Dear All,

Greetings from Al-Ain the oasis city of the Middle East. The March issue of
JSCAN an online professional news letter we produce from the UAE is now on
line. Please find below the topics covered in this issue. This is the 25th
issue of JSCAN and we have tried to give JSCAN a new look. As always please
feel free to send in your comments which will help us to improve.

With warm regards (it is really warm here with the mercury hitting 48 Deg C)

Badri

Evidence Based Practice

Incidence of Guillain-Barré Syndrome following Infection with Campylobacter
jejuni. McCarthy N, Giesecke J. Am J Epidemiol 2001;153:610-14.
The Question: Can Campylobacter jejuni infection cause Guillain-Barré
syndrome (GBS)?
Answer in a nutshell: GBS appears to be an important but rare complication
of C. jejuni infection The risk of developing GBS during the 2 months
following a symptomatic episode of C. jejuni infection is approximately 100
times higher than the risk in the general population.


Time trends in autism and in MMR immunization coverage in California. Dales
L, Hammer SJ et al. JAMA. 2001;285:1183-1185
The Question: Is there a correlation between secular trends of MMR
immunization coverage among young children and autism occurrence?
Answer in a nutshell: Data from California, USA do not suggest an
association between MMR immunization among young children and an increase in
autism occurrence.

Measles-Mumps-Rubella and other measles-containing vaccines do not increase
the risk for inflammatory bowel disease - A case-control study from the
vaccine safety datalink project. Davis RL, Kramarz P et al for the Vaccine
Safety Datalink Team. Arch Pediatr Adolesc Med. 2001;155:354-359
The Question: Does receiving or timing of measles-containing vaccine (MCV)
increase risk of inflammatory bowel disease (IBD)?
Answer in a nutshell: Results from the Centers for Disease Control and
Prevention's Vaccine Safety Datalink project show that vaccination with MMR
or other MCV, or the timing of vaccination early in life, does not increase
the risk of IBD.

Hormone replacement therapy and cognition. Systematic review and
meta-analysis. LeBlanc ES, Janowsky J et al. JAMA. 2001;285:1489-1499
The Question: Is there a relation between hormone replacement therapy (HRT)
and cognitive decline including dementia?
Answer in a nutshell:
In women with menopausal symptoms, HRT may have specific cognitive effects
such as improvements in verbal memory, vigilance, reasoning, and motor
speed.  HRT is also appears to be associated with a decreased risk of
dementia, although the studies had many methodological limitations.

Randomized trial of folic acid supplementation and serum homocysteine
levels.  Wald DS, Bishop L et al. Arch Intern Med. 2001;161:695-700.
The Question: What dose of folic acid is necessary to achieve the maximum
reduction in serum homocysteine level across the range of levels seen in the
population?
Answer in a nutshell: A dosage of folic acid of 0.8 mg/d appears necessary
to achieve the reduction in serum homocysteine level in the population and
current US food fortification levels will achieve only a small proportion of
the achievable homocysteine reduction.


Sudden sensorineural hearing loss - Does application of glucocorticoids make
sense? Alexiou C, Arnold W et al. Arch Otolaryngol Head Neck Surg.
2001;127:253-258
The Question: Should corticosteroids be used in patients with sudden
sensorineural hearing loss (SSNHL)?
Answer in a nutshell: Administration of glucocorticoids should be
recommended for treatment of patients with SSNHL. In particular, patients
with SSNHL in the lower and middle frequency range and pancochlear hearing
loss have significantly better recovery of hearing levels after treatment
with steroids.

Therapy for Helicobacter pylori in patients with nonulcer dyspepsia
A Meta-Analysis of randomized, controlled trials. Laine L, Schoenfeld P et
al. Ann Int Med 2001;134: 361-369
The Question: Is it beneficial to use eradication therapy for Helicobacter
pylori (H.Pylori) in patients with nonulcer dyspepsia?
Answer in a nutshell: According to this meta-analysis there appears to be no
benefit in the use of H. pylori eradication therapy in patients with
nonulcer dyspepsia.

