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Does acetaminophen affect liver function in alcoholic patients?
Acetaminophen in doses of 4 g/d did not affect liver function of alcoholic patients in this randomized study.
These results do not rule out the possibility of acetaminophen-induced liver failure in alcoholic patients, especially patients with pre-existing liver disease or those who continue to drink. Patient-oriented outcomes (ie, studying chronic acetaminophen use in alcoholics to determine the incidence of developing hepatic failure) ultimately would resolve this controversy.
However, these data do cast doubt on the medical myth (based on case reports) that acetaminophen use in alcoholics causes hepatotoxicity.
Acetaminophen in doses of 4 g/d did not affect liver function of alcoholic patients in this randomized study.
These results do not rule out the possibility of acetaminophen-induced liver failure in alcoholic patients, especially patients with pre-existing liver disease or those who continue to drink. Patient-oriented outcomes (ie, studying chronic acetaminophen use in alcoholics to determine the incidence of developing hepatic failure) ultimately would resolve this controversy.
However, these data do cast doubt on the medical myth (based on case reports) that acetaminophen use in alcoholics causes hepatotoxicity.
Acetaminophen in doses of 4 g/d did not affect liver function of alcoholic patients in this randomized study.
These results do not rule out the possibility of acetaminophen-induced liver failure in alcoholic patients, especially patients with pre-existing liver disease or those who continue to drink. Patient-oriented outcomes (ie, studying chronic acetaminophen use in alcoholics to determine the incidence of developing hepatic failure) ultimately would resolve this controversy.
However, these data do cast doubt on the medical myth (based on case reports) that acetaminophen use in alcoholics causes hepatotoxicity.
Is imiquimod effective and safe for treatment of actinic keratosis?
Imiquimod 5% cream, applied 3 times per week for 12 weeks, is effective for treatment of actinic keratosis. Severe erythema and other local reactions occurred in almost everyone receiving treatment, due to imiquimod’s immune system– modulating effects.
The 25 patients in the treatment group tolerated these adverse effects well. Despite these effects, imiquimod can be used as an alternative to traditional cryotherapy for the treatment of actinic keratosis among selected, motivated patients.
Imiquimod 5% cream, applied 3 times per week for 12 weeks, is effective for treatment of actinic keratosis. Severe erythema and other local reactions occurred in almost everyone receiving treatment, due to imiquimod’s immune system– modulating effects.
The 25 patients in the treatment group tolerated these adverse effects well. Despite these effects, imiquimod can be used as an alternative to traditional cryotherapy for the treatment of actinic keratosis among selected, motivated patients.
Imiquimod 5% cream, applied 3 times per week for 12 weeks, is effective for treatment of actinic keratosis. Severe erythema and other local reactions occurred in almost everyone receiving treatment, due to imiquimod’s immune system– modulating effects.
The 25 patients in the treatment group tolerated these adverse effects well. Despite these effects, imiquimod can be used as an alternative to traditional cryotherapy for the treatment of actinic keratosis among selected, motivated patients.
What are the risks of long-term NSAIDs and COX-2 inhibitors?
This review presents an interesting new analysis of cyclo-oxygenase-2 (COX-2) inhibitor safe-ty, concluding that long-term use results in more serious adverse events than traditional nons-teroidal anti-inflammatory drugs (NSAIDs).
The nonsystematic and retrospective properties of this analysis limit its validity. However, the fact that an evaluation of long-term data found some small harm to COX-2 inhibitors relative to traditional NSAIDs (number needed to harm=78 over 9 months) should give clinicians pause. Until better meta-analyses or new safety data are published, clinicians should prescribe COX-2 inhibitors long-term only for those patients deemed to be at high risk of ulcer complications.
This review presents an interesting new analysis of cyclo-oxygenase-2 (COX-2) inhibitor safe-ty, concluding that long-term use results in more serious adverse events than traditional nons-teroidal anti-inflammatory drugs (NSAIDs).
