AI technology was highly accurate at identifying malignancies and tumor origins — as accurate as senior pathologists, and significantly more accurate than junior pathologists. 

Patients with cancer of unknown primary site who received treatment concordant with tumor origins predicted by AI had significantly longer overall survival than those whose treatment was discordant with AI predictions (27 vs. 17 months).

https://www.nature.com/articles/s41591-024-02915-w

HERE IS WHEN IT IS RECOMMENDED TO USE ALBUMIN

New guidelines on the use of albumin (remember albumin is a blood product so if you have a Jehovah’s witness or any patient that avoids blood products you need to ask them if it is ok)


https://www.sciencedirect.com/science/article/pii/S001236922400285X?via%3Dihub

The results for weight loss was 

Tirzepatide also known as mounjaro – 8.5 kg 

Semaglutide also known as Ozempic -3.1 kg lost

Liraglutide aka Victoza – 1.3 kg lost


Tirzepatide also known as mounjaro – 8.5 kg 

But almost all of these weight loss drugs seem to lose the effect over time and as you increase the dose and increase the weight loss you can expect to increase the GI side effects

 

https://www.bmj.com/content/384/bmj-2023-076410

41 adults (mean age, 59) with obesity (mean weight, 99 kg) and prediabetes or diet-controlled diabetes – everyone got the same diet. Same  micro- and macronutrient composition; same calorie amounts

Food was prepared in a study kitchen and consumed onsite or taken home.

Key difference

The intervention group was instructed to eat between 8 a.m. and 6 p.m. and to consume 80% of calories by 1 p.m. The control group was instructed to eat between 8 a.m. and midnight, with 55% of calories after 5 p.m.

Weight loss in the two groups was similar at 12 weeks (about 2.4 kg).

3 months—and no difference—


https://www.acpjournals.org/doi/10.7326/M23-3132

recipients were more likely than placebo recipients to report much or very much improvement (55% vs. 25%) which isn’t shocking because half of the people were not getting medicine

they also report that the medication arm had improvement on CT imaging of the sinuses which also seems like another Duh moment as I am sure it was better than nothing

my concern is this new drug or deliver of the drug is a cash price of about 800-1000 per month while just simple fluticasone is around 10$ a month. I think for now stick with the normal 10$ fluticasone but if there is no success and continue to have severe symptoms then maybe consider this if they have good insurance

bottom line is there is a new drug out there that is basically fluticasone in a fancy delivery device.. for almost all my patients and family members they will be getting regular fluticasone not this fancy delivery device that goes but the name XHANCE

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S221321982301365X?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS221321982301365X%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.jwatch.org%2F

https://onlinelibrary.wiley.com/doi/10.1111/joim.13757


ECG abnormalities were present in 40% of hypokalemic patients and included t-wave flattening/inversion, ST-segment depression, QTc prolongation, longer QRS duration, and high heart rate. 

 after adjustment for potential confounders, only heart rate >100 beats per minute and not the ECG abnormalities was associated with those adverse outcomes, and this association was noted only when potassium levels were <3.0 mmol/L.

hypokalemia is not good and certainly not hypokalemia < 3.0 but its not the proarrhythmic effects of hypokalemia that is bad it is the acute illness it is the under lying reason the patient has a potassium of less than 3.

https://www.acpjournals.org/doi/10.7326/M23-3225

researchers randomized 160 patients with mostly unilateral hip OA to two 60-minute sessions weekly for 12 weeks,

you were randomized to receive either neuromuscular exercise (NEMEX; focusing on postural and functional stability) or progressive resistance training (PRT; focusing on muscle strength).

 primary outcome was the “chair stand test,” in which patients go from sitting to standing as many times as possible within 30 seconds. At 12 weeks, this outcome did not differ between the NEMEX and PRT groups; mean improvement in both groups was 1.5 repetitions (from a baseline of ≈11.5 repetitions).

1.5 repetitions did not meet anyones expections or criteria for clinically meaningful improvement.

adult smokers who are given e-cigarettes are significantly more likely to be abstinent at 6 months from a target quit date with a  (NNT = 8) but those individuals were not more likely to be abstinent from any nicotine product. In this study, the cost of e-cigarettes was paid by the study, so in the real world where patients have to buy their own e-cigarettes the results may be less favorable. The best nicotine replacement is the one the patient will actually use as the nnt is around 10 give or take for all of them.



https://pubmed.ncbi.nlm.nih.gov/38354139/

However, screening is not recommended because it has not been shown to improve patient outcomes.. 

Lifestyle recommendations include moderating alcohol use, quitting smoking, exercising, and losing weight if obese. Good news: Coffee need not be restricted.

The authors recommend using a risk score such as CHADS2-VASC to determine the patient’s risk of stroke; if the annual risk of stroke is between 1% and 2% anticoagulation should be considered, and if the annual risk of stroke is greater than 2% then anticoagulation is strongly recommended.

For patients who are low risk (< 1%) — for example, younger than 65 years and without any risk factors for stroke — anticoagulation is not recommended. The guidelines also do not recommend aspirin or aspirin plus clopidogrel for these patients unless there is another indication, such as coronary heart disease. 

 With regard to the choice of anticoagulant, a standard dose of a direct oral anticoagulant (DOAC) is recommended over vitamin K antagonists like warfarin. The exceptions are patients who those with moderate to several mitral stenosis, and those with a mechanical heart valve.

https://journals.lww.com/ajg/fulltext/2024/03000/american_college_of_gastroenterology_guidelines_.14.aspx


2 of the 3 following criteria: (i) abdominal pain consistent with the disease, (ii) serum amylase and/or lipase greater than 3 times the upper limit of normal, and/or (iii) characteristic findings from abdominal imaging 



Fluid--

• Moderately aggressive fluid resuscitation with lactated Ringer's solution should be started (NEJM JW Gen Med Oct 1 2023 and Am J Gastroenterol 2023; 118:2258), defined as a bolus of 10 mL/kg followed by infusion of 1.5 mL/kg/hour (NEJM JW Gen Med Oct 15 2022 and N Engl J Med 2022; 387:989), and additional boluses can be given if a patient has evidence of hypovolemia.

Feeding-- Early oral feeding (within 24–48 hours) should begin with a low-fat solid diet (as opposed to liquid) for patients with mild AP.

Surgery-

 Patients with mild acute biliary pancreatitis should undergo cholecystectomy early, preferably before discharge.

•  Following a second episode of AP with no identifiable cause, in patients fit for surgery, we suggest performing a cholecystectomy to reduce the risk of recurrent episodes of AP.