يشم الله الحمد لله

This week intersting reading on MRSA, Rochester rules for the newborn febrile children, why the UK is not offering the chickenpox vaccine, dealing with ovarian US reports, screening implications for cancer risk in child survivors of malignancies, Carotid Itima Media Thickness  and Sherlock Homes and more.

FEBRILE INFANT (60-90 days): Rochester criteria developed for febrile infants <60 days need a CBC/URINE/STOOL – the criteria (Well, Normal exam, No prior illness, Normal CBC (WBC 5-15)+(Band Nphils <1.5), Urine WBC<10 hpf, i diarrhoea WBC <5 hpf) means <1% risk of occult bataremia
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11-04-2010


SHERLOCK HOMES: What do you do in the quiet moments of your medical life when patients just don’t show up? This is what a certain Dr Conan Doyle did “The year 1891 found a little known Dr Conan Doyle struggling to build an ophthalmic practice in two rented rooms, one to be a consulting room and the other a waiting room, close to Harley Street. He later wrote that both proved to be waiting rooms, so that it was from there that he was able to submit for publication his first successful Sherlock Holmes stories, collected in The Adventures of Sherlock Holmes. ”
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11-04-2010


BREAST FEEDING: If 90% of mothers breast feed for 6 months exclusively they can save the country 13 billion USD becasue of less “necrotizing enterocolitis, otitis media, gastroenteritis, hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity”
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11-04-2010


AF: Dronedarone a Amiodarone cousin, less side effects but less efficacious and a lot more expensive : Simple algorithm for AF Rx: If HT but no( LVF / CVD) Sotalol, flecainide, propafenone, if CVD but no HF Dofetilide, Amiodarone is at the end.
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11-04-2010


OVARIAN CYST STUDIES [VIDEO]: US is superior, less expensive and safer than CT, simple cysts with a Ca 125 <35 (No 400 Cohort Study) : conservative management. Complex (cyst+solid) or solid needs = further workup. Dermoid and Hmgc cysts (relax). Ca 125 in post-menopausal more useful than pre-menopausal but diff to interpret on their own.
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11-04-2010



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11-04-2010


CHICKENPOX VACCINE: If you take it take two otherwise take none: JCVI (UK) says increased incidence of Shingles and pregnancy risk with single shot means it has to be two but only cost effective after 80-100 years – so no.
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10-04-2010


ANTIBIOTICS and I&D: MRSA is becoming widespread with increasing abscesses in healthy people, treatment failure at 7 days is no different with or without Abx but is different at 30 days (9% v 28% p<.02) – study used Trimethoprim (No 212).
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10-04-2010


CAROTID INTIMA-MEDIA THICKNESS: Not yet USPSTF recommended bec of lack of data – this study adds 15y of data supporting CIMT: It recalssified 40% of people of which most (62%) intermediate (10-20%) CVD risk people had their risk category LOWERED. “No patient from the low-risk group was reclassified as high risk, and nobody from the high-risk group was classified as low risk.” [JACC 2010]
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10-04-2010


CHILDHOOD CANCERS & LIFE EXPECTANCY: In short on average you live 10 years less than the general population so think monitoring: [The analysis showed an average lifetime probability of 0.10 for late-recurrence mortality, of 0.15 for treatment-related death from subsequent cancer or from other complications, and of 0.05 for death from other causes. Life expectancy for survivors was 50.6 years, which was 10.4 years shorter than for the general population. Reduced life expectancy varied by tumor type; it was 4.0 years for kidney cancer and 17.8 years for brain or bone cancer.]
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07-04-2010


MRSA & HOSPITAL STAFF: 4% positive cf. Staph Aureus carriage is 33% in gen population and CA-MRSA carriage in kids is .8-3% and lower in adults [http://www.medscape.com/viewarticle/498770_4].
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07-04-2010


BREAST CANCER RISK: Chest radiation for malignancies in childhood increases risk within 8 yrs to the same level as BRCA gene mutation.
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07-04-2010


MRSA FAMILY: Nice review on CA (Community Acquired), HA (Hospital Acquired) MRSA, VISA (Vancomycin Intermediate Resistance Staph Aureus) & VRSA (Vanc Resistant Staph Aureus) – for CA-MRSA time to think I&D first with Abx or line 2 : Tetracycline/Trimthoprim/Clindamycin. New kids on the block are Liezolid (>2wks assoc with BM depression) & Daptomycin (Lipopeptide Abx, soft tissue but not good in lung bec surfactant) Other contendors (Tigecycline next gen Tetracycline, Ceftobiprole 5th gen Cef, Televancin)
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07-04-2010


DIABETES & TRIAD Study (No 12K, Prospective since 1998): Intergrated care improevs processes of cae but does not always translate into better ABCs (hbA1c, Bp, Cholesterol) esp. in African-Americans, lower education/income, women, young – surprise surprise.
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07-04-2010


SOY PROTEIN & LIPIDS: 25g of soy protein and 60g of isoflavones (which act as phytoestrogens) no effect on LDL and TG, HDL slighlty higher. (No 87 x1yr)
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07-04-2010


GENE PATENTS: Patents that have been held for the BRCA1 & 2 genes are declared invalid – how did they award a patent for something natural int he first place?
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07-04-2010


OSA & VERBA L SKILLS: “patients with OSA…displayed reduced performance on verbal episodic memory tasks” compared to controls, “while visual episodic, semantic and working memory remained intact.”
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07-04-2010


MULTIPLE CANCERS: Lightning can strike more than once: 4 cancers in one patient.
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07-04-2010


ROSIGLITAZONE: Fights back, time for more pinches of salt?
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07-04-2010


FLU VACCINE & H1N1: Seasonal flu vaccine associated with increased risk of getting H1N1 (4 observational studies, Canadians Researchers)
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07-04-2010


OMEGA 3 & PERINATAL DEPRESSION – In short if it works it’s about as good as placebo. “The seven studies were limited by small sample sizes and variable dosing and study durations. In the studies that demonstrated statistical significance, improvement in depression rating scale scores for omega-3 fatty acids was comparable to placebo.”
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05-04-2010


CAFFEINE & GLUCOSE: Epidemiologically caffeine drinking is associated with decreased risk of T2DM, but this study (Diabetes Care, No 11) shows low insulin and high glucose levels post drinking coffee even with decaff.
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05-04-2010


ASPIRIN & BIOPSIES: It does not make a difference 0.6% v 0.4% risk if you compare taking Aspirin within 10 days of the biopsy v not taking Aspirin (No 3195).
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05-04-2010


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