1999.06.13 Pearls
 

In this study of 1621 men and women, the pulse pressure (systolic BP - diastolic BP) was predictive of heart failure. Those with a pulse pressure of > 67 had a 55% increased risk for CHF compared with those with a pulse pressure < 54. Chae CU et al. JAMA 1999 ;0281:0634 .

In this study of 75 male smokers (at least 1 pack per day), taking 1000 mg of vitamin C a day resulted in lowering their blood lead levels by 81%. Dawson EB et al. J Amer College Nutrition 1999 ;18:166 .

In 25 children with attention deficit-hyperactivity disorder (ADHD), amphetamine sulfate (Adderall) was as effective as methylphenidate (Ritalin). The amphetamine sulfate was effective at a lower dose than required with methylphenidate. Pelham W et al. Pediatrics 1999 ;103:E43 .

Significant resistance to antibiotics is developing. For example, resistance to penicillin by strep pneumo has increased from 2% to 10% in the 1980's to 50% to 80% today in some countries. Enterococci resistant to all antibiotics has been seen. Antibiotic resistance invariably is linked to the use of antibiotics. Frimodt-Moller N et al. Eur J Pub Health 1998 SEP;8(3):193 .

Recent guidelines on the treatment of acute poisoning strongly discourage the use of ipecac in the ED, and indicate that even gastric lavage has not been shown to be very helpful, even in the 1st hour after an acute ingestion. Cathartics have no role, and whole bowel irrigation only possibly for ingestions of enteric coated or delayed release tablets. Tenenbein M et al. Ped Emerg Care 1998 ;14(5):380 .

In a study of 4209 overweight adult onset diabetics, treatment with metformin (Glucophage) was associated with less weight gain and hypoglycemia as compared with insulin or sulfonylureas. The authors recommend metformin as 1st line therapy for adult onset diabetes in overweight patients. UK Prospective Diabetes Study Group. Lancet 1998 SEP 12;352:854 .

This article on plantar fasciitis recommends ice, stretching, massage, and supportive taping of the midfoot. . Australian Fam Phys 1998 SEP; .

This review found that predictors of an acute heart attack were: (1) chest pain [odds ratio = 2.0], (2) pain radiation to either the right shoulder [OR=2.9], the left shoulder [OR=2.3], or both [OR=7.1], (3) a history of a previous heart attack [OR=1.5], (4) the presence of nausea or vomitting [OR=1.9], (5) a third heart sound [OR=3.2], (6) hypotension [OR=3.1], or (7) rales. A reduced likelihood of an acute heart attack were: (1) pleuritic pain [OR=0.2], (2) sharp or stabbing pain [OR=0.3], (3) positional pain [OR=0.3], and (4) repoducibility of the pain with palpation. Notably, findings not associated with an acute heart attack were (1) pressure, aching, or squeezing chest pain, or (2) the presence of classic cardiac risk factors. Panju AA et al. JAMA 1998 OCT 14;280(14):1256 .

In this study of 1090 patients with an abdominal aortic aneurysm measuring between 4.0 and 5.5 cm in diameter, observation with ultrasound was as effective as early surgical intervention in terms of survival. All patients were operated on if the diameter exceeded 5.5 cm or if the growth rate exceeded 1 cm a year. UK Small Aneurysm Trial Participants. Lancet 1998 NOV 21;352:1649 .

These authors from the Minneapolis VA Medical Center studied the use of opiods in patients with chronic rheumatic disease. Their findings indicate that a trial of opiods should not be withheld in patients with chronic pain as the opiods are safe and effective. Ytterberg SR et al. Arthr Rheum 1998 SEP;41(9):1603 .

In patients with a painful stiff shoulder, cortisone injection of the shoulder was more effective than physical therapy in this study of 109 adults. van der Windt et al. BMJ 1998 ;317(7168):1292 .

In this study of 137 inpatients, aged 17 to 92, infrared ear thermometers were found to be very inaccurate. In one case, measuring the temperature in different ears of the same patient, with the same infrared thermometer, within seconds of eachother, resulted in a temperature difference of 3.8 degrees CENTIGRADE! Modell JG et al. South Med J 1998 JUL;91:649 .

This consensus statement from a workshop held at Yale, concluded that proton pump inhibitors are indicated as 1st line medical therapy in the treatment of gastroesophageal reflux, and should be used when nonmedical therapies fail. Moss SF et al. Clin Gastroenterol 1998 JUL;27:6 .

While a positive Troponin I level is an independent predictor of an acute cardiac event, a negative value does not necessarily predict a bening course; ie it is sensitive but not as specific. Polanczyk CA et al. J Am Coll Cardiol 1998 JUL;32:8 .

Women who eat at least 1 serving of whole grains a day have 1/3rd the risk of death from ischemic heart disease compared with women who eat less whole grains. Jacobs DR et al. Am J Clin Nutr 1998 AUG;68:248 .