20120630 internet medical journal: medical pearls


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Internet Medical Journal for June, 2012: Medical Pearls

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20120630 internet medical journal: medical pearls

  1. 1. TheInternet Medical Journal June, 2012 Tom Heston, MD Editor
  2. 2. NOTICE: All contents of the InternetMedical Journal is opinion and strictlyeditorial in nature. Errors and mistakes canand will occur. When it comes to clinicalhealth issues, always consult with yourdoctor or health care provider. Thiscollection of medical pearls is © 2012 withall rights reserved by the Internet MedicalJournal ISSN 1093-7935 and the InternetMedical Association. http://medjournal.org
  3. 3. Cost of pain management in the U.S. isapproximately $600 Billion annually - JPain. 2012 May 16.Hemodynamic compromise is decreasedwith manual removal of the placenta at 10minutes after delivery compared to 15minutes after delivery. - Am J Perinatol.2012 May 7.1 mmol/L reduction in LDL cholesterolappears to reduce the risk of major vascularevents by about 11 per 1000 people over 5years. - Lancet. 2012 May 16.Occipital nerve stimulation therapy appearsto be safe and effective in the treatment ofchronic migraine and medication overuse
  4. 4. headache - Pain Physician. 2012May;15(3):245-53.Singletons pregnancies after in-vitrofertilization / intracytoplasmic sperminjection are associated with higher risks ofobstetric and perinatal complications whencompared with spontaneous conception. -Hum Reprod Update. 2012 May 19.Childbirth in the lateral position resulted inless perineal trauma when compared withchildbirth in the lithotomy position, evenafter correcting for parity and birthattendant. - Birth (2012).It is estimated that a 3.9 to 4.3% increaseacross crime categories would result from a
  5. 5. 20% increase in neighborhood alcoholestablishment density. - Alcohol Clin ExpRes. 2012 May 15.The likelihood of completing <16 years ofeducation was significantly increased by: a)alcohol use before age 18; b) a lifetimealcohol dependence diagnosis; and c) dailynicotine use for 30 or more days. Nodifferences in education were observed forcannabis. - Alcohol Clin Exp Res. 2012 May15We concluded that photodynamic therapy inthis cohort is effective in the treatment ofACNE VULGARIS when combined withintralesional 5-aminolevulenic acid. It givessuperior results compared with intense
  6. 6. pulsed light alone with minimal andtolerable side effects and less recurrencerates. - Dermatol Ther. 2012 Jan;25(1):86-91.Less than half of Medicaid-insuredcolorectal cancer survivors received acolonoscopy in 3 to 18 months aftercolorectal resection. Improvements inscreening in this high-risk population shouldbe the target of future interventions toreduce the probability of recurrence. - Am JClin Oncol. 2012 Jun;35(3):205-11.For women in their 50s to 80s withoutclinical depression, increased total physicalactivity is correlated with improved currentand future health. - J Epidemiol Community
  7. 7. Health. 2012 Apr 27.Chest CT using 3D automatic exposurecontrol was shown to reduce patientradiation exposure from 800 DLP to 200DLP. - Eur J Radiol. 2012 Jun;81(6):1330-4.This study found atherosclerosis to beassociated with osteoarthritis of the knee andhand joints in women. - Ann Rheum Dis.2012 May 14.Increasing longevity coupled with a risingtrend of dementia is likely to mean a majorshift towards higher nursing home care usein the future. - J Epidemiol CommunityHealth. 2012 Apr 27.
  8. 8. A single ultrasound guided dexamethasoneinjection is a safe and effective short termtreatment for plantar fasciitis, but significantpain relief was found to NOT continuebeyond four weeks. - BMJ 2012;344:e3260In Europe and the U.S., 20-40% of womengain excessive weight during pregnancy,which is associated with adverse outcomes.Dietary interventions during pregnancyappear helpful, reducing the risk of pre-eclampsia and shoulder dystocia. - BMJ2012;344:e2088The INHOMESSS mnemonic(impairments/immobility, nutrition, homeenvironment, other people, medications,examination, safety, spiritual health,
  9. 9. services) addresses the components of acomprehensive house call. - Am FamPhysician. 2011 Apr 15;83(8):925-931.The diagnosis of pelvic inflammatorydisease is made clinically; no single test orstudy is sensitive or specific enough for adefinitive diagnosis. Patients should betreated empirically. Most can be treatedsuccessfully with ceftriaxone or cefoxitinIM plus oral doxycycline. - Am FamPhysician. 2012 Apr 15;85(8):791-796.Children with hypertension should bescreened for cardiovascular risk factors suchas diabetes and hyperlipidemia. Alsoevaluate for target organ damage with aretinal examination and echocardiography.
