Staying #Up2Date 🚨

1. Diabetes ‘n dementia 🧠

This study compared the risk of dementia in ~12K people with type 2 diabetes (age > 60) who started either sodium–glucose cotransporter-2 inhibitors (SGLT2i) vs. glucagon-like peptide-1 receptor agonists (GLP-1 RAs), namely dulaglutide. The incidence of dementia was slightly lower in the SGLT2i group at ~4 year follow-up, though not statistically significant: the estimated risk difference was−0.91 percentage point (95% CI, −2.45 to 0.63 percentage point), and the estimated risk ratio was 0.81 (CI, 0.56 to 1.16). 

2. Nefty neffy 💉

There’s a new needle-free epi on the block, called “neffy,” an intranasal spray approved by the FDA on August 9th. In a randomized crossover trial, the intranasal spray (2 mg dose) achieved a maximum plasma concentration of 481 pg/mL (IM injections = 339 pg/mL, EpiPen = 753 pg/mL). The spray also resulted in a maximum systolic blood pressure increase of 23.6 mm Hg, higher than the IM injection (11.9 mm Hg) but comparable to the EpiPen (18.3 mm Hg). Watch out for when this nefty drug drops in Canada. 

3. Transitional care clinic (TCC) ftw 🏥

This systematic review by Canadian authors studied the effect of TCC follow-up within 30 days of discharge in 3K patients without primary care physicians (PCPs). Patients followed at TCCs were compared against those either without follow-up care or those with referral to an accepting PCP. The literature review suggested that TCCs prevented some readmissions (3 of 5 studies showed benefit), and the largest observational trial suggested that TCCs might prevent some ED visits.

ASD AI

Can AI eliminate ASD diagnosis wait times?

What happened: A new AI tool could help identify toddlers who have autism spectrum disorder (ASD).

Why it’s interesting: The learning model, also known as AutMedAI, had an 80% accuracy. Researchers used a large US database of approximately 30K people, both with and without ASD. The team analyzed 28 parameters from before a child turns 24 months, such as their first smile and eating habits.

Researchers chose 1 of the 4 machine-created models to do further testing. 11,936 people were tested, and the machine could identify 10,476 participants with an ASD diagnosis. 

In Canada, it is estimated that 1 in 66 children aged 5 to 17 have ASD. According to researchers, early diagnosis is critical, as it can implement effective tools that can help children with ASD thrive. That’s why tech like AutMedAI can be helpful — especially for Ontario families where it can take up to 1 year for children to receive an ASD diagnosis. 

The research team behind AutMedAI say one of their next steps is to include genetic information in their tests, which could lead to more specific and accurate predictions. 

But: Despite the machines promising results, doctors stress that it’s not a replacement for physicians. Last year, it was reported that general pediatricians were able to accurately diagnose ASD 90% of the time.

Although AutMedAI’s 80% accuracy rate is impressive, 20% of participants may have been missed or flagged as possibly having ASD. Researchers have warned that the machine could make parents push for an early diagnosis, which can be problematic, especially if it’s a misdiagnosis. 

Bottom line: Until more research is done regarding the new AI, consulting an ASD specialist can still be a parent's best bet when it comes to the wellbeing of their child. 

Hot Off The Press

1: 😷 Whooping cough cases are soaring in Canada, with over 12K reported infections in 2024 — far surpassing the usual range of 500 to 4,500 cases per year. The resurgence is driven by a post-pandemic drop in immunity and disruptions to routine vaccinations, especially affecting children and teens.

2: 💉 Some doctors are recommending patients wait until fall for their next COVID-19 shot, since updated vaccines will soon be available. These new vaccines, expected by early autumn, aim to boost protection during the winter season, especially for those at high risk.

3: 🧑‍⚕️ The WHO delivered 1.2 million doses of polio vaccines to Gaza — and both sides are going to lay down their guns for a few days (in certain areas) to allow for the inoculation of over 640K children.

4: 💨 Cutting global PM2.5 pollution could add nearly 2 years to the average person's life expectancy, according to a study by the University of Chicago. South Asia faces the highest pollution levels, where residents could potentially gain 3.6 years if air quality meets WHO guidelines. There’s been global progress, but 77% of countries still fail to meet or lack national air quality standards.

5: 📱 If you have kids, they’re probably heading back to school with cell phone restrictions in place. The prospect of reducing distractions and cyberbullying makes sense to us, but surprisingly, the evidence that the restrictions achieve those outcomes is weak.

6: ❤️ Here’s a feel-good story for once… a positive ER experience!

Notable Numbers 🔢

7: the number of US studies using MDMA that are actively recruiting participants. Research into MDMA therapy continues, despite the FDA’s recent rejection. It’s set Lykos Therapeutics back, delaying potential approval by at least 2 years.

21: the number of confirmed Oropouche virus cases among travellers returning from Cuba, highlighting a rise in infections spread by midges and mosquitoes in Brazil and Cuba. Health officials advise travellers to take precautions against insect bites, as there are no vaccines or specific treatments.

8: the number of US States taking steps to reduce birth control access this year (so far). The CDC wants to make lidocaine, a local anesthetic, more readily available for reducing pain during IUD placement. The CDC’s updated guidelines on IUD placement emphasize the need for better pain management.

💬 In Our Community

In a recent FB post, a medical student sought some advice on whether they should pursue a career in FM, with hopes of sub-specialization in EM or undergo a 6-year PGY training route with higher projected earnings. This is in the context of wanting to help their parents and “take advantage of the last decade of [their parents] being in good health and helping [them] enjoy it.” Here are some responses we want to highlight:

• A first-year resident echoed very similar sentiments of wanting to provide for their parents. They ultimately pursued a longer training path in a specialty they will enjoy more knowing this will come at the expense of increased debt and delay financially supporting their parents. They recommended choosing “a path that aligns with your passions [and] it might be easier to navigate the financial challenges along the way.”

• Many recommended they pursue the speciality they love most, irrespective of income. They reassured the medical student that they “will be able to care for [their] parents regardless of speciality” and highlighted the importance of “reducing burnout” and prioritizing personal wellbeing & happiness. 

• Some parent-physicians weighed in and advised the student to pursue a specialty they are most happy, as their “parents will be happy if [they] are happy.” They recommended to not risk doing something they dislike for more income, as it would upset parents more if they saw their children doing something they did not enjoy. 

• A different perspective, which received nearly as many likes, was pursuing the higher pay speciality as “three extra years of residency will double your income… and win out very quickly in terms of financial strength.” As well, someone mentioned the “difference in mentality that income [$500k+] brings,” including increased confidence and being able to take on more risk (both in life and in investments).

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 this summary of different specialties… except pathology, they forgot about them again. 

🎧 Listen: to the newest episode of beyond MD to learn more about Dr. Chadha’s reasons for philanthropy and giving back to the community.  

🧠 Learn: about colonial genocide and its resulting health disparities in Indigenous communities from an upcoming seminar by Doctors of BC on September 11.

🤑 Save: 20% sitewide at FIGS for their back-to-school/Labour Day sale!

Relax

First Question: Who is someone who repeatedly says "The sun is shining,” even when out of context?

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