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Before coronavirus had the world spooked, EVALI was mystery syndrome #1. Answers have started to trickle in.
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E-cigarette or vaping product use–associated lung injury (EVALI) peaked in summer 2019, prompting your home-base ED to go nuts and a partial flavor ban from the Trump administration. All told, there have been 2,800 hospitalized patients and 64 deaths from EVALI as of writing, and half of admissions have landed in the ICU. Investigators honed in this summer on bootleg THC vaping cartridges as a major cause of illness. Time to get more specific.
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Vitamin E acetate (VEA), a thickening agent in illicit THC vaping cartridges, topped the list of suspects after the FDA found the compound in half of all cartridges from afflicted patients (most patients used 2 or more cartridge types). Now a case control study has found VEA in the broncheoalveolar fluid of 94% of EVALI patients (n = 51) compared to zero in a comparator arm of 99 healthy controls. The timing of when VEA began to appear in THC cartridges and on vaping websites fits perfectly with the outbreak.
NEJM
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Association is not causation, but there's enough evidence to confirm THC cartridges with VEA as EVALI's source. Further studies will explore how these products cause lung damage.
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When your no show becomes an add-on disaster
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If only your clinic stayed on trend. Primary care visits declined by 24% from 2008 - 2016 according to a cross-sectional analysis of insurance claims from a large commercial insurer. Visits declined most among the young, those without chronic medical problems, and patients from low-income areas. Out of pocket costs increased during the same timeframe, and visits to alternative care venues like urgent care and the ED rose by 45%.
Annals
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When pathologists sit back and let AI read slides
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Maybe you chose the wrong field. Researchers used artificial intelligence to classify H&E stained tissue slides from surgically resected colorectal cancer to select which patients were at highest risk of recurrence. The final deep learning model was able to stratify a high-risk tissue type that conferred a 3x increased risk of recurrence in a held-out validation set. The authors plan to test their biomarker in trials designed to identify which patients benefit from chemotherapy after surgery (adjuvant therapy).
Lancet
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When you'd eat and sleep at once, if you could
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Settle instead for 2-for-1 procedures. A study of 300 patients with paroxysmal atrial fibrillation and significant hypertension (hypertensive despite ≥1 BP med) found that renal artery denervation and catheter ablation of a-fib decreased a-fib recurrence at 12 months (72% vs. 57%) compared to catheter ablation alone. Renal denervation decreased SBP from a mean of 147 mmHg in the catheter ablation group to 135 mmHg for the dual intervention.
JAMA
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Is dairy good for you? It's been hard to prove. Studies designed to link dairy to weight loss have been largely negative, and associations with specific cancers have been mixed. At present, evidence to support reduced fat dairy products over the real thing is lacking. Here's a table comparing dairy's impact on all-cause mortality to other major food groups in a large dietary intake cohort study.
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Tying dairy to heart health in low income countries? 2018's PURE study evaluated dairy intake in over 130,000 participants in 21 countries and found that ≥ 2 servings of dairy a day was associated with a 23% lower incidence of cardiovascular mortality. Experts speculate that replacing highly-prevalent starch in low income diets with dairy calories reduces glycemic load and provides missing nutrients.
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What your med student friends are talking about
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Would you have locked yourself in a cave for 6 weeks if you knew Step 1 was pass / fail? The revamped test is slated to arrive in 2022.
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