Dear All,

Greetings from Al-Ain the oasis city. The curret issue of JSCAN is now on
line and can be accessed @ http://www.uaeu.ac.ae/jscan.
The aim of JSCAN is to up to date the busy health professionals on the
happenings in the field of medicine & health.

Please find below the list of topic covered in this issue. This 20 page
document can also be downloaded as a PDF file. If you do visit JSCAN and
have a minute to spare drop us a few lines on your thoughts about this
continuing professional development activity. You can mail us @
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Evidence Based Practice

Evaluation of an early two-dose measles vaccination schedule. Hutchins SS et
al. Am J Epidemiol 2001;154:1064-1071
The Question: What is the effect of an early two-dose vaccination schedule
on the subsequent prevention of measles?
Answer in a nutshell: According to this observational study from Florida,
early two-dose measles vaccination is associated with improved coverage and
a comparably high level of humoral immunity and clinical protection as a
single dose at age >=12 months.



Breast cancer risk in women with abnormal cytology in nipple aspirates of
breast fluid. Wrensch MR et al. JNCI 2001; 93:1791-1798.
The Question: Is the risk of breast cancer increased in women with abnormal
cytology in their nipple aspirates?
Answer in a nutshell: According to data from a large follow up study, women
with abnormal cytology in nipple aspirates of breast fluid have an increased
risk of breast cancer

Estrogen in the prevention of atherosclerosis. A randomized, double-blind
placebo controlled trial. Hodis HW et al for the Estrogen in the Prevention
of Atherosclerosis Trial Research Group Ann Intern Med. 2001;135:939-953.
The Question: What are the effects of unopposed estrogen replacement therapy
(ERT) on the progression of subclinical atherosclerosis in healthy
postmenopausal women without preexisting cardiovascular disease?
Answer in a nutshell: The average rate of progression of subclinical
atherosclerosis was slower in healthy postmenopausal women taking unopposed
ERT with 17beta-estradiol than in women taking placebo. However this
reduction in the progression of subclinical atherosclerosis was not seen in
women who took lipid-lowering medications.

Reported methodologic quality and discrepancies between large and small
randomised trials in meta-analysis. Kjaergard LL et al. Ann Intern Med.
2001;135:982-989
The Question: What are the reasons for the observed discrepancies between
the results of large and small randomised trials in meta-analyses?
Answer in a nutshell: Inadequate generation of the allocation sequence,
allocation concealment, and double blinding lead to exaggerated estimates of
intervention benefit and may contribute to discrepancies between the results
of large randomized trials and small randomised trials in meta-analyses.


Management of hypertension in patients with type 2 diabetes mellitus:
Guidelines based on current evidence. Kaplan NM. Ann Intern Med.
2001;135:1079-1083
The Question: Where can I find evidence-based information on the management
of hypertension in patients with type 2 diabetes mellitus?
Answer in a nutshell: This update in the Annals of Internal Medicine reviews
the current evidence on the management of this clinical condition.

Effects of diet and sodium intake on blood pressure: Subgroup analysis of
the DASH-Sodium trial. Vollmer WM et al for the DASH-Sodium Trial
Collaborative Research Group. Ann Intern Med. 2001;135:1019-1028
The Question: What are the effects of reduced sodium intake and the DASH
diet on blood pressure in DASH study participants?
Answer in a nutshell: Among DASH participants, the DASH diet and reduced
sodium intake were each associated with significant decreases in blood
pressure and these two factors combined produced the greatest reductions.

Effect of Omalizumab on symptoms of seasonal allergic rhinitis - A
randomized controlled trial. Casale TB, Condemi J et al for the Omalizumab
seasonal allergic rhinitis trial group. JAMA. 2001;286:2956-2967
The Question: What is the efficacy and safety of omalizumab for prophylaxis
of symptoms in patients with seasonal allergic rhinitis?
Answer in a nutshell: This randomised placebo controlled trial found that
Omalizumab decreased serum free IgE levels and provided clinical benefit in
a dose-dependent fashion in patients with seasonal allergic rhinitis.

