Staying #Up2Date 🚨

1. Weight loss in polycystic ovarian syndrome (PCOS)

This meta-analysis of patients with PCOS found that while weight loss (−3.8 kg) improved menstrual frequency and reduced insulin resistance and free androgen index values, it did not improve hyperandrogenism (e.g., acne, hirsutism), hormonal markers, or PCOS-related quality of life.  Additional therapeutic strategies could address hyperandrogenism and enhance symptom management.

2. Systolic blood pressure (SBP) in type II diabetes (T2DM)

This RCT compared SBP <120 vs. < 140 targets and found that intensive control was associated with fewer composite CV events (6.1% vs. 7.7%) and strokes (4.4% vs. 5.6%) in ≈13,000 high-risk T2DM patients. These findings align with prior trials (ACCORD and SPRINT); however, real-world applicability may be limited by the underreporting of symptomatic hypotension in this study.

3. Hip fractures from gabapentin?

This case–crossover found that hip fractures were 30% more common among patients aged ≥50 during periods of gabapentinoid use (adjusted OR, 1.3). The risk was elevated in subgroups with chronic kidney disease (OR, 2.4) and frailty (OR, 1.8). This study underscores the importance of assessing fall and fracture risks before prescribing gabapentinoids, especially for older or vulnerable patients.

Injecting Hope

Fasnera could be a game-changer for treating asthma.

What happened: A recent study led by King’s College London suggests that AstraZeneca’s Fasnera (benralizumab), an injectable treatment for severe asthma, outperforms oral steroids during attacks.

Why it’s interesting: For the past 50 years, oral steroids have been the norm for treating asthma. This new study found that Fasnera reduces the need for additional treatment by 30%.

First approved as a treatment for eosinophilic asthma, the antibody drug Fasnera was tested on 158 high-risk patients prone to asthma or COPD attacks. Results showed that Fasnera is more effective than prednisolone, an oral corticosteroid typically injected during severe attacks. 

After 28 days of treatment, patients receiving Fasnera showed significant improvement in respiratory symptoms. After 90 days, 4 times fewer patients in the Fasnera group experienced treatment failure compared to those receiving standard care. Findings indicate that Fasnera could be used effectively during emergencies, both at hospitals or at home.  

But: Potential side effects of Fasnera include hypersensitivity reactions (e.g. anaphylaxis, urticaria, rash), headaches, and pharyngitis. 

Bottom line: Asthma and COPD take millions of lives each year. With its ability to provide effective relief, Fasnera offers hope for patients seeking alternatives to traditional treatments – and it could save their lives. 

Hot Off The Press

1: 🩺 Dr. Elaine Ma is reeling after being told to cough up $600K for drive-in COVID vaccine clinics she ran in Kingston. The province says she broke OHIP rules by using unpaid med students and non-traditional spaces, but Ma argues she followed the guidelines given at the time. She’s worried this ruling could scare other docs from stepping up in future health emergencies.

2: 🏥 2024 is shaping up as Ontario's worst year for ER closures, with 1 in 5 hospitals experiencing shutdowns, particularly in rural areas. Progress has been made to address nurse shortages, but critics argue that relying on temporary fixes like agency staff is unsustainable and risks turning "emergency" care into a daytime-only service.

3: 💉 A vaccination campaign in Nova Scotia revealed an alarming gap: 52% of seniors over 70 received flu shots, but only 35% opted for COVID-19 vaccines. Experts warn that misinformation and COVID fatigue are overshadowing the proven benefits of immunization — especially with respiratory illness season approaching.

4: 🫀 Canada has approved Wegovy, a weight-loss drug by Novo Nordisk, to reduce the risk of nonfatal heart attacks in adults with cardiovascular disease — the first such treatment available in the country. Authorized to treat obesity since 2021, Wegovy's expanded approval aligns with similar endorsements in the US, UK, and EU for lowering heart risks in overweight individuals.

5: 🚭 The US Supreme Court decided not to hear a challenge from tobacco companies against the FDA's rule requiring graphic health warnings on cigarette packs and ads. The rule includes images like diseased lungs and kids with oxygen masks, aiming to raise awareness of smoking risks. Tobacco companies argued the warnings were too extreme.

6: 🇺🇸 President Biden’s decision to pardon his son Hunter is shaking up the political scene, fuelling claims of a justice system gone personal. With Biden leaving office and Trump returning, both sides are trading accusations of politicized justice. Trust in the system is hanging by a thread. Buckle up — this fight is far from over.

7: 🇰🇷 South Korea’s parliament voted unanimously to demand an end to President Yoon’s martial law declaration, calling it a step back from democracy. Lawmakers insist they’ll “protect democracy with the people,” but the next move is Yoon’s.

Notable Numbers 🔢

$16.25 billion: the projected size of the neuromodulation market by 2032. This neurotech revival is challenging the limits of pharmaceutical therapies with tailored approaches and emerging trials, gaining momentum for treating Alzheimer’s, chronic pain, and depression.

100%: the effectiveness of a new twice-yearly HIV prevention shot for women — and the results are nearly as strong in men. This treatment is being hailed as a breakthrough, but the limited access in Latin America highlights inequities in the global fight against AIDS.

330 to 275: the final vote in the British Parliament that clears the way for England and Wales to legalize assisted dying. Supporters hail it as compassionate; critics fear risks to the vulnerable.

Postcall Picks

👂️ Listen: to how an anesthesiologist turned his financial story around after divorce — through side gigs, a second marriage, and aligning on goals — on the WCI podcast.

🤑Save: on Littmann stethoscopes — 20% - 30% off right now at Amazon!

🤔 Thinking: of leaving the hustle and bustle of the big city to practice rural medicine? It might be worth it — here are the pros and cons (incl. a list of the incentive programs).

💰 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. **

** this is sponsored content

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