pearls and news

1. The Internet Medical Journal
Clinical Pearls 1997 #1
These one sentence summaries of recent articles in the medical literature are intended to direct the
reader to the source article. They provide medical information NOT ADVICE. Please consult with your
physician before making any changes in your lifestyle based upon the information contained in these
web pages
The use of the nicotine patch produced 1 additional lifetime quitter at a cost of $7332, in a
decision analytic model; this finding suggests that insurance companies should cover patches.
(JAMA 1996 04/24;275:1247)
Combining serum myoglobin and CK-MB in testing for acute myocardial infarction, a sensitivity
of 100% was obtained during the 1st 3 hours of evaluation in the ER in this prospective study of
190 pts, 21 of which suffered an acute MI. (Ann Emerg Med 1996 ;27:0001)
Kids of smokers are 2.8 times more likely to get a lower respiratory infection, 2.1 times more
likely to develop asthma, 3 times more likely to die of crib death, more likely to become smokers
themselves, and more likely to get ear infections (CD Summary 1996 04/16;45(8))
Men with a high flavinoid intake had a 73% lower risk of stroke;about 70% of their dietary
flavinoids came from black tea, and 10% came from apples. (Arch Intern Med 1996 03/25;)
Women who smoke during pregnancy increased their risk of a mentally retarded child by 50% in
a study of Atlanta area children. (Pediatrics 1996 ;97:0547)
The carbon-13 urea breath test was 95% accurate in detecting H. Pylori infection in peptic ulcer
disease. (Am J Gastroenterol 1996 ;91:0690)
Routine eye patching for corneal abrasions is not necessary. (South J Med 1996 02/01;89:0227)
The use of nicotine gum doubled the rate of smoking cessation at 2 year follow-up (39% vs 16%).
(Chest 1995 ;108:0447)
Regular aspirin use among a study of 121,701 women decreased the risk of colorectal cancer by
45%. (NEJM 1995 ;333:0609)
Smoking increased the risk of stroke by more than 4 times in this study of 7,264 men. (JAMA
1995 ;274:0155)
Compared with animal protein consumption, soy protein consumption was associated with a 9%
drop in total cholesterol and a 12% drop in LDL cholesterol. (NEJM 1995 ;333:0276)
Maternal asthma is a risk factor for premature labor. (Am J Epidemiol 1995 ;142:1078)
Using a "clock strategy" as an aid in smoking cessation is twice as effective as quitting cold
turkey; smokers follow a timed schedule with longer and longer times between lighting up. (J
Consulting Clin Psychol 1995 06/01;)
Type "D" personality (in which individuals suppress negative emotions) was shown to be an
independent risk factor for death from heart disease. (Lancet 1996 ;347:0417)

2. Women trying to get pregnant may benefit from cutting out caffeine from their diet. (Am J
Epidemiol 1995 ;142:1322)
Zinc supplementation (20 mg of elemental zinc) was associated with a significant reduction in the
severity and duration of diarrhea in this study of 937 children in New Delhi, India. (NEJM 1995 ;
333:0873)
The greatest barrier to hepatitis B immunization among 654 middle school students in Louisiana
was lack of parental consent. (J Adolesc Health 1995 ;17:0244)
Low income children with parents who smoked had a poorer quality diet than low income
children of nonsmokers, in this study of 515 children. (Pediatrics 1996 03/01;97:0312)
Ear lobe creases were shown to be associated with higher rates of cardiac events in this study of
264 consecutive patients. (Am J Med 1996 02/01;100:0205)
Moderate doses of vitamin E (up to 1200 IU) can be safely used in patients receiving warfarin; no
drug-drug interaction was identified in this study. (Am J Cardiol 1996 03/01;77:0545)
By comparing medical costs and outcomes in states which have enacted tort reform vs those who
haven't, the annual savings by enacting nationwide tort reform would be about $50 billion, with
no decrease in the quality of care. (Quarterly J Economics 1996 06/01;)
A couple of cups of coffee a day was shown to decrease the risk of suicide in a study of over
86,000 women. (Arch Intern Med 1996 03/11;)
Prenant women taking calcium supplements (1500 to 2000 mg) were 70% less likely to develop
high blood pressure and 60% less likely to develop pre-eclampsia. (JAMA 1996 04/10;)
Obesity during pregnancy is related to an increased risk of having a baby with a birth defect.
(JAMA 1996 04/10;)
In a study of 15,990 people aged 60 - 97 yrs old, reducing high blood pressure not only prevented
strokes (down 35%), but also cut the heart attack rate (down 18%), and decreased all cause total
mortality (down 15%). (Arch Fam Med 1995 11/01;4:0943)
High blood pressure medicine should be taken early in the morning, before dressing, or late at
night; oral steroids for asthma should be given at 3 pm instead of in the morning; ulcer medicine
ONCE a day (not twice), at about 6 pm. (JAMA 1996 04/17;275:1143)
Tai Chi classes can reduce the rate of falls in the elderly by 50% and greater. (J Am Geriatr Soc
1996 ;44:0489)
In a study of 27 Ohio firms, medical savings accounts decreased the out of pocket health care
expenses of employees with a family plan by more than 50%; employers also had their health
care costs decreased by 12%. (Investors Business Daily 1996 03/14;)
Among women who worked rotating night shifts for a period of 6 years or more, their risk of
coronary heart disease was increased by 50%. (Circulation 1995 ;92:3178)
Appetite suppressants as adjunctive therapy include: phenylpropanolamine (75 mg qAM),
phentermine (30 mg qAM), fenfluramine (20 mg TID), phentermine & fenfluramine together,
fluoxetine (60 - 80 mg qAM), diethylpropion (75 mg qD), and mazindol (1 mg qD). (J Family
Practice 1996 03/01;42:0287)
Pravastatin is useful in the PRIMARY prevention of coronary heart disease; in this study of
6,500 men, all0cause mortality was reduced by 22%. (NEJM 1995 ;333:1301)

