Staying #Up2Date 🚨

1. Serotonin pls ☀️

Stopping antidepressants sometimes leads to discontinuation symptoms, colloquially known as ‘antidepressant withdrawal,’ such as dizziness, headache, nausea, insomnia, and irritability. This meta-analysis showed that 31% of patients experience at least one discontinuation symptom after stopping their antidepressant (vs. 17% on placebo). However, severe symptoms are rare, affecting only about 3% of those on antidepressants. Gradual tapering and switching to longer half-life antidepressants like fluoxetine can help mitigate these symptoms.

2. Guideline watch 👀

In the US, updated guidelines now recommend annual anal cancer screening for all adults living with HIV. For those > 35, laboratory-based screenings such as anal cytology and high-risk HPV testing should be used. High-resolution anoscopy (HRA) is advised if lab results are abnormal. Lastly, don’t forget about HPV vaccination in this population.  Keep an eye out for this Canadian study to inform similar guidelines North of the border. 

3. Prenatal cannabis use 🫄🏽

In this study, researchers compared maternal outcomes of 20,000 cannabis users to 300,000 non-users, adjusting for demographic and behavioural differences. Prenatal cannabis use was associated with significantly higher risk for hypertensive disorders of pregnancy (i.e., gestational hypertension [adjusted risk ratio, 1.17] and preeclampsia [aRR 1.08]). Prenatal cannabis use was also associated with higher risk for placental abruption (aRR, 1.19) but lower risk for gestational diabetes (aRR, 0.89). Cannabis users were more likely than nonusers to have higher-than-recommended gestational weight gain (69% vs. 59%).

Goodbye STI?

Can a promising new tool help reduce the risk of getting STIs?

What happened: A new drug is being developed that could limit the risk of people contracting STIs.

Why it’s interesting: The drug DoxyPEP (doxycycline) is used as a post-exposure prophylaxis. The efficiency of the drug was studied in cisgender men and transgender women, and studies showed it significantly reduced the risk of contracting syphilis, chlamydia, and gonorrhea. The 200 mg dose DoxyPEP is best taken within 24 hours, but no later than 72 hours after unprotected oral or anal sex.

There have been 3 randomized controlled studies that showed patients who took doxycycline post-exposure had reduced risk of being infected with syphilis and chlamydia by 70%. However, access to DoxyPEP is limited, and depending on where patients live, it’s not a federally approved treatment. Health Canada hasn’t approved doxycycline as a preventative treatment for STIs, despite it being approved for widespread use. 

Currently, BC offers DoxyPEP to eligible patients free of charge through their BC-CfE’s PrEP program for HIV prevention. It’s the first program of its kind in Canada, and requires enrolment in the program, or be HIV positive and taking antiretroviral therapy drugs. They must also have contracted chlamydia, gonorrhea, and/or syphilis in the past year. 2,300 people have signed up for the program. Officials say that number increases by 300 participants each month. 

But: There isn’t conclusive evidence that DoxyPEP benefits cisgender women or transgender men. In one study, a majority of the women claimed they were taking doxycycline regularly after sex, but only had a third had the drug in their samples. There are also side effects of DoxyPEP that patients should know about, including upset stomach and sensitivity to sun. 

Postcall’s Take: DoxyPEP can be a great tool in helping decrease the number of STIs, but more research needs to be done to check in on its efficacy for various population groups. 

Hot Off The Press

1: 🧑🏽‍⚕️In an effort to secure more doctors and nurses, some small communities in Ontario are offering signing bonuses. Huntsville is giving $80,000 to any family physician who agrees to work in the town for at least 5 years. Critics point out this tactic can create disparities between communities, potentially triggering a Hunger Games-style competition for medical staff.

2: 🩸As a deadlier strain of mpox spreads beyond the Democratic Republic of Congo, the World Health Organization is considering whether to declare an international health emergency. Mpox vaccines and aggressive disease surveillance could control the spread.

