Print Issue: September 11, 2007

WHY NOT NIACIN FOR HYPERLIPIDEMIA?

Since niacin is known to be one of the best agents for fighting hyperlipidemia, why is it so rarely prescribed? Some of the reported side effects can be refuted: (1) Flushing can be minimized by starting with a minimal dose (50 mg) that is increased gradually and by taking an aspirin a day. (2) USP-labeled…

LOCAL REACTION TO TETANUS SHOT

A patient had a severe local reaction to an injection of tetanus toxoid. Was she not immune despite past tetanus toxoid injections? Was the booster repeated too soon or too long after her last injection? When should she have her next booster? After five years? Ten years?—Gita Dalal, MD, Edison, N.J. Pain, redness, swelling, fever,…

THYROID-INTERFERON INTERACTION

During follow-up of a 32-year-old woman whose hepatitis C is being treated with pegylated interferon alfa-2b and ribavirin, I found that her thyroid stimulating hormone (TSH) was suppressed (0.01 µIU/mL) and her free thyroxine was 3.7 ng/dL. Baseline thyroid determinations were normal. The patient is currently asymptomatic. What treatment would you recommend?—Butch Tubera, MD, Fort…

PROPHYLACTIC ACETYLCYSTEINE

How should N-acetylcysteine (Mucomyst) be used prophylactically for patients who have been diagnosed with chronic renal insufficiency and are undergoing cardiac catheterization?—Marilyn Otero, RPA-C, New York City N-acetylcysteine is an antioxidant and scavenger of free radicals. It also enhances the biologic effect of the endogenous vasodilator nitric oxide, which in turn maintains kidney perfusion (Patient…

ULTRASOUND FOR RECALCITRANT PODAGRA

On several occasions when my patient’s podagra has been unresponsive to colchicine and indomethacin, I have had remarkable results with ultrasound to the big toe. What do your experts think?—Stanley Miller, MD, Goodyear, Ariz. I am not aware that others have utilized this therapy, but its success is surprising since mechanical disruption of gouty tophi…

DUCT TAPE NO MORE EFFECTIVE THAN MOLESKIN FOR TREATING WARTS

Level 2: Mid-level evidence The efficacy of duct tape as a potential noninvasive treatment for warts, or verruca vulgaris, was recently evaluated in a randomized trial (Arch Dermatol. 2007;143:309-313). Ninety immunocompetent adults with at least one common wart measuring 2-15 mm were randomized to moleskin with transparent duct tape vs. moleskin alone, worn for seven…

LIVE ATTENUATED INFLUENZA VACCINE MORE EFFECTIVE THAN INACTIVATED VACCINE IN INFANTS AND CHILDREN

Level 2: Mid-level evidence The live attenuated flu vaccine (FluMist intranasally) appears more effective than the inactivated vaccine (Fluzone IM), based on a randomized trial of 8,352 immunocompetent children aged 6-59 months in 16 countries (N Engl J Med. 2007;356:685-696). Participants also received intranasal saline mist and IM saline injections as placebos to maintain blinding;…

APPLYING OINTMENT BEFORE DRESSING SURGICAL WOUND NOT BENEFICIAL

Level 1: Likely reliable evidence The use of sterile paraffin (Lacri-Lube) or mupirocin (Bactroban) ointment on surgical wounds was evaluated in a randomized trial and compared with no ointment (Br J Surg. 2006;93:937-943). Patients older than 18 years with a skin lesion requiring incisional or excisional surgery (N =778) were randomized to no ointment vs.…

PERGOLIDE OR CABERGOLINE MAY BE ASSOCIATED WITH CARDIAC-VALVE REGURGITATION

Level 2: Mid-level evidence Some dopamine agonists (pergolide [Permax] or cabergoline [Dostinex]) used to treat Parkinson’s disease may be associated with cardiac-valve regurgitation, based on a case-control study (N Engl J Med. 2007;356:29-38) and a cohort study (N Engl J Med. 2007;356:39-46). The nested case-control study was conducted within a cohort of 11,417 patients aged…

FOLIC-ACID SUPPLEMENTATION SLOWS PROGRESSION OF AGE-RELATED HEARING LOSS

Level 1: Likely reliable evidence In an elderly population with low dietary folate intake at baseline, folic-acid supplementation slows the progression of age-related hearing loss at low frequencies, based on a randomized trial of 819 adults aged 50-70 years in the Netherlands (Ann Intern Med. 2007;146:1-9). Enrollment criteria were plasma total homocysteine levels 13-26 µmol/L…

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