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September 2008 11 9 Issue of Clinical Advisor

Newsline

Trial integrates depression and BP treatment

An integrated approach to hypertension and depression treatment yielded significantly better results for both conditions in a recent six-week pilot study. Patients in the integrated-care ...

Melanoma rates jump in women under 40

The annual incidence of melanoma among Caucasian women aged 15-39 years rose...

Prostate screening in elderly men

A new recommendation from the U.S. Preventive Services Task Force (USPSTF) advises against prostate cancer screening for men...

Best test for detecting diabetes

A national panel of diabetes experts, pathologists, and internists are promoting hemoglobin A1c (HbA1c) testing as a...

Alternative treatment for gout offered

A short course of a corticosteroid could supplant nonsteroidal anti-inflammatory drugs (NSAIDs) as the medication of choice for...

Weight gain raises CKD risk even in lean folks

Combination therapy boosts RA remission

Adding etanercept (Enbrel) to methotrexate therapy for early rheumatoid arthritis (RA) resulted in...

Sildenafil eases antidepressant side effects in women

Off-label use of sildenafil (Viagra) relieved sexual side effects of antidepressants for...

Drug Updates from MPR

Pediatric combination vaccine available

Pentacel is indicated for active immunization against diphtheria, tetanus, pertussis, poliomyelitis, and invasive disease.

Injection for opioid-induced constipation

Advisor Forum

Can a statin reduce proteinuria in children?

Clot Prevention in a Patient with Drug Sensitivity

Would a large dose of vitamin E (1,600-2,400 IU) be an appropriate choice as a platelet inhibitor in a CAD patient who is allergic to ...

More Diabetes With Tortillas

Is there any direct relation between consumption of corn tortillas and the incidence of...

Sweating After Hemodialysis

A 28-year-old African American man who recently started hemodialysis complains of...

Stroke Prophylaxis For Women on HRT

Updated Approach to New-Onset Diabetes

In light of concerns surrounding rosiglitazone (Avandia), what agent would...

Treating Wet Macular Degeneration

A 62-year-old white male has been diagnosed with wet macular degeneration in the left eye based on...

Diabetes, Renal Disease, Heart Failure

What is the best oral medication for a diabetic patient in end-stage renal disease (ESRD) and...

Starting home oxygen therapy

When should home oxygen therapy be initiated in patients with COPD?

Surge in Neurocardiogenic Syncope Cases

I have noticed an unusually large number of patients (>20) with neurocardiogenic syncope (all of the...

Incidental Calcium on Statins

Calcium is attached to many statin molecules as a stabilizer. How much calcium will...

Role of Lipid Lowering in Dementia?

Could overly aggressive lowering of lipid levels in elderly patients interfere with...

Role of Lipid Lowering in Dementia?

Could overly aggressive lowering of lipid levels in elderly patients interfere with...

Can BP Therapy Worsen Hyperglycemia?

Will using a diuretic with hydrochlorothiazide in a patient with hypertension and type 2 diabetes contribute to worsening of his hyperglycemia?

Help For Polyarthritis With Gastritis

What is the most effective treatment for polyarthritis in a patient with...

Stop Crohn's and arthritis meds for knee surgery?

We are treating a patient who is currently on infliximab (Remicade) and methotrexate for severe Crohn's disease and rheumatoid arthritis. Because of severe joint pain, ...

HIPAA Rules For Patient Charts

I belong to a group of three internists who have separate outpatient clinics attached to the hospital in the same building. When I am on ...

Pre-cardioversion Anticoagulation

I recently diagnosed atrial fibrillation in a 24-year-old man with new-onset chest pain, irregular palpitations, and heart rate >170 beats per minute. The patient has ...

Staving Off Prostate Cancer

What strategies can patients with a strong family history of prostate cancer employ to...

Diabetics' Alcohol Limits

Are individuals taking metformin for type 2 diabetes still allowed one or two alcoholic drinks daily?

Potential Side Effects of Anitpsychotic Meds

A 14-year-old girl who takes ziprasidone (Geodon) and topiramate (Topamax) has developed episodic bilateral hand and toe rubor accompanied by brief...

Overattentive to Attention Deficit?

Every time I turn around, it seems someone else is being diagnosed with attention-deficit hyperactivity disorder (ADHD). Are too many...

Divergent BPs at Home and the Office

If you record a high BP in the office, but the patient says it is normal at home, should the dosage of his antihypertensive medication ...

Do Prenatal Steroids Cause Eczema in Newborns?

I have noticed a common pattern among mothers of babies with severe eczema—each woman was given some form of steroid during her pregnancies. Have any...

Dealing with a Sensitive Abdomen

Cover Feature

A comprehensive look at kidney stones

Some risk factors are unavoidable, but adjusting your patient's diet and addressing comorbidities can prevent excruciating episodes.

Clinical Feature

Managing acne vulgaris: Two important issues

A dermatologist explores dealing with increasing bacterial resistance and selecting the treatment that minimizes irritation and other skin reactions.

Athletes susceptible to shoulder injuries

Primary-care clinicians need to pay special attention to participants in sports that place emphasis on throwing or other overarm movements.

How to reduce the pain of herpes zoster

Given the minimal risk associated with approved medications, newly released guidelines recommend expanding treatment approaches.

Clinical Challenge

Surgery required to remove painless lump in a 7-year-old's arm

With the help of an expert orthopedist and pathologist, a definitive diagnosis was reached in this unusual case.

Typical angina with an atypical diagnosis

The patient continued her aerobic workouts despite persistent chest pressure with an unknown etiology.

Alternative Meds Update

Wolfberries

This unusually named berry is a staple in Chinese herbal medicine and is used for a multitude of health-boosting purposes. Also called goji berry, Chinese ...

Evidence-Based Medicine

KETOGENIC DIET MAY REDUCE SEIZURES IN CHILDREN WITH INTRACTABLE EPILEPSY

A recent trial evaluated the efficacy of the ketogenic diet for the treatment of seizures in children (Lancet Neurol. 2008;7:500-506). Children aged 2-16 years (N=145) ...

INCREASED PRACTITIONER INTERACTION MAY IMPROVE RELIEF IN IBS PATIENTS

HIGH-DOSE METOPROLOL INCREASES MORTALITY IN HIGH-RISK SURGERY PATIENTS

Perioperative beta blockers have been promoted to reduce the risk for perioperative MI. However, while high-dose perioperative extended-release metoprolol succinate (Toprol XL) for noncardiac surgery ...

DEXAMETHASONE MAY REDUCE MIGRAINE RECURRENCE WITHIN 72 HOURS

A systematic review of seven randomized placebo-controlled trials evaluated the...

LIMITED EVIDENCE ON CELL PHONES AND BRAIN TUMORS

A potential link between cell-phone use and brain tumors was recently discussed in the news, based on advice from...

D-DIMER PLUS MULTIDETECTOR CT FOR DIAGNOSIS OF PE

D-dimer plus multidetector CT (D-dimer/CT) is as effective as D-dimer/CT plus venous compression ultrasound (US) for identifying pulmonary embolism (PE) and short-term...

INVASIVE STRATEGY FOR ACS MAY REDUCE REHOSPITALIZATION RATE

A routine invasive strategy for non-ST-elevation acute coronary syndrome (ACS) may reduce rate of rehospitalization for ACS but not rate of...

Stat Consult

Otitis externa

Legal Advisor

Speeding through history

Mr. B, a 34-year-old physician assistant, was having another frenetic day in the gastroenterology clinic, and he was not happy. When he had taken the ...