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šŸ©ŗ Saving Lives AND Money

PLUS: titanium hearts & MDMA false starts

Another Olympic season has come and gone and congratulations are in order for Team USA who won 126 medals overall! Here are some highlights from the last few days of the competition:

  • Both men and womenā€™s track and field team won gold in the 4Ɨ400 relay, for the eighth time in a row.

  • Mens basketball was filled to the brim with MVPs including LeBron James and Steph Curry. The team took home gold after defeating France 98-87.

  • For the first time in 24 years USA won gold in weightlifting after Olivia Reeves won with a rough total of 578 pounds.

Todayā€™s issue takes 6 minutes to read.

If you only have one, here are the big things to know:

  • Is buprenorphine + naloxone safe during pregnancy?

  • The first ever successful implant of a BiVacor Total Artificial Heart

  • FDA rejects MDMA for PTSD treatment

Letā€™s get into it.

Staying #Up2Date šŸšØ

  1. HIV breakthrough

This RCT evaluated the efficacy of twice-yearly lenacapavir, a long-acting HIV capsid inhibitor, in preventing HIV among cisgender women in sub-Saharan Africa. Out of >2000 individuals, none of the participants receiving twice-yearly lenacapavir acquired HIV infection, representing a promising new drug for post-exposure prophylaxis (PrEP) that is yet to be approved by the FDA. 

  1. Buprenorphine + naloxone in pregnancy 

This study compared perinatal outcomes between pregnant individuals exposed to buprenorphine + naloxone (B/N) vs. buprenorphine alone. B/N was associated with a lower risk of neonatal abstinence syndrome, NICU admission, and small for gestational age infants compared to buprenorphine alone. No significant differences were observed in major congenital malformations, low birth weight, preterm birth, respiratory symptoms, or cesarean delivery. The results suggest that buprenorphine combined with naloxone is a safe and effective treatment option for opioid use disorder during pregnancy.

  1. Abx adverse reactions 

This study analyzed the risk of serious cutaneous adverse drug reactions (cADRs) associated with commonly prescribed oral antibiotics among older adults in Ontario, Canada. Sulfonamide antibiotics and cephalosporins were most strongly associated with serious cADRs, followed by nitrofurantoin, penicillins, and fluoroquinolones, compared to macrolides. Among those hospitalized for cADRs, a significant proportion required critical care, and 5.3% died in the hospital.

Heart to (Metal) Heart

How one patientā€™s change of heart could be the future of transplants.

What happened: The Texas Heart Institute of Houston performed the first-ever successful implant of a BiVacor Total Artificial Heart (TAH) on a 57-year-old man.

Why itā€™s interesting: The patient, who was critically ill and in cardiogenic shock, was offered a TAH, a titanium heart that uses magnetic technology to pump blood. It was designed to replace both ventricles of a failing heart. 

The surgery was part of an FDA early feasibility study where new medical devices are used on a small number of patients to test for safety and efficacy. The titanium heart pumps 12 litres of blood flow per minute, similar to a human heart.

Typical artificial hearts use compression sacs to squeeze the blood out of the device and distribute it to the body, but these can fail over time. They can also be too big for patients. Because they donā€™t have sacs, TAHs are smaller and easier to fit in the body. 

Yes, but: While having a titanium heart sounds cool, BiVacor said TAHs aren't currently available for long-term use, as the company reported that TAHs are just a placeholder. One of BiVacorā€™s goals is to make their artificial hearts an option for patients on the donor list. The founder of BiVacor said that after 10 years, a lot of patients that have donor hearts end up rejecting them. He hopes his colleagues at BiVacor can create TAHs that can last over 10 years without any complications. 

Bottom line: BiVacor will continue to make history as they continue to implant the titanium hearts into patients who need transplants, and monitor them for any side effects.

