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A HEALTHIER FRUIT?

I was recently given a publication extolling the value of the tropical fruit mangosteen. Does it have health benefits other fruits do not?—S.J. Smith, MD, Wells, Nev. Mangosteen is a fruit (not to be confused with mango) that is grown in the Asian tropics and is high in antioxidants, specifically xanthones. Mangosteen is also one…

COLD HAND AT THE COMPUTER

A patient who does a great deal of computer work complains of extreme coldness in the fingers of her right (mouse) hand. Could this be a positional or vascular problem?—Diana Koon, MS, FNP-C, Plano, Tex. Is the coldness strictly sensory, or is it palpable? Is the rest of her neurovascular exam normal (i.e., grip, sensation,…

PREDNISOLONE AS EFFECTIVE AS NSAIDs FOR ACUTE GOUT

Level 1: Likely reliable evidence Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for the treatment of acute gout. The efficacy of NSAIDs compared with prednisolone was evaluated in a randomized trial of 90 patients older than 17 years with a clinical diagnosis of goutlike arthritis (Ann Emerg Med. 2007;49:670-677). Patients were randomized within three days…

RIZATRIPTAN EFFECTIVE FOR RELIEF OF MENSTRUAL MIGRAINE

Level 1: Likely reliable evidence Two similar randomized trials show that rizatriptan (Maxalt) relieves menstrual migraine (Cephalalgia. 2007;27:414-421). Both trials evaluated women 18 years and older with menstrual migraine (based on International Classification of Headache Disorders-II 2004 definition) for at least six months who were randomized to rizatriptan 10 mg vs. placebo to treat a…

BETA BLOCKERS NOT INDICATED AS FIRST-LINE THERAPY FOR HYPERTENSION

Level 2: Mid-level evidence Beta blockers as monotherapy or first-line therapy were evaluated in a Cochrane review of 13 randomized trials with a total of 91,561 adults (Cochrane Database Syst Rev. 2007;[1]:CD002003) and were generally found no better or inferior to other antihypertensive medications. Compared with placebo or no treatment, beta blockers were associated with…

COMPUTER-AIDED MAMMOGRAMS SEEM TO OFFER LITTLE ADVANTAGE

Level 2: Mid-level evidence The use of computer-aided detection in screening mammograms was evaluated in a study of 222,135 women who had 429,345 screening mammograms at 43 separate facilities (N Engl J Med. 2007;356:1399-1409). The reference standard for breast cancer diagnosis was based on clinical diagnosis made within one year subsequent to screening mammography. During…

PROLONGED-EXPOSURE THERAPY REDUCES PTSD SYMPTOMS IN FEMALE VETERANS

Level 1: Likely reliable evidence Female veterans with post-traumatic stress disorder (PTSD) and clear memory of the trauma that caused it at least three months before (N=284) were randomized to prolonged exposure (a type of cognitive-behavioral therapy) vs. present-centered therapy (a type of supportive therapy) for 10 weeks (JAMA. 2007;297:820-830). Both groups had therapy delivered…

ROSIGLITAZONE AND METFORMIN MAY BE MORE EFFECTIVE FOR GLYCEMIC CONTROL

Level 2: Mid-level evidence Before rosiglitazone was linked to increases in heart disease, researchers for A Diabetes Outcome Progression Trial (ADOPT) compared the efficacy of rosiglitazone (Avandia) vs. metformin (Glucophage, Fortamet) vs. glyburide (Diabeta, Glynase, Micronase) for glycemic control in 4,360 patients aged 30-75 years with type 2 diabetes (N Engl J Med. 2006;355:2427-2443). Patients…

Giardiasis

OVERVIEW: What every practitioner needs to know Are you sure your patient has giardiasis? What are the typical findings for this disease? Infection with Giardia typically presents with insidious symptoms developing over 1 to 2 weeks. Symptoms of acute giardiasis include: Watery diarrhea, frequently foul smelling with fatty stools Abdominal cramps and bloating Flatulence Acute…

CDC kicks off preteen vaccine campaign

Have an unusually large number of parents been inquiring lately about vaccinations for their 11- and 12-year-old children? Credit a recently launched CDC campaign. The agency is promoting checkups to implement its current recommendations for three preteen vaccines: • MCV4, which protects against meningitis and its complications; • Tdap, a booster against tetanus, diphtheria, and…

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