Staying #Up2Date 🚨

It’s smoky szn, so here’s an #UptoDate on asthma:

1. Activity as tolerated

In a Brazilian study of 426 adults with moderate-to-severe asthma, physically active patients (≥7500 steps daily) were more likely to have better asthma control (44% vs. 24%) and less anxiety and depression compared to inactive patients. Sedentarism and obesity were not linked to asthma control. Perhaps promoting physical activity in your patients with asthma should be right up there with choosing the right inhaler.

2. Azithro AMAZES

There’s a new post hoc analysis of the AMAZES trial (in 2017 it showed that Azithro 500 mg TID/week x 1y lowered asthma exacerbation rates in adults with uncontrolled asthma despite standard inhaled therapy). A remission analysis was performed on the 335 of the 420 original patients: patients who received azithro had higher rates of clinical remission (i.e. no exacerbations or oral corticosteroid use and normal asthma-control questionnaires in the final 6 months of the 12-month study) compared to placebo recipients (51% vs. 39%; NNT of 9). The effect was seen in both TH2-high and TH2-low patients.

3. New biologic on the block

In these phase 3 RCTs, depemokimab (ultra-long-acting IL-5 inhibitor) demonstrated efficacy in reducing exacerbations in patients with severe eosinophilic asthma. Patients receiving depemokimab (100 mg SC q6mo) had significantly lower annualized exacerbation rates compared to placebo (0.46 vs. 1.11 in SWIFT-1 and 0.56 vs. 1.08 in SWIFT-2; P<0.001 for both). No significant differences were observed in quality-of-life outcomes (SGRQ scores), and the safety profile was comparable between groups. These results suggest depemokimab offers an effective 6-month dosing option for eosinophilic asthma management.

Dr. Death

How one surgeon’s rookie mistake cost him a patient's life (and maybe his career).

What happened: A Florida surgeon is being sued after mistakenly removing a patient's liver instead of their spleen. 

Why it’s interesting: Last month, Dr. Thomas Shaknovsky was scheduled to do a splenectomy on a patient complaining about abdominal pain. It was reported that Dr. Shaknovsky persuaded the man into getting emergency surgery, despite his hesitancy. 

A routine splenectomy turned into a hepatectomy after Dr. Shaknovsky took out the patient’s liver. After the surgery, he told the patient’s wife that her husband's spleen was “severely diseased,” and “four times its normal size.” If that’s not enough to make your head spin, the surgeon also said the “spleen” had migrated to the other side of the patient’s body. 

It was discovered that the liver was mislabeled as the spleen, and it wasn’t until the patient died due to prolific blood loss that anyone caught the error. The patient’s wife has filed a lawsuit against him and the hospital.

Have a look at what other docs and healthcare workers had to say about this bizarre turn of events:

If you’d like to read more about what folks have to say, you can find the full reddit threads here.

But: This isn’t the first mistake Dr. Shaknovsky has made. The lawsuit uncovered that, last year, the physician allegedly removed part of a patient’s pancreas instead of performing an adrenal gland resection. This has raised further concerns about his competency as a surgeon. So far, Dr. Shaknovsky has not been criminally charged and has no public complaints against his file. 

Postcall’s Take: It goes without saying that removing the wrong organ is serious. It’ll be interesting to understand what really happened in that operating room once more information is revealed.

Hot Off The Press

1: 🩸 As of two days ago, Ontario Health has changed the baseline for iron deficiency testing, raising the minimum threshold to 30 µg/l, which could transform patient care across the province. Doctors say this change — which is particularly beneficial for women and marginalized groups — will address a long-standing health equity issue.

2: 🫀New research has found that continuing beta-blocker therapy after a heart attack leads to better long-term outcomes without negatively impacting quality of life, challenging current guidelines that suggest stopping the medication after 1 year. These results from the ABYSS trial are reigniting the debate over optimal duration of beta-blocker use in post-MI patients.