Preventing recurrent upper gastrointestinal bleeding in patients with
Helicobacter pylori Infection who are taking low-dose aspirin or Naproxen.
Chan FKL, Chung SCS et al. N Engl J Med 2001;344:967-73
The Question: In patients with H.pylori infection who are taking low dose
aspirin for cardiac protection, does eradication therapy protects against
subsequent gastric bleeding?
Answer in a nutshell: Among patients with H. pylori infection and a history
of upper gastrointestinal bleeding who are taking low-dose aspirin, the
eradication of H. pylori is effective in preventing recurrent bleeding.

Efficacy and safety of recombinant human activated protein C for severe
sepsis. Bernard GR, Vincent J-L et al for the Recombinant Human Activated
Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) Study Group. N
Engl J Med 2001;344:699-709.
The Question: Does the treatment with drotrecogin alfa activated reduce the
rate of death from any cause among patients with severe sepsis?
Answer in a nutshell: Treatment with drotrecogin alfa activated
significantly reduces mortality in patients with severe sepsis but may be
associated with an increased risk of bleeding.

Evidence-based medicine: useful tools for decision making. Craig JC, Irwig
LM et al.  MJA 2001; 174: 248-253
The Question: Where can I find an Australian perspective of evidence-based
medicine (EBM)?
Answer in a nutshell: The Medical Journal of Australia (MJA) is running a
series on EBM and the above article can be accessed on line @
http://www.mja.com.au/public/issues/174_05_050301/craig/craig.html#refbody7

Influence of bone densitometry results on the treatment of osteoporosis.
Fitt NS, Mitchell SL et al. CMAJ 2001;164:777-81
The Question: How does the testing for osteoporosis by bone densitometry
affects subsequent treatment of osteopenia and osteoporosis with either HRT
or bisphosphonates and what are the clinical factors associated with
starting either therapy after the scan?
Answer in a nutshell:  The proportion of women with osteoporosis receiving
hormone replacement therapy or bisphosphonate therapy increases after
diagnosis with densitometry.

Relation between plasma ascorbic acid and mortality in men and women in
EPIC-Norfolk prospective study: a prospective population study. Khaw KT,
Bingham S et al.  Lancet 2001; 357: 657-63.
The Question: What is the relation between plasma ascorbic acid levels and
subsequent mortality due to all causes, cardiovascular disease, ischaemic
heart disease, and cancer?
Answer in a nutshell: Data from this European prospective investigation show
that plasma ascorbic acid concentration is inversely related to mortality
from all-causes, from cardiovascular disease, and ischaemic heart disease in
men and women


Urinary sodium excretion and cardiovascular mortality in Finland: a
prospective study. Tuomilehto J, Jousilahti J et al. Lancet 2001; 357:
848-51.
The Question: Does high sodium intake, measured by 24 h urinary sodium
excretion, increase the risk of acute coronary heart disease and stroke
events, and mortality from cardiovascular disease and all causes in adult
population?
Answer in a nutshell: This Finnish prospective study found that high sodium
intake predicted mortality and risk of coronary heart disease, independent
of other cardiovascular risk factors, including blood pressure.

Broad-spectrum antibiotics for preterm, prelabour rupture of fetal
membranes: the ORACLE I randomised trial. Kenyon SL, Taylor DJ et al for the
ORACLE Collaborative Group. Lancet 2001; 357: 979-88
The Question: Is treating preterm, prelabour rupture of the fetal membranes
(pPROM) with antibiotics lead to any health benefits in the neonates?
Answer in a nutshell: Erythromycin for women with pPROM is associated with a
range of health benefits for the neonate, and thus could lead to probable
reduction in childhood disability. (Critically appraised in JSCAN)

Head Lice Infestation: Single drug versus combination therapy with one
percent Permethrin and Trimethoprim/Sulfamethoxazole. Hipolito RB, Mallorca
FG et al. Pediatrics 2001;107:e30.
The Question: How effective are the 3 different treatments for head lice
infestation (HLI) and does combination therapy reduce treatment failures?
Answer in a nutshell:  After 4 weeks of follow up the success rates for the
treatment of HLI were 72%, 78%, and 92.5% for 1% permethrin creme rinse (1%
PER), oral administration of trimethoprim/sulfamethoxazole (TMP/SMX) and
acombination of 1% PER and TMP/SMX respectively.