Hot Off The Press

1: āš”ļø Spark Biomedical is electrifying opioid withdrawal treatment ā€” literally. Sparrow Ascent, a wearable earpiece that uses mild electric pulses to ease symptoms like nausea, insomnia, and anxiety without drugs, is an FDA-approved device that helps patients safely detox at home. The companyā€™s current trying to make this $4,500 device accessible through insurance.

2: šŸ’Š 3 papers about MDMA-assisted therapy have been retracted because of ā€œunethical conductā€ at one of the studyā€™s sites. This comes on the heels of the FDA rejecting MDMA-assisted therapy to treat PTSD. Lykos Therapeutics, the drug company that applied to the FDA, says itā€™ll appeal the decision.

3: šŸ‡ŗšŸ‡ø In a bizarre move, Trump says Kamala Harris looks like wife Melania while calling her ā€œbeautifulā€ at the same time in his recent interview with Elon Musk.

4: šŸ‡®šŸ‡³ Doctors at hospitals in large cities around India pledged to strike indefinitely and halt elective procedures after the rape and murder of a medic in a state-run hospital, CBS News reported.

5: šŸ¦  A new study has found that routine blood tests are not reliable in diagnosing long COVID. Scientists found few differences in bio-makers between participants who had COVID prior, and those who didnā€™t. The team who conducted the study will continue to collect blood, and spinal fluid samples to help better understand the pathophysiology of long COVID.

Notable Numbers šŸ”¢

2 million: the number of acres being burned by wildfires in the US right now. A new study in Anesthesiology suggests that inhaling wildfire smoke could affect the safety of surgeries, complicating the effects of anesthesia and potentially hampering recovery.

17: the number of cancers that are on the rise in younger generations, according to a new study. For example, the number of cancers of the small intestine, kidney and pancreas was 2 to 3 times higher in people in their mid-30s than in boomers.

159: the number of calls to US poison control centres this year involving GLP-1s. In 2023, there were only 32.

šŸ’¬ In Our Community

The FDA recently approved the first nasal spray for treating anaphylaxis. The tool is called Neffy and it can be great for patients or caregivers who are afraid of needles or arenā€™t well versed when it comes to injecting epipens

Here are what some health care folks on reddit think about the new drug:

I worry about patients who are afraid of nasal sprays. I encounter a surprisingly large number of people who cannot tolerate anything in their nose, particularly not liquid.

I feel like it is easier to give a child a needle than spray something in their nose, if they are uncooperative. You can easily immobilize a leg, but the head is trickier to keep still.

Emergency Medicine

Great but my patients still canā€™t afford the injectable form of epinephrine which has existed for a century. I will keep an eye out for information on cost once it is on the market but Iā€™m not optimistic I will be able to prescribe this often

MD

This is really cool - we've had intratracheal epi as an option in codes so it makes sense that nasal administration could work as well. I do worry that many of our more atopic patients with allergies requiring epi tend to also have more baseline nasal congestion/edema/polyps, and absorption may be inhibited in these patients - we just don't have the data to back up the use of intranasal epi in these patients yet. Will likely continue prescribing IM epi for those patients until that data is available. 

MD-PGY6

The company behind Neffy hasnā€™t disclosed a price yet but itā€™s estimated that it might cost $200 per pack, and insurance plans still have to decide whether to cover the product and how much.

Postcall Picks āœ…

šŸ˜­ Laugh: Babyā€™s mouth is on a strict no-open policy at the doctorā€™s office.

šŸ§  Learn: Red-40 is under scrutiny. Is there a real link between food dyes and hyperactivity, or is it just a colorful debate?

šŸ“š Read: Being Mortal by Atul Gawande for profound perspectives on enhancing patient care when tackling realities of aging and end-of-life care in modern medicine.

šŸ¤‘ Save: Up to 40% off past-season styles at Patagonia!

Relax

First Question: This muscle flexes the arm and is innervated by the musculocutaneous nerve.

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Help Us Get Better

Thatā€™s all for this issue.

Cheers,

The Postcall team.