Staying #Up2Date 🚨

1. Is 7 days of abx enough for uncomplicated bacteremia?

The  BALANCE trial showed that 7 days of antibiotics is adequate for uncomplicated bacteremia. Exclusion criteria was: S. aureus bacteremia, neutropenia, severe immunocompromise, prosthetic heart valves or endovascular grafts, or other indications for prolonged therapy. Most infections were monomicrobial (gram-negative 70%; gram-positive 17%) and some were polymicrobial (12%). The 90-day mortality was 261 (14%) in the 7-day group and 286 (16%) in the 14-day group. 

2. Antidiabetics for asthma?

In this self-controlled case series and population-based cohort study of over 12K patients with asthma, metformin was associated with 30% lower risk of asthma attacks. Adding GLP-1 receptor agonists resulted in further risk reduction. Associations were found regardless of glycemic control, weight, or asthma phenotype.

3. Urea in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

This meta-analysis suggests that urea treatment (7.5-90g qdaily) significantly raised serum sodium (mean difference, 9 mEq/L) that was significant at 24h, 2, 5, 7, 14 days, and 1 year. Urea treatment was as effective as fluid restriction or vaptans, superior to placebo, safe, and tolerable.

From Cradle To Lab

How placenta tissue is saving lives

What happened: A groundbreaking wound-care program using donated placenta tissue helped save a man's leg from amputation at Mount Sinai Hospital.

Why it’s interesting: In 2021 a nurse asked if he wanted to try a treatment that would involve a donated placenta through a new wound-care program. With little to lose, the man agreed. The placenta’s amnion – a thin membrane – was grafted onto his foot wound.

The graft was applied, dressed and left to work its magic. It’s then replaced with new tissue and repeated until the wound heals. The hospital shared images of the progress with The Canadian Press and within a week the open wound was almost 60% healed. The man was one of Mount Sinai’s first recipients, and since then about 80 patients have been treated using placenta tissue. 

The process starts with pregnant women who choose to donate their placenta after a C-section. The placenta is then placed in a sterile bag and brought down to the hospital's tissue bank. Doctors and nurses who have performed the procedure say it’s simple, painless, and minimally invasive. So far Mount Sinai has sent birthing tissue to 3 other Ontario hospitals for wound treatments and saw positive results.

But: The use of amniotic membranes for healing is new. It was first documented as a way to heal patients over 100 years ago, but wasn’t used out of fear of disease transmission. While tissue banks follow strict protocols, there’s also a lack of awareness on how to collect and deliver placenta tissue to wound treatment centres. Mount Sinai’s director of allograft technologies said another reason why the placenta treatment isn’t widely used is because many clinicians still don’t know it exists. 

Bottom line: It seems the placenta is the gift that keeps on giving, transforming what was once considered medical waste into a second chance for healing. It's helping to transform the afterbirth into a form of rebirth for wounded tissues.

Hot Off The Press

1: 🩺 How does a London-trained ophthalmologist (who had a knack for reassuring anxious patients) become the architect of a war that’s killed over 400,000 people? Once known for his calm, reassuring presence with patients, Assad now oversees the systematic bombing of civilians, the destruction of over 400 hospitals, and the deaths of nearly 800 medical workers—an unprecedented weaponization of healthcare. His transformation has horrified the global medical community, but calls for solidarity through humanitarian efforts. Their doctor-president may have betrayed his fellow Syrians, but the world hasn’t.

2: 🤢 Formaldehyde — a chemical found in everything from furniture to paper towels — causes more cancer than any other air pollutant, yet regulatory efforts keep facing pushback from the powerful chemical industry. ProPublica’s investigation reveals that the risks are far higher than government estimates suggest, both inside and outside.

3: 🩷 According to a recent study, mobile mammography (MM) is bridging the gap in breast cancer screening for underserved Medicare beneficiaries, especially those in rural and low-income areas. While only 0.4% of women in the study used MM, it was linked to increased mammogram adherence, particularly among American Indian and Alaska Native women. MM isn't a replacement for facility-based screenings, but it offers a crucial supplement for those facing barriers to traditional care.

4: 💊 Luigi Mangione, accused of shooting UnitedHealth Group exec Brian Thompson, has hired top NYC prosecutor Karen Friedman Agnifilo to defend him. The ex-Manhattan DA's right hand is exploring a potential insanity defense, with overwhelming evidence stacking against Mangione, including a manifesto and ghost gun. Meanwhile, the FBI’s manhunt tipped off by multiple sources led to his arrest in Pennsylvania after a 5-day search.

Notable Numbers 🔢

412,164: the number of patients who waited for NHS heart care in October 2024, as delays continue to rise, leaving thousands at risk of premature death. A national investigation has been launched into the cardiology crisis, with many patients suffering harm as they wait for critical surgeries like heart valve replacements. Experts warn that worsening ambulance delays and overcrowded hospitals are exacerbating the problem, leading to a surge in preventable heart failures and deaths.

50%: Feeling stuck in traffic and life? A recent US survey found that using a car for more than 50% of out-of-home trips is linked to lower life satisfaction. So switching to transit, walking, or cycling could lead to more happiness — a shift Canadian cities may want to accelerate.

📚️ Read: about how, for the first time in more than a decade, obesity rates among US adults fell slightly last year. The graph above might have something to do with it.

👂️ Listen: to Dr. Mark Soth and Ben Felix’s presentation at the latest CPFW conference here.

💰️ Invest: Missed the free iPhone/Macbook offer from Wealthsimple? No worries — we got another offer for you to get some cold hard cash by transferring your brokerage account: TD is offering 1% back.

😆 Laugh: at an inappropriate ER visit. (PCP is Americano for family doctor.)

First Question: What is the tract responsible for voluntary movement on the contralateral side?

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