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December 2009 Issue of Clinical Advisor

Newsline

Med combo averts MI and stroke in some

A simplified method for bundling fixed doses of a generic statin and an ACE inhibitor or angiotensin II receptor blocker (ARB) reduced the risk of ...

Increase skin cancer screening in primary care

Primary-care clinicians are ideally suited to screen and triage people who are at high risk for skin cancer and those with suspicious lesions, but a ...

Weight control not enough for sleep apnea

Overweight and obese patients can significantly improve sleep apnea by losing approximately 10% of their body weight—but even a strict diet-and-exercise program is unlikely to ...

Investigate bad vaccine reactions

Avoiding future immunizations after an allergic reaction to a vaccination is not always necessary.

Include prostate screening risks

Men should be made aware of the possible harms of prostate cancer screening as well as the benefits, but many don't appear to be getting ...

Cause of osteoporosis in celiac patients?

People with celiac disease may develop osteoporosis due to immune-system attacks on bone tissue.

Quick eye test can indicate possible stroke

Clinicians may soon have a simple method for diagnosing stroke in patients complaining of dizziness, nausea, and spinning sensations.

Kidney dysfunction speeds cognitive decline

Impaired kidney function is associated with a more rapid rate of cognitive decline in old age, according to a new study.

Drug Updates from MPR

Biologic for treatment of plaque psoriasis

Once-daily tab for children with ADHD

Advisor Forum

Herpes zoster risk in an infant

What is the best way to prevent transmission of the varicella-zoster virus?

Confirming dye allergy

I have been unable to find a lipid-lowering medication that is dye-free for my hyperlipidemic patient who is allergic to all dyes. Any suggestions?

Can meds increase risk of diabetes?

Can long-term use of beta blockers or selective serotonin reuptake inhibitors (SSRIs) be implicated in the development of type 2 diabetes?

Delaying surgery in an infected patient

Surgeon wanted to perform an emergency operation, but the anesthesiologist recommended waiting to allow the patient to be examined by an internist over the weekend. ...

Is cinnamon useful in preventing diabetes?

Some of my patients have reported taking large quantities of cinnamon to prevent diabetes. What is the overall effect of ingesting this spice?

How to use HFA inhalers

Should hydrofluoroalkane (HFA) inhalers be placed at the mouth rather than two finger spaces away? Are spacer devices appropriate for use with HFA inhalers?

Menorrhagia treatment without estrogen

What suggestions do you have for treating menorrhagia in a 28-year-old nulliparous patient?

Father-son medical team

As employees of covered entities are allowed free access to patient records, shouldn't he also be covered?

Complications of intralesional corticosteroids

What potential complications are associated with cortisone shots to the scalp? Is there is any link to glaucoma?

Treatment of vulvar lichen sclerosus

My patient was diagnosed with lichen sclerosus on vulvar biopsy. What is the recommended treatment, and how long should it be used? If the patient ...

Cover Feature

Laboratory evaluation of thyroid function

Blood tests can detect thyroid dysfunction, which can result in cardiac, GI, and menstrual disturbances as well as abnormalities in fetal neural development.

Clinical Feature

Practical guidelines for managing GERD

Start with antisecretory drugs, i.e., proton-pump inhibitors, then make medication, dosage, and lifestyle changes to suit the individual patient.

Dermatologic Look-Alikes

Can you identify these similar scalp nodules?

Two women present with growing scalp nodules. One patient reported recent unintentional weight loss.

Clinical Challenge

Fever and chills in a toddler having frequent wetting episodes

The child arrived at the emergency department in a clearly distressed state and with an elevated WBC count.

Blood in the stool raises concerns

With no changes in the child's diet, clinicians search for another cause.

Commentary

Why depression is hard to diagnose

Occupational, financial, and life events must be considered when trying to pinpoint the problem.

Alternative Meds Update

Is the aronia berry the newest superfruit?

The aronia berry, high in vitamin C and other antioxidants, reduces gastric irritation and prevents swelling associated with allergic reactions.

Dermatology Clinic

Brown bumps that evolved into verrucous plaques

The asymptomatic rash on a young woman's chest and back appeared to be spreading. Hyperpigmented papules had become larger verrucous plaques.

Nonhealing painless ulcer on the sole

For three years, the patient lived with an enlarging painless ulcer on the sole of his foot. The lesion occasionally drained liquid but never became ...