The nonsystematic and retrospective properties of this analysis limit its validity. However, the fact that an evaluation of long-term data found some small harm to COX-2 inhibitors relative to traditional NSAIDs (number needed to harm=78 over 9 months) should give clinicians pause. Until better meta-analyses or new safety data are published, clinicians should prescribe COX-2 inhibitors long-term only for those patients deemed to be at high risk of ulcer complications.
This review presents an interesting new analysis of cyclo-oxygenase-2 (COX-2) inhibitor safe-ty, concluding that long-term use results in more serious adverse events than traditional nons-teroidal anti-inflammatory drugs (NSAIDs).
The nonsystematic and retrospective properties of this analysis limit its validity. However, the fact that an evaluation of long-term data found some small harm to COX-2 inhibitors relative to traditional NSAIDs (number needed to harm=78 over 9 months) should give clinicians pause. Until better meta-analyses or new safety data are published, clinicians should prescribe COX-2 inhibitors long-term only for those patients deemed to be at high risk of ulcer complications.
Is permethrin 5% cream effective for rosacea?
Permethrin 5% cream is a safe alternative for the topical treatment of papulopustular rosacea.
Permethrin 5% cream is superior to metronidazole 0.75% gel and placebo in decreasing Demodex folliculorum, and is as effective as metronidazole 0.75% gel in treating erythema and papules.
Permethrin 5% cream is a safe alternative for the topical treatment of papulopustular rosacea.
Permethrin 5% cream is superior to metronidazole 0.75% gel and placebo in decreasing Demodex folliculorum, and is as effective as metronidazole 0.75% gel in treating erythema and papules.
Permethrin 5% cream is a safe alternative for the topical treatment of papulopustular rosacea.
Permethrin 5% cream is superior to metronidazole 0.75% gel and placebo in decreasing Demodex folliculorum, and is as effective as metronidazole 0.75% gel in treating erythema and papules.
Is topical nifedipine effective for chronic anal fissures?
Patients in this study showed remarkable improvement when 1.5% lidocaine and 0.3% nifedipine were applied twice daily for 6 weeks. This extremely safe, well tolerated, and effective treatment should provide family physicians with a reliable nonsurgical method for treating chronic anal fissures.
- BACKGROUND: Acute anal fissures generally heal spontaneously with minimal or no intervention. Conversely, chronic anal fissures are traditionally treated with surgery. Therapies such as botulinum toxin, isosorbide dinitrate, and glyceryl tinitrate have shown some benefit, but their side-effect profiles are substantial. With the knowledge that topical nifedipine has been shown to relax smooth muscle, lower anal resting pressure, relieve pain, and heal acute anal fissures, these authors studied its effect on chronic anal fissures.
- POPULATION STUDIED: Patients were recruited from the emergency surgery and gastroenterology center in Italy that conducted the study. Inclusion criteria were chronic anal fissure and age older than 18 years. Chronic anal fissure was assessed by clinical examination and a history of anal pain on defecation for longer than 2 months that did not resolve with stool softeners and simple anesthetic agents. Exclusion criteria were pregnancy, allergy to nifedipine or lidocaine, and complications warranting surgery.
- STUDY DESIGN AND VALIDITY: This was a prospective, randomized, double-blind study. The control group received 1.5% lidocaine and 1% hydrocortisone acetate, and the treatment group received 1.5% lidocaine and 0.3% nifedipine. The ointments were applied every 12 hours for 6 weeks. The ointments were indistinguishable, and all parties were blinded with proper allocation concealment. Data analysis was by intention-to-treat. The groups were randomly assigned and had similar baseline characteristics.
- OUTCOMES MEASURED: Healing of the chronic anal fissure was the primary outcome and was defined by anoscopy when epithelialization or formation of a scar was achieved at 42 days. Patients also subjectively rated pain as absent, modest, or persistent at day 21. Manometric studies were used as a secondary measure of clinical improvement and were measured at baseline and 21 days.
