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MorningMed is the best way to keep up with the world of health and medicine through curated round-ups, useful insights and other practical resources.

Amid the devastating wildfires in Maui, Dr. Reza Danesh mobilized his medical clinic to aid those affected. He treated individuals with asthma and other health issues exacerbated by the smoke and stress of the situation, as well as minor burns. Danesh's mobile clinic provided antibiotics, eye drops, and inhalers, and he helped transport people to evacuation shelters. The wildfires have led to many fatalities, injuries, and destruction of property, including medical facilities and urgent care clinics. Despite the challenges, medical professionals like Danesh are working to provide much-needed care and support to the affected population.

Health officials are expressing concerns about the upcoming respiratory virus season and are urging eligible individuals to receive vaccines against Covid, flu, and RSV. The season is expected to present challenges due to the potential co-circulation of these viruses, and experts emphasize the importance of getting vaccinated to prepare for what could be an intense winter respiratory season. The overlap of vaccination campaigns against COVID-19, the flu, and RSV will be a significant challenge, but health officials emphasize the importance of getting vaccinated regardless of timing uncertainties to mitigate the risk of severe respiratory illnesses.

The U.S. experienced an all-time high in suicides in 2022, with approximately 49,500 individuals taking their own lives, marking a 3% increase from 2021, according to provisional data from U.S. death certificates. Experts attribute this rise to various factors, including higher rates of depression and limited access to mental health services. The increasing availability of guns is considered a key driver, as suicide attempts involving firearms are more likely to result in death. Despite efforts to address the issue, suicides remain a complex challenge with multifaceted causes.

The obesity drug Wegovy, produced by Novo Nordisk, has been found to reduce the risk of cardiovascular events like heart attacks and strokes by 20%, according to preliminary findings from a late-stage clinical trial involving over 17,000 adults with overweight or obesity and existing cardiovascular disease. This marks the first time a weight-loss drug has demonstrated medical benefits beyond weight reduction. The results could potentially change the perception of Wegovy from a cosmetic or vanity drug to one with significant health benefits, potentially leading to increased insurance coverage for its use. The drug has been linked to potential cardiovascular benefits, but further research is needed to understand the mechanism behind these effects.

Patients taking weight-loss drugs like Wegovy or Ozempic may face increased risks of life-threatening complications during surgery due to the drugs' impact on digestion. These drugs can slow down digestion, making patients more prone to inhaling food and liquids into their lungs while under anesthesia, a condition known as pulmonary aspiration. Anesthesiologists are urging patients to stop these medications for a longer period before undergoing surgery or procedures requiring anesthesia, possibly up to three weeks in advance. While these drugs have shown weight loss benefits, the potential for complications during anesthesia highlights the need for careful consideration and discussion with medical professionals before using them.

Abstaining from alcohol is considered the healthiest option, with light drinking being deemed acceptable for most individuals. However, research is conflicted about the line between permissible and risky alcohol consumption and whether any health benefits come from light drinking.

• While some studies have suggested potential heart health benefits, experts caution that such research might not fully account for other healthy lifestyle factors and that the risks of alcohol consumption often outweigh the potential benefits.
• Alcohol-related deaths have risen, particularly among middle-aged adults, and experts advise considering moderation or even cutting back on drinking for overall health benefits.

In recent years, the healthcare industry has witnessed a remarkable transformation through the integration of advanced technologies. One such revolutionary advancement is Generative Artificial Intelligence (AI), a cutting-edge technology that holds immense potential to reshape health systems. Health system executives have taken notice of generative AI’s capabilities, recognizing its potential to enhance decision-making and patient care. However, despite the growing interest, there is still a notable gap in formulating a clear strategy for its effective implementation.

A shortage of the crucial chemotherapy drug cisplatin began in India, where a manufacturing plant suspended production due to FDA concerns about its quality. This caused a ripple effect throughout the drug's global supply chain, affecting its availability in the U.S. Intas Pharmaceuticals, responsible for about 50% of the cisplatin used in the U.S., suspended production, leading to shortages. The complexity of cisplatin's supply chain, involving multiple countries and stages of production, illustrates how a disruption at any point can impact drug availability and patient treatment.