  10. 10. Treatment is usually lifestyle changes,including weight management, a healthy,low-sodium diet, regular physical activity,and avoidance of tobacco and alcohol.Children with symptomatic hypertension,secondary hypertension, target organdamage, diabetes, or persistent hypertensiondespite nonpharmacologic measures shouldbe treated with antihypertensivemedications. - Am Fam Physician. 2012 Apr1;85(7):693-700Asking high-risk patients about suicidalintent leads to better outcomes and does notincrease the risk of suicide. - Am FamPhysician. 2012 Mar 15;85(6):602-5Use of pharmacologic support during
  11. 11. smoking cessation (e.g. nicotinereplacement, buproprion, or varenicline) candouble the rate of successful abstinence. -Am Fam Physician. 2012 Mar15;85(6):591-8Divalproex (Depakote), valproic acid,carbamazepine, risperidone, quetiapine(Seroquel), and (olanzapine + SSRI) areused in the treatment of bipolar disorder. -Am Fam Physician. 2012 Mar 1;85(5):483-93For elderly individuals without dementia,increased total daily physical activityresulted in a 50% decreased risk indeveloping Alzheimers Disease. -Neurology. 2012 Apr 24;78(17):1323-9.
  12. 12. A city-wide smoking ban in Pueblo,Colorado resulted in decreased maternalsmoking and preterm births. - J WomensHealth (Larchmt). 2012 Jun;21(6):621-7.Controlling hypertension can reduce the riskof Alzheimers Disease by decreasing theactivation of a receptor for advancedglycation end products - Hypertension. 2012May 21.The American Academy of FamilyPhysicians is recommending againstperforming prostate-specific antigen (PSA)-based screening for prostate cancer inasymptomatic men, a position that is in linewith a final recommendation from the U.S.Preventive Services Task Force (USPSTF)
  13. 13. that was published May 22 in the Annals ofInternal Medicine. - AAFP News Now,Posted 5/22/2012, 4:00 p.m.Among children and adolescents in a low-income, urban population, supplementingusual care with text messaging wasassociated with an increased rate ofinfluenza vaccination. However, the overallvaccination rate remained low. - JAMA.2012;307(16):1702-1708.Extremely dense breasts and first degreerelatives with breast cancer were eachassociated with at least a 2 fold increase inrisk for breast cancer in women aged 40 to49 years. - Ann Intern Med. 2012 May1;156(9):635-48.
  14. 14. Young adults are using more sunscreen, butcontinue to get excess sunburns. In 2010,over half of all U.S. adults aged 18-29reported one or more sunburns in the pastyear. Exposure to UV rays from tanningbeds and the sun is the most importantpreventable risk factor for skin cancer, andsunburns are evidence of too muchexposure. Ongoing public health efforts inthis area are needed. - MMWR 10-May-2012In 2010, 32 percent of non-Hispanic whitewomen aged 18-21 years reported indoortanning, with an average of 28 sessions inthe past year. - MMWR 10-May-2012The teen birth rate of 34.3 births per 1,000females reflect a 44 percent decline from
  15. 15. 1990. The increased use of contraceptivesmay be a contributing factor to the declineof teen births. Teen pregnancy can best beprevented by delaying the initiation ofsexual activity. - MMWR 03-May-2012Elective induction of labour at termgestation can reduce perinatal mortality indeveloped countries without increasing therisk of operative delivery. - BMJ2012;344:e2838Women who use transdermal patches orvaginal rings for contraception have a 7.9and 6.5 times increased risk of confirmedvenous thrombosis compared with non-usersof hormonal contraception of the same age -BMJ 2012;344:e2990
  16. 16. Circuit training after a stroke is as effectiveas standard physiotherapy after a stroke, andmay be better in terms of gait speed atfollow-up. In this study, the circuit trainingconsisted of 90 minute sessions twice aweek for three months. It included eightdifferent workstations in a gym, designed toimprove performance in tasks relating towalking competency. - BMJ2012;344:e2672Risk of cardiovascular disease does notappear to be increased with the use ofvarenicline (Chantix) for smoking cessation.- BMJ 2012;344:e2856In men, an abdominal aortic diameter of 25mm or greater is associated with greatly