- RESULTS: Of the 55 patients in the nifedipine group, 94.5% healed clinically at 42 days and 87.3% reported no pain at 21 days. Conversely, of the 55 patients in the control group evaluated at the same intervals, 16.4% healed and 10.9% reported no pain (P<.001; number needed to treat=1.3).
Patients in this study showed remarkable improvement when 1.5% lidocaine and 0.3% nifedipine were applied twice daily for 6 weeks. This extremely safe, well tolerated, and effective treatment should provide family physicians with a reliable nonsurgical method for treating chronic anal fissures.
- BACKGROUND: Acute anal fissures generally heal spontaneously with minimal or no intervention. Conversely, chronic anal fissures are traditionally treated with surgery. Therapies such as botulinum toxin, isosorbide dinitrate, and glyceryl tinitrate have shown some benefit, but their side-effect profiles are substantial. With the knowledge that topical nifedipine has been shown to relax smooth muscle, lower anal resting pressure, relieve pain, and heal acute anal fissures, these authors studied its effect on chronic anal fissures.
- POPULATION STUDIED: Patients were recruited from the emergency surgery and gastroenterology center in Italy that conducted the study. Inclusion criteria were chronic anal fissure and age older than 18 years. Chronic anal fissure was assessed by clinical examination and a history of anal pain on defecation for longer than 2 months that did not resolve with stool softeners and simple anesthetic agents. Exclusion criteria were pregnancy, allergy to nifedipine or lidocaine, and complications warranting surgery.
- STUDY DESIGN AND VALIDITY: This was a prospective, randomized, double-blind study. The control group received 1.5% lidocaine and 1% hydrocortisone acetate, and the treatment group received 1.5% lidocaine and 0.3% nifedipine. The ointments were applied every 12 hours for 6 weeks. The ointments were indistinguishable, and all parties were blinded with proper allocation concealment. Data analysis was by intention-to-treat. The groups were randomly assigned and had similar baseline characteristics.
- OUTCOMES MEASURED: Healing of the chronic anal fissure was the primary outcome and was defined by anoscopy when epithelialization or formation of a scar was achieved at 42 days. Patients also subjectively rated pain as absent, modest, or persistent at day 21. Manometric studies were used as a secondary measure of clinical improvement and were measured at baseline and 21 days.
- RESULTS: Of the 55 patients in the nifedipine group, 94.5% healed clinically at 42 days and 87.3% reported no pain at 21 days. Conversely, of the 55 patients in the control group evaluated at the same intervals, 16.4% healed and 10.9% reported no pain (P<.001; number needed to treat=1.3).
Patients in this study showed remarkable improvement when 1.5% lidocaine and 0.3% nifedipine were applied twice daily for 6 weeks. This extremely safe, well tolerated, and effective treatment should provide family physicians with a reliable nonsurgical method for treating chronic anal fissures.
- BACKGROUND: Acute anal fissures generally heal spontaneously with minimal or no intervention. Conversely, chronic anal fissures are traditionally treated with surgery. Therapies such as botulinum toxin, isosorbide dinitrate, and glyceryl tinitrate have shown some benefit, but their side-effect profiles are substantial. With the knowledge that topical nifedipine has been shown to relax smooth muscle, lower anal resting pressure, relieve pain, and heal acute anal fissures, these authors studied its effect on chronic anal fissures.
- POPULATION STUDIED: Patients were recruited from the emergency surgery and gastroenterology center in Italy that conducted the study. Inclusion criteria were chronic anal fissure and age older than 18 years. Chronic anal fissure was assessed by clinical examination and a history of anal pain on defecation for longer than 2 months that did not resolve with stool softeners and simple anesthetic agents. Exclusion criteria were pregnancy, allergy to nifedipine or lidocaine, and complications warranting surgery.
