Staying #Up2Date 🚨

1. Menopause matters

Postmenopausal women often experience vulvovaginal, urinary, and sexual sx associated with genitourinary syndrome of menopause (GSM). This review summarizes (low-certainty) evidence for sx control:

• Vaginal moisturizers and estrogens were more effective than placebo for vulvovaginal dryness (both have uncertain benefits for dyspareunia).

• Vaginal dehydroepiandrosterone (DHEA) and oral ospemifene were more effective than placebo for vulvovaginal dryness and dyspareunia.

• No tx was found to be more effective than placebo for urinary sx.

• Vaginal testosterone, vaginal oxytocin, oral DHEA, oral raloxifene, and oral bazedoxifene were of uncertain benefit for managing any GSM sx.

2. Dual antiplatelet therapy (DAPT) still INSPIRES

The INSPIRES trial concluded that giving DAPT up to 72h post sx onset of mild ischemic stroke or high-risk TIA reduced stroke risk compared to ASA alone (of course, moderate-to-severe bleeding risk increased). Now, a secondary analysis of the trial shows clinical benefit of DAPT in the first 3 weeks, including a significantly favourable net clinical benefit in the first week (absolute risk reduction: 1.29%).

3. Transfusion targets

The MINT trial suggested that a transfusion threshold of 10 g/dL rather than 7 or 8 g/dL resulted in lower 30-day recurrent myocardial infarction (MI) or death. Now, secondary analysis suggests that a transfusion threshold of 9 g/dL likely confers similar benefit to 10 g/dL in patients with acute type 1 MI.

Heart to Brain

How taking care of your heart can also help take care of your brain

What happened: The American Heart Association has released a new statement claiming that taking care of your heart can lower the risk of Alzheimer’s disease and other related dementias. 

Why it’s interesting: According to the World Health Organization (WHO), coronary heart disease is the leading cause of death in the world, with 9.1 million deaths in 2021. Not only does the illness take a toll on the heart, but also on the brain. This is due to the reduced blood flow to the brain causing damage to the blood vessels, resulting in cognitive impairment. Coronary heart disease raises the risk of dementia by 27%.

Atrial fibrillation (A-fib) can also lead to a greater risk of brain diseases, since microhemorrhages are more common in people with A-fib. In fact, people with A-fib have a 39% increased risk of memory or thinking problems. 

But: There are some things people can do to prevent or slow down heart disease. The most obvious is to take prescribed medications on a daily basis. Aside from drugs, there are also lifestyle tips to boost brain health:

• Sleep: It’s recommended to get about 7 to 8 hours of uninterrupted sleep each night.

• Diet: Eating anti-inflammatory foods like grains, fruits, and vegetables could lower the risk of dementia by 31%.

• Reduce stress: A study published in 2023 found that people with elevated stress levels were 37% more likely to have poor cognition. Staying connected to others and meditation are a few ways people can reduce stress.

• Exercise: People who walked a brisk pace of 112 steps per minute for 30 minutes a day lowered the risk of dementia by 62%. 

Bottom line: While there isn’t a cure for brain diseases like dementia or Alzheimer’s (yet), focusing on heart health is a good starting point in lowering patients’ chances of getting sick. 

Hot Off The Press

1: ⏰ Scientists from Duke-NUS and UC Santa Cruz have discovered a new way to regulate our body clocks by pinpointing key spots on a protein, CK1δ, that control circadian rhythms. This breakthrough could help tackle jet lag, improve sleep, and even aid treatments for conditions like cancer.

2: 🐁 A large study involving nearly 1,000 mice reveals that the longevity benefits of severe calorie restriction aren’t solely due to weight loss or metabolic improvements. The research shows that factors like immune health, genetic resilience, and red blood cell function play a more significant role in extending life. Surprisingly, mice that lost the most weight tended to die younger, suggesting that metabolic regulation alone doesn't explain the connection between dietary restriction and longevity.

3: 💍 A new 3-month dapivirine vaginal ring shows promise in providing long-lasting HIV protection for women, since it performs as well as the current 1-month version. This longer-lasting option could reduce costs by 60% and lessen clinic visits, potentially improving adherence. The ring, already approved in 11 African countries, offers women more choices in HIV prevention.

4: 🤝🏼 This past Monday was Indigenous Peoples’ Day, and while the US has come a long way in trying to decolonize many institutions, Indigenous peoples’ say there is much more work to be done. This includes Indigenous peoples’ reclaiming control over Indigenous data including genomic and biological data that was stolen without their consent. To learn more about what Indigenous Peoples’ Day means check out this article by Science. 

Notable Numbers 🔢

38: the age of professional tennis player Rafael Nadal at the time of his retirement, marking the end of a remarkable 23-year career. With 22 Grand Slam titles, including a record 14 French Open victories, Nadal is celebrated for his resilience, especially on clay courts, and his fierce rivalries with legends like Roger Federer and Novak Djokovic.

28: the age of Sammy Basso, the longest-known survivor of progeria, a rare disease causing rapid aging, who passed away on October 5, 2024. Basso dedicated his life to researching progeria and raising awareness.

130,000: the number of US cancer cases that went undiagnosed during the COVID-19 pandemic. As of right now scientists say there isn’t enough data to understand what happened to the missing cancer cases. But health professionals are monitoring data to watch for any cases that might show up.

Postcall Picks

😭 Laugh: at the “life-long learner” motto of medicine. 

📚 Read: Deep Medicine by Dr. Topol to learn how AI can help us rediscover human connection in medicine. 

🎧 Listen: to the experience of a doctor as a patient and how easy it is to fall through the cracks of the healthcare system… even as an insider. 

🤑 Save: Up to 50% off on scrubs with Uniform Advantage until Oct. 28th!

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