Similar effectiveness of Paroxetine, Fluoxetine, and Sertraline in primary
care - A randomised trial. Kroenke K, West SL et al. JAMA.
2001;286:2947-2955
The Question: Is there any difference in the effectiveness of 3 SSRIs
(paroxetine, fluoxetine, and sertraline) in depressed primary care patients?
Answer in a nutshell: This randomised trial found that the SSRI
antidepressants paroxetine, fluoxetine, and sertraline were similar in
effectiveness for depressive symptoms as well as multiple domains of
health-related quality of life over the entire 9 months of this trial.

Antipsychotics and the risk of sudden cardiac death. Ray WA, Meredith S et
al. Arch Gen Psychiatry. 2001;58:1161-1167
The Question: Is there an increased risk of sudden cardiac death in patients
on antipsychotic drugs?
Answer in a nutshell: In this retrospective record based study patients
prescribed moderate doses of antipsychotics had large relative and absolute
increases in the risk of sudden cardiac death and the authors caution
regarding the use of this drugs in cardiac patients.

Preoperative cardiac risk assessment. An updated approach. Romero L, de
Virgilio C. Arch Surg. 2001;136:1370-1376.
The Question: Where can I find up to date information on the preoperative
cardiac risk assessment in patients undergoing noncardiac surgery?
Answer in a nutshell: This review provides an updated algorithm for
approaching preoperative cardiac risk assessment in patients undergoing
noncardiac surgery.

Frequency of eating and concentrations of serum cholesterol in the Norfolk
population of the European prospective investigation into cancer
(EPIC-Norfolk): cross sectional study. Titan SMO, Bingham S et al. BMJ
2001;323:1286.
The Question: Is there a relation between self reported eating frequency and
serum lipid concentrations in a free-living population?
Answer in a nutshell: There is a negative correlation between frequency of
eating and concentrations of total and low density lipoprotein cholesterol
in free living humans.
Frequent eating keeps your cholesterol under control – JSCAN. Full free text
access: http://bmj.com/cgi/content/full/323/7324/1286

Effects of remote, retroactive intercessory prayer on outcomes in patients
with bloodstream infection: randomised controlled trial. Leibovici L. BMJ
2001;323:1450-1451
The Question: Does remote, retroactive intercessory prayer has any effect on
outcomes in a group of patients with a bloodstream infection?
Answer in a nutshell: Remote, retroactive intercessory prayer said for a
group is associated with a shorter stay in hospital and shorter duration of
fever in patients with a bloodstream infection.

Sensitivity of a clinical examination to predict need for radiography in
children with ankle injuries: a prospective study. Boutis K, Komar L et al.
Lancet 2001; 358: 2118-21.
The Question: What is the predictive value of a clinical examination in
diagnosing fractures in children with ankle injuries?
Answer in a nutshell: A low-risk clinical examination in children with ankle
injuries identifies 100% of high-risk diagnoses and may result in greater
reduction of radiographic referrals.

Fluconazole prophylaxis against fungal colonization and infection in preterm
infants. Kaufman D, Boyle R et al. N Engl J Med 2001; 345:1660-1666
The Question: What is the efficacy of prophylactic fluconazole in preventing
fungal colonization and invasive infection in extremely-low-birth-weight
infants?
Answer in a nutshell: Prophylactic administration of fluconazole during the
first six weeks of life is effective in preventing fungal colonization and
invasive fungal infection in infants with birth weights of less than 1000 g

Computed tomography of the head before lumbar puncture in adults with
suspected meningitis. Hasbun R, Abrahams J et al. N Eng J Med 2001;
345:1727-1733
The Question: Can clinical signs predict subsequent abnormalities in
computed tomography (CT) in adult patients with suspected meningitis?
Answer in a nutshell: In adults with suspected meningitis, clinical
features can be used to identify those who are unlikely to have abnormal
findings on CT of the head.

Coronary magnetic resonance angiography for the detection of coronary
stenoses. Kim WY, Danias PG et al. N Engl J Med 2001; 345:1863-1869
The Question: How accurate is coronary magnetic resonance angiography in
detecting coronary artery disease among patients with suspected coronary
disease?
Answer in a nutshell: Among patients referred for their first x-ray coronary
angiogram, three-dimensional coronary magnetic resonance angiography allows
for the accurate detection of coronary artery disease of the proximal and
middle segments.

