Staying #Up2Date 🚨

1. Adding sodium–glucose cotransporter-2 inhibitors (SGLT-2i) 

In this retrospective cohort study of ≈13K adults already on hypertensives, researchers examined the effect of SGLT-2 inhibitors (prescribed for diabetes) on BP. The average reduction in systolic BP was 5mmHg, with slightly greater effect in patients with resistant hypertension, and 13% more patients achieved <130/80 mmHg after starting SGLT-2i.

2. Timing diagnostic paracentesis (para) 

In this meta-analysis, patients with cirrhosis who underwent diagnostic para within 12-24h after admission had lower rates of acute kidney injury (24% vs. 35%), shorter hospital stay (5 fewer days), and lower in-hospital mortality (7% vs. 10%) compared with patients who had more-delayed or no paracentesis. In a subgroup analysis of a higher-risk subgroup, in-hospital mortality was significantly lower with paracentesis within 12h (12% vs. 26%).

3. Overtreating prostate cancer (PCa)

This study examined treatment rates in men with PCa with limited life expectancy for whom interventions are not recommended.  Rates of definitive treatment increased from 38% to 60% in men with life expectancy of <10 years and intermediate-risk disease, and from 17% to 47% in men with life expectancy of <5 years and high-risk disease.

Fluoride In Florida

Why some specialists warn against the removal of fluoride in drinking water

What happened: Florida surgeon general advises against the use of fluoride in drinking water despite dental benefits.

Why it’s interesting: Joseph Ladapo, Florida’s general surgeon, announced that Florida communities should consider removing fluoride from their water due to “neuropsychiatric risk,” associated with it. He claimed constant exposure to fluoride could cause reductions in IQ levels. While some studies have suggested that this may be a factor, the research is preliminary and far from conclusive. Currently 70% of community water systems in Florida have fluoride in their water. 

This isn’t the first time Ladapo has gone against basic public health measures. In February he let parents decide whether they wanted to quarantine their children after the massive measles outbreak. He has also questioned the COVID-19 vaccine and threatened to press criminal charges against TV stations in Florida that aired an ad supporting abortion rights. 

But: Despite the surgeon general’s claims, many states are trying to get the mineral back in their water supply. Last January an investigative reporter found that residents of Buffalo, New York had fluoride missing from their water since 2015 resulting in many cavities amongst children. Both the CDC and the American Dental Association (ADA) support the use of fluoride, citing that it reduces tooth decay by 25%. A class action lawsuit was filed on behalf of the parents and less than two years later fluoride returned. The ADA found that other cities like Kansas and North Dakota have taken similar measures.

Children that belong to lower income families are three times more likely to have untreated cavities, according to the CDC. There are several reasons for this including that almost half of US kids don’t receive regular dental care. This is why healthcare professionals, including an epidemiologist say that having fluoride in water systems is important because it lowers the risk of dental issues. 

Bottom line: Although some believe that fluoride should be removed from water systems in the US, more research needs to be done before it’s fully implemented.

Hot Off The Press

1: 🏥 A recent study reveals that US for-profit hospice facilities, especially those backed by private equity, provide lower-quality care compared to their not-for-profit counterparts. Despite the growing dominance of for-profit hospices in the US, which now account for 70% of the sector, not-for-profits scored higher across key care metrics, prompting calls for more transparency and accountability in hospice ownership.

2: 🐭 Scientists have trained rats to drive tiny cars — and the rodents are loving it. Not only do the rats eagerly anticipate their "joyrides," but the research suggests the anticipation itself boosts brain health, promoting optimism and problem-solving. Turns out, enjoying the journey might be as rewarding as the destination—whether you're a rat or a human!

3: 🦃 With Thanksgiving creeping up and the rise of food poisoning in the U.S, food scientists are handing out tips to ensure Americans have a healthy and happy holiday. One of their most controversial takes is advising folks to not wash their turkeys to prevent the spread of contamination. Instead they said to wipe the bird down after it’s defrosted with paper towel.

4: 💊 The US Drug Enforcement Administration found that less-potent fentanyl pills may be playing a role in the decrease of US overdose deaths. 5 out of 10 fentanyl pills that were tested were lethal. This is a decrease from last year with 7 in every 10 pills. According to federal data there were also about 16,000 fewer lives lost in the most recent 12 month period, with most of the decrease stemming from fentanyl and synthetic opioids.

Notable Numbers 🔢

16.3%: How much global antibiotic use spiked between 2016 and 2023. Consumption across 67 countries surged 16.3%, from 29.5 to 34.3 billion DDDs. While high-income nations saw a decline during the pandemic, middle-income countries rebounded rapidly, with some, like Vietnam, more than doubling their use. With the global antibiotic rate projected to jump by 52% by 2030, this trend shows no signs of slowing down.

500: the number of kidney transplants from HIV positive donors that have been done in the US. A new rule was announced by US health officials stating that the change in protocol will help expand the organ donor pool and improve outcomes for transplant patients.

37%: of adults 18 and older have received a seasonal flu shot, almost 10% lower than last winter. Health officials say the hesitancy surrounding vaccines could be linked to the rise of misinformation on social media, which in some cases have overshadowed public health campaigns.

Postcall Picks

🤑 Buy: starting your holiday shopping early? Pickup a copy of If You Give A Mouse Metformin, a book that teaches how clinical trials work in a fun and digestible way. It’s a perfect stocking stuffer or gag gift!

👂🏻Listen: to the latest episode of the Mayo Clinic Talks podcast. This week the hosts discuss nicotine dependency and the risk of second hand exposure.

😂 Laugh: at this TikTok reinforcing the importance of sterilizing medical instruments!

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First Question: What is the hormonal medication commonly referred to as "Plan B"?

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