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Morning Rounds Shraddha Chakradhar

No more active cases of measles in N.Y. from recent outbreaks

New York state just announced that there are no longer any active cases of measles there associated with two outbreaks that began last October. The last two counties in New York with active cases — Orange and Sullivan — just passed the 42-day mark without a case, or the equivalent of two incubation periods. Rockland County, N.Y., met this milestone last week and New York City, where the outbreak was largely concentrated in Brooklyn, declared its measles outbreak over at the beginning of September. Yesterday’s news also means that the U.S. is likely to maintain its measles elimination status, which was under threat given the length of the New York measles outbreaks. So far this year, more than 1,200 people in the U.S. contracted the disease, the greatest number of cases since 1992.

Flavored e-cigarettes are growing in popularity among students



New data from the CDC add to the evidence that flavored e-cigarettes are increasingly popular among youths. Two-thirds of high school and middle school students who are tobacco users said they also used a flavored product in the month prior to being surveyed. Around 65% of high schoolers in 2014 reported using flavored e-cigarettes, but that rose to nearly 68% last year. Among middle schoolers, those figures went from around 40% in 2015 to 52% in 2018. 

In more e-cigarette news, the Federal Trade Commission yesterday sent letters to six vaping companies, including Juul, seeking information about their advertising and promotional methods. The CDC also issued updated figures for vaping-related illnesses: There are 1,080 confirmed and probable cases in 48 states and the U.S. Virgin Islands, and 18 people have died. 

U.K. restricts export of drugs in short supply

In an effort to address ongoing shortages of some essential medicines, the U.K.’s Department of Health and Social Care yesterday published a list of drugs whose export will be limited. The list contains 24 drugs, including hormone therapy drugs and hepatitis B vaccines. In an accompanying letter to wholesalers, the department also said that these sellers were also not allowed to hoard supplies of any drug on the list. The new guidance is not directly related to Brexit — which is still scheduled for Oct. 31 — but that event is also expected to bring drug shortages. These restrictions, however, are seen as a precedent to how the government may address Brexit-related changes to medical supplies. 

Inside STAT: Tumors in a dish help personalize pancreatic cancer therapy 


Each spherical or odd shaped structure is a tumor organoid. (MUTHUSWAMY LAB/BETH ISRAEL DEACONESS MEDICAL CENTER)

Only 15% of pancreatic cancer patients are alive two years after their diagnosis, and 54-year-old Margaret Schwarzhans is among them. She’s not only made it 2 1/2 years following her diagnosis, but has thrived, which she partially credits to her mental state. Beyond the regular yoga and smattering of inspirational quotes around her house, Schwarzhans’ success can also be traced back to an experimental trial, one where her tumor cells are grown in a lab dish and dosed with different drugs to see which ones are most likely to have an effect on her cancer. Although most other patients will have to wait until Phase 2 of the trial to let the lab experiments guide their treatment, Schwarzhans is among the first to already have her physician try this approach. STAT contributor Karen Weintraub has more here.  

Gender-affirming surgery could help reduce mental health problems among trans people

Transgender individuals are more likely to experience mental health problems than those who are cisgender. And new research suggests that gender-affirming surgery can provide long-term benefits to help with the dysphoria some experience. Data from a Swedish population registry revealed that, compared to the general population, those who had been diagnosed with gender incongruence were more than six times as likely to have been hospitalized following a suicide attempt, and more than three times as likely to have been prescribed antidepressants. At the same time, the chance of receiving mental health treatment went down by 8% for every year following gender-affirming surgery among those who underwent the procedure. Although this is only an association, it “supports policies that provide gender-affirming surgeries to transgender individuals who seek such treatments,” the authors write. 

Genetic testing of women with breast cancer may be cost-effective

Testing all women with breast cancer for underlying genetic factors — regardless of family history — may be cost-effective. Only 30% of patients currently get tested, and regular testing could help identify factors that could also help relatives. Data from nearly 12,000 women with breast cancer was used to simulate one of two situations: Testing for three different breast cancer genes regardless of family history or clinical criteria, or testing only if they had a history and met certain criteria. Multigene testing regardless of background was cost-effective for nearly all health care simulations in the U.K. and for about two-thirds of simulations in the U.S. Moreover, the simulations revealed that, in one year, such a test could prevent more than 2,100 breast and ovarian cancer cases in the U.K., and nearly 10,000 cases in the U.S. 

What to read around the web today

  • “It’s very unethical”: Audio shows hospital kept vegetative patient on life support to boost survival rates. ProPublica
  • Trump implies drug industry is behind impeachment. STAT
  • Why lifesaving drugs may be missing on your next flight. The New York Times
  • HIV cases soar in the Philippines, as dating apps spread. The Wall Street Journal
  • Congress just quietly passed a bill that will cost drug makers $3 billion. STAT Plus

Have a nice weekend! My colleague Andrew Joseph will be filling in for me Monday and Tuesday, and I'll be back Wednesday! 

Shraddha

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Friday, October 4, 2019

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