Staying #Up2Date 🚨

1. Menopause matters

Postmenopausal women often experience vulvovaginal, urinary, and sexual sx associated with genitourinary syndrome of menopause (GSM). This review summarizes (low-certainty) evidence for sx control:

• Vaginal moisturizers and estrogens were more effective than placebo for vulvovaginal dryness (both have uncertain benefits for dyspareunia).

• Vaginal dehydroepiandrosterone (DHEA) and oral ospemifene were more effective than placebo for vulvovaginal dryness and dyspareunia.

• No tx was found to be more effective than placebo for urinary sx.

• Vaginal testosterone, vaginal oxytocin, oral DHEA, oral raloxifene, and oral bazedoxifene were of uncertain benefit for managing any GSM sx.

2. Dual antiplatelet therapy (DAPT) still INSPIRES

The INSPIRES trial concluded that giving DAPT up to 72h post sx onset of mild ischemic stroke or high-risk TIA reduced stroke risk compared to ASA alone (of course, moderate-to-severe bleeding risk increased). Now, a secondary analysis of the trial shows clinical benefit of DAPT in the first 3 weeks, including a significantly favourable net clinical benefit in the first week (absolute risk reduction: 1.29%).

3. Transfusion targets

The MINT trial suggested that a transfusion threshold of 10 g/dL rather than 7 or 8 g/dL resulted in lower 30-day recurrent myocardial infarction (MI) or death. Now, secondary analysis suggests that a transfusion threshold of 9 g/dL likely confers similar benefit to 10 g/dL in patients with acute type 1 MI.

Heart to Brain

How taking care of your heart can also help take care of your brain

What happened: The American Heart Association has released a new statement claiming that taking care of your heart can lower the risk of Alzheimer’s disease and other related dementias. 

Why it’s interesting: According to the World Health Organization (WHO), coronary heart disease is the leading cause of death in the world, with 9.1 million deaths in 2021. Not only does the illness take a toll on the heart, but also on the brain. This is due to the reduced blood flow to the brain causing damage to the blood vessels, resulting in cognitive impairment. Coronary heart disease raises the risk of dementia by 27%.

Atrial fibrillation (A-fib) can also lead to a greater risk of brain diseases, since microhemorrhages are more common in people with A-fib. In fact, people with A-fib have a 39% increased risk of memory or thinking problems. 

But: There are some things people can do to prevent or slow down heart disease. The most obvious is to take prescribed medications on a daily basis. Aside from drugs, there are also lifestyle tips to boost brain health:

• Sleep: It’s recommended to get about 7 to 8 hours of uninterrupted sleep each night.

• Diet: Eating anti-inflammatory foods like grains, fruits, and vegetables could lower the risk of dementia by 31%.

• Reduce stress: A study published in 2023 found that people with elevated stress levels were 37% more likely to have poor cognition. Staying connected to others and meditation are a few ways people can reduce stress.

• Exercise: People who walked a brisk pace of 112 steps per minute for 30 minutes a day lowered the risk of dementia by 62%. 

Bottom line: While there isn’t a cure for brain diseases like dementia or Alzheimer’s (yet), focusing on heart health is a good starting point in lowering patients’ chances of getting sick. 

Hot Off The Press

1: 🏥 Quebec is considering limiting family doctors to only vulnerable patients, such as those with chronic conditions, leaving healthy individuals to use an alternate service. It’s a controversial proposal that aims to address the shortage of doctors, but it’s raised concerns about access to care and emergency room congestion. Critics argue it contradicts preventive health principles and could overwhelm an already strained healthcare system.

2: ⏰ Scientists from Duke-NUS and UC Santa Cruz have discovered a new way to regulate our body clocks by pinpointing key spots on a protein, CK1δ, that control circadian rhythms. This breakthrough could help tackle jet lag, improve sleep, and even aid treatments for conditions like cancer.

3: 🐁 A large study involving nearly 1,000 mice reveals that the longevity benefits of severe calorie restriction aren’t solely due to weight loss or metabolic improvements. The research shows that factors like immune health, genetic resilience, and red blood cell function play a more significant role in extending life. Surprisingly, mice that lost the most weight tended to die younger, suggesting that metabolic regulation alone doesn't explain the connection between dietary restriction and longevity.

4: 💍 A new 3-month dapivirine vaginal ring shows promise in providing long-lasting HIV protection for women, since it performs as well as the current 1-month version. This longer-lasting option could reduce costs by 60% and lessen clinic visits, potentially improving adherence. The ring, already approved in 11 African countries, offers women more choices in HIV prevention.

Notable Numbers 🔢

39%: the incremental cost for people with disabilities to thrive in the GTA compared to those without disabilities, according to Wellesley Institute research. People with disabilities face extra costs in areas like food, housing, transportation, and health needs, making it much more expensive to live a healthy, engaged life.

38: the age of professional tennis player Rafael Nadal at the time of his retirement, marking the end of a remarkable 23-year career. With 22 Grand Slam titles, including a record 14 French Open victories, Nadal is celebrated for his resilience, especially on clay courts, and his fierce rivalries with legends like Roger Federer and Novak Djokovic.

28: the age of Sammy Basso, the longest-known survivor of progeria, a rare disease causing rapid aging, who passed away on October 5, 2024. Basso dedicated his life to researching progeria and raising awareness.

💬 In Our Community

A physician interested in pursuing a telemedicine role for virtual emergency and hospitalist services sought insights from their colleagues. Here’s what some people had to say:

• Some thought that this was “insane” and voiced concerns about the lack of proper virtual skills training for most providers. Many shared their discomfort with physicians making treatment decisions remotely, emphasizing the need for better training in virtual care before such services are offered. 

• A physician who was offered a similar role expressed hesitation about telemedicine work, stating they “felt the medico-legal risk wasn't worth it.” They highlighted that risk tolerance, knowledge of the area's geography for appropriate patient transfers, and reliance on others for clinical exams were significant barriers they couldn't overlook. 

• Others were supportive of this pursuit and highlighted the critical role of virtual emergency services. They describe working in northern Ontario communities, where nursing stations “rely on virtual ER doctors for care guidance and patient transfers.” They note that while some provinces lack robust systems, companies are slowly stepping in to support these remote areas.

• Another physician supported this endeavour but forewarned that it could be “frustrating, annoying, and difficult,” due to poor health literacy, logistical hurdles, such as bad weather affecting transport, medication shortages, and confusion from multiple EMR systems, but emphasized that this work is among the most clinically important and satisfying.

Postcall Picks

😭 Laugh: at the “life-long learner” motto of medicine. 

📚 Read: Deep Medicine by Dr. Topol to learn how AI can help us rediscover human connection in medicine. 

🎧 Listen: to the experience of a doctor as a patient and how easy it is to fall through the cracks of the healthcare system… even as an insider. 

🤑 Save: $500 on NordicTrack Treadmill at Canadian Tire. Winter is coming, but you can still hit those PRs!

💰 Avoid: leaving money on the table! Discover year-end tax and planning strategies for Canadian doctors in Vijay Wealth's winter workshop. Claim your spot here. **

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