  17. 17. increased morbidity and mortality comparedto those with an abdominal aortic diameterof 24 mm or less. The risk of hospitaladmission, after accounting for smokingstatus, was increased for cerebrovasculardisease, atherosclerosis, peripheral arterialdisease, and respiratory disease. The authorsconclude that men can benefit fromundergoing routine abdominal aorticaneurysm screening. - BMJ 2012;344:e2958Bullying appears to be correlated with non-suicidal self injury for children 12 years old.Bullied children who self-harm were morelikely to have a family history of suicide orsuicide attempts, and have concurrentmental health problems. - BMJ2012;344:e2683
  18. 18. Compression ultrasonography is as effectiveat ruling out a deep vein thrombosis (DVT)in pregnant or postpartum women ascompared to non-pregnant women. In thesepatients, when there is no evidence of apulmonary embolism, a single compressionultrasound when normal suggests it is safe tofollow these patients without givinganticoagulants. - BMJ 2012;344:e2635Antihypertensive therapy usually should notbe initiated with diuretics, as this tends toresult in the need for a greater number ofmedications while not achieving betterblood pressure control. - J Hypertens. 2012Jun;30(6):1225-32.Aspirin appears to reduce the risk of cancer
  19. 19. with distant metastasis by about 30%. Thereis some evidence that aspirin may decreasethe risk of metastases in patients withadenocarcinoma. Aspirin may beparticularly helpful in smokers. A low-dose,slow-release formulation of aspirin designedto inhibit platelets but to have little systemicbioavailability was found to be as effectiveas higher doses. - Lancet. 2012 Apr28;379(9826):1591-601.Matthew effect (sociology): thephenomenon in sociology where "the richget richer and the poor get poorer." Basedupon a passage (Matthew 25:29) in the NewTestament: "For unto every one that hathshall be given, and he shall have abundance:but from him that hath not shall be taken
  20. 20. away even that which he hath." - Wikipedia:Matthew EffectAnalyses suggest that childrens proceduralanxiety mediates the relation betweenparents anticipatory anxiety and childrensprocedural pain. Thus, targeting parents’preprocedural anxiety might be beneficial tothe parents as well as the childrenundergoing a distressing medical procedure.- J Pediatr Psychol. 2012 May 22.In obese peoples, modest weight lossreduces arterial stiffness which appears to berelated to improved markers ofinflammation. - Diab Vasc Dis Res. 2012Apr 25.
  21. 21. In patients with advanced heart failure,higher HbA1c levels were associated withimproved outcomes. For every unit HbA1cincrease, there was a 15% decreased hazardratio of death or urgent heart transplantationand all-cause mortality - Amer J Cardiol 29March 2012.Breastfeeding for at least 4 months wasfound to be associated with a protectiveeffect on a childs social, attention, andaggression problems in early adolescence. -Breastfeed Med. 2012 May 21.Nonvascular deaths, including cancerdeaths, are reduced with low-dose aspirin.There were 162 of 7998 (2.02%) and 210 of8068 (2.60%) cancer deaths among low-
  22. 22. dose aspirin users versus non-aspirin users,respectively, reported over an averagefollow-up of 2.8 years, a mortality reductionof about 20%. - Am J Med. 2012Jun;125(6):560-7.Children who attended schools where sodapop and non-low-fat salty snacks could bepurchased were 2 to 4 times more likely tobe obese than children at schools where suchitems were not sold. - J Sch Health. 2012Jun;82(6):285-93.Poor adult modelling of regular handwashing and unattractive facilities were seenas important barriers to regular handwashing among children in primary school.- Health Educ Res. 2012 May 22.
  23. 23. Tigecycline monotherapy is non-inferior to acombination regimen of ceftriaxone plusmetronidazole in the treatment ofcomplicated intra-abdominal infections. -Clin Microbiol Infect. 2010Aug;16(8):1274-81.Human papillomavirus infection increasesthe risk of esophageal squamous cellcarcinoma in smokers, but does not increasethe risk in non– smoking and non– alcoholconsuming people. - Dis Esophagus. 2012Mar 9.Patients on statins were found to have a 20%decreased risk of developing C difficileinfection in the hospital. - Gut. 2012 Mar22.
