Staying #Up2Date 🚨

1: Less Face Time, Fewer Antibiotics

A cross-sectional study of 694 pediatric and family medicine care clinics evaluated the differences in antibiotic management for pediatric acute respiratory tract infections at in-person visits vs telemedicine. For primary care telemedicine visits, antibiotic prescriptions were given in 34.6% of visits, compared to 46.8% of primary care in-person visits. Additionally, children with respiratory tract infections followed via telemedicine visits did not require increased follow-up visits for subsequent antibiotic prescriptions, meaning that the online option may be a strategy for better antimicrobial stewardship. 

2: Steroids Take the Sting Out of Tonsillectomy 

An RCT of 209 children undergoing adenotonsillectomy found that a post-operative course of oral dexamethasone reduces pain compared to a placebo. The steroid group also saw a considerable reduction in postoperative opioid prescription and no increase in complications. These results support steroids for sweet relief after surgery.

3: CGM: One Size Doesn’t Fit All

A review of randomized trials and clinical guidelines evaluating continuous glucose monitor (CGM) use beyond type 1 diabetes found that CGM use was associated with a modest yet consistent reduction in HbA1c (roughly 0.3%) when compared to finger-stick monitoring in adults with type 2 diabetes. These findings show that CGM should be deployed in response to a specific patient problem rather than default intervention in those with type 2 diabetes. 

Course of the Week 📚

When is virtual cancer care the right call?

Virtual care is here to stay, but in oncology, knowing when a screen is enough and when a patient needs to be in the room matters.

This free, 30-minute CME gives physicians practical strategies for making virtual cancer care work better. You’ll learn how to identify which oncology scenarios are appropriate for visits, communicate effectively through a screen or phone, and tackle barriers that can leave some patients behind.

What you’ll get:

• 4 short video lectures

• 2 interactive quizzes

• 0.5 Mainpro+® credits

The course also explores how virtual care can better serve older adults, rural and remote patients, and other populations facing barriers to care.

30 minutes. Practical takeaways. Better virtual visits.

👉 Take the free course

A Smaller Door to the Same Heart🫀

Cardiac surgery asks: why break down a door when you can slide through a window?

What happened: A Canadian-led study proves that minimally invasive cardiac surgery is possible.

Why it matters: Bypass surgery is the most common heart surgery in the world, with about 15,000 Canadians undergoing the procedure each year. This study is the first randomized clinical trial to compare minimally invasive coronary artery bypass surgery (MICS CABG) with conventional bypass surgery in patients with multivessel coronary artery disease. Patients who underwent the less invasive procedure regained physical function faster in the first month after surgery, measured by a standard recovery score, and also needed fewer blood transfusions and spent less time on bypass.. 

During a randomized trial of 170 bypass patients, a surgical team performed both types of heart surgery. Instead of opening a patient’s chest through the breastbone, the less invasive procedure uses a 5- to 7-cm incision on the side of the chest, leaving a small scar. Patients who underwent this surgery needed fewer blood transfusions and spent less time on breathing machines. 

But: After 1 year, safety outcomes and overall pain levels evened out between the 2 groups, so the early recovery edge didn’t translate into a permanent gap. Some questions still linger, like long-term effects and healing, but the surgery does show that less invasive options are possible. That’s promising enough that The University of Ottawa Heart Institute says it’s committed to training other surgeons from all around the world on how to perform minimally invasive heart surgeries.

Bottom line: Minimally invasive surgeries are not new, with procedures like laparoscopic cholecystectomies and other types of general surgery taking centre stage for years. Cardiac surgery has been slower to catch up, largely because the heart leaves less room for error. This trial suggests that gap is starting to close, and as more surgeons train in the technique, minimally invasive bypass may become less of an exception and more of a standard option.

Hot Off The Press 🔥

1: 💊 A vaccine just did what a century of shigella research couldn’t: WRSs2, a live-attenuated oral vaccine, posted 89% efficacy against shigellosis in a phase 2 human challenge trial, with only 3 of 34 vaccinated participants developing shigellosis versus 21 of 26 on placebo after deliberate S. sonnei exposure. The trial wasn’t entirely clean, with 6 participants experiencing grade 3 adverse events, and next up is testing in the kids who actually bear the brunt of the disease, since these results came from healthy US adults rather than the low-income settings where shigella does its worst damage,

2: 🦠 Don’t panic — you haven’t time-travelled to 2020. And yet COVID is back in the news to reveal some truth about its origins: we’ll probably never know it. A Senate panel voted to hold former US chief medical adviser Anthony Fauci in contempt of Congress after he pled the 5th more than 100 times during questioning about the pandemic response. Meanwhile, former US COVID-19 response coordinator Ashish Jha freely offered his take: “Here’s the truth: no one in America knows for sure,” and, “I think lab leak is much more likely.” But every theory remains unproven, and no first case has been identified. Don’t expect any satisfying answers to come out of this. Maybe just some nightmarish flashbacks of home-baked bread.

