geoffrey modest medical blogs

  I heard an impressive segment on NPR on May 6 about the rather extensive potential environmental damage done by asthma/COPD inhalers that use a propellant (the boot-shaped inhalers):  https://www.npr.org/sections/health-shots/2024/05/06/1248504466/could-better-asthma-inhalers-help-patients-and-the-planet-too  . This segment highlighted Dr. Miguel Divo, a pulmonologist in Boston, who is a strong advocate for using dry powder inhalers (DPIs) instead of the environmentally toxic ones using a propellant gas, now hydrofluoroalkanes (HFAs).   Details : From a 2021 report by the US environmental protection agency ( https://www.epa.gov/sites/default/files/2021-03/documents/epa-hq-oar-2021-0044-0002_attachment_1-mdis.pdf  ):     -- the pharmaceutical industry initially used chlorofluorocarbons (CFCs) as the propellant in metered dose inhalers (MDIs), though these were phased out and fully replaced by hydrofluoroalkanes (HFAs) by 2014    ...

  Tirzepatide, the combo of a potent  glucagon-like peptide-1 receptor agonist (GLP-1) plus a glucose-dependent insulinotropic polypeptide (GIP) agonist, was found to be highly effective in patients with metabolic dysfunction-associated steatohepatitis (MASH): see  NASH tirzepatide NEJM2024  in dropbox, or  DOI:  10.1056/NEJMoa2401943)   Details : -- 190 participants who had biopsy confirmed MASH and stage F2 or F3 (moderate or severe) fibrosis were randomized in a phase 2, dose-finding, multicenter, double-blind, randomized, placebo-controlled trial to tirzepatide 5 mg, 10 mg or 15 mg versus placebo subcutaneously weekly for 52 weeks -- mean age 54, 57% female, 86% white/12% Asian/36% Latino, body weight 100 kg/BMI 36 -- type II diabetes in 58% -- liver fibrosis stage: F2 in 43%/F3 in 57%; NAFLD activity score 5.3 (unweighted sum of scores for steatosis, lobular inflammation, and hepatocellular ballooning), ALT 62, AST 51, A1c 6.5%, liver fat con...