  24. 24. Unenhanced CT is the preferredexamination for evaluation of urolithiasisbecause of its availability, ease ofperformance, and high sensitivity. - AJR AmJ Roentgenol. 2012 Jun;198(6):W540-7.The addition of simvastatin to enalapril inhypertensive patients was found to improveparameters of diastolic function. This islikely clinically relevent because diastolicdysfunction is frequent and increasesmortality. - Atherosclerosis. 2012Jun;222(2):444-8. Epub 2012 Apr 3.Statin use is strongly associated withimproved discharge disposition afterischemic stroke. - Neurology. 2012 May22;78(21):1678-83.
  25. 25. In school-aged children with an acuteasthma exacerbation, adding a 3-wk courseof clarithromycin to standard treatmenthelped decrease duration of the exacerbationand increase the number of subsequentsymptom-free days. - Pediatr AllergyImmunol. 2012 Jun;23(4):385-90.Beclomethasone/formoterol (Fostair)appears to be less expensive but as clinicallyeffective as fluticasonepropionate/salmeterol (Advair) in adultswith moderate to severe persistent asthma. -Clin Drug Investig. 2012 Apr 1;32(4):253-65.Airway responsiveness, lung volumes andasthma severity/control markedly improved
  26. 26. with weight loss following bariatric surgeryin severely obese patients (BMI ~ 50 kg/m2)- Respir Med. 2012 May;106(5):651-60.In people with urinary incontinence,associated anal incontinence is common.These authors recommend routinelyscreening for anal incontinence in patientswith urinary symptoms. - Int Urogynecol J.2012 May 15.Awareness of the breastfeedingrecommendation to breastfeed exclusivelyfor 6 months is an independent positivepredictor of breastfeeding initiation andduration. - Breastfeed Med. 2012 May 8.Overweight and obese adolescents had 36%
  27. 27. and 37% more sick days, respectively, thanadolescents of normal weight. - J AdolescHealth 24 May 2012.Serum uric acid level is a significantpredictor of cardiac events in patients withdiabetes when using a Cox regressionmodel, however, it does not appear to addadditional information beyond that providedby N-terminal pro-B-type natriuretic peptidelevels. - Diabet Med. 2012 Jun;29(6):721-725.Antidepressants and benzodiazepines are ingeneral safe regarding survival in heartfailure patients, with the possible exceptionof fluoxetine. - Int J Cardiol. 2012 Apr 14.
  28. 28. This study found that the most commonlyused anti-diabetic oral medication wasmetformin, followed by repaglinide(Prandin), DPP4 inhibitors (e.g. sitagliptin /Januvia), and sulphonylureas (mostcommonly glimepiride). Measuring renalfunction in diabetics is helpful in modifyingmedications, since at low GFRs it may bebeneficial to change from metformin toanother agent. - Nefrologia. 2012 May14;32(3):367-373.Metformin appears to be associated with alower risk of liver cancer in patients withtype 2 diabetes. - J Clin Endocrinol Metab.2012 Apr 20.Quetiapine and quetiapine XR are valuable
  29. 29. additions to the first-line treatments forbipolar depression. A common side-effectappears to be clinically relevant increases inblood glucose or lipid parameters. - CNSDrugs. 2012 May 1;26(5):435-60.Subcutaneous sumatriptan is effective as anabortive treatment for acute migraineattacks, quickly relieving pain, nausea,photophobia, phonophobia, and functionaldisability, but is associated with increasedadverse events. - Cochrane Database SystRev. 2012 Feb 15;2:CD009665.Oral diclofenac potassium 50 mg is aneffective treatment for acute migraine,providing relief from pain and associatedsymptoms, although only a minority of
  30. 30. patients experience pain-free responses.Adverse events are mostly mild andtransient and occur at the same rate as withplacebo. - Cochrane Database Syst Rev.2012 Feb 15;2:CD008783.Divalproex sodium, sodium valproate,topiramate, metoprolol, propranolol, andtimolol are effective for migraine preventionand should be offered to patients withmigraine to reduce migraine attackfrequency and severity. - Neurology. 2012Apr 24;78(17):1337-45.Prochlorperazine (Compazine) is superior orequivalent to all other classes of medicationsin rescue therapy for acute migraine painrelief. - Headache. 2012 Mar;52(3):467-82.
