The Learning Blog

I just recently received MedScape’s email listing their Top Ten Articles for 2008 for the Internal Medicine Specialty. Click on the numbered headings for more information on the particular articles.

1. New guidelines for Management of Urinary Tract Infection in Nonpregnant Women.

Among the recommendations made by the American College of Obstetricians and Gynecologists:

• In nonpregnant, premenopausal women, screening for and treatment of asymptomatic bacteriuria is not recommended.
• Antibiotic class should be changed when resistance rates are higher than 15% to 20%.
• Patients with acute pyelonephritis should complete 14 days of total antimicrobial therapy, regardless of whether treatment is on an inpatient or outpatient basis.
• For uncomplicated acute bacterial cystitis in women, including women 65 years and older, antibiotics should be administered for 3 days.
• Urine culture is not required for the initial treatment of a symptomatic lower UTI with pyuria or bacteriuria, or both.
• For the treatment of acute uncomplicated cystitis, beta-lactams, including first-generation cephalosporins and amoxicillin, are less effective than the preferred antimicrobials listed as treatment regimens (Co-trimoxazole, ciprofloxacin, nitrofurantoin, and fosfomycin tromethamine.)

2. Drug used for COPD linked to Increased Mortality Risk.

Ipratropium used for chronic obstructive pulmonary disease (COPD) is associated with the risk for all-cause and cardiovascular death, according to the results of a nested case-control study reported in the September 16 issue of the Annals of Internal Medicine.

3.  Familiar Names Top Ten US News Best-Hospital Rankings for Heart Care.

The first three in the list are:

1. Cleveland Clinic
2. Mayo Clinic
3. Johns Hopkins Hospital

4.  Osteoporosis Drug Promotes Atrial Fibrillation in Population-based Study.

Women who have ever taken alendronate (Fosamax, Merck), the bisphosphonate widely prescribed for preservation of bone density that recently went off-patent, have an increased risk of developing atrial fibrillation (AF), according to a population-based, case-control study in the April 28, 2008 Archives of Internal Medicine.

5.  ADVANCE* Does Not Confirm ACCORD* results.

Preliminary findings from the ADVANCE* trial provide no evidence that intensive treatment to lower blood-glucose levels in type 2 diabetics increases mortality risk.

*ADVANCE is Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation. ACCORD is Action to Control Cardiovascular Risk in Diabetes.

6.  Reducing Heart Rate in Hypertension is Harmful — or Is It Just Atenolol?

“Slowing the heart rate with beta blockers in people with hypertension is associated with an increased risk of cardiovascular events and death, a new systematic review shows. Furthermore, the slower the heart rate, the greater the risk, report Dr Sripal Bangalore (St Luke’s Roosevelt Hospital, New York) and colleagues in the October 28, 2008, issue of the Journal of the American College of Cardiology.“

7.  Bisphosphonate Therapy Linked to Risk for Severe Musculoskeletal Pain.

“Temporary or permanent discontinuation of bisphosphonate therapy should be considered in patients who present with severe musculoskeletal pain, the US Food and Drug Administration (FDA) warned healthcare professionals yesterday. Overlooking bisphosphonate therapy as a causal factor may delay diagnosis, thereby prolonging pain and/or impairment and the use of analgesics. In contrast with the acute-phase response that sometimes accompanies initial exposure to bisphosphonate therapy, some patients experience severe and sometimes incapacitating bone, joint, and/or muscle pain that begins months or years later.“

8.  Societies Confront GI Risks for Antiplatelets, NSAIDS in Consensus Document.

“Proton-pump inhibitors (PPIs) should be the mainstay of treatment and prevention of gastrointestinal ulcers and bleeding in patients on antiplatelet therapy who are at increased risk for the gastrointestinal (GI) complications, according to an “expert consensus document” developed by the American College of Cardiology, American Heart Association, and American College of Gastroenterology and published online October 3, 2008.”

9.  Guidelines Issued on Preventing Herpes Zoster.

“These recommendations represent the first statement by [ACIP] on the use of a live attenuated vaccine for the prevention of herpes zoster (zoster) (i.e., shingles) and its sequelae, which was licensed by the U.S. Food and Drug Administration (FDA) on May 25, 2006,” write Rafael Harpaz, MD, from the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, and colleagues from the ACIP. “This report summarizes the epidemiology of zoster and its sequelae, describes the zoster vaccine, and provides recommendations for its use among adults aged >60 years in the United States.”

10.  Guidelines Issued for Early Detection of Colorectal Cancer (CRC).

“There is compelling evidence to support screening average-risk individuals over age 50 years to detect and prevent CRC,” the panel concludes. “Screening of average-risk individuals can reduce CRC mortality by detecting cancer at an early, curable stage and by detecting and removing clinically significant adenomas. . . . No CRC screening test is perfect, either for cancer detection or adenoma detection.”

Commentary:

Interestingly, the Medscape editors didn’t merit the JUPITER study as worthy for a top-ten article. This study suggests lowering the LDL-cholesterol to less than a hundred (< 100 mg/dL) even in a person whose LDL-cholesterol is within the normal range using rosuvastatin or CRESTOR to lower the risk of cardiovascular morbidty and mortality by almost 50%.

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Sorry, but comments are closed. Check out another post and speak up!