In the Literature
Literature at a Glance
A guide to this month’s abstracts
- Steroids reduce mortality only in patients with confirmed bacterial meningitis.
- Probiotics can be useful in the treatment of acute diarrhea in children.
- CT pulmonary angiography is not inferior to V/Q scanning for exclusion of PE.
- Hospitalist care results in shorter LOS compared with care by traditional general internists and family practice physicians.
- The early risk of stroke after TIA is approximately 15% to 20% at 90 days after the sentinel event.
- Different anti-thrombotic strategies produce no difference in outcomes of early acute coronary syndromes.
- The risk of fatal PE is highest in the first year after medication is stopped.
- Beers criteria medications are associated with fewer ED visits by elderly patients compared with warfarin, digoxin, and insulin.
Elevated BMI in Childhood Increases Risk of Coronary Heart Disease in Adulthood
A cohort study of 276,835 children with 5,063,622 person-years of follow-up showed a linear increase in risk of coronary heart disease as body-mass index increased in boys and girls ages 7 to 13.
Citation: Baker JL, Olsen LW, Sorensen TIA. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357:2329-2337.
Pre-emptive Ablation Reduces Incidence of ICD Firing
A randomized control trial of patients with myocardial infarction (MI) within one month and spontaneous ventricular tachycardia/fibrillation to either ablation and defibrillator placement or defibrillator alone. Ablation provided no mortality benefit but reduced ICD firing/pacing (37% vs. 12%).
Citation: Reddy VY, Reynolds MR, Neuzil P, et. al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. 2007;357:2567-2565.
Dexmedetomidine Causes Fewer Side Effects than Lorazepam in Ventilated Patients
Double-blind, randomized controlled trial demonstrated that dexmedetomidine (an alpha 2 agonist) sedated, mechanically ventilated intensive-care unit patients had more days without delirium or coma than patients treated with lorazepam.
Citation: Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs. lorazepam on acute brain dysfunction in mechanically ventilated patients. JAMA 2007;298(22):2644-2653
Rosiglitazone Increases Risk of CONGESTIVE HEART FAILURE, MI, Mortality
Population-based case-control cohort study of elderly patients (65 or older) with type 2 diabetes found that rosiglitazone was associated with an increased risk of congestive heart failure (RR, 1.60), MI (RR, 1.40) and all-cause mortality (RR, 1.29) compared with other oral diabetic agents. Pioglitazone was not associated with adverse outcomes, potentially because of the relatively small number of patients receiving it.
Citation: Lipscombe LL, Gomes T, Levesque LE, Hux JE, Juurlink DN, Alter DA. Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. JAMA. 2007;298:2634-2643.
CRT Not Beneficial in Heart Failure Patients with Narrow QRS
Randomized trial of cardiac resynchronization therapy (CRT) of heart failure patients with dyssynchrony showed no benefit with QRS less than 120 milliseconds, but did improve six-minute walk and New York Heart Association classification if QRS was more than 120 and less than 130 milliseconds. Patients with QRS more than 130 milliseconds were not studied.
Citation: Beshai JF, Grimm RA, Nagueh SF, et al. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med. 2007;357:2461-2471.
Early Nephrology Referral Reduces Mortality in Patients with Chronic Kidney Disease
Meta-analysis of more than 12,000 patients with chronic kidney disease showed that early referral to nephrologists shortened hospital stay by 12 days from the initiation of dialysis (CI 8.0-16.1, p=0.0007) and decreased mortality (RR 1.99, CI 1.66-2.39).
Citation: Chan MR, Dall AT, Fletcher KE, Lu N, Trivedi H. Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. Am J Med. 2007; 120:1063-1070.
