Zucchini gets the spicy parm treatment in this skillet orzo
I love the bounty of produce that summer brings. There are berries of all types, juicy melons, revered tomatoes, sweet corn and prized peaches. I could eat a diet of just these items and be a very happy camper all season long. (I have been known to eat a large bowl of cubed watermelon as a no-cook meal.) But not all of summer's offerings induce such cravings — just look at zucchini and other summer squash.
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Medscape
13 minutes ago
- Medscape
GLP-1 Users Should Fast 24 Hours Before Anesthesia
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The statement is 'the first to provide recommendations for perioperative management of patients taking GLP-1 RAs based on an in-depth systematic literature review of both clinical perioperative studies and gastric emptying data,' Adriana Oprea, MD, the first author of the document, and her colleagues wrote. Changing Guidance In June 2023, the American Society of Anesthesiologists (ASA) released the first guidance statement regarding preoperative management of patients on GLP-1 RAs, after some case reports documented aspiration events in these patients. While the number of these events is generally low and rates of aspiration appear to be similar between patients on GLP-1 RAs and the general population, 'people got really worried with these drugs because of [the] delayed gastric emptying,' Oprea, an associate professor of anesthesiology at Yale School of Medicine in New Haven, Connecticut, told Medscape Medical News . The 2023 ASA guidance recommended holding GLP-1 RAs for one half-life — a week for patients on long-acting medication and a day for short-acting GLP-1s. Due to a lack of adequate evidence at the time, the document suggested these patients should follow the standard ASA fasting guidelines of 8 hours after a full meal. However, evidence suggests stopping GLP-1s for one half-life is not enough for the effects on gastric emptying to subside, according to the new statement. For longer-acting drugs like dulaglutide, semaglutide, and tirzepatide, patients would need to discontinue these medications for several weeks to restore normal gastrointestinal motility. For patients with type 2 diabetes, discontinuation of these medications over this period could lead to poor glycemic control, which is linked to worse postoperative outcomes. For patients taking GLP-1 RAs for weight loss, restarting these medications can result in increased gastrointestinal symptoms, Oprea said, such as nausea, vomiting, diarrhea, or constipation. 'Because adverse effects are more prevalent at higher GLP-1 RA doses, discontinuation of these medications might lead to a high likelihood of side effects upon medication reinitiation or require reinitiation of therapy at lower doses followed by dose reescalation,' Oprea's group wrote. 'This is logistically difficult for both patients and treating clinicians.' In October 2024, the ASA, along with other professional societies, published updated practice guidance stating GLP-1 RAs may be continued preoperatively in patients without an elevated risk for delayed gastric emptying and aspiration. Those defined as 'higher risk' included patients in the escalation phase, on weekly dosing, on higher doses, and with gastrointestinal symptoms. 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Inpatient and outpatients can restart GLP-1 RAs when they resume their original diets. Patients with significant gastrointestinal symptoms including severe nausea, vomiting, and inability to tolerate oral intake should postpone elective procedures that require anesthesia and refer to their prescribing physician for diet and medication modifications to manage symptoms, the authors advised. 'Our recommendation for a clear liquid diet for 24 hours preprocedurally might appear overly restrictive. However, evidence points to the safety of this approach in patients on GLP-1 RAs,' they wrote.
News24
18 minutes ago
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Looking for the perfect Father's Day gift? Leatherman has two perfect products.
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Vogue
28 minutes ago
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Susan Choi is known for writing novels that mine enormous richness from highly specific settings, whether a high school-level theater program in 2019's Trust Exercise, a sexually charged campus environment in 2013's My Education, or a life on the run from the FBI in 2003's American Woman. But her latest book, Flashlight—out now from Macmillan Publishers—is perhaps her most ambitious effort yet. In Flashlight, a Korean national named Serk (formerly Seok) leaves the Japan of his youth to build a new life in the United States. What follows is a chronicle of four generations' worth of his family life—the precision and emotional resonance of Choi's sentences proving endlessly dazzling. This week, Vogue spoke to Choi about how winning the National Book Award in 2019 affected (or didn't affect, as the case may be) the process of writing Flashlight, digging into historical research about Korean-Japanese relations, and her preoccupation with abduction stories. The conversation has been edited and condensed. Vogue: What did the craft process of writing this book look like for you? Susan Choi: Oh, gosh, the process was so…I don't want to say chaotic, because I think that that gives an impression of a lot of energy and movement and this was much more slow, meandering, confused, you know, like a blindfolded person trying to navigate a very complicated obstacle course. I mean, I really struggled with this book. I feel like it evolved in a lot of disconnected bursts of writing that then required me to go back and go in circles. It was a composition process kind of like no other. Honestly, it was more like the first book I ever wrote than my sixth book. I just felt like I'd never written a book before. How did it feel to embark on a new project after winning the 2019 National Book Award in Fiction for Trust Exercise? I have to say, it wasn't really on my mind, and I'm so grateful for that. I definitely am someone who I would have thought would be really prone to finding that really stressful, but it was very hard to even connect those two facts in my mind. It feels so strange to say this, but it was partly thanks to COVID; like, COVID was such a huge rupture in our shared reality and in my individual reality, and this book really kind of grew out of COVID. I published the short story that now forms the very opening pages of the book during COVID—that was something that I had been working on during quarantine in 2020—and then started growing the rest of the book out of that. I just wasn't really thinking much about 2019, or the National Book Award, or the fact that this book, if it even ever came to exist, would follow the previous book. There was a big gap that separated those two realities, and I think it wasn't until this book was really close to being finished that I was like, Oh, this is the follow-up to that, and in the experience of any outsider to my life, this will be the next thing that comes after that other thing. I'm really glad I didn't think about that much before, because it feels very strange. I don't want to preoccupy myself about: Is this a good follow-up? Is it a weird follow-up? Is it a bad follow-up? It just is, and I can't change it now.
