Staying #Up2Date 🚨

1. Stones with SGLT-2 inhibitors 

In this Canadian observational study, researchers identified 20K adults with diabetes and previous nephrolithiasis, 22% of whom also had gout. Patients who initiated SGLT-2 inhibitors had a significantly lower rate of recurrent nephrolithiasis vs. those who initiated GLP-1 agonists (156 vs. 103 per 1000 person-years; NNT of 20). Patients with gout who started SGLT-2 inhibitors developed significantly fewer urinary stones and had fewer gout flares than those who started GLP-1 agonists.

2. Secondary hypertension (2HTN) stats 

In this cross-sectional study of 2000 young adults (18–40) with confirmed hypertension, 30% of patients were found to have 2HTN - more common in age 30-40 (compared to 18-30), women, BMI ≤25 kg/m2, and in those with diabetes. Over half of those with 2HTN had primary aldosteronism and 20% had renovascular hypertension.

3. Solo short-acting β-agonists (SABA)

In this systematic review of 50K patients, ICS/formoterol lowered relative risk for severe asthma exacerbations by 35%, and ICS/SABA lowered relative risk by 16%, compared with SABA alone i.e., albuterol, salbutamol, or terbutaline in those at highest risk. ICS/formoterol was associated with fewer exacerbations than ICS/SABA among high-risk patients (RR, 0.78). This study further supports the GINA 2022 guidelines, which recommend against SABA monotherapy.

The Menopause Effect

How a new study helps women navigate symptoms

What happened: British Columbia just launched a groundbreaking study on the real impacts of menopause on women’s lives.   

Why it’s interesting: Women’s health only gets 7% of national funding in Canada, and even less goes to menopause research. The study interviewed 2,000 women in BC – half perimenopause and half postmenopausal – and asked about their symptoms and experiences. Researchers wanted to see how menopause affects mood, well-being, and loneliness. 

Around 80% of women experience menopause symptoms, including hot flashes, sleep disturbances, brain fog, mood swings, and urinary issues. For doctors, understanding the full range of these symptoms means understanding how they impact patients’ lives. Participants in the study said they mostly felt uninformed about menopause and unprepared for what menopause brought on.

But: There are ways women can be supported during this life changing time. Researchers say the first thing that needs to be done is prioritize public health campaigns. 

The study report recommended increasing education among primary care providers and other medical professionals. Many of the participants expressed frustration with family doctors when discussing menopause or hormonal treatment – some of whom didn’t even want to talk about it. Massage and psychotherapy are both treatments that women can look into to help alleviate symptoms. In fact, BC became the first province in Canada to sign a pharmacare agreement that helps the province fund hormone replacement therapy and diabetes expenses. 

Many women reported taking vacation days to attend appointments or manage symptoms – often out of embarassment. The report recommended that employers provide accommodation to their Human Rights Code that protects women on the basis of age, sex, and disability.

Bottom line: The conversation around menopause is growing, but shame and stigma are still big obstacles. More needs to be done to ensure women feel informed, supported, and less alone.

Presented by Vijay Wealth | Raymond James

Your Year-End Guide to Tax Savings & Financial Clarity 🩺

The holidays are just around the corner, and while you’re busy caring for patients, it’s also time to wrap up your finances before year-end!

Join Vijay Wealth on December 10th from 7-8 PM EST for a special year-end tax strategy workshop designed just for physicians. They’ll cover actionable tips to help you save big and hold onto more of your hard-earned money. It’s a holiday gift to yourself—more savings, less stress!

Whether you’re dealing with complex portfolios, Medical Professional Corporations, or unique investment properties, Anant Vijay and Sonya Dolguina have seen it all with 18+ years of combined experience. They take a harmonized approach to tax planning, making sure that it integrates with your life goals and investments.

Spots are limited, so don’t wait! Sign up now and get ahead of your financial goals before the year ends!

They’ll help you make sure you finish the year off well 🎄

Hot Off The Press

1: 🩺 Quebec Premier François Legault is prepared to use the notwithstanding clause to keep new doctors working in Quebec’s public health system, requiring those who want to leave to pay back training costs. This controversial move aims to tackle the province's doctor shortage, though legal experts warn it likely breaches Charter mobility rights. With about 20% of Quebec-trained family doctors heading to Ontario, Quebec’s healthcare system feels the strain.

2: 🧑🏽‍⚕️When Canadians see different doctors, is anyone connecting the dots on their health? For most, the answer is no, a new report finds, thanks to outdated information-sharing systems across clinics and hospitals. Alberta's 'Data Disarray' report calls for sweeping reforms to catch Canada up with countries like Denmark, where health info flows freely for connected care.

3: 💉 A UK doctor has been sentenced to 31 years for attempting to kill his mother’s boyfriend with a fake COVID-19 vaccine poisoned with pesticides, all due to an inheritance dispute. Dr. Thomas Kwan, disguised as a nurse, injected Patrick O’Hara with a deadly toxin in an elaborate scheme to secure his mother’s home. O’Hara survived after a harrowing hospital stay — and a search of Kwan’s home revealed an arsenal of toxins and weapon-making materials.

4: 😷 Canada has reported its first probable human case of H5 bird flu, involving a teen in British Columbia who was likely exposed through a bird or animal. Health officials are investigating the exposure but say the public risk is low, and there’s no evidence yet of human-to-human spread.

Notable Numbers 🔢

7: the number of years earlier that Black, First Nations, and Métis women in Canada die of breast cancer compared to white women. Canadian researchers found that non-white women are diagnosed at younger ages and often face more aggressive breast cancer trajectories.

400 million: the number of people infected annually by Aedes aegypti mosquitoes, which scientists aim to reduce by making male mosquitoes deaf, stopping them from mating. Researchers at the University of California, Santa Barbara, targeted a hearing-related gene in males, preventing them from finding females mid-air, which could curb mosquito populations and limit disease spread.

17: the number of pathogens identified by the WHO as top priorities for new vaccines to tackle major public health threats. This list — which includes well-known diseases like HIV and tuberculosis, as well as antibiotic-resistant threats like Group A streptococcus and Klebsiella pneumoniae — is part of WHO’s push to guide vaccine R&D toward pathogens causing significant disease burden (especially in vulnerable communities worldwide).

1 in 3: the number of Ontario cancer patients who visit the ER within 3 months before diagnosis, with over half requiring hospitalization afterward. The CMAJ study highlights how frequent emergency visits are during the diagnostic phase, especially for older patients, those in rural areas, and those with certain aggressive cancers like brain or lung — indicating a need for streamlined pathways to diagnosis.

Postcall Picks

😭Laugh: at the reality that real-life medicine is nothing like the MCCQ.

🎧 Listen: to why advocating for a centralized referral system in Ontario is a realistic option to help address anxiety and wait time uncertainty.

📚 Read: The House of God, an unfiltered look at the realities of medical training, which follows 5 interns through their gruelling hours and life-altering lessons.

🤑Save: up to 50% off Christmas trees at Michaels! With Halloween 2 weeks behind us, it's the perfect time to put up the tree.

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