- STUDY DESIGN AND VALIDITY: This was a prospective, randomized, double-blind study. The control group received 1.5% lidocaine and 1% hydrocortisone acetate, and the treatment group received 1.5% lidocaine and 0.3% nifedipine. The ointments were applied every 12 hours for 6 weeks. The ointments were indistinguishable, and all parties were blinded with proper allocation concealment. Data analysis was by intention-to-treat. The groups were randomly assigned and had similar baseline characteristics.
- OUTCOMES MEASURED: Healing of the chronic anal fissure was the primary outcome and was defined by anoscopy when epithelialization or formation of a scar was achieved at 42 days. Patients also subjectively rated pain as absent, modest, or persistent at day 21. Manometric studies were used as a secondary measure of clinical improvement and were measured at baseline and 21 days.
- RESULTS: Of the 55 patients in the nifedipine group, 94.5% healed clinically at 42 days and 87.3% reported no pain at 21 days. Conversely, of the 55 patients in the control group evaluated at the same intervals, 16.4% healed and 10.9% reported no pain (P<.001; number needed to treat=1.3).
HRT and vitamins C and E do not improve coronary disease in women
Hormone replacement therapy (HRT) and antioxidant vitamin supplements (vitamins E and C) do not provide cardiovascular benefit for postmenopausal women with known coronary heart disease. Moreover, a potential for harm exists with each of the treatments. Therefore, neither should be prescribed specifically for cardiovascular benefit for postmenopausal women with coronary heart disease.
Hormone replacement therapy (HRT) and antioxidant vitamin supplements (vitamins E and C) do not provide cardiovascular benefit for postmenopausal women with known coronary heart disease. Moreover, a potential for harm exists with each of the treatments. Therefore, neither should be prescribed specifically for cardiovascular benefit for postmenopausal women with coronary heart disease.
Hormone replacement therapy (HRT) and antioxidant vitamin supplements (vitamins E and C) do not provide cardiovascular benefit for postmenopausal women with known coronary heart disease. Moreover, a potential for harm exists with each of the treatments. Therefore, neither should be prescribed specifically for cardiovascular benefit for postmenopausal women with coronary heart disease.
Duct tape removes warts
Duct tape (or any durable, occlusive, tacky tape) appears to be at least as effective as traditional cryotherapy for removal of the common wart. It is an unusual and welcome event in health care when a common ailment is proven equally amenable to an inexpensive, tolerable, and safe alternative therapy.
Duct tape (or any durable, occlusive, tacky tape) appears to be at least as effective as traditional cryotherapy for removal of the common wart. It is an unusual and welcome event in health care when a common ailment is proven equally amenable to an inexpensive, tolerable, and safe alternative therapy.
Duct tape (or any durable, occlusive, tacky tape) appears to be at least as effective as traditional cryotherapy for removal of the common wart. It is an unusual and welcome event in health care when a common ailment is proven equally amenable to an inexpensive, tolerable, and safe alternative therapy.
Digoxin increases mortality among women with congestive heart failure
Digoxin increases mortality in women with congestive heart failure, compared with men; however, the clinical significance of this is unknown since gender is a nonmodifiable risk factor. More importantly, there is a suggestion of harm when looking at women treated with digoxin versus placebo. Since there are other therapies with definite benefit in congestive heart failure (angiotensin-converting enzyme inhibitors, beta-blockers, spironolactone), it is prudent to reconsider the use of digoxin in women with ejection fractions less than 45%.
Digoxin increases mortality in women with congestive heart failure, compared with men; however, the clinical significance of this is unknown since gender is a nonmodifiable risk factor. More importantly, there is a suggestion of harm when looking at women treated with digoxin versus placebo. Since there are other therapies with definite benefit in congestive heart failure (angiotensin-converting enzyme inhibitors, beta-blockers, spironolactone), it is prudent to reconsider the use of digoxin in women with ejection fractions less than 45%.
