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         --  CFCs not only deplete the ozone layer in the at

  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 content 18.4% (MRI imaging of proton densi