HHAL
MEDICAL NEWS MARCH08
"Do I Have to Take Off My Shirt?"
Reading blood pressure on a sleeved arm might be fine, but one expert urges caution.
Measuring
blood pressure on a sleeved arm violates long-established guidelines for this procedure, but, in busy clinical settings, it’s
done all the time. Does taking the time to extract patients’ arms from their sleeves really make any difference?
Canadian
researchers used automatic oscillometric cuffs to obtain two blood pressure measurements — taken 3 minutes apart —
in 376 adult medical-clinic patients. In 180, both measurements were performed on unsleeved arms, and, in 196,
the second reading was taken on sleeved arms. In both groups, the mean systolic and diastolic values in the second
reading were slightly lower than those from the first (as would be expected after more time in a seated position); however,
the presence of sleeves resulted in no significant difference in the size of the decrement. In the subset of patients with
hypertension, the presence of sleeves was similarly unimportant. The researchers estimated the mean thickness of the sleeves
at 4.3 mm, equivalent to that of a shirt or light sweater.
Comment: In several other studies, researchers
have concluded that the bare-arm requirement in blood pressure measurement probably is not warranted. But an editorialist
says that an immediate guideline change might be premature, because automated devices, such as the one used in this study,
were all validated on bare arms, and individual models could lose accuracy at highly variable rates when clothing interferes
with oscillometry.
Does Omeprazole Affect Antiplatelet Therapy?
Circumstantial evidence shows that coadministration of clopidogrel and PPIs can
affect platelet reactivity.
Pharmacologic Treatment of Dementia
Clinical Practice Guideline Watch | Free
Drugs do not lead to dramatic improvements
in patients with dementia.
This practice guideline, based on an extensive evidence review, reflects observations
in clinical practice — in particular, that these medications do not lead to dramatic clinical improvements for dementia
patients. In my view, development of new agents with more-meaningful clinical benefits should be a higher priority than further
research on the currently available ones.
http://www.annals.org/cgi/content/full/148/5/370?linkType=FULL&journalCode=annintmed&resid=148/5/370
Vitamin D2 vs. Vitamin D3
Supplementation — Does It Matter?
Vitamin D2 and vitamin D3 supplements were equally effective
in raising serum levels of 25-hydroxyvitamin D.
Holick MF et al. J Clin Endocrinol Metab 2008 Mar 93:677
Enteral
Probiotics Increase Short-Term Mortality in High-Risk Acute Pancreatitis Patients
Researchers warn that probiotics can no longer be viewed as harmless.
Besselink MGH et al. Lancet 2008 Feb 23; 371:651
Statins
in Patients with Chronic Kidney Disease
Summary and Comment | Subscription Required
Risks for nonfatal cardiovascular events and cardiovascular death were lower with
statins.
Strippoli GFM et al. BMJ 2008 Mar 22; 336:645
Improvements in Long-Term Mortality After Myocardial
Infarction and Increased Use of Cardiovascular Drugs After Discharge
A 10-Year Trend Analysis
Results: Of 21,484 patients identified, 12,142 died during
74,982 person-years of follow-up. After adjusting for demographics and comorbidities, we found that
mortality after MI decreased significantly from 1995 to 2004 (hazard ratio for annual trend 0.97; 95% confidence
interval 0.97 to 0.98), a 3% reduction in mortality each year. Adjusting for the use of statins, BBs, ACEIs/ARBs,
and antiplatelet drugs after discharge completely eliminated the association between time trend and
mortality (hazard ratio 1.00; 95% confidence interval 0.99 to 1.01).
Conclusions: The observed improvement in long-term mortality
in elderly patients with MI may be mainly due to increased use of cardiovascular medications after discharge.
http://content.onlinejacc.org/cgi/content/abstract/51/13/1247
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=505166
Individuals
with high index also score lower on some physical quality-of-life measures
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=505163
Long-term study of former medical students shows
significantly elevated risk throughout life
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=505164
Oral Sodium Phosphate
Bowel Prep Associated with Decline in Renal Function
Use
of sodium phosphate for bowel preparation before endoscopy is associated with declines in kidney function, reports Archives of Internal Medicine.
Conclusions Oral sodium phosphate solution preparation
is associated with decline in GFR in elderly patients with creatinine levels in the normal range. Its routine
use for elective and screening procedures should be discouraged in the elderly population.
Archives of Internal Medicine article (Free)
FDA Investigates Possible Link Between Singulair and Suicidal Behavior
FDA early communication (Free)
Associated Press story (Free)
FDA's MedWatch reporting site (Free)
Singulair prescribing information (Free PDF)
Once-Daily Basal
Insulin as Effective as Prandial
Once-daily
treatment with insulin glargine lowers hemoglobin A1c as effectively as prandial lispro, according to an open-label study
published in Lancet and performed by glargine's maker.