Effectiveness of oral or nebulized dexamethasone for children with mild
croup. Luria JW, Gonzalez-del-Rey JA et al. Arch Pediatr Adolesc Med.
2001;155:1340-1345
The Question: Does the efficacy of oral dexamethasone differs from that of
nebulized dexamethasone sodium phosphate in children with mild croup?
Answer in a nutshell: Children with mild croup who receive oral
dexamethasone treatment are less likely to seek subsequent medical care and
demonstrate more rapid symptom resolution compared with children who receive
nebulized dexamethasone.

Women’s Health

Persistent Human Papillomavirus infection as a predictor of cervical
intraepithelial neoplasia. Schlecht NF, Kulaga S et al. JAMA.
2001;286:3106-3114
The Question: What is the risk of cervical neoplasia related to prior
persistent HPV infections?
Answer in a nutshell: There appears to be a strong relationship between
persistent HPV infections and squamous intraepithelial lesions incidence,
particularly for HPV types 16 and 18.

Identification and fracture outcomes of undiagnosed low bone mineral density
in postmenopausal women. Results from the National Osteoporosis Risk
Assessment. Siris ES et al. JAMA. 2001;286:2815-2822
The Question: What is the incidence of low bone mineral density (BMD),
fractures and their risk factors in the primary care setting?
Answer in a nutshell: In this national survey almost half of the population
had previously undetected low BMD, including 7% with osteoporosis.
osteoporosis was associated with a fracture rate approximately 4 times that
of normal BMD and osteopenia was associated with a 1.8-fold higher rate.

Oral contraceptives and the risk of myocardial infarction. Tanis BC, . van
den Bosch MAAJ et al. N Engl J Med 2001; 345:1787-1793.
The Question: Is the risk of myocardial infarction different for second and
third generation oral contraceptives?
Answer in a nutshell: According to this case control study the risk of
myocardial infarction is higher in women who use second-generation oral
contraceptives. Although the risk due to third generation OCs is
inconclusive, there are suggestions from the data that the risk is lower
than the risk associated with second-generation oral contraceptives.

Paediatrics

Control of Hepatitis A through routine vaccination of children. Averhoff F,
Shapiro CN et al. JAMA. 2001;286:2968-2973
The Question: What is the effect of routine vaccination of children on
disease incidence in a community with recurrent hepatitis A epidemics?
Answer in a nutshell: In a Californian community hepatitis A vaccine was
highly effective in preventing disease among recipients. Childhood
vaccination appears to have decreased hepatitis A incidence among children
and adults and controlled the disease in a community with recurrent
epidemics.


Childhood Vaccinations, Vaccination Timing, and Risk of Type 1 Diabetes
Mellitus. DeStefano F, Mullooly JP et al and the Vaccine Safety Datalink
Team http://www.pediatrics.org/cgi/content/abstract/108/6/e112
The Question: Is there an association between childhood vaccinations,
particularly against hepatitis B and Haemophilus influenzae type b, and risk
of developing type 1 diabetes whether timing of vaccination influences this
risk?
Answer in a nutshell: This large population-based case-control study did not
find an increased risk of type 1 diabetes associated with any of the
routinely recommended childhood vaccines and also the risk was not increased
by the timing of the vaccine.

Maternal folate supplementation in pregnancy and protection against acute
lymphoblastic leukaemia in childhood: a case-control study. Thompson JR,
Gerald PF et al. Lancet 2001; 358: 1935-40
The Question: Does maternal iron or folate supplementation protects against
acute lymphoblastic leukaemia (ALL) in children?
Answer in a nutshell: Folate supplementation in pregnancy appears to reduce
the risk of common acute lymphoblastic leukaemia in the child.


Folic acid supplementation and risk for imperforate anus in China. Myers MF
et al for the China–US Collaborative Project for Neural Tube Defect
Prevention. Am J Epidemiol 2001;154:1051-1056.
The Question: Does folic acid supplementation before and during early
pregnancy reduce the risk of imperforate anus in their newborns?
Answer in a nutshell: According to this cohort study from China, daily
maternal consumption of 400 µg of folic acid before and during early
pregnancy may reduce the risk for imperforate anus in their offspring.

