The FDA has concluded that OTC cough and cold products (including decongestants, expectorants, antihistamines, and antitussives) should not be used to treat infants and children younger than 2 years (FDA Press Release 2008 Jan 17; full-text available online free of charge at: www.fda.gov/bbs/topics/NEWS/2008/NEW01778.html; accessed April 10, 2008) and FDA Public Health Advisory 2008 Jan 17;…
Level 1: Likely reliable evidence A liquid herbal solution containing Pelargonium sidoides (EPs), an extract of the South African geranium, was evaluated in a randomized, placebo-controlled trial (Explore [NY]. 2007;3:573-584). EPs is the active ingredient in Umcka ColdCare and Zucol products in the United States. Patients aged 18-55 years in the Ukraine with cold symptoms…
Level 1: Likely reliable evidence Foot-temperature monitoring reduces diabetic foot ulcers in high-risk patients, based on two randomized trials that compared dermal thermometry (infrared skin temperature measurements at six plantar sites on each foot twice daily) vs. standard therapy. In the most recent study, 225 adults with diabetes and at high risk for foot ulcer…
Dangerous or even fatal skin reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis) with carbamazepine (Tegretol, Carbatrol) are significantly more common in patients with the HLA allele B*1502, based on an FDA MedWatch notice and FDA Press Release (FDA MedWatch 2007 December 12; full-text available online at: www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine, FDA Press Release 2007 Dec 12; full-text available…
Level 2: Mid-level evidence Vitamin E (α-tocopherol) supplementation 400 units daily for prevention of MI was evaluated in a randomized, placebo-controlled trial of 1,434 patients older than 55 years with type 2 diabetes mellitus and the haptoglobin 2-2 (Hp 2-2) genotype (Arterioscler Thromb Vasc Biol. 2008;28:341-347). The Hp 2-2 genotype is reported to occur in…
Hemoptysis can signal conditions ranging from the mild to life-threatening. Here’s how to determine which cases demand immediate intervention. Hemoptysis is frequently encountered by primary-care clinicians. Most cases are self-limiting or resolve with treatment of an underlying condition. But the expectoration of blood can also be a symptom of an acute or life-threatening illness, such…
Vaginal discharge can be harmless or deserving of therapy. Experts explain how to make the correct diagnosis and determine appropriate treatment. Most women find changes in vaginal discharge distressing. Too often women attribute symptomatic discharge (e.g., one that is off-color, has a foul odor, and causes burning or itching) to a yeast infection, which they…
An overlooked case of appendicitis can lead to rupture and cause peritonitis, yet 12%-18% of appendectomies are unnecessary.
If a patient presents with nausea and epigastric pain, the cause may well be acute pancreatitis. Here is how the condition is diagnosed and treated. Acute pancreatitis is generally managed in a hospital setting, but its symptoms can prompt a visit to the primary-care clinician for initial diagnosis. A pathologic inflammatory condition involving both the…
You’re a key player in identifying patients with this debilitating chronic infection. Here’s the latest thinking on assessment and therapy strategies. In light of recent developments in the assessment and treatment of infection with the hepatitis B virus (HBV), the American Association for the Study of Liver Diseases has issued new practice guidelines, updating earlier…
