💊Trump, 🌬️Asthma and 💣A Bomb Fetish?

WHAT’S. THAT. COMING OVER THE HILL?
IS IT THE MED NEWS?
IT’S THE MED NEWSSSS
(Yes, it’s increasingly clear we’re running out of ideas for these intros)

👋 Happy Friday. Here’s what we got:

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

Join me for a trip down memory lane.

In yesteryear (2018), humankind was distinctly divided into two parties.
Those with asthma, and those without.

If you were lucky, a simple blue cap inhaler would allow you to blend in with wider society.
But if that didn’t do the trick, you were cast out.
Condemned.
Separated from the healthy and the normal.
Escorted to a dingy side room called Allergy Clinic - a sort of pathway purgatory. 

And there, your pilgrimage began.
Through the 7 Circles of Hell, politely referred to by NICE as: The chronic asthma management pathway.

Every time you coughed, wheezed or fell short of breath, you were labelled uncontrolled.
Circle 1: SABA
Circle 2: SABA + ICS
Circle 3: SABA + ICS + LTRA
Circle 4: SABA + ICS + LABA +/- LTRA
On and on and on. Deeper in the belly of the beast. 

But one day, a saviour emerged.
Not from a stable in Bethlehem but instead from the front pages of NEJM…
The SYGMA trials.

In this multinational, phase 3 double-blind RCT, these researchers asked if there was a better way…

The trial aimed to determine if MART therapy(ICS/LABA) was more effective at controlling asthma than standard SABA or SABA + ICS management.

3,849 patients aged 12+ with mild asthma were randomly assigned to one of three groups:

Then these patients were followed for 52 weeks (that’s one year).

The primary outcome?
Simply: Out of 52, how many weeks were truly well-controlled? No symptoms, no exacerbations, no descent into the next circle.

And what did they find?

Ultimately, severe exacerbations were significantly lower in the MART group compared to SABA alone. 

And with that, the covenant was broken. The Gates of Wheeze Hell were permanently closed. 

This evidence led GINA (Global Initiative for Asthma) to fundamentally change recommendations in 2019, moving from the old stepwise approach to the new and improved MART pathway:

Circle 1: ICS Maintenance
Circle 2: Low Dose MART
Circle 3: Moderate Dose MART
Circle 4: Send em’ to the specialists 
Simple as can be.

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Between you and me… The prescribing guidelines are confusing ASF. 

“It’s so simple though, everything is there”

Oh yes. I see it 🧐
Just prescribe it once daily in the morning. Easy 👍
Oh… also:

It feels like every damn medication requires 6-Factor-Authentication before being given to patients. Prescribing shouldn’t feel like defusing a bomb

Thank God for Medwise.ai

It’s kinda like ChatGPT…but actually trained on NICE CKS, MHRA, Royal College and Society guidelines and all the good stuff you’re supposed to know but can never remember when you’re bleeped mid-cannula.

You get instant, accurate, evidence-based answers.
No more guideline trawling.
No more second-guessing.

It’s used by over 2,000 NHS organisations.
It’s completely free.
If you’re still not convinced, you get free CPD points just for asking questions too!

Keep up and try Medwise.ai below 👇

Acetaminophen and Autism. 
Are they linked?  

Famous women's rights activist and renowned researcher Donald Trump seems to think so. 

After sagely advising his citizens to inject bleach to cure COVID, he took a brave stance last September against the only painkiller licensed in pregnancy.

In an eloquent and compelling speech, he proclaimed, “Tylenol is not good. All right, I’ll say it; it’s not good,” and then went on to mispronounce acetaminophen three times. 

His confidence? Unparalleled. 
His evidence? Non-existent. 

Despite decades of safe paracetamol use in pregnancy, claims made by the US president (no matter how absurd) will have people listening. 

Even with endorsements from the American College of Obstetricians and Gynaecologists and the UK RCOG, paracetamol is becoming increasingly vilified thanks to the presidential indictment.

So how can we shore up our pro-pregnancy-paracetamol evidence base?

Enter The Lancet (a journal famous for taking great care to peer review any claims about autism 👀)

They carried out a systematic review and meta-analysis investigating associations between prenatal paracetamol exposure and:

Here’s what they did:

Sibling-comparison data alone included ~262,000 children for ASD outcomes, ~335,000 for ADHD, and ~406,000 for intellectual disability. That’s a lotta kids. 

(Added bonus: siblings are largely controlled for shared genetic and familial environmental factors. duh.)

And the million-dollar question … is there a link?!

Across multiple analytical approaches, there was no evidence of a causal link between prenatal paracetamol use and risk of autism, ADHD or intellectual disability. 

Sibling-comparison analyses:

Earlier weak associations seen in a handful of observational studies disappeared once more rigorous methods were used. Which suggests they were probably due to confounding factors and the overall poor quality of research. Rather than paracetamol itself.

But we all know Trump is self-interested.
Who cares if he goes around spouting medical nonsense sometimes? 

We all should.
Paracetamol remains the first-line analgesic AND antipyretic for pregnancy globally.

Mothers suffering unneeded pain is a terrible consequence of such widespread misinformation. Untreated maternal fever is associated with miscarriage, preterm birth and adverse foetal outcomes. 

Discouraging safe paracetamol use is therefore actively harmful to the pregnant population.

So the tea this week ☕: 
Paracetamol remains safe in pregnancy, and Trump remains… well… Trump.

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✅Strike Mandate Extended 

There's no letting up, huh? That’s the way to go, guys✊. A whopping 93.4% of Resident BMA members have voted to keep the strike party going. Extending the mandate for a further 6 months. 

Whilst extending the mandate doesn’t necessarily guarantee more industrial action, it will keep the pressure on the Gov to bring us closer to full pay restorations.

Speaking of which, a little birdie(The Guardian) has informed me(and anyone who reads The Guardian) that a cheeky 5% uplift could be on the cards. Let’s wait and see if there's any truth to it 👀

🦠Nipha Virus: Pandemic 2.0%?

There are 3 things guaranteed in life: Death, Billionaires exposed in the Esptein and a virus every 5 years that threatens to put the world into complete lockdown. 

This time round, it’s the Nipah Virus. A virus with a 40-70% fatality rate. No treatment, no prevention.
Whilst it’s more likely to take the course of Ebola rather than COVID-19, it’s worth knowing about. Full article on it coming next week 💯

🩸Smear No More

Everyone hates the feeling of getting older...once you hit 25, a hangover feels like death. That 25-milestone is even scarier for women because it's time to receive that dreaded NHS letter..."To whom this may concern, your swab time has come!"

But researchers from Wuhan University might've found a less invasive alternative:
HPV testing using menstrual blood. They developed a 'minipad' that sticks onto your regular pad and collects a sample, no stirrups or speculum required.

In a study of 3,000+ women, the minipad method detected high-grade cervical lesions with 94.7% sensitivity and 89.1% specificity, which matches smear tests in accuracy, with both hitting 99.9% for ruling out HPV.

The future is bright and Specul-less.

💣And A Bomb Up The Bum

Yes, you read that right. A patient presented to a hospital in France with a bomb lodged in their bottom. Not in a terrorist kinda way, but in a kinky kinda way.
A World War I shell at that! I mean, each to their own i guess…

At The Handover, we listen, we don’t judge 😌

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