Consider The Evidence: Med/Peds Journal Roundup

February 28, 2006

G-CSF can’t stem the tide of Acute MI

Filed under: Cardiology, JAMA, myocardial infarction, stem cells — medblog @ 10:45 pm

JAMA 3/1 – Disappointing results from Zohlnhofer et al. in this weeks’ JAMA from a trial utilizing G-CSF to mobilize stem cells after acute MI (free full text avail.) Although some preliminary studies were promising, this is the first true RCT to address the subject. The researchers administered G-CSF 5 days after infarct and then followed up patients with T-99 scintigraphy, MRI, and/or angio. Although a significant increase of CD34+ cells was detected, indicating a surge of stem cells was mobilized – there was no significant difference in LVEF or infarct size at follow up. . . (more…)

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How low can you go?

Filed under: Uncategorized — medblog @ 5:47 pm

Dr RW’s blog has a post regarding the results of the ALLIANCE trial showing that a strategy that agressively targets low LDL-C levels is superior to “usual care.” More evidence for a “lower is better” theory for LDL-C….

February 25, 2006

Crohn’s breakthrough: Have we had it wrong all along?

Filed under: crohns, IBD, immunity, lancet — medblog @ 2:43 pm

Lancet 2/25 – In what is being touted as a landmark study, Marks, et al. show evidence that Crohn’s disease is due to an immune deficiency rather than an autoimmune process. This controversial finding seems to contradict the evidence supporting the use of immunosuppressive therapy that has been the mainstay of treatment for years.

The study involved the biopsy of rectal mucosa from Crohn’s pts, UC pts, and healthy controls. Samples were taken from clinically unaffected tissue. Immune cell and cytokine markers were compared among the pre- and post- biopsy samples. The response was significantly lower in the Crohn’s group.

One of the most telling parts of the study involved (more…)

February 23, 2006

bathtime fun and killing VRE, CRP for HTN?

Archives 2/13 – Why didnt anyone think of this earlier? Apparently a study by Vernon, et al. cleaning ICU patients with Chlorhexidine cloths effectively lowers patient colonization and contamination of healthcare workers’ hands and hospital surfaces. The intervention does a much better job than soap and water, or cloths alone. Anything to keep me from having to wear those stupid isolation gowns….

In another article – apparently you cant use CRP to measure risk all things cardiovascular. Unlike in older adults, CRP is not associated with risk of incident hypertension in young adults when adjusted for BMI – not suprising considering the two are probably strongly related…. (more…)

February 22, 2006

Melatonin meta-analysis: Back to counting sheep?

Filed under: BMJ, melatonin, sleep — medblog @ 3:46 pm

BMJ 2/10 – Although Melatonin continues to be one of the most widely used supplements for sleep, its popularity seems to be driven by anecdotal evidence than RCTs. A meta-analysis in the BMJ looks at more than 30 trials with melatonin, and concludes that it is pretty much useless for anything related to sleep. Travelers, shiftworkers, and insomniacs are just going to have to keep getting refills on their Ambien until the next natural sleep-aid fad comes around.

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February 20, 2006

Facilitated PCI a bust yet again

Filed under: Cardiology, lancet, myocardial infarction, PCI — medblog @ 3:22 pm

Lancet 2/20 – There has been some buzz of late about facilitated percutaneous coronary intervention (PCI) – using fibrinolytics before going to the cath lab in order to increase the critical 2-3 hour window of opportunity for reperfusion. An article by the ASSENT4-PCI group in this weeks Lancet adds to the data that such a strategy is not beneficial. (more…)

February 17, 2006

Statins alter initial presentation of CAD

Filed under: annals of internal medicine, CHD, statins — medblog @ 11:49 am

AnnalsIM 2/21 – Clearly statins reduce the risk of CAD, and act in several ways to prevent the formation of unstable plaques. So theoretically, the initial presentation of cardiac disease in patients on statins would be less likely to be unstable angina/MI vs. stable angina. In this weeks Annals, Go et al. present a study that supports just that conclusion. (more…)

February 15, 2006

will RIO make you less grande?

Filed under: CVD, JAMA, medicine, obesity — medblog @ 12:16 am

JAMA 2/15 – Do we finally have a drug to help combat obesity? Eagerly awaited results of the RIO trial are published in this weeks JAMA. Rimonabant (trade name: Accomplia) is a novel approach to reducing obesity and other CVD risk factors by targeting endocannabinoid receptors. This is the product of a hotbed of research targeting the signaling pathways that facilitate appetite and weight gain. RIO is the first large scale study of the safety and effectiveness of the drug, and it followed patients over 2 years. The results? Well I guess every little bit helps, but – keep looking for that magic pill.

Not to understate the success…Rimonabant definetly seems to help shed about 10lbs or so and there are significant positive effects on cholesterol levels and insulin sensitivity. (more…)

February 13, 2006

R.I.P. Physical Exam

Filed under: diabetes, NEJM, physical exam, public health — medblog @ 1:46 pm

NEJM 2/9 – This weeks New England has a couple of interesting editorials on the dying art of the physical exam and whether the golden age of the stethoscope is over?

Public Health departments are not just for tracking STDs anymore… an article by Steinbrook describes the NYC effort to require mandatory electronic reporting of HBA1c levels this year. I, for one, hope this is the start of a trend.

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February 12, 2006

BMJ update

Filed under: BMJ — medblog @ 11:14 pm

BMJ 2/12 – Nothing too exciting this week in the BMJ. Apparently Fondaparinux is effective for thromboprophylaxis in medical patients. And the News section makes mention of the approval of inhaled insulin for use in the US and UK.

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