Staying #Up2Date 🚨

1. Uterus transplants deliver

In this study involving 20 women with uterine-factor infertility, 14 (70%) experienced successful uterus allografts, leading to the birth of at least one live-born infant per recipient. Maternal and obstetrical complications occurred in 50% of the successful pregnancies, including gestational hypertension, cervical insufficiency, and preterm labor, but there were no congenital malformations among the 16 infants born. 

2. In the metola-zone

This multi-center, open-label trial compared dapagliflozin vs. metolazone in patients with heart failure and diuretic resistance. In 61 patients, weight reduction post 96h was slightly greater with metolazone (3.6 kg vs. 3.0 kg, p = 0.11), however, changes in pulmonary congestion and volume assessment scores were comparable. Dapagliflozin was associated with smaller reductions in plasma Na+/K+ and less increase in urea and creatinine.

3. Liquid biopsy

Circulating tumour DNA (ctDNA) sequencing assays (“liquid biopsies”) could play a critical role in guiding prophylactic anticoagulation in cancer patients at risk for cancer-associated venous thromboembolism (VTE). The study published in Nature analyzed data from over 6,000 patients across multiple cohorts. ctDNA detection was strongly associated with VTE risk, independent of traditional clinical factors. A machine learning model using liquid biopsy data outperformed conventional risk scores like the Khorana score.

Pain Free IUD?

Why the CDC’s newest recommendation for IUD pain is not what the doctor ordered.

What happened: The CDC have issued new guidelines on managing pain during IUD insertion.

Why it’s interesting: The guideline recommends using Lidocaine as a local anesthetic or applied topically as a numbing cream. They also are asking doctors to inform all patients about potential pain and personalize IUD placement and pain management plans for each individual.

But: Many doctors believe while the new guidelines are a step in the right direction, it doesn’t tackle all the sources of discomfort during the procedure. For example, one OB-GYN said evidence to prove that lidocaine injection relives the cramps felt after an IUD is inserted are ambiguous. She’s found that giving her patients anti-inflammatory drugs like ibuprofen helps to relieve pain, even though the CDC didn’t include it in their recommendation.

Other physicians argued that not everyone experiences the same type of pain during an IUD insertion, so having set guidelines may not be the best way to help patients. An attorney at the National Health Law Program said pain counseling (another thing the CDC did not recommend) should be “nonnegotiable” as women’s pain is often overlooked.

Bottom line: While the CDC’s efforts to make the procedure of getting an IUD less painful can be see as a validation of good practice, more needs to be done to ensure the comfortability of every patient.

Hot Off The Press

1: 💔 5 people have been charged in connection with Matthew Perry’s ketamine overdose death, including his live-in personal assistant and 2 doctors. The doctors are accused of exploiting Perry's addiction by supplying him with large amounts of the drug, while his assistant allegedly administered several injections on the day of his death. All of them, prosecutors claim, attempted to cover up their involvement.

2: 💉 Northwestern Medicine is introducing a new program, called AWAKE, that offers patients the option to undergo kidney transplants while awake using spinal anesthesia and mild sedation. This technique, which reduces risks associated with general anesthesia, has been successfully performed on 3 patients, with promising recovery outcomes.

3: 🫱🏾‍🫲🏿 A recent study in JAMA Oncology revealed that spouses of cancer patients face a significantly higher risk of suicide, particularly in the first year following a cancer diagnosis. The study highlights the often overlooked mental burden on caregivers, suggesting that more support is needed for families, especially those dealing with aggressive cancers and individuals with a history of psychiatric issues.

4: 🇮🇱 Israel accepted a proposal the US put forward for a cease-fire in Gaza and a return of hostages, US Secretary of State Antony Blinken said, urging Hamas to do the same.

5:⛓️ A study in JAMA Internal Medicine found that inmates in US prisons aren’t seeking the health care they need because they can’t afford the co-pay. People who are incarcerated are paid as little as 4 to 40 cents an hour, making the co-pay hard for them to afford.

6:👨🏻‍💻 National Public Data (NPD) has confirmed a massive data breach resulting in millions of American Social Security numbers and other personal information to be leaked. NPD has implemented additional security measures to prevent any reoccurring leaks in the future.

Notable Numbers 🔢

> 15,000: the number of known infections of the latest form of the mpox virus this year. The WHO has declared mpox a global health emergency, as this dangerous new strain, which is linked to higher death rates, has spread beyond the borders of the Democratic Republic of Congo.

350 million: the number of people globally who live with a rare disorder, 80% of which are related to genetics, according to the NIH. The Gene and Cell Therapy Institute (GCTI) at Mass General Brigham is trying to accelerate the development of gene and cell therapies for rare diseases.

37: the age of Thailand's newest (and youngest) prime minister.

💬 In Our Community

In a recent FB post, a physician shared their dilemma about pursuing job opportunities in a high-cost of living (HCOL) city. For context, they own a home in their current OK cost of living city (OKCOL), have kids nearing high school, and an underfunded savings account. Here’s some of the advice and comments from the group:

• Many said they needed “much more information” to help with making an informed decision — but, from the info provided, they believed moving was “like living hell,” citing decreased quality of life, endless expenses, and instability in social circles. 

• A very common sentiment was “what matters financially at the end of the day is how much assets are going into your savings.” Since they had “some” savings growing slowly, then it might be worth staying in the OKCOL city and accumulating more. Some were concerned about accommodating a family lifestyle in a HCOL city, and recommended they speak to other physicians in the same specialty in the new city. 

• An interesting take was to see this as an “opportunity to negotiate” at the current position. 

• We do commend the one brave soul who said: “sound a bit airy fairy…but consider what will give you most joy/satisfaction.”

• As an aside, many thought “OKCOL city” was their new favourite term, and we agree! Interested to see where your city’s cost of living ranks? Check out this calculator!

Postcall Picks ✅

🎧Listen: to Dr. Sydnee discussing all things mushrooms, including the ones sold at countless pop-ups all over the city and the infamous cordyceps from The Last of Us.

😭Laugh: in honour of the first week of medical school for many up-and-coming physicians across the country!

🤑Save: $200 on HP laptops at Costco!

🧠CGM: Not just for endos anymore. Primary care, this is for you! Springer Healthcare IME's.

Relax

Have you seen this study that shows “crossword puzzles provide positive educational impact for [health professions education] learners”?

First Question: What is characterized by pelvic pain, dyspareunia, dyschezia?

If you enjoyed this puzzle, please share it!

Image Challenge

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