Health Services Research

Awareness and use of the Ottawa ankle and knee rules in 5 countries: can
publication alone be enough to change practice? Graham ID, Stiell IG et al.
Ann Emerg Med 2001;37:259-66.
The Question: What is the attitude of physicians towards Ottawa ankle and
knee rules and clinical decision rules in general?
Answer in a nutshell: This cross sectional survey among emergency physicians
conducted across five countries showed striking differences among countries
with regard to knowledge and use of decision rules. Despite similar
awareness in the United States, Canada, and the United Kingdom, US
physicians appeared much less likely to use the Ottawa Ankle Rules.

Women’s Health

Plasma Folate, Vitamin B12, and Homocyst(e)ine concentrations in
preeclamptic and normotensive Peruvian women. Sanchez SE, Zhang C et al. Am
J Epidemiol 2001;153:474-480
The Question: Is there an association between third trimester plasma folate,
vitamin B12, and homocyst(e)ine concentrations and preeclampsia in women?
Answer in a nutshell: Women with low folate concentrations had a
non-significant increase in the risk of preeclampsia whereas women with
higher homocyst(e)ine levels had a four fold increase in the risk of
preeclampsia.

Physical activity and coronary heart disease in women. Is "No Pain, No
Gain"?  Lee I-M, Rexrode KM et al. JAMA. 2001;285:1447-1454.
The Question: What is the relation between physical activity, specifically
walking and CHD in normal women and in women at high risk of CHD?
Answer in a nutshell: Prospective data from female health professionals show
that even light-to-moderate activity is associated with lower CHD rates in
women and at least 1 hour of walking per week predicts lower risk. This
inverse association with physical activity is also observed in women at high
risk for CHD.

Estrogen replacement therapy and ovarian cancer mortality in a large
prospective study of US women. Rodriguez C, Patel AV et al. JAMA.
2001;285:1460-1465
The Question: Is there an association between postmenopausal estrogen use
and ovarian cancer mortality and does it differ according to duration and
time of use?
Answer in a nutshell: Data from the US population show that, postmenopausal
estrogen use for 10 or more years is associated with increased risk of
ovarian cancer mortality and this excess mortality persists up to 29 years
after cessation of use.

Postmenopausal estrogen replacement therapy and the risk of Alzheimer
disease. Seshadri S, Zornberg GL et al. Arch Neurol. 2001;58:435-440
The Question: Does exposure to estrogen replacement therapy (ERT) reduce the
risk of Alzheimer disease (AD)?
Answer in a nutshell: The use of ERT in women after the onset of menopause
is not associated with a reduced risk of developing AD.

Chronic diseases

Serum triglycerides and risk of coronary heart disease among Japanese men
and women.  Iso H, Naito Y et al. Am J Epidemiol 2001;153:4909-94.
The Question: Is there an association between serum triglycerides and risk
of coronary heart disease in people with low serum total cholesterol levels?
Answer in a nutshell: In Japanese men and women who possess low mean values
of total cholesterol nonfasting serum triglycerides predict the incidence of
coronary heart disease.

Infectious diseases

Comparative efficacy of treatments for Pediculosis Capitis infestations
Update 2000. Meinking TL, Entzel P et al.  Arch Dermatol. 2001;137:287-292
The Question: What is the performance of various medical preparations in
treating head lice infestation?
Answer in a nutshell: Ovide lotion (0.5% malathion) is the fastest-killing
pediculicide and the most effective ovicide. One percent lindane shampoo is
the slowest-acting pediculicide and least effective ovicide. Nix is highly
effective in both undiluted and diluted forms.