Digoxin increases mortality in women with congestive heart failure, compared with men; however, the clinical significance of this is unknown since gender is a nonmodifiable risk factor. More importantly, there is a suggestion of harm when looking at women treated with digoxin versus placebo. Since there are other therapies with definite benefit in congestive heart failure (angiotensin-converting enzyme inhibitors, beta-blockers, spironolactone), it is prudent to reconsider the use of digoxin in women with ejection fractions less than 45%.
Self-examination does not reduce breast cancer mortality
Breast self-examination does not decrease breast cancer mortality, according to the results of this randomized controlled trial of 266,000 women who were given intensive instruction in breast self-examination. These findings correspond with the US Preventive Services Task Force policy not to recommend breast self-examination for the reduction of breast cancer mortality.
Breast self-examination does not decrease breast cancer mortality, according to the results of this randomized controlled trial of 266,000 women who were given intensive instruction in breast self-examination. These findings correspond with the US Preventive Services Task Force policy not to recommend breast self-examination for the reduction of breast cancer mortality.
Breast self-examination does not decrease breast cancer mortality, according to the results of this randomized controlled trial of 266,000 women who were given intensive instruction in breast self-examination. These findings correspond with the US Preventive Services Task Force policy not to recommend breast self-examination for the reduction of breast cancer mortality.
Negative ELISA D-dimer assay can miss pulmonary embolism
This evaluation of the use of enzyme-linked immunosorbent assay (ELISA) D-dimer test in routine clinical practice supports other evidence that the assay has a high sensitivity to exclude pulmonary embolism in patient populations in which there is clinical suspicion. Nevertheless, the assay incorrectly excluded the diagnosis of pulmonary embolism in 2 cases.
Other examples of clinical decision-making exist for which the acceptable negative predictive value for screening is set at 100%—eg, the diagnosis of phenylketonuria in newborns.
Physicians who do not want to miss cases of acute pulmonary embolism when they clinically suspect the diagnosis should not rely solely on negative D-dimer assay results when the value to rule out the diagnosis is set at 500 ng/mL. If a lower value is used to define normal—eg, 250 ng/mL, as used in other studies—no cases of acute pulmonary embolism would have been missed in this group of patients. Regardless of the cutoff used, the assay will yield many false-positive results.
This evaluation of the use of enzyme-linked immunosorbent assay (ELISA) D-dimer test in routine clinical practice supports other evidence that the assay has a high sensitivity to exclude pulmonary embolism in patient populations in which there is clinical suspicion. Nevertheless, the assay incorrectly excluded the diagnosis of pulmonary embolism in 2 cases.
Other examples of clinical decision-making exist for which the acceptable negative predictive value for screening is set at 100%—eg, the diagnosis of phenylketonuria in newborns.
Physicians who do not want to miss cases of acute pulmonary embolism when they clinically suspect the diagnosis should not rely solely on negative D-dimer assay results when the value to rule out the diagnosis is set at 500 ng/mL. If a lower value is used to define normal—eg, 250 ng/mL, as used in other studies—no cases of acute pulmonary embolism would have been missed in this group of patients. Regardless of the cutoff used, the assay will yield many false-positive results.
This evaluation of the use of enzyme-linked immunosorbent assay (ELISA) D-dimer test in routine clinical practice supports other evidence that the assay has a high sensitivity to exclude pulmonary embolism in patient populations in which there is clinical suspicion. Nevertheless, the assay incorrectly excluded the diagnosis of pulmonary embolism in 2 cases.
Other examples of clinical decision-making exist for which the acceptable negative predictive value for screening is set at 100%—eg, the diagnosis of phenylketonuria in newborns.
Physicians who do not want to miss cases of acute pulmonary embolism when they clinically suspect the diagnosis should not rely solely on negative D-dimer assay results when the value to rule out the diagnosis is set at 500 ng/mL. If a lower value is used to define normal—eg, 250 ng/mL, as used in other studies—no cases of acute pulmonary embolism would have been missed in this group of patients. Regardless of the cutoff used, the assay will yield many false-positive results.