Staying #Up2Date 🚨

1. Holding angiotensin-converting enzyme inhibitors (ACEi) & angiotensin receptor blockers (ARB)

This RCT with 2,222 adults studied holding vs. continuing ACEi or ARB in patients undergoing elective major noncardiac surgery. Continuation strategy was associated with a similar rate of all-cause mortality and major postoperative complications compared with a discontinuation strategy (22% in both groups). Intraoperative vasopressor-requiring hypotension was more common in the continuation group (54% vs. 41%), but the difference in hypotension duration was minimal (3 minutes longer in the continuation group). 

2. Self-discharge associated with overdose risk

This retrospective study found that 3.4% of hospital stays in BC ended in patient-initiated discharge before medically advised (BMA). The unadjusted overdose rate was 10x higher after BMA discharge vs. physician-advised discharge, and after adjusting for confounders. A BMA was associated with increased overdose risk (adjusted HR 1.58; 95% CI 1.31–1.89). 

3. Bladder scan over Foley

A multidisciplinary expert panel developed an algorithm to standardize in-hospital urinary retention. The algorithm recommends bladder scanning over catheterization for symptomatic or asymptomatic patients who haven’t voided after 3 hours. If bladder scanning is unavailable, intermittent straight catheterization (ISC) is preferred initially over indwelling urinary catheter (IUC). Catheterization is advised when bladder scan volumes are ≥300 mL in symptomatic patients or ≥500 mL in asymptomatic patients.

Rise Of The Whooping Cough

As whooping cough cases rise, doctors are asking young people to consider getting vaccinated.

What happened: Whooping cough cases are at their highest level in a decade, especially among unvaccinated teens.

Why it’s interesting: The CDC reported that 14,569 cases of whooping cough have been confirmed in 2024 so far. This is a huge jump from last year with only 3,475 cases. Babies are given the DTaP vaccine (pertussis, diphtheria, and tetanus), and while it is effective for diphtheria and tetanus, over time it becomes less effective for pertussis, also known as whooping cough.

That’s why doctors recommend getting a booster for pertussis every 10 years, but due to the COVID-19 pandemic there’s been a lot of vaccine hesitancy in the US. Another factor is since most doctors appointments were conducted online during the pandemic, many teens and children missed their booster shots. In Wisconsin, children aged 11 to 18 make up nearly half of the cases reported this year. These fast growing numbers have health care professionals concerned and they urge parents to consider getting their child vaccinated.

Groups most at risk of the disease are babies due to their small airways. Babies can’t be vaccinated for whooping cough until they turn 2 months, so the CDC recommends pregnant people get vaccinated in the last trimester of their pregnancy to protect their newborn.

Bottom line: Doctors are asking people to wash their hands and wear a mask if they feel sick, but say that getting vaccinated (if you can) can help decrease the chances of contracting the illness at all.

Hot Off The Press

1: 🇮🇱🇱🇧 Israeli airstrikes hit Lebanon in a major escalation, killing 569 people, including 50 children, and injuring over 1,800, according to Lebanese officials. As the conflict with Hezbollah intensifies, both sides are ramping up attacks, with Israel targeting over 1,300 sites and Hezbollah firing 240 rockets into northern Israel. Tens of thousands of people in both countries are fleeing amid fears of a full-scale war.

2: 💔 New research suggests that childhood trauma raises the risk of developing diseases later in life, with the effects varying by individual experiences and biological sex. This UCLA-led study shows how adverse childhood experiences can disrupt biological systems, with females being more prone to metabolic issues, males to mental health challenges.

3: 📱Jony Ive, Apple’s former design chief, has confirmed he's working with OpenAI's Sam Altman on a groundbreaking AI hardware project. Few details are known, but the project’s rumoured to leverage generative AI for a revolutionary computing device. The reported goal of the project: to build the iPhone of AI.

👁️ 4: A new study has found that one in three children are short-sighted. Researchers link the surge to COVID-19 lockdowns as children had to stay inside and look at screens rather than be outside. The highest rates are in Asia with 85% of children being short-sighted.

Notable Numbers 🔢

$15 million: how much Cards Against Humanity is suing SpaceX for. They’ve accused the company of trespassing and damaging land CAH purchased in Texas as part of a 2017 publicity stunt against the border wall. The lawsuit alleges SpaceX used the property without permission, damaging vegetation.

5 in 6: the ratio of Americans who tried to quit smoking in 2022 and failed. Critics argue that both the FDA's strict approval standards and drugmakers' focus on more profitable drugs have stalled progress. Shockingly, no new smoking-cessation drugs have been approved in nearly 20 years.

$863 billion: the market cap of Eli Lilly, which produces Zepbound and Mounjaro. The other big player in weight-loss drugs, Novo Nordisk, has a market cap of $448 billion.

💬 In Our Community

To report or not to report — a dilemma faced by a physician caring for an ophthalmologist in a memory care unit, suspected to have severe dementia while still treating patients. Below is a summary of what others advised them:

• Someone said that the ophthalmologist “wields sharp objects in and around people’s eyes” and should be urgently reported. Many also said “uh… yah” and questioned why this physician is even asking for advice.

• Similarly, some posed questions along the lines of, “would you even be conflicted if they had any other cognitively demanding job? Or do you just not want to be wrong by a physician?”

• Another commenter actually warned that the reporting physician “could actually be punished for not reporting a colleague who was a danger to patients,” and urged them to report this incident immediately. 

• An interesting perspective was brought up about “difficulty of diagnosing neurocognitive disorders in the inpatient setting” (i.e., many other factors that cannot be ruled out, including delirium). This commenter recommended longitudinal follow-up and formal assessment before starting a potentially “life- and career-altering process.”

We found this article reporting that as many as 28% of US physicians with active licenses who are aged 70 and older have mild cognitive impairment or dementia. It also mentioned different strategies to help address this, including mandatory aged-based cognitive screening and self-assessment tools.

Postcall Picks ✅

😭 Laugh: We’re gonna get imaging anyway…

📚 Read: The Butchering Art by Lindsey Fitzharris to learn how surgery started from the bottom and now it’s here. 

🤑 Save: With Nordstrom’s Under $50 Sale!

👂Listen: To the new episode of Sawbones, a medical podcast about misguided medicine!

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First Question: delusions, hallucinations, disorganized speech, negative symptoms?

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