Consider The Evidence: Med/Peds Journal Roundup

March 7, 2006

Attack of the clones: Community Aquired MRSA

Filed under: annals of internal medicine, infectious disease, lancet, MRSA — medblog @ 10:00 pm

Community Aquired MRSA and the USA 300 clone are making news in two journals this week… Get used to those stupid yellow gowns šŸ˜¦
AnnalsIM 3/7 – A study by King et al. in The Annals of Internal Medicine documents the epidemiology of community aquired MRSA in a major hospital system in Atlanta, GA. The study included patients with community aquired skin and soft tissue infections due to Staph aureus. The results show that a majority (63%) of S. aureus isolates were methicillin resistant. 99% of the CA-MRSA samples that were further analyzed were the USA 300 clone.

A second paper, by Graham et al., analyzed the NHANES data on nasal swabs taken in a population sample. They found that, “The prevalence of colonization with S. aureus and with MRSA was 31.6% and 0.84%, respectively, in the noninstitutionalized U.S. population.”

Lancet 3/4 – An article in the Lancet by Diep et al. details the genome of the USA300 clone and the particular elements that lead to its epidemiology and virology. Frankly, much too dense for me to read more than the abstract – but I’m glad somebody else cares… (more…)

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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 initialĀ presentation of cardiac disease in patients on statinsĀ would be less likely to beĀ unstable angina/MI vs. stable angina. In this weeks Annals, Go et al. present a study that supports just that conclusion. (more…)

February 1, 2006

Connecting GFR to Cardiovascular Outcomes: ALLHAT

Filed under: annals of internal medicine, cardiovascular, hypertension, renal — medblog @ 2:45 am

Annals 2/7 – Picking apart two frequently co-morbid diagnoses, Rahman et al. propose that low GFR is an independent predictor for CVD in hypertensive patients. In fact, patients with a moderate to severe reduction in GFR had a higher 6-year incidence of developing CHD than ESRD.

They also report that amlodipne is less effective than the diuretic chlorthalidone in preventing CHD, and lisinopril is less effective than chlorthalidone in preventing heart failure. (more…)

PE scoring Ad Nauseam

Filed under: annals of internal medicine, pulmonary, VTE — medblog @ 2:29 am

AnnalsIM 2/7 – This weeks Annals has 2 more articles on PE, didnt they read last weeks Archives? I’ll make this a 2 for 1…
Roy et al. find that ER diagnostic managment of suspected PE was incorrect in 43% of cases. Incorrect management occurred in 57% of those who ruled out and 8% percent of those that had PE.

Le Gal et al. propose a revised Geneva score to stratify pre-test risk for suspected PE. This is different than the old Geneva score in that it does not require an ABG. And unlike the Wells score – there is no need to assess the probablility of alternative diagnoses.
(more…)

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