Latest / Morning Medical with Dr. Chow / New Cardiovascular Guidelines, EBCare Mask, and Whooping Cough Surge in Canada

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New Cardiovascular Guidelines, EBCare Mask, and Whooping Cough Surge in Canada · Morning Medical with Dr. Chow

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Good morning, everyone, and welcome to another episode of Morning Medical with Dr.
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Chow.
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I’m your host, Dr.
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Chi-Ming Chow.
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Today, we’ve got a lot of exciting updates to cover in the world of medical and health news.
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Let’s dive right in!
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Our first story today comes from the European Society of Cardiology meeting, where new
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guidelines have been announced to streamline the management of several cardiovascular
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conditions.
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These guidelines cover atrial fibrillation, chronic coronary disease, peripheral artery
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disease, aortic disease, and hypertension.
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The focus is on simplifying recommendations and emphasizing shared decision-making between the
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healthcare provider and the patient.
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Dr.
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Roxana Mehran from the Icahn School of Medicine at Mount Sinai in New York City commented on
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the updates, saying, 'There’s so much undertreatment in atrial fibrillation,
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peripheral artery disease, and even with chronic coronary syndromes.
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I think simplifying things and bringing it to a point of allowing us to make diagnosis easier
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and to move ahead and maybe be more aggressive on our medical management of these patients,
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I’m really pleased to see those changes.'
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Let’s start by discussing the updates on chronic coronary syndromes.
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The new guidelines introduce a redefined understanding of chronic coronary syndromes,
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shifting from the older concept of stenosis causing myocardial ischemia to a more dynamic
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one.
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Now, coronary microvascular dysfunction, alongside stenosis in the epicardial coronary
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artery and vasomotor disturbances, is recognized as contributing to myocardial
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ischemia and chronic coronary syndromes.
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Dr.
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Christiaan Vrints from Antwerp University Hospital in Belgium, who co-chaired the
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guideline, explained that these mechanisms are present in many patients, even if they seem
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rare.
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A significant change in the guidelines is the introduction of a new risk factor-weighted
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likelihood model for pretest probability of obstructive coronary artery disease.
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This new model replaces the previous one that often overestimated risk, thereby avoiding
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unnecessary additional testing for many patients.
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Exercise testing is now recommended only for assessing prognosis and adjusting likelihood,
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rather than for diagnosis.
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Dr.
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Mehran pointed out that she was particularly excited about the new class 1 recommendations
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for intravascular imaging and physiology.
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She noted that United States guidelines still don’t have class 1 recommendations for these
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areas, but she hopes that will change soon.
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For patients without obstructive disease, the guidelines suggest considering angina or
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ischemia with non-obstructive coronary arteries.
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The guidelines also update antithrombotic therapy recommendations.
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Now, combining aspirin with a strong P2Y twelve inhibitor is advised for certain
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high-thrombotic-risk conditions like left main bifurcation, chronic total occlusion, and
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genetic prothrombotic genotypes.
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Clopidogrel is now an alternative to aspirin in long-term single-antiplatelet therapy.
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Aspirin is still recommended for patients with significant coronary artery disease, even if
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they don’t have a history of myocardial infarction.
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For those at high bleeding risk, short dual-antiplatelet therapy is recommended.
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In terms of tackling residual risk, the guidelines now point to GLP-1 drugs for
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patients with obesity and colchicine for reducing inflammation.
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Dr.
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Mehran called these updates 'really exciting.'
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Moving on to atrial fibrillation, the new guidelines emphasize integrated care.
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This means treating comorbidities and risk factors in paroxysmal cases before focusing on
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stroke risk reduction.
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The CHA two DS two VASc score now has a class 1 recommendation for selecting patients for
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anticoagulation, and the guidelines advise against using a bleeding risk score to start or
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withdraw anticoagulation.
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For treatment, ablation is now recommended as the first line in paroxysmal atrial
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fibrillation.
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Endoscopic or hybrid treatments have a class IIa recommendation for persistent atrial
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fibrillation despite antiarrhythmic drug use.
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The guidelines also stress the importance of dynamically reassessing patients, which could
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be as simple as adjusting the dose of a direct oral anticoagulant after resolving an acute
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kidney injury.
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The ESC combined guidelines for peripheral artery disease and aortic diseases for the
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first time, highlighting that these conditions are part of one unique vascular system.
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Dr.
