Internal Medicine
RSSArticles
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Clinical Briefs
Accumulation of briefs: Consequences of NSAID Use in Patients Receiving Post-MI Antithrombotic Prophylaxis, Psoriasis Is Associated with Insulin Resistance, and Difficult Questions About Testosterone and Mortality
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Steroids for Severe Community-Acquired Pneumonia: More Evidence or More Uncertainty?
Community-acquired pneumonia (CAP) is the leading cause of mortality from infection in industrialized countries, and treatment failure occurs in 10-20% of cases despite appropriate antibiotic therapy. Thus, effective treatment strategies that reduce the burden of CAP would have a major impact on public health. Several previous studies that investigated the role of corticosteroids in CAP produced mixed results. Torres and colleagues hypothesized that corticosteroids modulate the immune response in severe CAP, thereby decreasing treatment failure.
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Effects of Lifestyle Modifications on the Coronary and Carotid Atherosclerotic Burden
A look at how lifestyle changes, including dietary modifications and regular exercise, impact therapy for atherosclerotic cardiovascular disease.
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Diet Sodas: Are They Really Diet?
Over the past several decades, concerns about increased sugar consumption has led some experts to recommend the use of non-nutritive sweeteners (NNSs).1
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Controversial Removal of Dietary Supplements from Retailers’ Shelves
Until sound testing methodology and retailer/government oversight is honed, clinicians and consumers should discuss the appropriateness of dietary supplement use and the choice of products from reputable companies.
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Lactobacillus casei Supplementation Improves Inflammatory Markers and Disease Activity Scores in Rheumatoid Arthritis
In this randomized, double-blind, placebo-controlled study, the probiotic strain Lactobacillus casei 01 was provided to women with rheumatoid arthritis at a dosage of 108 colony forming units for a period of 8 weeks and compared to a placebo treatment. Disease activity score and levels of the proinflammatory cytokines tumor necrosis factor-α, interleukin-6, and interleukin-12 were found to be significantly decreased at the end of the intervention. Additional parameters of state and trait anxiety were also evaluated and were not significantly altered by therapies.
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Acupuncture and Moxibustion in the Treatment of Crohn’s Disease
This randomized, placebo-controlled trial demonstrated that acupuncture and moxibustion treatment in patients with Crohn’s disease significantly improved the patient’s CD symptoms, quality of life, mucosal inflammation, serum hemoglobin, and C-reactive protein levels compared to the control group.
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Live Longer: Substitute in Whole Grains
When adjusted for possible confounding variables, this analysis of U.S. men and women found an association between higher whole grain intake and lower mortality from all causes, including cardiovascular disease, but no association for cancer mortality.
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The Disruptive Effects of Tablet Readers on Sleep Patterns
The use of light-emitting tablet devices prior to bedtime negatively impacts sleep patterns through disturbances in circadian rhythms.
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Corticosteroids in Severe Community-Acquired Pneumonia: The Controversy Continues
Treatment failure in hospitalized patients with severe community-acquired pneumonia (CAP) is associated with an excessive inflammatory response and worse outcomes. Torres and colleagues sought to determine the effect of corticosteroids in patients with severe CAP and a significant inflammatory response. In this multicenter, randomized, double-blind, placebo-controlled trial, 120 severe CAP patients with C-reactive protein (CRP) levels >150 mg/L were randomized to receive either an IV methylprednisolone bolus of 0.5 mg/kg every 12 hours or placebo. Treatment began within 36 hours of hospital admission and lasted for 5 days. Severe CAP was defined as two out of the three minor criteria independently associated with severity including PaO2 /FiO2 < 250, multilobar involvement, and systolic blood pressure < 90 mmHg, or one out of two major criteria, including a requirement for mechanical ventilation or septic shock.1 Risk class V for the Pneumonia Severity Index was also considered severe CAP.2 The primary outcome was early or late treatment failure. Early treatment failure was defined as the development of shock, need for mechanical ventilation not present at baseline, or death within 72 hours of treatment. Late treatment failure was defined as radiographic progression, persistence of severe respiratory failure, development of shock, need for invasive mechanical ventilation not present at baseline, or death between 72 hours and 120 hours after treatment.