3: 🧪 An Ontario trial, PROMPT-LTC, found that rapid on-site testing at long-term care homes could prevent 8,000 ER visits across Canada every year. 10 Ontario-area homes got on-site PCR testing for COVID, flu, and RSV with 35-minute results, versus 3 to 7 days at standard off-site labs, resulting in an 11% drop in ER transfers overall and a 28% drop in transfers or deaths per 100 beds during peak RSV season. Outbreak sizes didn’t budge, but that’s likely because rapid-testing homes tested more than twice as often, catching milder cases the standard-testing homes were missing entirely.

4: 🥵 💦 Researchers may finally have something more satisfying than “overactive sweat glands” for some hyperhidrosis patients. New data links a subset of inherited cases to rare variants in SCN10A, a gene involved in the nerve signalling that controls sweating. They reproduced excessive sweating by putting one of the mutations into mice, then reducing it with sodium-channel inhibitors. It’s still early, but this knowledge could lead to a targeted treatment, rather than suppressing the symptoms with antiperspirants, Botox, and a duffel bag full of dry undershirts.

5: ⌚️ Smart TVs and phones that listen, laptops that see — those are the usual suspects of security precautions. But it seems there’s nothing hackers can’t infiltrate, because a recent WIRED report showed how even a $30 kids’ GPS watch can become a surveillance device. A reporter wore the watch to work while researchers took it over remotely, tracking, listening, and silently taking his picture. They also found that tens of millions of devices ultimately came from just 3 major underlying supply chains/platforms. Apparently, when it comes to choosing GPS devices, having a sense of choice makes… little sense. Still, maybe go update your Apple Watch.

Notable Numbers 🔢

16: the number of AI-designed viruses that actually worked, out of 300 Stanford scientists built with a model called EVO 2 to hunt E. coli, each far leaner than nature’s version (about 6,500 units of genetic code vs. 50,000+). The pitch: new antibiotics take $2B and 10 years, this could take hours, though critics warn the safety rules haven’t caught up to the tech yet.

$50,000: the price tag on a private island for sale in Quebec, up 285% from the $13,000 the current owners paid just 3 years ago. The 10,000-square-foot spit of rock and shrub shifts size with the water level, and building on it is basically off the table. Still, the broker says he’s already fielding several offers.

9: how many 12-inch stone-fired pizzas on the menu at a full micropizzeria run out of the trunk of a Smart car. The setup swaps the usual roadside kit for olive oil, sauce, and cheese, runs mini ovens off a portable generator, and skips the $8,000-to-$20,000-a-month storefront rent in favour of chasing foot traffic street corner by street corner.

Postcall Picks ✅

🦞 Visit: Oscar, Dalhousie’s 1-in-50-million, half-blue, half-orange lobster, now on display at the Beaty Centre for Marine Biodiversity in Halifax. His two-toned colouring is genetic, so it grows back with every new shell. When was the last time you saw a genetic chimera up close?

🧪 Track: Ottawa’s announcement awarding a $10.2M design contract for a brand-new $267M Medical Countermeasures Laboratory in Winnipeg. Co-located with the National Microbiology Lab, it will focus on preclinical research into experimental vaccines and therapeutics for future pandemics.

🧬 Note: Health Canada’s milestone decision to drop all remaining sexual behaviour screening questions for sperm donors. The decision eliminates the final systemic barriers that previously restricted gay and bisexual men from donating.

🛞 Save: on your pre-winter routine. Canadian Tire has Michelin X-Ice Snow winter tires on clearance. Getting ahead of snow season means shorter waits at the garage and extra cash left in your pocket

🎬 Watch: how your brain turns moments into permanent physical structures. The video breaks down the cellular mechanics of memory formation with gorgeous visuals that make neurobiology surprisingly soothing.

Relax 🧩

First clue: IM injection

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Need a rematch? We’ve got you covered. Check out our Crossword Archive to find every puzzle we’ve ever made, all in one place.

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Meme of the Week 😂

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