3: 👾 Synchron, a leading brain-computer interface (BCI) company, has integrated OpenAI's ChatGPT into its brain implant tech. The mission: to assist people with paralysis in controlling digital devices more efficiently. It’s currently undergoing clinical trials and could potentially transform how people with disabilities interact with their environment.

4: 🥇Traditionally ad-free spaces at the Olympics are being filled with prominent product placements, with Louis Vuitton trays used in medal ceremonies and custom Dior outfits for performers during the opening ceremony. Samsung provided Galaxy Z Flip6 Olympic Edition smartphones for athletes to take official selfies on the podium. Historically, branding’s been kept out of the actual games themselves.

5: 🔍️ Google may not be the default search option on your iPhone for much longer - this week the search engine company lost a landmark antitrust case (basically, the court confirm it built an illegal monopoly over the online search and advertising industry). It’s not super clear what they’ll be forced to change, but the case specifically called out the exclusive agreements Google made with device makers like Apple and Samsung as “unfairly suppress competition“.

6: 🇺🇸 Tim Walz was announced as VP and running mate to Kamala Harris yesterday afternoon. “If I have to run through a brick wall, if I have to do the hard things, I’m willing to do it because I’m not angling for anything else” said Tim Walz in his interview.

Notable Numbers 🔢

< 40%: the amount of US smokers who used counselling or medication to try and quit smoking in 2022. (Research has shown that the odds of quitting successfully increase with clinical intervention and evidence-based treatment.)

14: the number of modifiable risk factors that could prevent or delay 45% of dementia cases, according to the Lancet commission on dementia.

> 230,000: the number of searches of electronic devices between 2018 and 2023 conducted at the border. A recent ruling declared that the Customs and Border Protection (CBP) can’t search travellers’ phones without a warrant — though, right now, this only applies to New York’s Eastern District.

💬 In Our Community

We found an interesting discussion where an early career IM specialist faced a tough decision: should he become a guarantor for their brother's $400k medical school loan in Australia? The guarantor role could strain his financial goals, including home ownership and starting a family. On the flip side, declining might cause long-lasting familial tension and regret. Here are the take-home points:

• Many said they’d absolutely help a family member in a similar situation, noting they “can’t say no unless your brother is a hopeless person,” and “Family is always first and I would be honoured to help out in any way possible.” Though many did note that it also “depends on your relationship.”

• Others recommended NOT going through with the plan, citing concerns about significant financial risk and the possibility of strained family relationships if the brother’s plans don’t unfold as expected, warning that "matching back to Canada is always going to be a challenge” (see figure for CaRMS data on percentage of IMGs showing only 40% of IMGs match on their first attempt).

• Some recommended that the parents consider securing a loan against assets like their house, and suggested speaking to various lenders to find one willing to provide the $400k loan despite the parents’ lack of active income (both retired).

Read the comments on Facebook here. (Link may not work if you’re not already part of the private FB group.)

Insight of the Week 🔍️ 

If you’re as into food as us here at Postcall and planning your next vacation, take a look below.

Since 1926 (when that tire company started giving stars to the best restaurants in its travel guides), the stars have become perhaps the most trusted seal of foodie approval — and some cities’ chefs have proved much more adept at earning plaudits than others.

(This insight is especially juicy given the CAD/JPY exchange rate is a historically favourable level, even including the big drop this past week).

Source: Chartr Stories

Postcall Picks

😭Laugh: Doctor vs. Nurse: Who should put in the IV?  

✈️Travel: Embark on a cultural tour of Vietnam, Cambodia, and Laos from February 7-24, 2025! Sign up by Sept. 9 to snag a $1,000 per couple discount. Get ready for breathtaking sights, rich cultures, and CME credits!

🧠Learn: Supplement shelves are growing faster than your workload. Tune in to This Podcast Will Kill You to decode what's real and what's just hype in the booming dietary supplement market.

🤑Save: The patagucci may not be on sale, but Patagonia is offering sweet deals on other essentials like puffers and fleece pullovers.

Relax

First Question: It was a photo finish for this USA 100m gold medal winner!

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