Dear All,
Greetings from Al-Ain, the oasis city of the Middle East. The September
issue of JSCAN is now on line. You can either read JSCAN on line or download
as a PDF file from http://www.uaeu.ac.ae/jscan
Please find below topics covered in this issue of JSCAN and do feel free to
send us your comments.
(Apologies for X posting as I have posted this to EB & Public health lists).
Cheers & warm regards,
Badri
Evidence Based Practice
A comparison of inhaled fluticasone and oral prednisone for children with
severe acute asthma. Schuh S, Reisman J et al. N Engl J Med 2000;343:689-94
The Question: How does inhaled corticosteroids compare with oral
corticosteroids in the treatment of children with severe acute asthma?
Answer in a nutshell: Oral prednisone significantly increased the FEV1 and
decreased the rate of hospitalisation as compared to inhaled
corticosteroids.
Gastrointestinal toxicity with Celecoxib vs Nonsteroidal Anti-inflammatory
Drugs for osteoarthritis and rheumatoid arthritis. The CLASS Study: A
randomized controlled trial. Silverstein FE, Faich G et al. JAMA.
2000;284:1247-1255.
The Question: Is celecoxib, a COX-2-specific inhibitor, associated with a
lower incidence of significant upper GI toxic effects and other adverse
effects compared with conventional NSAIDs?
Answer in a nutshell: Celecoxib, at dosages greater than those indicated
clinically, was associated with a lower incidence of symptomatic ulcers and
ulcer complications combined, as well as other clinically important toxic
effects, compared with NSAIDs at standard dosages.
Users' Guides to the Medical Literature. XXV. Evidence-Based Medicine:
Principles for Applying the Users' Guides to Patient Care. Guyatt GH, Haynes
RB et al for the Evidence-Based Medicine Working Group. JAMA.
2000;284:1290-1296
Effect of niacin on lipid and lipoprotein levels and glycemic control in
patients with diabetes and peripheral arterial disease. The ADMIT Study: A
Randomized Trial. Elam MB, Hunninghake DB et al for the ADMIT Investigators.
JAMA. 2000;284:1263-1270
The Question: Is Niacin effective and safe as a lipid-modifying agent in
patients with diabetes?
Answer in a nutshell: Niacin is safe as lipid-modifying agent in patients
with diabetes and niacin therapy may be considered as an alternative to
statin drugs or fibrates for patients with diabetes in whom these agents are
not tolerated or fail to sufficiently correct hypertriglyceridemia or low
HDL-C.
Periodontal disease and coronary heart disease risk. Hujoel PH, Drangsholt M
et al. JAMA. 2000;284:1406-1410.
The Question: Is the risk of coronary heart disease (CHD) higher in patients
with periodontitis or gingivitis?
Answer in a nutshell: There appears to be no association between CHD risk
and periodontitis or gingivitis.
Whole grain consumption and risk of ischemic stroke in women. A prospective
study. Liu S, Manson JE et al. JAMA. 2000;284:1534-1540
The Question: Does higher whole grain intake reduces the risk of ischemic
stroke in women?
Answer in a nutshell: Higher intake of whole grain foods is associated with
a lower risk of ischemic stroke among women, independent of known CVD risk
factors.
Outpatient urine culture-does collection technique matter? Lifshitz E,
Kramer L. Arch Intern Med. 2000;160:2537-2540
The Question: In young women with acute dysuria do methods of obtaining
specimens for culture influence the contamination rates?
Answer in a nutshell: In young, outpatient women with symptoms suggestive of
a urinary tract infection, methods of obtaining specimens including the
midstream clean-catch technique does not differ in contamination rates.
SOAP - Solutions to often asked clinical problems.
Chlamydia trachomatis testing. Reust CE.
http://archfami.ama-assn.org/issues/v9n9/ffull/fqa0006-1.html
Are antibiotics necessary in the treatment of locally infected ingrown
toenails? Reyzelman AM, Trombello KA et al. Arch Fam Med. 2000;9:930-932
The Question: Is oral antibiotic therapy is beneficial as an adjunct to the
phenol chemical matrixectomy in the treatment of infected ingrown toenails?