Infectious Diseases

Predictors of bacterial meningitis in the era after Haemophilus influenzae.
Freedman SB, Marrocco A et al. Arch Pediatr Adolesc Med. 2001;155:1301-1306
The Question: What is the diagnostic utility of cerebrospinal fluid (CSF)
white blood cell (WBC) count children suspected of having bacterial
meningitis in the post Haemophilus influenzae type b (Hib) era?
Answer in a nutshell: Bacterial meningitis does occur in children in the
absence of CSF pleocytosis. Hence other factors should be considered in the
diagnostic evaluation of suspected bacterial meningitis

Modeling potential responses to smallpox as a bioterrorist weapon. Meltzer
MI, Damon I et al. Emerging Infectious Diseases, November-December, 2001,
Volume 7, Number 6. Full free text access available @
http://www.cdc.gov/ncidod/eid/vol7no6/meltzer.htm
The Question: What will be the scenario if small pox is used as a
bioterrorist weapon?
Answer in a nutshell: The results of this modelling study indicates that
small pox might have devastating implications and identified four policy
areas. 1) Delay in intervention will be costly, dramatically increasing the
total number of cases; 2) Postrelease intervention should be a combination
of quarantine and vaccination; 3) Planning requires not only an appreciation
of how many persons may be infected initially, but also an understanding of
the likely rate of transmission; and 4) a stockpile of approximately 40
million doses of vaccine should be adequate in the US context.

Transmission potential of smallpox in contemporary populations. Gani R,
Leach S. Nature 2001;414: 748 – 751.
The Question: What is the transmission potential of smallpox in contemporary
populations?
Answer in a nutshell: According to this Nature article transmission
potential (R0 from 3.5 to 6) of small pox is sufficiently high which will
lead to a reasonably rapid epidemic rise before the implementation of public
health interventions, because little residual herd immunity exists now that
vaccination has ceased.

Sexual behaviour in Britain: partnerships, practices, and HIV risk
behaviours. Johnson AM, Mercer CH et al. Lancet 2001; 358: 1835-42.
The Question: What are the sexual behavioural patterns at a population level
in a western country?
Answer in a nutshell: The National Survey of Sexual Attitudes and Lifestyles
(Natsal 2000) in 1999-2001 provides population estimates of sexual behaviour
patterns and its correlates for the British population.

Chronic Diseases

Acetaminophen, aspirin, and chronic renal failure. Fored MC, Ejerblad E et
al. N Engl J Med 2001; 345:1801-1808
The Question: Is there an association between use of nonnarcotic analgesics
and subsequent chronic renal failure?
Answer in a nutshell: Acetaminophen and aspirin appear to increase the risk
of chronic renal failure. However, one cannot rule out the bias that
predisposing conditions could have triggered the use of analgesic
consumption.

Incidence of schizophrenia in ethnic minorities in London: ecological study
into interactions with environment. Boydell J, van Os J et al. BMJ
2001;323:1336
The Question: Is the incidence of schizophrenia among people from non-white
ethnic minorities greater in neighbourhoods where they constitute a smaller
proportion of the total population?
Answer in a nutshell: According to this ecological study the lower the
proportion of non-white ethnic minorities in a local area the higher the
incidence of schizophrenia in those minorities

Effect of age on acute pain perception of a standardized stimulus in the
emergency department. Greenwald PW et al. Ann Emerg Med 2001;38:644-647
The Question: Does the perception of pain varies by age?
Answer in a nutshell: This cross sectional observational study found that
elderly patients experienced less acute pain than their younger counterparts
in response to a standardized stimulus in a clinical setting.

Frequency and risk factors for Pterygium in the Barbados eye study. Luthra
R, Nemesure, BB et al for the Barbados Eye Studies Group. Arch Ophthalmol.
2001;119:1827-1832
The Question: What are the risk factors for pterygium?
Answer in a nutshell: In blacks the frequency of pterygium was 2.5 to 3
times higher than whites. Pterygium was almost twice as frequent among
persons who worked outdoors but was only one fifth as likely among those who
always used sunglasses outdoors.

