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Old September 24th, 2001, 21:06
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1999.12.10 Pearls

WHOLE GRAIN INTAKE REDUCES MORTALITY. In this study of 38740 women aged 55 to 69 years of age, mortality risk was increased with refined grain intake, and decreased with whole grain intake. This association held up after adjustment for lifestyle and baseline health status. Jacobs DR et al. Am J Public Health 1999;89(3):322-329.

VITAMIN C ASSOCIATED WITH LOWER BLOOD LEAD LEVELS. In this study of 19578 participants in the US NHANES III study, those with higher blood levels of vitamin C, had lower levels of lead in their blood. The authors hypothesize that an increased consumption of vitamin C may lead to lower blood lead levels. Simon JA, Hudes ES. JAMA 1999;281:2289.

NUCLEAR SCANS PREDICT MORTALITY AFTER MYOCARDIAL INFARCTION. In this study of 73 patients over 65 years old with a recent myocardial infarction, reversible defects on cardiac nuclear scanning was highly predictive of a recurrent MI or death. Among the 60% with reversible defects, 30% died during the following 18 months, and 14% suffered another MI (total 44%). Among the 40% without reversible defects, 17% died during the following 18 months, and there were no recurrent MI's. Thus, the risk of death was found to be twice as high in the group with reversible defects on nuclear scanning. Jain S et al. J Am Geriatr Soc 1999;47:295.

BLOOD PRESSURE CONTROL NEARLY HALVES RISK OF STROKE. This study of 1000 diabetic men in the United Kingdom found that controlling the blood pressure to a target of less than 150/85 (compared with a target of < 180/105) reduced by 44% the risk of a stroke, reduced the risk of an MI by 21%, and the overall mortality by 18%. Ibrahim HAA et al. J Hum Hypertens 1999;13:221.

LOPERAMIDE-SIMETHICONE COMBINATION BETTER THAN EITHER ALONE IN TREATING DIARRHEA. The combination of loperamide (found in Imodium) and simethicone (found in Maalox and Mylanta) was better at relieving the symptoms of diarrhea in this study of 493 adult outpatients with nonspecific acute diarrhea. Kaplan MA et al. Arch Fam Med 1999;8(3):243.

WOMEN MORE SUSCEPTIBLE TO ERYTHROMYCIN INDUCED CARDIAC CHANGES. This review article found that women were much more likely to have erythromycin induced prolongation of the QT interval compared to men. The authors advise clinicians to be especially aware of this effect when prescribing erythromycin to women who are on other medications that inhibit the cytochrome P450 3A4, such as fluconazole, clarithromycin, itraconazole, ketoconazole, indinavir, and rionavir. Osborne NG et al. J Gyn Surg 1999;15(1):65.

SINGLE DOSE AZITHROMYCIN EFFECTIVE IN TREATING PNEUMONIA. A single 1.5g dose of azithromycin was as effective as the standard 4 day regimen in treating community acquired pneumonia. There also was no difference in the frequency of side-effects. Schonwald S et al. Infection 1999;27(3).

ST. JOHN'S WORT AS EFFECTIVE AS IMIPRAMINE IN MODERATE DEPRESSION. This German study of 263 moderately depressed patients found that the herb St. John's Wort (hypericum extract) was as effective as the tricyclic antidepressent imipramine, and also associated with fewer side effects. BMJ 1999;319:1534-1539.

LOW CHOLESTEROL NOT OF BENEFIT IN SMOKERS. Lowering the cholesterol level in smokers was found to not be helpful in preventing cardiovascular disease.



Commentary

An interesting pearl this month is the finding that single dose azithromycin is not only as well tolerated as the multi-dose regimen, but also as effective. Could large, single dose antibiotic regimens be effective in other situations? We already know that single dose azithromycin works in treating genital chlamydia, that often a single dose antibiotic successfully treats urinary tract infections, and that single dose (IM) ceftriaxone works for otitis media and genital gonorrhea. Shortening of antibiotic regimens seems to be a trend. Going smack in the face of standard dogma, a few years ago an article in JAMA even found that treating sinusitis could be shortened to just 5 days. Also, there is a movement to increase the daily dose of amoxicillin for pediatric otitis media. Yet another article I've come across over the past couple of years found that a single, daily dose of amoxicillin worked as well as the standard TID regimen. Perhaps giving a single knock-out punch is more effective that repeated jabs in the treatment of infectious diseases.

Another provocative article is the finding that lowering cholesterol levels in smokers doesn't help prevent cardiovascular disease. Should smokers be eligible for the expensive HMG-CoA inhibitors? Will HMO's require negative urinary nicotine (or cotine) level before authorizing the prescription of cholesterol lowering medications? This reminds me of my very first lecture on peptic ulcer disease during my initial year at St. Louis University School of Medicine. The speaker flatly stated that he didn't bother treating acid peptic disease unless the patient would quit smoking. What's next? A body-mass-index cutoff above which treatment for type II diabetes, coronary artery disease, or sleep apnea? The implications of this article on cholesterol levels in smokers is really uncertain.
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