Medical Bulletin 12/April/2023

Here are the top medical news for the day:

Pitt study shows mint flavor vape juice to be more toxic for lungs

Using a specially designed robotic system that mimics the mechanics of human breathing and vaping behavior, researchers showed that commercially available e-cigarette liquids containing menthol generate a greater number of toxic microparticles compared to menthol-free juice. An accompanying analysis of patient records from a cohort of e-cigarette smokers revealed that menthol vapers took shallower breaths and had poorer lung function compared to non-menthol smokers regardless of age, gender, race, pack-years of smoking and the use of nicotine or cannabis-containing vaping products.

“Many people, especially youth, erroneously assume that vaping is safe, but even nicotine-free vaping mixtures contain many compounds that can potentially damage the lungs,” said senior author Kambez H. Benam, D.Phil., associate professor in the Division of Pulmonary, Allergy and Critical Care Medicine at the University of Pittsburgh School of Medicine. “Just because something is safe to consume as food does not mean that it’s safe to inhale.”

Reference:

Electronic cigarette menthol flavoring is associated with increased inhaled micro and sub‑micron particles and worse lung function in combustion cigarette smokers,Respiratory Research,doi 10.1186/s12931-023-02410-9

Study finds parathyroidectomy not effective on kidney function in older adults with hyperparathyroidism

Primary hyperparathyroidism is a common endocrine disorder associated with an increased risk for chronic kidney disease (CKD). The only treatment is surgical removal of one or more abnormal parathyroid glands (parathyroidectomy). Current guidelines recommend parathyroidectomy in patients with primary hyperparathyroidism and CKD, in part to mitigate the risk for and effects of CKD progression. However, there are limited data documenting the association of parathyroidectomy with long-term kidney function to support this recommendation.

An emulated randomized trial performed using observational data from more than 43,000 adults with primary hyperparathyroidism found that parathyroidectomy had no estimated effect on long-term kidney function in older adults when compared to observation. However, early parathyroidectomy may preserve kidney function in patients younger than 60 years of age with primary hyperparathyroidism. The study is published in Annals of Internal Medicine.

Reference:

AMERICAN COLLEGE OF PHYSICIANS,Annals of Internal Medicine, DOI10.7326/M22-2222

Novel primary care model proves effective for patients with severe mental illness

Cardiometabolic health conditions - such as high blood pressure, diabetes, and heart attacks - are more common in American adults with serious mental illness than the general population. With 14.2 million adults living with a serious mental illness, this represents a major challenge that the United States healthcare system must face head-on.

Over the past few years, the Department of Family Medicine and the Department of Psychiatry in UNC’s School of Medicine have been working together to spearhead the development of a new “enhanced primary care” model to provide better primary care for patients who have severe mental illnesses.

Reference:

Enhanced Primary Care for People With Serious Mental Illness: A Propensity Weighted Cohort Study,Journal of Clinical Psychiatry,doi 10.4088/JCP.22m14496

Immunotherapy response in advanced melanoma influenced by prior treatments: Study 

When a patient is diagnosed with advanced melanoma, they usually are treated with immune therapies like anti-PD-1 blockade and anti-CTLA-4 blockade, in combination or alone. By blocking different proteins that diminish the effectiveness of T cells, these checkpoint inhibitors enhance the body’s immune response to cancer.

Research led by scientists at UCLA Jonsson Comprehensive Cancer Center found that responses to a type of immunotherapy called PD-1 checkpoint blockade in patients with advanced melanoma depended on whether or not they had previously received another immunotherapy - CTLA-4 blockade - as well as other factors.

Their findings, based on analysis of seven data sets generated over the past decade, which included results of tumor biopsies from more than 500 patients, are published in Cancer Cell.

Reference:

Katie Campbell et al, Prior anti-CTLA-4 therapy impacts molecular characteristics associated with anti-PD-1 response in advanced melanoma, Cancer Cell, Volume 41, Issue 4, 10 April 2023, Pages 791-806.e4, DOI: 10.1016/j.ccell.2023.03.010