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Lucia Mazzolai from Lausanne University Hospital in Switzerland, who chaired the
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guideline, mentioned that the new classification simplifies PAD into three
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clinical presentation groups: asymptomatic, symptomatic with exertion, and chronic
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limb-threatening ischemia.
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A new recommendation advises against revascularization for asymptomatic PAD.
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For symptomatic cases, revascularization is recommended only after a period of supervised
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exercise training and optimal medical therapy, and in a multidisciplinary setting.
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The guidelines also call for at least annual follow-up for PAD patients and introduce
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standardized measurements and nomenclature for aortic disease.
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Dr.
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José F.
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Rodríguez-Palomares from Universitat Autònoma de Barcelona, the co-chair of the guideline,
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emphasized the importance of using consistent nomenclature and measurement methodologies for
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aortic disease.
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This will ensure better communication and more accurate decision-making based on the diameter
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in specific regions of the aorta.
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For hypertension, the guidelines have been streamlined into three diagnostic categories:
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hypertension, elevated, and non-elevated.
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There’s a new emphasis on out-of-office measurement for both diagnosis and management,
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along with equivalents to in-office measurements.
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Dr.
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Rhian Touyz from McGill University in Montreal, the co-chair of the guideline, highlighted the
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importance of increasing potassium intake for patients with hypertension.
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She noted that the increase should come from sodium-substitution salt and/or a high
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potassium diet such as the DASH diet or the Mediterranean diet.
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In terms of treatment, the guidelines recommend starting with combination therapy for
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hypertension and aiming for a target of 120 to 129 millimeters of mercury within three months.
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If that’s not feasible due to poor tolerance, the goal is to get the blood pressure as low as
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reasonably achievable.
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For resistant hypertension uncontrolled despite medication intensification, renal denervation
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is now an option under shared decision-making and when performed at a medium- to high-volume
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center.
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Our next story takes us into the realm of pulmonology with a fascinating new development
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in wearable health technology.
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Researchers have developed and validated a prototype of a mask-based device designed to
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continuously monitor exhaled breath condensate, or EBC, in pilot studies.
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This innovative device is called the EBCare mask and it looks quite similar to a KF94 mask.
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What sets it apart is its self-cooling strategy, an automated microfluidic system, an
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electrochemical sensor array, and a wireless reading circuit.
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Wei Gao, PhD, from the California Institute of Technology in Pasadena, and his colleagues
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reported this breakthrough in the journal Science.
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Unlike previous smart masks, EBCare provides real-time monitoring of multiple biomarkers
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simultaneously.
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Gao explained that the tandem cooling and bioinspired microfluidic design ensure
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efficient EBC collection and transport, enabling in situ quantitative analysis.
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The integration of highly selective electrochemical biosensors further enhances its
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capability to provide detailed molecular insights that were previously inaccessible with
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other wearable technologies.
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EBC is a noninvasive aqueous matrix in which soluble gaseous and nonvolatile biomarkers can
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be measured.
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Clinically, it is collected with a commercial condenser or condensation instruments, then
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analyzed in a lab using mass spectrometry or photometric assays to assess airway
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inflammation and substance metabolism.
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Traditional EBC capture methods rely on external refrigeration, which can be
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cumbersome, but EBCare uses a passive cooling system to effectively chill exhaled breath.
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Gao noted that the research was motivated by the critical need for comprehensive respiratory
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monitoring, especially in light of recent respiratory pandemics.
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The researchers validated the EBCare in various real-life settings.
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Their pilot studies included 31 healthy adults, 12 people newly recovered from COVID-19, 10
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smokers, 10 people with asthma, and 9 people with chronic obstructive pulmonary disease, or
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COPD.
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Over a span of 14 hours, participants engaged in both indoor and outdoor activities like
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exercise, eating, drinking, office work, and napping, wearing the mask the entire time
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except for short eating periods.
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The results were intriguing.
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After breakfast, ammonium concentration slightly decreased and then increased.
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These levels also rose more substantially after a protein-rich lunch and dinner.
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Alcohol consumption resulted in a rapid elevation of EBC alcohol concentration, and the
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levels were comparable to blood alcohol concentration.
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Patients with airway inflammation, especially those with asthma, had higher nitrite levels
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than controls, suggesting that EBC nitrite may help diagnose, monitor, or manage these
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patients.