Answer in a nutshell: The use of oral antibiotics as an adjunctive therapy
in treating ingrown toenails does not decrease the healing time or
postprocedure morbidity.
Systematic review and economic evaluation of Helicobacter pylori eradication
treatment for non-ulcer dyspepsia. Moayyedi P, Soo S et al. BMJ.
2000;321:659-64.
The Question: What is the efficacy and cost effectiveness of Helicobacter
pylori(H.Pylori) eradication treatment in patients with non-ulcer dyspepsia
infected with H pylori.
Answer in a nutshell: H pylori eradication treatment is significantly
superior to placebo in treating non-ulcer dyspepsia and this treatment
appears to be cost effective.
A low-glycemic index diet in the treatment of pediatric obesity. Spieth LE,
Harnish JD et al. Arch Pediatr Adolesc Med. 2000;154:947-951
The Question: What is the effect of low-glycemic index (GI) diet compared
with a standard reduced-fat diet in the management of pediatric obesity.
Answer in a nutshell: Low-glycemic index diet significantly reduces BMI and
body weight as compared to standard reduced-fat diet and seems to be a
promising alternative to standard dietary treatment for obesity in children.
International guidelines for Neonatal Resuscitation: An excerpt from the
guidelines 2000 for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care: International Consensus on Science. Pediatrics Vol. 106
No. 3 September 2000, p. e29.
The Question: Where can I find the latest guidelines on Neonatal
Resuscitation?
Early respiratory infections and childhood asthma. Nafstad P, Magnus P.
http://www.pediatrics.org/cgi/content/full/106/3/e38
The Question: What is the role of early respiratory infections in the
development of bronchial obstruction in the first 2 years of life, and
asthma by the age of 4 years?
Answer in a nutshell: Early respiratory infections increases, the risk of
developing bronchial obstruction during the first 2 years of life and of
having asthma at 4 years of age.
Pacifier as a risk factor for acute otitis media: A randomized, controlled
trial of parental counseling. Niemelä M, Pihakari O et al. Pediatrics
2000;106:483-488.
The Question: Is there an association between pacifier use and the increased
occurrence of acute otitis media (AOM)?
Answer in a nutshell: Pacifier use is a preventable risk factor for AOM in
children and its restriction to the moments when the child was falling
asleep effectively prevented episodes of AOM.
Efficacy of selective serotonin-reuptake inhibitors in premenstrual
syndrome: a systematic review Dimmock PW, Wyatt KM et al. Lancet 2000; 356:
113136
The Question: How effective are serotonin-reuptake inhibitors (SSRIs) in the
management of severe premenstrual syndrome (PMS).
Answer in a nutshell: SSRIs are an effective first-line therapy for severe
PMS. The safety of these drugs has been demonstrated in trials of affective
disorder, and the side effects at low doses are generally acceptable.
Comparison of St John's wort and imipramine for treating depression:
randomised controlled trial. Helmut Woelk BMJ 2000;321:536-539.
The Question: What is the efficacy and tolerability of Hypericum perforatum
(St John's wort extract) as compared to imipramine in patients with mild to
moderate depression?
Answer in a nutshell: The Hypericum perforatum extract is therapeutically
equivalent to imipramine in treating mild to moderate depression, but
patients tolerate hypericum better.
Early androgenetic alopecia as a marker of insulin resistance Matilainen V,
Koskela P et al. Lancet. 2000;356:1165-6.
The Question: Is there an association between early onset androgenetic
alopecia and cardiovascular risk factors?
Answer in a nutshell: Early androgenetic alopecia is associated with a
clustering of cardiovascular risk factors including hyperinsulenemia, a
marker of insulin resistance.
Antidepressants are effective for clinical improvement in unexplained
physical symptoms and syndromes. ACP Journal Club. September/October 2000.
The Question: In adults who have medically unexplained physical symptoms
(MUPS), do antidepressants improve outcomes?
Answer in a nutshell: In patients with medically unexplained physical
symptoms or syndromes, anti-depressants are effective for improving
outcomes, including symptoms and disability.
