.

Notable Numbers 🔢

93%: the number of respondents in a new Delta Dental survey that expressed a desire for more guidance on managing oral health during menopause. Nearly 50% of women over 40 are unaware of the connection between menopause and oral health.

$249: the cost of Apple AirPods Pro 2. The FDA has approved Apple’s Hearing Aid software for the device, marking the first time over-the-counter hearing aid software that’s been authorized by the agency. The new feature will allow users to take a hearing test, adjust sound settings, and monitor hearing health.

27%: the number of people with type 2 diabetes who participated in a diet replacement program who achieved remission.

$1.5MM: the new upper limit for mortgage default insurance (previously $1MM). Also, 30 year amortizations are now allowed for first time buyers and new builds as the Trudeau government loosened up the rules in order to try to make housing ownership more accessible.

💬 In Our Community

A physician in their 40s and about 8 years into full-time practice is concerned with having $400k in savings and difficulty envisioning saving millions for retirement. They wondered how far behind they are, and whether they should hire a third-party to manage their finances. Here are some responses that stood out:

• One physician noted that they’re “far behind some and far ahead of others.” They reassured OP that they’re likely still in the very top earning bracket and gave them a simplified breakdown which would net them $3.2M in savings by the age of 60.

• Some recommended not consulting a financial advisor. However, many disagreed, citing that advisors “take the emotions” out of the equation and are experienced in appropriately investing and selling at the right time.

• A few physicians advised them to focus on their own journey and that “comparison is the death of joy.” Simultaneously, they recommended investing and putting money aside ASAP to make sure it “works for them” even when they’re not working. 

• A line we really resonated with was: “work some, spend some, enjoy some, save some, invest some.” This speaks to the importance of working hard and saving, but not letting life pass — which can happen trying to attain an arbitrary goal post set-up via comparison.

• The Loonie Doctor chimed in and shared some insight on how to calculate net worth, assets, liabilities, and project growth overtime. They shared this incredible resource that unpacks their net worth! 

Read the rest of the conversation and contribute your own thoughts here. Link may not work if you’re not already part of the private FB group.

Postcall Picks

😭 Laugh: at Internal Medicine when it’s anything other than COPDe or CHF.

🎧 Listen: to Drs. Chadha and Poyner talk about the RESP and other ways to best set your kids up for future financial success on this week’s episode of beyond MD.

🧠 Learn: all about conflict resolution and how to handle difficult situations with your patients at the OMA’s upcoming Managing Patient Expectations Series on September 25th. Register here.

🤑 Save: 25% Off (and bonus Aeroplan points) on select base fares at Air Canada, including national and international flights!

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First Question: "Dawson's fingers" on an MRI and optic neuritis point to this neurologic disease.

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