Health & Wellness for a LIFETIME
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Archive:
- 2012
- January (11)
- PFC Lowers Antibodies!
- People Don't Stop Smoking After Seing Plaque in Carotids!
- Pharmaceutical Companies and Physicians
- Importance of Vitamin D
- Statin Drugs and Diabetes
- Heart Attacks and Long Distance Running
- Wasted Research Money?
- Nicotine Patch Ineffective
- So How Much Exercise Can You Squeeze In?
- Neti-Pot Problems
- AHA Study: Heart Disease Increasing
- 2011
- December (11)
- Cranberries vs. Antibiotics for UTI
- Antioxidants Reduce Cancer Risk
- Back Surgery: Too Many, Too Costly, Too Ineffective!
- Simvastin (Zocor, Vytorin, Simcor) Danger
- Physicians Rate Insurance Companies
- Anti-coagulant Drug Problems
- Bad News about Stop Smoking Drug
- Antibiotics: Inappropriately Used
- Exercise More Important Than BMI
- Pediatric Antibiotis: Over Prescribed?
- FDA Criticized Dr. Oz But Was It Fair?
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Posts for: February, 2012
AHA Releases Statement on Women and Peripheral Artery Disease
The American Heart Association has released a "call-to-action" to raise awareness of the burden of peripheral artery disease (PAD) in U.S. women.
Published in Circulation, the statement emphasizes the dearth of research on PAD in women, but notes the following based on existing data:
- Women have at least as many PAD-related physician visits as men.
- Like men, most women with PAD do not present with "classic symptoms" of intermittent claudication; rather, many are asymptomatic or have atypical leg symptoms.
- Women face greater risk for graft failure and limb loss than men.
In addition, the statement advises primary care clinicians to use ankle-brachial index measurements to identify women who have PAD or who are at high risk for it.
AHA statement in Circulation (Free)
Amoxicillin Has No Effect on Acute, Uncomplicated Bacterial Rhinosinusitis
Amoxicillin doesn't ameliorate the severity of acute, uncomplicated bacterial rhinosinusitis any better than placebo, according to a JAMA study.
Some 160 patients with clinically confirmed disease (purulent nasal discharge and maxillary pain or facial tenderness) were randomized to receive either 1500 mg/day of amoxicillin or placebo for 10 days. In addition, all received a supply of symptomatic treatments (e.g., acetaminophen) for use as needed.
Patients' assessment of improvement in 16 sinus-related symptoms did not differ between groups at day 3 or at day 10. (While symptom scores did favor antibiotics at day 7, the authors judge the difference to be "too small to represent any clinically important change.")
In his Journal Watch HIV and ID Observations blog, Dr. Paul Sax says the study reminds us that "most of the common community-acquired infections resolve spontaneously."
JAMA article (Free abstract)
Bread, Poultry Account for Large Part of America's Sodium Consumption
More than 40% of sodium consumed in the U.S. comes from 10 food categories, with bread and poultry among the top 5, according to an MMWR report.
CDC researchers examined data on some 7200 U.S. individuals aged 2 years and older who completed 24-hour dietary recalls as part of the 2007–2008 National Health and Nutrition Examination Survey. Overall, the mean daily sodium consumption (excluding table salt) was 3266 mg, well above recommendations to keep intake below 2300 mg.
The top 10 food categories contributing to sodium consumption were, in descending order: bread and rolls, cold cuts, pizza, poultry, soups, sandwiches, cheese, pasta mixed dishes, meat mixed dishes, and savory snacks. Two thirds of sodium came from foods purchased at stores; the rest came from restaurants, cafeterias, and other sources.
Interesting study, but we need more specifics. Where did the bread and poultry come from? Did the they come from fast food restaurants? What was added to the bread?
Can Carotid Ultrasound Screening Motivate Smokers to Quit?
In a randomized trial, screening was ineffective.
One possible role of cardiovascular (CV) screening tests is to motivate people with abnormal results to make lifestyle changes. To see whether this strategy works, Swiss researchers randomized 536 heavy smokers (age range, 40–70) to receive carotid ultrasound screening or no screening. Those with carotid plaques (58% of screened patients) received photographs of the plaques along with detailed explanations. Patients in both groups received intensive smoking cessation counseling.
Smoking abstinence rates at 1 year (confirmed by measurement of exhaled carbon monoxide and serum cotinine levels) were about 20% in both groups. Moreover, 12-month changes in CV risk factors such as lipid levels and blood pressure were similar in the two groups. Within the screening group, smoking cessation outcomes in patients with plaques did not differ significantly from outcomes in those without plaques.
Comment: Carotid ultrasound screening failed to motivate patients to quit smoking, over and above smoking cessation counseling. These findings — added to the evidence that patients with asymptomatic carotid stenosis who receive contemporary preventive medical therapies are unlikely to benefit from carotid revascularization (JW Gen Med Sep 15 2011) — suggest that carotid screening is not appropriate. An editorialist argues that, to motivate patients, improving patient–physician communication and relationships is a more-promising approach than ordering tests.
In essence, if the carotid ultrasound shows that a patient is at a high reisk for a stroke and the patient refuses to make necessary lifestyle changes, then what is the point of doing the test to begin with? If there is a 90% obstruction and the patient undergoes surgery, but does not change his/her eating habits, the patient will not benefit from the surgery because there will be a fast recurrence.
To be honest, the results of this study is not at all surprising considering that the average person who suffers a heart attack is scared and improves his/her lifestyle for a couple of months then slips back to old habits...until the second heart attack. If a heart attack and almost death does not scare the patient, then certainly a picture of plaque partially blocking an artery is not going to encourage the patient to take better care of him/herself.....unfortunately.
Symptoms May Say Sinusitis, but Scans Disagree
Infection and even inflammation were not reliably present in the scans of patients with classic sinusitis symptoms.
Chronic sinusitis can be difficult to diagnose precisely and sometimes even more difficult to treat. Increasingly, experts are suggesting that antibiotics may be wildly overprescribed for this condition.
In this prospective study, patients referred to a single sinus expert for classic sinusitis symptoms were methodically evaluated with computed tomography (CT) scans and nasal endoscopy. Of 125 consecutive patients, only 75 (60%) had evidence of sinusitis on CT scan (meatal obstruction, air-fluid levels, or mucosal thickening [one area with >10 mm thickening, or any thickening involving at least 4 sinuses]). A decreased sense of smell predicted an abnormal CT scan, but headache, facial pain and difficulty sleeping were all more common in the patients with a normal scan. Further, the worse the reported facial pain, the less likely the scan was to show abnormalities.
Purulent secretions were found on endoscopy in only 18 patients, all of whom had abnormal CT scans. Standard pathogens associated with bacterial sinusitis were identified in only five of these patients. No environmental exposures (including alcohol, tobacco, pets, and mold) could distinguish patients with normal scans from the others.
Comment: This series emphasizes not only the absence of standard bacterial pathogens in chronic sinusitis, but also the frequent absence of sinusitis itself in those who present with the usual symptoms. The authors suggest that confounding diagnoses such as migraine headaches are often overlooked in these patients. They recommend that antibiotics be prescribed only if mucopurulence is seen on endoscopy and call for "a moratorium on the widespread practice . . . of long-term empiric antibiotics" in these patients. Finally, they note that much of the chronic sinusitis literature includes cases identified without this careful evaluation and should thus be viewed "with extreme skepticism."
Published in Journal Watch
I am always skeptical when patients come in diagnosed with Sinusitis and placed on antibiotics.