Garlic for treating hypercholesterolemia A meta-analysis of randomized
clinical trials. Stevinson C, Ernst E.Ann Intern Med. 2000;133:420-429
The Question: What is the effect of garlic on total cholesterol level in
persons with elevated levels of cholesterol?
Answer in a nutshell: Though the available data suggest that garlic may be
superior to placebo in reducing total cholesterol levels, the size of the
effect is modest, and the robustness of this effect is debatable. Hence the
use of garlic for hypercholesterolemia is therefore of questionable value
Type of alcohol consumed and mortality from all causes, coronary heart
disease, and cancer. Grønbæk M, Becker U et al. Ann Intern Med.
2000;133:411-419
The Question: What is the relation between intake of different types of
alcohol and death from all causes, coronary heart disease, and cancer?
Answer in a nutshell: Wine intake appears to confer a beneficial effect on
all-cause mortality that is additive to that of alcohol. This effect may be
attributable to a reduction in death from both coronary heart disease and
cancer
Proteinuria in adults: A diagnostic approach. Carroll MF, Temte JL. Am Fam
Physician 2000;62:1333-40.
The Question: What should be the diagnostic approach towards protenuria in
adults? Answer in a nutshell: An algorithmic approach can be used to
differentiate benign causes of proteinuria from rarer, more serious
disorders.
Health Services Research
Rates of in-hospital arrests, deaths and intensive care admissions: the
effect of a medical emergency team. Bristow PJ, Hillman KM et al. MJA 2000;
173: 236-240
The Question: How effective are hospital medical emergency teams (METs) in
reducing the rates of selected adverse events?
Answer in a nutshell: The MET teams in hospitals lead to a reduction in
intensive care and high dependency unit (ICU/HDU) admissions. Also the rates
of non-"do not resuscitate" (DNR)deaths were lower compared with hospitals
without METS.
Chronic diseases
Arterial abnormalities in the offspring of patients with premature
myocardial infarction. Gaeta G, Michele MD N Engl J Med 2000;343:840-6.
The Question: Do adolescents and young adults with a parental history of
premature myocardial infarction exhibit markers of early atherosclerosis?
Answer in a nutshell: Adolescents and young adults with a parental history
of premature myocardial infarction exhibit structural and functional changes
in the arteries at an early age.
Prevalence of and risk factors for dry eye syndrome. Moss SE, Klein R et al.
Arch Ophthalmol. 2000;118:1264-1268
The Question: What is the prevalence of dry eye syndrome and what are its
risk factors?
Answer in a nutshell: The overall prevalence is around 15% and the various
risk and protective factors are: history of arthritis, current smoking,
diabetes and current multivitamin use; caffeine use and total to
high-density lipoprotein cholesterol ratio
Coronary heart disease in smokers: vitamin C restores coronary
microcirculatory function. Kaufmann PA; Gnecchi-Ruscone T et al. Circulation
2000;102:1233-8
The Question: What is the effect of vitamin C on coronary reserves of
smokers?
Answer in a nutshell: Vitamin C restores coronary microcirculatory
responsiveness and impaired coronary flow reserve in smokers.
Medical Education
Racial and ethnic disparities in faculty promotion in academic medicine.
Fang D, Moy E et al. JAMA. 2000;284:1085-1092.
The Question: Do rates of academic promotions differ between ethnic
minorities and white faculty across medical schools in the USA?
Answer in a nutshell: Minority faculty are promoted at lower rates compared
with white faculty in US medical schools.
Is evidence based medicine neglected by royal college examinations? A
descriptive study of their syllabuses. Leung WC, Whitty P BMJ
2000;321:603-604 .
The Question: To what extent do royal college examinations assess the skills
in evidence based medicine?
Answer in a nutshell: Only very few specialty examinations of the royal
college assess the evidence based medicine skills to any depths and nearly
two thirds of the postgraduate examinations have no dedicated sections to
examine skills in evidence based medicine.
>From the Pages of Bandolier
http://www.jr2.ox.ac.uk/Bandolier/band79/b79-4.html
Treatments for infant colic
Money Matters
The potential clinical and economic benefits of silver alloy urinary
catheters in preventing urinary tract infection. Saint S, Veenstra DL et al.
