Imj 1997 3

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Imj 1997 3

  1. 1. Clinical Pearls 1997 #3 These one sentence summaries of recent articles in the medical literature are intended to direct thereader to the source article. They provide medical information NOT ADVICE. Please consult with your physician before making any changes in your lifestyle based upon the information contained in these web pagesAfter 2 years of treatment, amenorrhea (i.e. no periods or spotting) was achieved in 90% ofwomen on continuous combined hormone replacement therapy. (Am J Obstet Gynecol 1995 ;173:1446)In this study, the nicotine patch did help smokers quit; only minimal counseling was necessary asadjunctive therapy (i.e. intensive counseling was not superior to a physicians advice to quit).(JAMA 1995 ;274:1347)Fish oil at a daily dose of 4 g per day was effective in lowering blood pressure and triglyceridelevels in this study of 78 non-diabetics. (Ann Intern Med 1995 ;123:0911)Full implementation of the 2-dose schedule of measles vaccination is essential for community-wide protection. (Pediatr Infect Dis J 1996 ;015:0031)Women with a prior c-section and a lower uterine segment thickness of less than 3.5 mm at 37weeks gestation are at high risk of uterine rupture during a trial of labor after c-section. (Lancet1996 ;347:0281)Vitamin D deficiency is highly prevalent among homebound and community-dwelling elderlypatients. (JAMA 1995 ;274:1683)The results of skin testing for tuberculosis (PPD testing) should be interpreted by health careprofessionals; self reporting is highly inaccurate. (Pediatr Infect Dis J 1996 ;015:0090)Famotidine (pepcid) at a dose of 40 mg twice daily significantly decreased the rate of gastric andduodenal ulcer formation in patients with arthritis require long term nonsteroidal anti-inflammatory drug (e.g. ibuprofen) therapy. (NEJM 1996 ;334:1435)In addition to the ECG and CK-MB level, it is helpful to look at the relative lymphocyte count:pts with a differential of less than 20.3% lymphocytes were much more likely to have an acutemyocardial infarction. (Ann Intern Med 1996 ;122:0335)In a study of 336 people with adult onset diabetes, 52% of men had impotence, nearly half hadvascular injury, and more than a third had mental problems such as forgetfulness, depression,and blurred vision. (Arch Fam Med 1996 ;005:0135)In 18 patients with chronic low back pain, 13 were found to have major depression, suggestingthe need to rigorously look for depression in those with chronic (more than 6 months) low backpain. (Gen Hosp Psychiatr 1995 11/01;017:0399)In this study of pregnant Indonesian women, once a week supplementation with iron was aseffective as daily supplementation. (Am J Clin Nutr 1996 06/01;063:0884)Low thyroid homone levels were found in this group of recently obese (now normal weight)women compared with a similar group of never obese women, suggesting that mildhypothyroidism plays a role in the obese and obese-prone. (Am J Clin Nutr 1996 06/01;063:0879)
  2. 2. Chromum supplementation has no benefitial effects on strength gain or body composition in thisstudy of 36 men. (Am J Clin Nutr 1996 06/01;063:0897)In Alzheimers Disease, the average age of onset is 72, average age of diagnosis is 75; mostpatients institutionalized at age 77, with death occuring at an average age of 80 1/2 years old inthis study of 100 patients with Alzheimers. (J Am Geriatr Soc 1995 ;043:1248)Requiring vision testing as part of a drivers license renewal increases road safety; given a 4 yearrenewal interval, adding vision testing is estimated to prevent 7% of all fatal crashes. (JAMA1995 ;274:1026)In this study of 46 black men, regular moderate aerobic exercise significantly decreased bloodpressure, left ventricular hypertrophy, and medication requirements. (NEJM 1995 ;333:1462)In this study of 1,957 randomly selected Oregon high school students, 31% reported beingphysically abused; these students were more likely to carry weapons, use cocaine, smoke, havemultiple sexual partners, and have suicidal thoughts. (Arch Pediatr Adolesc Med 1995 ;149:1254)A useful screening tool for cardiovascular risks is the waist circumference: above 37.6 inches formen and 32 inches for women indicates a need for more in depth evaluation, and most likely aneed for weight loss. (BMJ 1995 ;311:1401)The use of an epidural for anesthesia during labor was associated with a 2 fold increase in thelikelihood of c-section, when compared with the use of intravenous meperidine; also, labor wasprolonged and evidence of infection (chorioamnionitis) increased (Obstet Gynecol 1995 ;086:0783)The use of selegiline in patients with new onset mild Parkinsons Disease is associated with anincreased mortality and no clinical benefit. (BMJ 1995 ;311:1602)The induction of labor in women who have premature rupture of membranes at term wasassociated with shorter labors and less maternal infection. (NEJM 1996 ;334:1005)Nicotine nasal spray, soon due on the market for prescription use, has been associated with quitrates of 33% at 6 months; this compares with rates for the patch of 22% and placebo of 12-15%at 6 months. (Physicians Clin Digest 1996 07/01;007:0053)Late whiplash syndrome--neck pain, headaches, and mental impairment after a motor vehicleaccident--causes significant disability in the US, however, this international study suggests thecause of late whiplash