😨🔪 A Handovian Horror Story

Running into Pennywise in your nightmares? That’s proper scary.
Asking microbiology for advice? Scarier yet.
But the scariest thing of all...
is a Friday without medical news 😨

I’ll spare you the fright. 👋 Happy(Halloween) Friday.

Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

First case of the day…

Crushing chest pain. SoB. More sweat than Matt Hancock after that footage leak.
Textbook. You know this condition like the back of your hand. 
It’s obviously a heart attack.

Troponin off the charts. ECG with clear ST elevation. This is bread and butter. 

Morphine ✅Oxygen ✅GTN ✅Aspirin ✅

Scrub in. Contrast in. Angiogram takes the snap. Let’s find this blockage. 

…

There is none. 

You scrutinise that scan. Double check. Triple check.
You’re perplexed. Every blood vessel is as wide as the Grand Canyon.

Your consultant whispers in your ear.

It’s MINOCA…

Umm, Wtf is that? It’s definitely not in the PassMed High-Yield textbook. 
Which is strange since it accounts for 10% of all acute heart attacks

MICONA stands for Myocardial Infarction with Non-Obstructive Coronary Arteries. In other words, a Myocardial infarction with no proper infarction.
How does that work?

Hard to say 🤔the literature has been a bit confused. Lots of theories. No consensus. So no one really knew how to treat it or whether they even should.

Until now.

As the Heart BMJ has released a meta-analysis and systematic review. 

The aim being to see what multiple studies have said about MINOCA.

It's causes, its outcomes, and most importantly, what advanced imaging (like ICA, OCT, and vasospasm testing) can reveal about this mysterious condition.

The PROSPERO study analysed 45 RCTs, including 17,539 patients.

This analysis focused on:

What did they find?

More interestingly, this seems to have a significant impact on morbidity & mortality:

At 1 Year, NObs-CA patients were 1.5x more likely to experience the combined outcome of death or another heart attack(95% CI 1.17 to 1.90) - though deaths alone were insignificant. This was also true over a longer time horizon of 2-10 years.

What does this all mean?

Well. Firstly, you actually know what MINOCA is now.
Second, stratification of MINOCA according to presence or absence of NObs-CA can actually impact whether you’ll see that patient in a year for round 2… but this time with a real myocardial infarction. 

Study authors suggest OCT and vasospasm should be included in the standard MINOCA algorithm to enable new targeted therapy strategies.

So next time, a simple STEMI turns complex.
Remember the myth of MINOCA…

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It really is that damn phone.

No, don't roll your eyes at me. And don’t even think about closing this email and scurrying over to whichever doomscroll app you insta-open whenever you sit on the loo.

Let’s face it. You’re addicted. I’m addicted. And now the kids are addicted. 

Toddlers hooked on Roblox before they can scribble.
Kids plugging homework straight into ChatGPT.
11-year-olds skipping Claire's and beelining to Sephora. 

So yeah, today’s children are about as fried as their parents. So what? 

Well, the longer we all prance around glued to our little blue light boxes, the more research makes it crystal clear it’s really, really not fantastic for our wellbeing. 

You know that groggy, slightly ashamed feeling when you finally pry yourself away from a 3-hour social media haze? The twitching eyes, buzzing skull, slight existential dread? 

Now imagine being ten, with only a half-baked brain, and bombarding it like that. Every. Day. Ouch. 

A new JAMA paper asked: Does more screen time in older kids lead to more depression? (Try to guess the answer - difficulty level: impossible.)

Here’s what they did:

And here’s the headline: 

Every additional hour of daily screen time at baseline was associated with less sleep AND an average 0.12 point increase in depressive score after two years (95% CI, 0.04-0.20, p =.008)

Additionally:

Caveats to consider: Screen time was self-reported (10-year-old me was definitely NOT forthcoming about the 10 hours of Minecraft PE I played every day).

Plus, observational data can’t prove one-way causality. Kids who are already low might seek more screens, ie, a bidirectional relationship.

So what do we do? In a nutshell:

^^^

The bottom line is pretty clear. And most of us probably knew that already. 

But the more the crappy effects of screens are proven in the literature, the more seriously we have to take precautions to protect tiny humans still in development. 

Consistent bedtimes, removing devices from bedrooms, evening wind-down routines - anything that could help them switch off and unplug. 

And it ain’t just the kids. You should maybe consider it too.
(After, of course, reading the full Handover, voting in the poll and forwarding this to one friend 🙏)

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Cure For The Incurable: “Bubble Boy” Gene Therapy 🫧
This one is pretty remarkable. There is a curative treatment for Severe Combined Immunodeficiency (SCID), nicknamed “bubble boy” disease(these kids had to live in plastic bags to avoid infection). This study follows treatment with a gene-corrected haematopoietic stem cell transplant. After 11 years, survival was 100%... a condition whose life expectancy used to be just 2 years. 

Wanna Strike? There Goes Your Job Buddy
The Health Sec’s cycle of confusion continues… let's try and make sense of this. The UK has a doctor shortage => Gov artificially restricts job postings => doctors get upset about lack of jobs => public gets upset about lack of doctors => Doctors go on strike => threaten doctors with even fewer jobs if they do strike 👍. This pretty much goes against everything in the Motivational Interviewing markscheme Wes. Using 1000 new training posts as a bargaining chip doesn’t tend to go down well, sir. 

Morning After Pill Free For All💊
Described as “the biggest change to sexual health services since the 1960s,” emergency contraception will soon be available for free from over 10,000 pharmacies–no GP appointment required. Massive news for the ten handover readers who actually get some. Even bigger news for Sexual Health clinicians who will surely see an uptick in STI-related appointments(keep the cryo guns on standby 💯)

Rapid Blood Test For Paediatric Sepsis🧛
A new test is being trialled to help determine whether a serious infection is bacterial or viral – without having to chase a vein in a wriggly 6-year-old, then do the classic sprint to the labs. It uses fingerprick samples to check levels of CRP, IP-10, and TRAIL, then runs them through a machine-learning algorithm to give you an answer in just 15 minutes. Which is great, till you realise you’re starting SEPSIS-6 anyway. So whether this actually changes anything… We’ll see.

Insidious: The Pancreatic Cancer Breath Test🫥
There is no cancer quite like pancreatic cancer. It’s as insidious as it comes. Super vague symptoms, then BAM — painless jaundice. Sadly, 80% of cases are too late, hence the high mortality. The people of Imperial have developed a test that measures volatile organic compounds(VOCs) present in breath. This differs in those with and without cancer + can even determine the stage of cancer too. After an initial trial, 40 sites around England, including 6000+ patients, will assess the effectiveness of this test. Great news. To Hell with Pancreatic Cancer!

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