Arch Intern Med. 2000;160:2670-2675.
The Question: What is the clinical and economic impact of using silver alloy
urinary catheters in hospitalized patients?
Answer in a nutshell: Using silver alloy catheters in hospitalized patients
requiring short-term urinary catheterization reduces the incidence of
symptomatic UTI and bacteremia, and is likely to produce cost savings
compared with standard catheters.
Nosocomial Respiratory Syncytial Virus Infections: The Cost-Effectiveness
and Cost-Benefit of infection control. Macartney KK, Gorelick MH et al.
Pediatrics 2000;106:520-526.
The Question: Is it cost-effective and cost-beneficial to implement an
infection control program to reduce nosocomial respiratory syncytial virus
(RSV) transmission in a large pediatric hospital.
Answer in a nutshell: A targeted infection control intervention was
cost-effective in reducing the rate of RSV NI. For every dollar spent on the
program, approximately $6 was saved.
Women's Health
Risk and prognosis of endometrial cancer after tamoxifen for breast cancer.
Bergman L, Beelen MLR et al and the Comprehensive Cancer Centres' ALERT
Group* Lancet 2000; 356: 88187
The Question: Are clinicopathological and immunohistochemical
characteristics and the ultimate prognosis of endometrial cancers in
tamoxifen-treated women different from those in patients not treated with
tamoxifen?
Answer in a nutshell: Long-term tamoxifen users have a worse prognosis of
endometrial cancers, which seems to be due to less favourable histology and
higher stage. However, the benefit of tamoxifen on breast-cancer survival
far outweighs the increased mortality from endometrial cancer.
Infectious disease
Update on Rift Valley Fever (RVF)
Prevalence of postherpetic neuralgia after a first episode of herpes zoster:
prospective study with long term follow up. Helgason S, Petursson G et al.
BMJ 2000;321:794.
The Question: What is the frequency, duration, and clinical importance of
postherpetic neuralgia after a single episode of herpes zoster?
Answer in a nutshell: Post herpetic neuralgia occurred in 1.8% of the
patients under 60 years, and in patients aged over 60 years there was slight
increase in post herpetic neuralgia though the pain was not of clinical
significance.
Miscellaneous
A practical approach to uncomplicated seizures in children. Mcabee GN, Wark
JE. Am Fam Physician 2000;62:1109-16.
Smokers' corner
Publication of Surgeon General's Report on Smoking and Health. MMWR.
2000;49:718-727
Nargile smoking keeps Arabs in Wonderland Kandela P Lancet 2000; 356: 30
September 2000
News from the region
Uterine transplantation failure causes Saudi Arabian government clampdown.
Kandela P. Lancet 2000, 2nd September 2000.
UN report underscores hardship in Iraq Ahmad K. Lancet 2000; 356, 23
September
For your patients
Here is a patient information leaflet on Sickle cell disease, which may be
of interest to some of our readers.
Webwatch
http://www.poems.msu.edu/InfoMastery/
http://www.infopoll.com/designer.htm#Form
http://www.fda.gov/cder/cancer
www.mdchoice.com
http://www.census.gov/ipc/www/idbsum.html
http://www.census.gov/ipc/www/idbpyr.html
http://www.cdc.gov/iceid/webcast/promo_webcast.htm
www.mentalhealth.com
Book Corner
Studying a Study and Testing a Test: How to Read the Medical Evidence. by
Richard K. Riegelman, 4th ed, with CD-ROM, 356 pp, paper, $32.95, ISBN
0-7817-1860-0, Philadelphia, Pa, Lippincott Williams & Wilkins, 2000.
Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)
Clinical Assistant Professor and Epidemiologist,
Department of Community Medicine,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates.
Tel: 00 971 3 7039 652
Fax: 00 971 3 7672022.
[log in to unmask]
"For an excellent review of the current medical literature, go to Journals
Scan http://www.uaeu.ac.ae/jscan/index.htm" - BMJ 3rd June
2000,Reviews(Netlines)
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