Principles of appropriate antibiotic use for acute pharyngitis in adults.
Snow V, Mottur-Pilson C et al. Ann Intern Med. 2001;134:506-508
The Question: Where can I find latest guidelines on the principles of
appropriate antibiotic use for acute pharyngitis in adults?
Answer in a nutshell: The Annals of internal medicine has published a
position paper on “Principles of appropriate antibiotic use for treatment of
acute respiratory tract Infections in adults which can be accessed free on
line @
http://www.annals.org/issues/v134n6/full/200103200-00018.html


Otitis Externa: A practical guide to treatment and prevention. Sander R. Am
Fam Physician 2001;63:927-36,941-2.
The Question: Where can I find up to date information on the management of
otitis externa?
Answer in a nutshell: This review in the American family physician presents
the anatomy and physiology of auditory canal, precipitants of otitis
externa, causes of Otorrhea, how it presents and the ways of evaluating, and
treating the condition including the cost. Guidelines on the evaluation and
management of otitis externa can be accessed @
http://www.aafp.org/afp/20010301/927.html

Money Matters

Cost-Benefit Analysis of a strategy to vaccinate healthy working adults
against influenza.  Nichol KL. Arch Intern Med. 2001;161:749-759
The Question: Does vaccinating healthy working adults against influenza
leads to cost savings?
Answer in a nutshell: On an average influenza vaccination of healthy working
adults saves costs and this finding support a strategy of routine, annual
vaccination for this group of the population.

Chronic diseases

Garlic shows promise for improving some cardiovascular risk factors.
Ackermann RT, Mulrow CD et al. Arch Intern Med. 2001;161:813-824.
The Question: What is the effect of garlic on various cardiovascular related
risk factors?
Answer in a nutshell: Garlic preparations may lead to small reductions in
the total cholesterol levels, low-density lipoproteins and tryglyceride
levels. There are also small reductions in platelet aggregation but garlic
does not have an effect on glycemic related outcomes.

Risk factors for coronary heart disease in men 18 to 39 years of age.
Navas-Nacher EL, Colangelo L et al. Ann Int Med 2001;134: 433-439
The Question: What are the major coronary risk factors in younger than 40
years of age?
Answer in a nutshell: All major risk factors including age, serum
cholesterol level, systolic blood pressure, and cigarette smoking-were
significantly associated with death from coronary heart disease in men aged
under 40 years.

Osteoporosis: Part I. Evaluation and assessment. South-Paul JE. Am Fam
Physician 2001;63:897-904,908.
Osteoporosis: Part II. Nonpharmacologic and pharmacologic treatment.
South-Paul JE. Am Fam Physician 2001;63: 1121-8
The Question: Where can I find an up date on osteoporosis?
Answer in a nutshell: The above two reviews deal with risk factors,
laboratory values and provide a flow chart on evaluation a patient with
suspected osteoporosis.

Blood pressure measuring devices: recommendations of the European Society of
Hypertension. Brien EO, Waeber B et al on behalf of the European Society of
Hypertension Working Group on Blood Pressure Monitoring. BMJ
2001;322:531-536
The Question: Where can I find the latest recommendations on the use of
various blood pressure measuring devices?
Answer in a nutshell: The recent recommendations by the European Society of
Hypertension provide comprehensive information on this topic and can be
accessed @ http://www.bmj.com/cgi/content/full/322/7285/531

Medical Education

Model for directly assessing and improving clinical competence and
performance in revalidation of clinicians. McKinley RK, Fraser RC et al.
BMJ 2001;322:712-715.

Assessment of clinical competence. Wass V, Vleuten CVD et al. Lancet 2001;
357: 945-49.

Drug Watch

Ischaemic colitis in a patient taking meloxicam. Garcia B, Ramaholimihaso F
et al. Lancet. 2001;357:690.

From the pages of Bandolier

Identifying patients likely to fall in hospital
Bandolier review at http://www.jr2.ox.ac.uk/bandolier/band85/b85-3.html.
Also the March issue of Bandolier has an excellent review on obesity and
health @
http://www.jr2.ox.ac.uk/bandolier/band85/b85-4.html

There are also links to 6 patient information leaflets and 25 websites of
interest to health professionals and a CAT.


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.
http://myprofile.cos.com/badrishanthi

"For an excellent review of the current medical literature, go to Journals
Scan www.uaeu.ac.ae/jscan/index.htm" - BMJ 3rd June 2000,Reviews(Netlines)

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