Primary Care/Hospitalist
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Data Indicate Efficacy of Liletta IUD for Four Years’ Use
Four-year data from the ongoing multicenter, U.S.-based pivotal trial of the 52 mg Liletta levonorgestrel-releasing intrauterine device (IUD) indicate its safety and efficacy for four years of use in nulliparous and parous women, as well as in non-obese and obese women.
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More Teens Using Contraception, Data Show
While more relying on IUDs and other methods, pill use remains common
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Fungus Among Us? Dermatophyte Infections, Mimickers, and Treatment Options
Tinea refers to a superficial fungal infection of the skin, hair, and nails caused by dermatophytes, which are filamentous fungi. Trichophyton rubrum is the most common cause of dermatophyte infection, accounting for nearly 70% of infections worldwide. These infections are extremely common, but are more prominent in warm, tropical climates. Tinea is seen more commonly in black and Asian patients, has a predilection for young adults, and is three to four times more common in males.
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Prevalence of Coronary Atherosclerosis in Indigenous South American Tsimané
Tsimané, a population living in the Bolivian Amazon, have the lowest prevalence of coronary artery disease among any population studied; individuals ≥ 40 years of age have mean low-density lipoprotein and high-density lipoprotein of 91 mg/dL and 39.5 mg/dL, respectively, despite a high inflammatory burden from parasites and pathogens.
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Yoga for Lumbago?
A review of randomized, controlled trials of treatments for chronic non-specific, low back pain revealed that yoga provides improvements in back-related function compared to non-exercise controls at intermediate time points, and in pain scores in the short term. Also, yoga seems to be comparable to exercise interventions, although the quality of evidence was low enough to preclude us from knowing for sure.
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Saffron and Depression: What Do We Know and Where Do We Go?
Saffron studies, while still preliminary, show potential for use of this ancient spice in combatting mild-moderate depression.
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Distinguishing Ischemic from Non-ischemic Cardiomyopathy Clinically
SYNOPSIS: This cardiac catheterization-based study of patients with newly diagnosed reduced left ventricular ejection fraction of unknown etiology showed that 15% had ischemic cardiomyopathy and they could be identified by clinical characteristics and an ECG-based risk score.
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B-type Natriuretic Peptide Is Less Useful in Elderly Patients with Dyspnea
SYNOPSIS: Among patients ≥ 80 years of age presenting with acute dyspnea, B-type natriuretic peptide level was not useful for differentiating cardiac vs. respiratory etiologies when added to a model of clinical predictors.
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Sepsis Management: What We Think We Know
SYNOPSIS: In the Protocolized Resuscitation in Sepsis Meta-Analysis (PRISM), 3,723 patients’ outcomes from the ProCESS, ARISE, and ProMISe randomized, controlled trials of early goal-directed therapy (EGDT) were evaluated. EGDT did not result in better outcomes than usual care and was associated with higher costs. The authors of a second study looked at outcomes of 49,331 patients with sepsis treated in New York from April 2014 to June 2016. More rapid completion of the three-hour sepsis bundle and antibiotic administration (but not rapid bolus administration of IV fluids) was associated with reduced in-hospital mortality.
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Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis
SYNOPSIS: A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.