Epstein-Barr virus antibodies and risk of multiple sclerosis. A prospective
study. Ascherio A, Munger KL et al. JAMA. 2001;286:3083-3088
The Question: Is there an association between Epstein-Barr virus (EBV)
infection and risk of multiple sclerosis (MS)?
Answer in a nutshell: In this prospective study MS patients had high titres
of EBV antibodies prior to disease onset as compared to controls and these
results support a role of EBV in the aetiology of MS.

Health Services Research

A comparison of dermatologists' and primary care physicians' accuracy in
diagnosing melanoma. A systematic review. Chen SC, Bravata DM et al. Arch
Dermatol. 2001;137:1627-1634
The Question: Is there a difference between dermatologists and primary care
physicians (PCPs) in identifying pigmented lesions suggestive of melanoma
and making the appropriate management decision to perform a biopsy or to
refer the patient to a specialist?
Answer in a nutshell: This systematic review found that published data are
inadequate to demonstrate differences in dermatologists' and PCPs'
diagnostic and biopsy or referral accuracy of lesions suggestive of
melanoma.

Money Matters

Economic burden of pneumonia in an employed population. Birnbaum HG, Morley
M et al. Arch Intern Med. 2001;161:2725-2731
The Question: What is the overall economic burden of pneumonia from an
employer perspective?
Answer in a nutshell: Patients with pneumonia present an important financial
burden to employers. These patients use more medical care services,
particularly inpatient services, than the average beneficiary in the
employer overall population. In addition to direct health care costs related
to medical utilization and the use of prescription drugs, indirect costs due
to disability and absenteeism also contribute to the high cost of pneumonia
to an employer.

Medical Education

The personal digital assistant: a new medical instrument for the exchange of
clinical information at the point of care. Wilcox RA, La Tella RR. MJA
2001;175: 659-662.
The Question: Where can I find information on personal digital assistant
(PDA)?
Answer in a nutshell: This excellent review article published in the MJA
covers over 60 web sites and provides comprehensive information on PDAs.

Miscellaneous

Malnutrition and mortality in Kohistan district, Afghanistan, April 2001.
Assefa F et al. JAMA. 2001;286:2723-2728
The Question: What is the magnitude and causes of mortality and prevalence
of malnutrition in Kohistan district, Faryab province, Afghanistan?
Answer in a nutshell: The mortality and malnutrition among adults and
children has reached alarming proportions in Afghanistan and among children
the leading causes of mortality were diarrhoea, respiratory infections,
measles and scurvy.

Successful aging in the oldest old. Who can Be characterized as successfully
aged? von Faber M, Bootsma–van der Wiel A et al. Arch Intern Med.
2001;161:2694-2700
The Question: How can we measure successful aging?
Answer in a nutshell: This can be measured from two perspectives. If
successful aging is defined as an optimal state of overall functioning and
well-being, only a happy few meet the criteria. However, elderly persons
view successful aging as a process of adaptation. Using this perspective,
many more persons could be considered to be successfully aged.


So long, Best Evidence; hello, ACP Journal Club online. ACP Journal Club.
2001 Nov-Dec;135:A12.

Notice of Triplicate Publication
http://jama.ama-assn.org/issues/v286n24/ffull/jcx10030.html

Smokers’ Corner

Effect of seeing tobacco use in films on trying smoking among adolescents:
cross sectional study. Sargent JD, Beach ML et al. BMJ. 2001 323:1394-7.
The Question: Is greater exposure to smoking in films is associated with
trying smoking among adolescents?
Answer in a nutshell: There is a strong, direct, and independent association
between seeing tobacco use in films and trying cigarettes, a finding that
supports the hypothesis that smoking in films has a role in the initiation
of smoking in adolescents.

From the pages of Bandolier
http://www.jr2.ox.ac.uk/bandolier/band94/b94-4.html

Treatment of Warts

We also have our usual features including Web Watch(20 sites), For your
patients and What U say.

Apologies for this long posting.

Cheers & regards,

Badri

Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)DFPHM(UK).,MPH(Distinc)
Clinical Assistant Professor & Hon Consultant in Preventive Medicine,
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" - BMJ 3rd June 2000, Netlines



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