Some
400 adults whose type 2 diabetes was inadequately controlled with oral medications were randomized to take insulin glargine
once daily or insulin lispro three times daily before meals. After 44 weeks, HbA1C was reduced as effectively with glargine
as with lispro (mean reduction, –1.7 and –1.9 percentage points, respectively). Glargine recipients were less
likely to experience hypoglycemia (66% vs. 89%), and they expressed more treatment satisfaction.
The
authors call the addition of glargine to oral hypoglycemic agents a "simple and well tolerated intervention ... that can be
regarded as a first-line insulin initiation approach in type 2 diabetes mellitus, as has been recommended in a joint consensus
guideline" by American and European diabetes associations.
Consensus statement on type 2 diabetes management from the American Diabetes Association and
the European Association for the Study of Diabetes (Free)
SGI: High Cholesterol Persists in Mothers of Preemies
total cholesterol was an average of two to three times higher for
women with a history of preterm birth compared to those with normal gestation births."
More Information
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=506039&contextCategoryId=40130
Hair
Dyes Linked to Risk of Bladder Cancer
Increased risk seen in hairdressers, barbers; no
clear evidence of increased risk from personal use of hair dyes
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=506032&contextCategoryId=40130
Analysis suggests it may
be cheap alternative to supplementation with potassium citrate
In
patients with recurrent hypocitraturic nephrolithiasis, fresh tomato juice may be a feasible alternative to traditional supplementation
consisting of potassium citrate two to three times daily, researchers report in the March issue of Urology.
Abstract
http://www.modernmedicine.com/modernmedicine/content/printContentPopup.jsp?id=506038
Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia
Conclusions In patients with familial hypercholesterolemia, combined
therapy with ezetimibe and simvastatin did not result in a significant difference in changes in intima–media
thickness, as compared with simvastatin alone, despite decreases in levels of LDL cholesterol and C-reactive
protein. (ClinicalTrials.gov number, NCT005520
http://content.nejm.org/cgi/content/full/NEJMoa0800742?query=TOC
http://content.nejm.org/cgi/content/full/NEJMe0801842?query=TOC
Severity of diabetes correlates with reduction in lung function
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=506241&contextCategoryId=40130
Oral Sodium Phosphate
Bowel Prep Associated with Decline in Renal Function
http://archinte.ama-assn.org/cgi/content/full/168/6/593
No Effect of DHEA on Exercise Training in Older Women
With DHEA or without it, exercise provided the same benefits.
Dehydroepiandrosterone
(DHEA) and its sulfate (DHEA-S) are produced robustly in men and women until the third decade of life, when production begins
to markedly and progressively decline with age. These observations have led to recommendations that DHEA be provided to older
adults. But does DHEA improve physical performance, body composition, and metabolic parameters? So begins the great debate.
In
this 12-week blinded randomized trial, 31 sedentary, healthy, postmenopausal white women received both endurance (4 days weekly)
and resistance (3 days weekly) exercise training; half received daily DHEA (50 mg) and half received placebo. DHEA treatment
resulted in increases in circulating DHEA-S (by a mean of 650%), total testosterone (by 100%), estradiol (by 165%), estrone
(by 85%), and insulin-like growth factor-1 (by 30%). Exercise with or without DHEA resulted in similarly significant improvements
in physical performance, body composition, and insulin sensitivity.
Comment: These results are consistent
with findings from another recent study of DHEA supplementation in women (Journal Watch Oct 18 2006). The bottom line here is that, as is well recognized, exercise improves a number of parameters in postmenopausal
women, but DHEA does not result in further improvement. Women are well advised to remember the exercise and forget the DHEA.
http://www.ncbi.nlm.nih.gov/pubmed/18029465?dopt=Abstract
High
Calcium Intake May Not Help Prevent Fractures, Reports The Harvard Health Letter
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=98497
Spiriva Linked to Possible Increased Risk for Stroke, FDA
Says
http://www.fda.gov/cder/drug/early_comm/tiotropium.htm
http://online.wsj.com/article/SB120587199789846207.html?mod=health_home_stories
Lipid hydroperoxide is a marker of inflammation,
can be a predictor in coronary artery disease patients
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=503815&contextCategoryId=40130
Vitamin D Supplementation
in Infants May Protect Against Type 1 Diabetes
http://adc.bmj.com/cgi/content/abstract/adc.2007.128579v1
Low-Dose Aspirin Cuts Asthma Risk in Women
Conclusions: In this large, randomised clinical trial of apparently
healthy adult women, assignment of 100 mg of aspirin on alternate days reduced the relative risk of newly
reported diagnosis of asthma. Key words: asthma, aspirin, randomised trial.
http://thorax.bmj.com/cgi/content/abstract/thx.2007.091447v1
Tussionex Safety Alert
The
FDA has issued a safety alert on the prescription cough suppressant Tussionex (hydrocodone polistirex
and chlorpheniramine polistirex) in response to reports of adverse events, including death, associated with misuse of the
drug.
The
alert reminds clinicians that Tussionex should not be given to children under age 6 years and should not be administered more
frequently than every 12 hours.
FDA alert (Free)
Tussionex prescribing information (Free PDF)