  31. 31. Alternative acute and preventive agentsshould always be explored since opioids donot work well clinically in migraine. -Headache. 2012 May;52 Suppl 1:30-4.Tramadol hydrochloride 37.5 mg withacetaminophen 325 mg has been shown tobe most effective in patients with mild tomoderate pain and has a lower risk ofserious adverse events. The combinationappears more effective than tramadol alone.- Drugs Today (Barc). 2011 Oct;47(10):763-72.In the long-term (1h and 24h afteradministration), dexamethasone 8 mg IVreduces the severity of acute migrantheadache more than morphine 0.1 mg/kg IV.
  32. 32. - Pak J Biol Sci. 2011 Jun 15;14(12):682-7.Cathinone is a naturally occurring beta-ketone amphetamine analogue found in theleaves of the Catha edulis plant. Syntheticcathinones ("Bath Salts") are derivatives ofthis compound that have emerged as drugsof abuse. The effect is similar toamphetamines and MDMA. - J Med Toxicol.2012 Mar;8(1):33-42.Vegetable intake is inversely associated withallergic asthma and moderate/severe airwayhyper-responsiveness. - Pediatr Pulmonol.2012 May 24.Side effects were fewer with exercisetreadmill testing combined with
  33. 33. regadenoson, compared to regadenosongiven with the patient supine. - J NuclCardiol. 2012 May 8.In painful diabetic neuropathy, duloxetineand amitriptyline have similar efficacy.Good, moderate, and mild pain relief wasachieved in about 55%, 20%, and 10% ofpatients, respectively. Dry mouth wassignificantly more common in theamitriptyline group. Patients preferredduloxetine over amitriptyline, however, thisdifference was not statistically significant. -Diabetes Care. 2011 April; 34(4): 818– 822.Elevated serum glucose levels on admissionto the hospital is associated with anincreased risk of death in patients with
  34. 34. community acquired pneumonia withoutpre-existing diabetes - BMJ 2012;344:e3397Women with atrial fibrillation have amoderately increased risk of strokecompared with men, and thus, female sexshould be considered when makingdecisions about anticoagulation treatment.However, women younger than 65 years andwithout other risk factors have a low risk forstroke, and do not always benefit fromanticoagulant treatment. - BMJ2012;344:e3522Pioglitazone in type 2 diabetics is associatedwith a 1.2 increased risk of bladder cancer.The absolute risk of bladder cancer in thisstudy of type 2 diabetics was 0.9 per 1000
  35. 35. patient years. With at least 2 years ofpioglitazone use, the risk increased to 1.2per 1000 patient years. The number neededto harm was approximately 750 for acumulative pioglitazone use of 28,000 mgand 1100 for a cumulative pioglitazone useduration of more than 24 months.Rosiglitazone does not appear to beassociated with an increased risk of bladdercancer. - BMJ 2012;344:e3645Daily consumption of dark chocolateappears to be of benefit to patients withmetabolic syndrome. - BMJ2012;344:e3657In preschool children with an acutewheezing episode presenting to the
  36. 36. emergency department, using 4ml ofhypertonic saline 5% mixed with 0.5 ml ofalbuteral for nebulizer treatments, ascompared with using normal saline mixedwith the albuterol solution, significantlyshortened length of stay and lowered theadmission rate. - Pediatrics. 2012Jun;129(6):e1397-403.In 12 to 17 year olds with 2 to 8 migrainesper month for ?6 months, treatment of anacute attack with an oral sumatriptan andnaprox combination pill was effective forpain relief. The 85/500 dose was no moreeffective than lower doses (as low as 10/60).This suggests that 1/2 of a tablet of the85/500 strength formula (Treximet) is aseffective as a whole tablet in this population.