syndrome is purely economic and/or legal. (Lancet 1996 ;347:1207)Elevated blood homocysteine levels appear to increase the risk of heart disease, fortunatelylowering the level is easy- just take a multivitamin or B-Complex vitamin pill with folate daily;recommended dose is unknown, 1 mg/d probably sufficient. (Your Patient & Fitness 1996 ;10(4):0006)It is estimated that 650,000 to 900,000 persons in the US were infected with HIV in 1992,approximately 0.3% of the population. (JAMA 1996 07/10;276:0126)Failure to achieve the target heart rate on exercise treadmill testing was shown to be anindependent predictor of coronary heart disease, with the risk of a cardiac event increased by75% over the average 7.7 years of follow-up. (Circulation 1996 ;093:1520)In this study of 333 patients with an ischemic stroke, those given thrombolytic therapy with t-PAwere at least 30% more likely to have a favorable outcome at 3 months after the stroke;treatment was given within 3 hours of the onset of symptoms. (NEJM 1995 12/14;333:1581)Nearly 50% of participants in a 4 community wide sample of patients with a history of
  3. 3. myocardial infarction did not take aspirin regularly indicating a servere underutilization ofaspirin in the prevention of subsequent myocardial infarctions. (Am Heart J 1996 ;131:0915)In this study of 11178 people aged 67 - 105 years, the use of vitamin E supplementation reducedthe risk of all cause mortality by 34%; simultaneous use of vitamin C reduced the risk by 42%.(Am J Clin Nutr 1996 ;064:0190)According to the HALT trial of 851 patients studied for 16 weeks, doxazosin effectively loweredblood pressure while also lowering total cholesterol by 2.7%, LDL cholesterol by 2.4%, andsignificantly reducing the ratio of total to HDL cholesterol. (Am Heart J 1996 ;131:0966)In a study of 411 patients, compliance with advice to exercise was increased if their doctor was ofan appropriate weight, exercised regularly, and didnt smoke. (Clin J Sport Med 1996 ;6(2):0112)The treatment of asymptomatic bactiuria in older women is not helpful; in this study of 50women, antibiotic treatment did not lower the rate of symptoms during the following 6 months; itis recommended that antibiotic treatment not be given. (J Am Geriatr Soc 1996 ;044:0293)Eradication of H. Pylori is useful not only in patients with ulcers, but also in those withdyspepsia. Treatment with pepto-bismol, Flagyl, and amoxicillin lead to a 75% eradication, andoverall improvement in symptoms. (Am J Gastroenterol 1996 ;091:0441)The use of calcium channel blockers is associated with an increased risk of gastrointestinalbleeding compared with beta-blockers and ace-inhibitors. (Lancet 1996 ;347:1061)Transdermal estrogen is helpful in the treatment of postpartum depression. (Lancet 1996 ;347:0930)In a study of 307 pts presenting with symptoms and complaints of a common cold, approximately20% had bacterial colonization and benefitted from antibiotics; the other 80% did not benefitfrom antibiotics and were more likely to experience side-effects. (Lancet 1996 ;347:1507)The initiation of early feeding after a cesarean section (sips of water immediately after surgeryand pudding within 6 hours) was associated with a more rapid return of gastrointestinal function.(Obstet Gynecol 1996 ;087:1006)In this study of 500, treatment of deep venous thrombosis can be safely treated with outpatientenoxaparin, 1 mg per kg body weight twice daily. (NEJM 1996 ;334:0677)In this study of 400, treatment of deep venous thrombosis can be safely treated with outpatientenoxaparin. (NEJM 1996 ;334:0682)In this meta-analysis of 2459 women, calcium supplementation of 1.5 g to 2.0 g per day duringpregnancy decreased blood pressure and the rate of preeclampsia; the mean number needed totreat to prevent 1 case of preeclampsia was estimated to be 23. (JAMA 1996 ;275:1113)Membrane stripping of the woman at term promoted the onset of labor in this study of 120; themean time to onset of labor was 12.7 d for controls and 8.2 d for those receiving stripping. (ObstetGynecol 1996 ;087:0767)Results from a 6 year study indicates that that both aspirin and nonsteroidal anti-inflammatorydrugs can lead to a significant reduction in risk for colorectal neoplasia, possibly as much as a50% reduction in risk. (Dig Dis Sci 1996 ;041:1319)Postmenopausal estrogen use was associated with a decreased risk and delayed onset ofAlzheimers disease in this study of 1124 elderly women. (Lancet 1996 ;348:0429)Results of a 7-year study of over 475,000 people indicate that passive smoking is associated with
  4. 4. an approximately 20% increased risk of heart disease death. (Circulation 1996 ;094:0622)Adding progesterone to postmenopausal estrogen therapy does not appear to reduce thecardiovascular benefits of estrogen therapy. (NEJM 1996 ;335:0453)A continuous infusion of furosemide was found to be more efficacious and safer than intravenousbolus administration. (JACC 1996 ;028:0376)We subscribe to the HONcode principles of the Health On the Net Foundation.© The Internet Medical Journal. Webmaster: Tom Heston, MD.The information contained on all web pages maintained by this webmaster constitute medicalinformation NOT ADVICE. Use common sense by consulting with your doctor before making anylifestyle changes or other medical decisions based on the content of these web pages.

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