3: 🚀 NASA's Boeing Starliner has returned safely from space without its crew due to technical issues, such as helium leaks and thruster problems. The Starliner crew will remain in space until February 2025, continuing their mission with NASA’s SpaceX Crew-9.

4: 🦠 Last week, the UN World Health Organization launched their first-ever guidance for antibiotic pollution to fight superbugs. The guidance was created by a diverse group of international experts, and provides human-based targets to reduce the spread of antimicrobial resistance (AMR).

5: 🇺🇸 Donald Trump and Kamala Harris faced off in their first presidential debate last night. The Vice President contrasted her economic vision with Trump's, emphasizing middle-class priorities, while Trump continued to reiterate his belief in a declining nation. Here’s a play by play from the BBC. CTV has already fact-checked some of the pretty wild claims.

Notable Numbers 🔢

74%: the percentage of dentists participating in the Canadian Dental Care Plan (CDCP), although that rate varies widely from province to province. According to the CBC, the participation rate is lowest in New Brunswick, PEI, Nunavut, Yukon, and the Northwest Territories. In the 3 territories, only 38% are participating.

732: the number of Albertans who have died from COVID-19 over the past year — more than 4x the death toll from the flu. There’s been a decline in COVID deaths from previous peaks, but experts warn that low vaccination rates could leave Alberta vulnerable in the upcoming respiratory virus season.

6.6%: Canada’s unemployment rate, which rose from 6.4% between July and August. It’s the highest it’s been since 2017. The reason? Economists say hiring isn’t keeping up with population growth.

💬 In Our Community

We found an interesting discussion on a reddit thread where a family MD expressed concerns about “the dying art” of family medicine. They shared frustrations about lower pay, endless administrative tasks, and decreased respect from fellow medical colleagues and society. Here are some of the top/most interesting responses we read:

• A popular comment was that a “well trained and confident family physician is really the only way healthcare can make sense again.” Many agreed with this sentiment, adding that “family physicians are the gatekeepers of the system,” and without their critical expertise, the healthcare system as we know it would collapse. 

• A more controversial take disagreed with this sentiment, stating that “there is no way FM gets nearly enough training.” They suggested instead that IM, peds, and OB should be the backbone of the healthcare system. PCPs were not impressed with this, rebutting that this “paradigm needs work,” while other specialists defended FM, stating “the average FM physician is superior in outpatient skills” compared to an IM resident. 

• Another user noted that “medicine has become too specialized” while allowing “competent generalists to die off.” Many agreed and expressed concern about the 15-minute per follow-up guideline being inadequate for the complexity of the aging and increasingly co-morbid populations. 

• Other PCPs shared additional frustrations, including the “medicalization of social problems” and being required to take on the role of a social worker rather than focusing on their physician duties. This elicited mixed responses: some agreed that “doctors being responsible for people’s social problems has been a major downfall and led to increased burnout,” while others thought this was a “disrespectful” opinion and that it is “entirely within the realm of a PCP to care for the social well-being of their patients.” 

Read the rest of the conversation and contribute your own thoughts here.

Postcall Picks

😭 Laugh: if pharmacy requests a medication hold… you best believe you’re holding it. 

✈️ Travel: to Vietnam, Cambodia, and Laos from February 7-24, 2025 on a journey of breathtaking sights, rich cultures, and delicious food… Oh, and you get 15 CME credits!

🧠 Learn: about the coldest place on earth and what happens to the body when its -89 degrees Celsius outside!  

🤑 Save: on a Ninja air-fryer ($148 from $270) and much more during Canadian Tire’s Birthday Event!

📱 Get: The new Apple goodies — they just announced the new iPhone 16 lineup (incl. Pro and Max models), and new Airpods and the Apple Watch 10. If you recently got the 15, don’t FOMO too much, it’s just a slightly bigger screen and battery.

Relax

First Question: What do “wet (urinary incontinence), wacky (dementia), and wobbling (gait apraxia)” all point to?

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