Internal Medicine Alert – July 15, 2008

July 15, 2008

• Long-Term Cognitive Decline and Coronary Artery Bypass Surgery (CABG)

  Enthusiasm for coronary artery bypass grafting (CABG) as an intervention for cardiovascular disease has been tempered by concerns about postoperative cognitive decline.

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• Meta-analysis: Sequential Therapy Appears Superior to Standard Therapy for Helicobacter pylori Infection in Patients Naïve to Treatment

  Standard eradication therapy for H. pylori in the U.S. has involved use of a proton pump inhibitor (PPI) plus clarithromycin and either amoxicillin or an imidazole (metronidazole).

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• Value of Homocysteine-lowering Folic-Acid/ vitamin B Therapy in Cardiovascular Prevention-Have We Been Wrong Again?

  After 7.3 years of treatment and follow-up, a combination pill of folic acid, vitamin B6 and vitamin B12 did not reduce a combined endpoint of total cardiovascular events among high-risk women despite significant homocysteine lowering.

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• Duloxetine Delayed-Release Capsules (Cymbalta®)

  Duloxetine is the first serotonin norepinephrine reuptake inhibitor (SNRI) to be approved for the treatment of fibromyalgia.

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• Clinical Briefs by Louis Kuritzky, MD

  There have been no major therapeutic steps added for the management of acute gouty arthritis (AGA) for over 30 years.

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• ECG Review: A Scooped ST Tachycardia

  The 12-lead ECG and lead II rhythm strip in the Figure were obtained from a 83-year old woman who presented with rapid heart rate. She was on no antiarrhythmic medications. How would you interpret her ECG?

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• Pharmacology Watch

  Shingles vaccine added to CDC list of vaccines for adults 60 and older; CDC recommends Tdap for postpartum women; new study suggests sequential therapy with antibiotics for H. pylori may be more effective than standard therapy; FDA Actions.

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