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To demonstrate the clinical significance of EBC nitrite in asthma and other respiratory
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diseases, the researchers validated the EBCare sensors against fractional exhaled nitric acid,
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or FeNO, and found a strong correlation between EBC nitrite and FeNO in 31 people.
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Elevated EBC ammonium in COPD patients potentially indicated higher serum urea, and a
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lower EBC pH may be related to airway acidification in asthma patients.
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Gao highlighted that EBCare effectively monitors a range of biomarkers, including
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ammonium, pH, nitrite, and alcohol, across various indoor and outdoor activities.
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This could have significant implications for monitoring respiratory conditions and metabolic
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disorders, as well as in respiratory pandemics like COVID.
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The alcohol metabolism monitoring capabilities could also be used by law enforcement or
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individuals.
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Raed Dweik, MD, chief of the Integrated Hospital Care Institute at the Cleveland Clinic
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in Ohio, remarked that historically, devices to collect EBC have been bulky.
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Collecting the breath condensate in a simple, reproducible, easy, and portable way is novel
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and exciting.
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While there are other ways to measure nitrite, alcohol, ammonia, and pH, Gao and his team
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demonstrated they can measure these biomarkers in EBC, he noted.
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Dweik observed that it is unclear whether EBCare has an immediate clinical application,
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but he sees its potential.
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Future studies will need to determine whether the device helps in diagnosis, monitoring, and
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follow-up, and whether it can measure other biomarkers.
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The researchers aim to expand EBCare's biomarkers and perform more trials to validate
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its use in diverse populations and settings.
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They also hope to further develop the device for affordable mass production and explore the
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possibility of integrated data analytics.
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Whooping cough is making a surge in Canada just as schools are reopening and ahead of the fall
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respiratory illness season.
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Some provinces, including Ontario, Quebec, and New Brunswick, have reported sharp increases in
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whooping cough cases compared to pre-pandemic averages.
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Whooping cough, which is a bacterial illness, can be seasonal, peaking in late summer and
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early fall, according to Dr.
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Anna Banerji, a pediatric infectious diseases specialist in Toronto.
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With kids returning to school, experts warn that cases could rise even higher.
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Dr.
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Banerji explained, 'I think that now that kids are going back to school and some of the kids
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are not completely vaccinated, I expect to see an increase.
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We’ve already had huge numbers, four times the normal rate of whooping cough that we normally
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see across Canada and really around the world, but I think that might even go up as kids go
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back to school.'
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Dr.
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Earl Rubin, a pediatric infectious disease specialist in Montreal, noted that schools can
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play a role in whooping cough spread and 'certainly increase the risks of transmission.'
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Like respiratory viruses such as influenza, respiratory syncytial virus, and COVID-19,
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bacterial infections like whooping cough are more common during the fall and winter months,
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said Dr.
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Isaac Bogoch, an infectious diseases specialist at Toronto General Hospital.
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So, how can you tell the difference between whooping cough and a common cold?
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Whooping cough, also known as pertussis, is a highly contagious respiratory infection.
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The bacteria that cause whooping cough spread easily from person to person through the air,
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according to the United States Centers for Disease Control and Prevention.
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When a person who has whooping cough sneezes or coughs, they can release small particles with
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the bacteria in them, and other people can then breathe in the bacteria.
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Dr.
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Banerji mentioned that a distance of about one meter is enough to get exposed.
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Dr.
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Bogoch pointed out that while whooping cough infection can be more pronounced and severe in
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the youngest population, it can affect people of all ages.
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'It’s important to recognize that whooping cough can affect anybody of any age,' he said.
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Whooping cough symptoms can typically start appearing within a week to ten days after
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exposure to the bacteria, but sometimes it can also take as long as four weeks, according to
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the Public Health Agency of Canada.
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The early symptoms of whooping cough make it appear as if it’s a common cold, with a
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low-grade fever, runny or stuffed-up nose, red watery eyes, and a mild, occasional cough.
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'The initial week or so would be indistinguishable from other upper respiratory
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tract infections,' Dr.
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Bogoch said.
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'But the hallmark feature of whooping cough is a prolonged cough and a severe cough.'
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The illness can evolve over several weeks to include coughing fits that often end with a
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high-pitched 'whoop' sound when an infected person is catching their breath.
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The coughing fits may cause difficulty breathing, choking, and vomiting, according to
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the Public Health Agency of Canada.
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The coughing spells can also make people feel very tired, have difficulty sleeping at night,
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or even fracture a rib, according to the United States Centers for Disease Control and
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Prevention.
