March 18, 2008 Archives - Clinical Advisor

Print Issue: March 18, 2008

Study links soft drinks to gout

Men who drank more than two servings of soda a day were 85% more likely to develop gout than those who drank less than one serving a month.

Death rate hits all-time low

The U.S. mortality rate posted an all-time low in the latest report from the CDC’s National Center for Health Statistics. The 2,448,017 deaths reported in 2005 yielded an age-adjusted mortality rate of 798.8 per 100,000 Americans. While only a 0.2% drop from the rate in 2004, it was almost half the rate of 65 years…

CAN ESR RULE OUT TEMPORAL ARTERITIS?

Does a normal erythrocyte sedimentation rate (ESR) rule out temporal arteritis so that no further testing is needed?— Kashif A. Memon, MD, Vernal, Utah ESRs can be slow to rise, and in 5%-10% of patients with polymyalgia-temporal arteritis, a second normal value may be needed to exclude these inflammatory illnesses. The assay for C-reactive protein,…

Watch vitamin K while on warfarin

Remind patients taking warfarin (Coumadin) that foods high in vitamin K (e.g., lentils, chickpeas, coleslaw, liver, hummus, seaweed, and green tea) can cause the international normalized ratio to drop. Maintaining a diet that keeps vitamin K levels stable is essential.—Joan Ferrelli, APRN-BC, Wall Township, N.J. (113-25)

CLINICAL PEARL- NASOGASTRIC TUBE INSERTION

To facilitate nasogastric tube insertion, use lidocaine (Xylocaine) in ointment form around the nares and and as a spray to the back of the throat. Also, use metoclopramide (Reglan) to assist with motility.—Diana Meeks-Sjostrom, PhD, MSN, FNP-C, Atlanta (113-24)

ARE OCS SAFE IN PERIMENOPAUSAL WOMEN?

The discussion of oral contraceptives (OCs) in perimenopausal women (Item 110-20) included the recommendation that “women older than 50 might stop the pill altogether or change to an estrogen-only regimen if needed for symptoms.” Switching to an estrogen-only regimen for menopausal symptoms may cause women with a uterus to develop endometrial hyperplasia and increase the…

INTERMITTENT SOFT-TISSUE PAIN

A 50-year-old woman complains of unilateral, tearing, soft-tissue pain, usually in the posterior heel/Achilles area, with stretching. The problem has occurred on both sides but widely spaced in time. There is no pain on palpation and no redness, swelling, or weakness. Function is normal; no triggering event is apparent. The pain will last for weeks…

EMERGENCY THERAPY FOR PRIAPISM

All the advertisements for erectile dysfunction medications suggest that four hours of priapism requires emergent care, but neither the Physicians’ Desk Reference nor the detailer can tell me what that entails. A 10-year-old textbook suggests drainage with a large-bore syringe/needles. Do you have any better suggestions?—Charles W. Patterson, MD, Yuma, Ariz. Drug-induced priapism is much…

THE ETERNAL COLD QUESTION

What is considered the best therapy for the common cold?—Mohammad Yousuf, MD, Dyersburg, Tenn. This is an ongoing hot topic. Some examples of recent literature to guide evidence-based practice include these therapies: zinc gluconate glycine lozenges (Cold-Eeze) (Am J Ther. 2003;10:324-329); ruprintrivir nasal spray (experimental formulation) (Antimicrob Agents Chemother. 2003;47:3907-3916); and ibuprofen (effective for aches/pains/fevers/sore…

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