  37. 37. - Pediatrics. 2012 Jun;129(6):e1411-20.In people with chronic kidney disease, thebenefits of antiplatelet therapy are uncertainand potentially outweighed by bleedinghazards. Antiplatelet therapy appears to haveuncertain effects on cardiovascular hardevents and mortality, while increasingbleeding hazards. - Ann Intern Med. 2012Mar 20;156(6):445-59.Manual therapy in chronic low back painappears to be beneficial in terms ofimproving range of motion. - Man Ther.2012 May 31.After fortification of grain products withfolic acid in the U.S. in 1996 - 1998, the
  38. 38. incidence of Wilms tumor and primitiveneuroectodermal tumors were significantlyreduced. - Pediatrics. 2012Jun;129(6):1125-33.Lithium treatment can reduce the attackfrequency in episodic cluster headache. Inthis study where lithium blood levels wereperiodically monitored, adverse drugreactions from the lithium were mild andaffected about 15% of patients. - Headache.2012 Jun 1.Doubling the clopidogrel dose was noteffective to reduce high on-treatmentplatelet reactivity in almost half of the studypatients with coronary artery disease,pointing to the need of a more powerful
  39. 39. platelet inhibitor. - Cardiovasc Revasc Med.2012 May;13(3):159-66.Danshen dripping pill (DSP) is a popularChinese medicinal product and oftencompared with isosorbide dinitrate (ISDN)in treating coronary heart disease anginapectoris. This meta-analysis found that DSPwas more effective than ISDN in treatingangina pectoris. - Int J Cardiol. 2012 Jun14;157(3):330-40.Preoperative statin administration isassociated with early reductions in mortalityamong patients undergoing isolated valvularheart surgery, leading to improved latesurvival. - Ann Thorac Surg. 2012Jun;93(6):1881-7.
  40. 40. BMI is an independent predictor of CVmortality but waist circumference is not. -Nutr Metab Cardiovasc Dis. 2012 May 25.A 15-minute massage applied with almondoil during pregnancy reduced thedevelopment of striae gravidarum. - J ClinNurs. 2012 Jun;21(11-12):1570-6.This study demonstrated a slight advantageof breastfed infants on cognitivedevelopment compared with formula-fedinfants. - Pediatrics. 2012 Jun;129(6):1134-40.Limiting access to pharmaceuticalrepresentatives can have the unintendedeffect of reducing appropriate changes in
  41. 41. prescribing habits. This means patients ofphysicians with limited access were putthrough greater potential risks compared topatients being treated by more open-accessphysicians. - J Clin Hypertens (Greenwich).21 MAY 2012.Exercise stress test-induced ST-segmentdepression in asymptomatic subjects withnormal coronary arteries cannot beconsidered as a simple false-positive result,because it can be related to coronarymicrovascular dysfunction. - Am J Cardiol.2012 Jun 15;109(12):1705-10.Patients with nonvisualization of theappendix on ultrasonography, but otherwisenormal scans, are at significantly lower risk
  42. 42. for appendicitis, either perforated ornonperforated. Active clinical observationshould be considered in these patients, ratherthan direct referral for CT. - J ClinUltrasound. 2012 May 25.There is growing evidence that oxidativestress may play a role in psychiatricdisorders, including depression, and thatantioxidants such as N-acetyl-cysteine maybe useful in the prevention and treatment ofdepression. - CNS Drugs. 2012 Jun1;26(6):477-90.This study found that the prevalence ofsmoking in Chinese urban areas was 30%.Tobacco advertising was associated withincreased smoking, whereas workplace and
  43. 43. household smoking bans were associatedwith decreased smoking rates. - DrugAlcohol Depend. 2012 Jul 1;124(1-2):121-7.The CDC is proposing HCV screening forall people born from 1945 through 1965 inaddition to testing people at high risk orrecent possible exposure. Thisrecommendation to screen all BabyBoomers is contrary to recommendationsfrom U.S. Preventive Services Task Forceand the American Academy of FamilyPhysicians. - AAFP News Now, posted6/6/2012.Monotherapy with metformin wasassociated with durable glycemic control in
  44. 44. approximately half of children andadolescents with type 2 diabetes. Theaddition of rosiglitazone, but not anintensive lifestyle intervention, was superiorto metformin alone. - N Engl J Med. 2012Apr 29.Maternal vitamin D deficiency andinsufficiency is prevalent among gravidwomen and is associated with markers ofaltered glucose homeostasis. - J ObstetGynecol Neonatal Nurs. 2012;41(3):328-338.
  45. 45. While every attempt has been made toensure accuracy, mistakes can and dooccur. Use these medical pearls at yourown risk.Please submit comments or suggestions tothe Internet Medical Association.