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Dr.
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Banerji said that since it’s a 'very violent cough,' people can also turn blue or rupture
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blood vessels in their eyes.
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Coughing fits can last one to ten weeks, which is why this illness is typically called the
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'100-day cough,' Dr.
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Bogoch explained.
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Babies and young children are at the greatest risk, as their symptoms can be more severe, and
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they could develop serious complications such as weight loss, apnea, pneumonia, convulsions,
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and brain damage.
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There is also a risk of death for the youngest cohort.
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Teenagers and adults can get pneumonia from whooping cough, but complications are usually
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less serious in older age groups, according to the United States Centers for Disease Control
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and Prevention.
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A nasal test can confirm if a person has whooping cough or not.
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The best way to prevent whooping cough infection is through vaccination, experts say.
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Vaccines that protect children against whooping cough are part of Canada’s routine immunization
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program, beginning at two months old.
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Primary immunization requires four doses, followed by booster shots later in childhood
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and adolescence.
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A dose of acellular pertussis-containing vaccine is also recommended for adults and
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during pregnancy.
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Vaccinated people can still get sick with whooping cough, but the illness is 'generally
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milder,' according to the United States Centers for Disease Control and Prevention.
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Dr.
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Banerji said the pertussis vaccine is 'very effective,' but the immunity can wane over
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decades, so parents should make sure children going back to school are up to date on their
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vaccinations.
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If a child is sick, they should stay home until treated to reduce the infectiousness, she said.
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Antibiotics can help treat whooping cough and should be given early in the illness to reduce
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the severity and maybe even avoid the coughing spells, Dr.
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Banerji noted.
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Once the whooping cough phase is established, taking fluids and rest can manage the symptoms,
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she added.
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Our final story today brings some much-needed clarity to a long-standing public health
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concern: the potential link between mobile phones and brain cancer.
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A major systematic review, commissioned by the World Health Organization, has found no
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association between mobile phone use and brain cancer.
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This review, published in the journal Environment International, analyzed 28 years of
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research on the subject.
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The review was conducted by experts Sarah Loughran from the University of Wollongong and
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Ken Karipidis from Monash University.
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They examined over 5,000 studies, of which 63 were included in the final analysis.
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These studies spanned from 1994 to 2022 and provided the most comprehensive evidence to
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date that radio waves emitted by mobile phones are not a health hazard.
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Mobile phones emit radio waves, a type of non-ionizing radiation, and they are often held
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close to the head during use.
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These factors had led to concerns that mobile phones could potentially cause brain cancer.
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However, the scientific consensus has remained strong over the years: there’s no association
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between mobile phone radio waves and brain cancer or other health issues.
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Despite the consensus, occasional studies have suggested the possibility of harm.
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In 2011, the International Agency for Research on Cancer, or IARC, classified radio wave
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exposure as a possible carcinogen based on limited evidence from human observational
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studies.
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This classification led to increased public concern, but it was largely misunderstood.
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Observational studies, while useful, can often be biased.
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For example, people with brain cancer might report higher mobile phone use than they
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actually had.
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The new systematic review provides the strongest evidence yet that radio waves from
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mobile phones are not associated with an increased risk of brain cancer.
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It aligns with previous research showing that despite the massive increase in mobile phone
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use over the past few decades, there has been no corresponding rise in brain cancer
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incidence.
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Importantly, the review found no association between mobile phone use and any other head or
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neck cancers, even with prolonged use.
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Whether a person used a mobile phone for over ten years, the number of calls made, or the
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time spent on the phone did not make a difference.
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These findings are very reassuring and support that national and international safety limits
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for radio wave exposure are protective.
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Mobile phones emit low-level radio waves that are well below these safety limits, and there
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is no evidence that this exposure impacts human health.
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While the results are comforting, it’s essential that research continues.
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Technology is rapidly evolving, and with it, the ways we use radio waves.
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Ongoing scientific investigation is crucial to ensure that exposure from these technologies
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remains safe.
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In summary, this comprehensive review dispels the persistent misconceptions and
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misinformation regarding mobile phones and brain cancer.
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There remains no evidence of any established health effects from mobile phone use, and
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that’s certainly good news for all of us.
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That wraps up today’s episode of Morning Medical with Dr.
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Chow.
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Thank you for joining me to stay updated on the latest medical and health news.
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I look forward to bringing you more insights tomorrow.
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Stay healthy and take care!