3. Simvastatin has been shown to be useful in the SECONDARY prevention of coronary heart
disease; all-cause mortality was decreased by 33% in this study. (Lancet 1994 ;344:1383)
It is cost-effective to vaccinate healthy adults against influenza. (NEJM 1995 ;333:0889)
"Krazy Glue" is an excellent, cost-effective alternative to suturing in closing minor pediatric
lacerations (J Pediatr 1995 ;126:0892)
Sexual intercourse among permanent or married partners was not associated with a significantly
increased risk of malignant cardiac arrhythmias among a group of 88 male patients with known
coronary artery disease. (Chest 1996 ;109:0922)
A diet consisting of 2 or more servings of broiled or baked fish was associated with a lower risk of
rheumatoid arthritis. (Epidemiology 1996 ;7:0256)
The estimated risk of contracting aids from receiving a blood transfusion is between 1 in 83,000
and 1 in 122,000. (NEJM 1995 12/28;333:1721)
Low levels of blood vitamin B-12 was associated with an impaired antibody response to the
pneumococcal vaccine. (Ann Intern Med 1996 02/01;124:0299)
The Norplant was tolerated as well as birth control pills, however, Norplant users had an
unplanned pregnancy rate of 2% vs 20% for birth control pill users; 166 teens were part of the
study group. (Arch Ped Adol Med 1995 ;967-972)
Enalapril reduced progression of microalbuminuria to macroalbuminuria by 42% over a 7 yr
period in normotensive diabetics. (Arch Intern Med 1996 ;156:0286)
In a study of 8877 women, estrogen replacement therapy resulted in a significantly decreased risk
for tooth loss and edentia (relative risk=0.64). (Arch Intern Med 1995 11/27;155:2325)
All americans should get at least 30 minutes a day of exercise, which may be done in 10 minute
spurts, according to a National Institutes of Health consensus panel. (Medical Tribune 1996
01/11;)
In a study of 1623 patients, anger outbursts doubled the risk of myocardial infarction within the
following 2 hours (relative risk =2.3). (Circulation 1995 10/01;92:1720)
Low serum pyridoxal 5'-phosphate (from vitamin B6) was associated with a 4 fold increased risk
of coronary disease (relative risk=4.3, p < 0.05). (Circulation 1995 11/15;92:2825)
In a study of 258 breast cancer patients compared with 614 control patients, there was no
association between stressful life event scores and breast cancer. (Cancer 1996 03/15;77:1089)
Smoking at least 20 cigarettes per day was a stronger risk factor for myocardial infarction in
women (who had a sixfold increace) than in men (who had a threefold increase) in this study of
11,843 patients. (Circulation 1996 ;93:0450)
The acellular pertussis vaccine (which is safer than the standard whole-cell vaccine) is effective in
protecting against pertussis. (JAMA 1996 01/03;275:0037)
Lead exposure in childhood was associated with an increased risk of antisocial and delinquent
behavior in a study of grade school boys. (JAMA 1996 02/07;275:0363)
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4. information NOT ADVICE. Use common sense by consulting with your doctor before making any
lifestyle changes or other medical decisions based on the content of these web pages.