Key takeaways

• Step 1: Mining the raw material Cisplatin originates from the rare metal platinum, which is mined in countries like South Africa and Russia. This reliance on a limited number of sources presents potential issues including supply disruptions due to mining problems and potential price hikes due to the limited availability. Platinum is extracted from ore deep underground and then refined; a process that necessitates specialized facilities due to the hazardous nature of working with the metal.
  
  
• Step 2: Manufacturing the API Once refined, the platinum is chemically transformed into cisplatin, the active pharmaceutical ingredient (API) responsible for its intended therapeutic effect, which in cisplatin's case is to kill cancer cells. Cisplatin API manufacturing facilities have been identified in Germany and India, but the process of converting platinum into cisplatin is complex and involves handling risky chemicals like ammonia and chlorine.
  
  
• Step 3: Fill finish After the active ingredient cisplatin is produced, the final step involves packaging, labeling, and preparing the drug for distribution, a process known as "fill finish." This step takes place in FDA-approved facilities across several countries. The drug is placed in its container, such as vials or syringes, and then sealed to prevent contamination. The drug can be sent directly from the fill-finish facility or to a distribution center before reaching its intended destinations, often involving complex distribution channels.

Is There a Doctor in the House?

An 88-year-old man with osteoarthritis is brought to the office by his daughter because of a 2-day history of severe low back pain and inability to walk. He says he has not fallen and does not recall any trauma to his back. Five years ago, he underwent bilateral hip replacement. His pain and mobility improved following the operation but have worsened during the past year. He now is most comfortable using a wheelchair for ambulation but is able to ambulate for short distances with a walker and assistance. One year ago, carcinoma of the prostate was diagnosed, but he declined therapy and said, "I'm an old man. When my time comes, I want to die. Just keep me as comfortable as you can." Vital signs today are temperature 36.6°C (97.9°F), pulse 88/min, respirations 16/min, and blood pressure 188/66 mm Hg. The patient is grimacing with pain and holding his lower back. Palpation discloses point tenderness over L3 through L4, and S1. X-rays of the lumbosacral spine show lytic lesions and compression fracture. The patient refuses additional diagnostic studies. The daughter fears that her father will be "abandoned" if he is not evaluated for additional treatment.

Which of the following is the most appropriate next step in response to the daughter's concern?

A new study challenges the belief that 10,000 steps per day are necessary for health benefits. Research spanning 17 studies from six countries reveals that walking just 4,000 steps daily is linked to reduced mortality risk. Each extra 1,000 steps daily is associated with a 15% decrease in overall death risk. The study emphasizes that accumulating as many steps as possible, starting early in life, can bring substantial health benefits, highlighting that even 2,337 steps per day can lower cardiovascular death risk.

Improperly sized blood pressure cuffs used with automated devices can lead to significantly inaccurate readings, warns a clinical trial published in JAMA Internal Medicine. Regular-sized cuffs often used instead of size-appropriate ones can distort readings, particularly for individuals requiring larger cuffs. This one-size-fits-all approach can impact hypertension diagnoses and treatment accuracy, emphasizing the importance of facilities having a full range of cuff sizes, education for healthcare providers and patients, and the significance of accurate blood pressure measurement in overall health management.

A study published in the Annals of Internal Medicine indicates that a substantial number of American women aged 70 to 85 are potentially overdiagnosed with breast cancer, leading to unnecessary treatment. Technological advancements in screening have led to increased diagnoses, but not all breast cancers are destined to grow, spread, or be life-threatening, so aggressive treatment may be unnecessary and even harmful for older women. The study highlights the need for personalized screening approaches and further research on the benefits of mammograms for older women.

A study published in the journal Lancet Planetary Health suggests a connection between air pollution and the rise of antibiotic resistance. The study examined levels of particle pollution (PM2.5) and antibiotic resistance in 166 countries and found a correlation between elevated levels of PM2.5 air pollution and high levels of antibiotic resistance, which became stronger over time. The research indicates that particle pollution might be responsible for about 11% of changes in average antibiotic resistance levels globally. While the study is observational and can't prove a direct connection, researchers suggest that reducing air pollution could have twofold benefits: improving air quality and combating the rise of antibiotic-resistant bacteria.

Thank you for reading! More next week,

My best wishes for a productive and idea-filled week ahead. Thanks for your ongoing efforts to improve the lives of the patients we all serve. Please send any news, comments, suggestions and ideas to hello@morningmed.email.

Quiz answer: The correct answer is D) "Reassure the daughter and recommend hospice care consultation"

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