Search

The article explores the health benefits of probiotics such as Lactobacillus and Bifidobacterium. Topics discussed include the use of probiotics to prevent diarrhea caused by viruses, bacteria and parasites and the effectiveness of probiotics in Crohn's disease and ulcerative colitis. Also presented is a chart of probiotic species found in popular food products.

The article provides an answer to a question of which are the most effective combination drug therapies for hypertension.

The article provides information on the most effective and safe malaria prophylaxis during pregnancy. Although all antimalarials are effective for prophylaxis, the Chloroquine and mefloquine have superior safety profiles in pregnancy. Based on systematic review of consistent, good-quality patient-oriented evidence, antimalarials decrease the severity of maternal malaria infection and malaria-associated anemia, while decreasing the incidence of low birth weight and perinatal death in women having their first or second baby. A patient-oriented expert urges women to delay travel until after pregnancy.

The article presents the five methods that adequately purify water according to U.S. Environmental Protection Agency standards. They include boiling for 1 minute if below 2000 meters and 3 minutes if above, chloride dioxide tablets, MIOX purifier, ultraviolet light, and portable filtration with a absolute pore size <1 micrometer combined with halogenation or charcoal filtration. It is being recommended by expert opinion to bring water to a rapid boil for at least 3 minutes and letting it cool as an effective means for water purification.

The article presents a clinical inquiry as to when travelers begin malaria prophylaxis. Although no drug regimen guarantees protection against malaria, the authors note physicians should prescribe 1 of the several options based on the location of travel, the susceptibility of Plasmodium falciparum and the side-effect profile. They stress that travelers should begin on chloroquine 1-2 weeks before entering an area without chloroquine resistance. On the other hand, travelers will need to take atovaquaone/proguanil or primaquine 1 day before entering the area of mefloquine 2-7 weeks before travel in areas with chloroquine-resistant Plasmodium falciparum.

The article presents the best initial treatment for orbital cellulitis of children in the U.S. Orbital cellulitis is a serious soft-tissue infection of childhood with very different etiologies. Although antibiotics are the best initial treatment, surgical intervention is warranted when a child has visual impairment, complete ophthalmoplegia or well-defined abscess. As with the systematic steriods, it is said that there are no proven benefit in the treatment of pediatric orbital cellulitis with subperiosteal abscess. Periorbital and orbital cellulitis are not specifically addressed in the guidelines, however, oral dicloxacilin, cephalexin and erythromycin are recommended for superficial cellulitis.

The article discusses the dietary treatment for low high-density lipoprotein (HDL) cholesterol. The study has indicated that the low HDL was recognized as a risk factor for atherosclerosis. It has noted that there was no specific guidelines on dietary therapy of HDL exist, however, the American Heart Association has published diet and lifestyle recommendations in 2006, wherein it has recommended a diet low in fat, saturated fat, trans fat, and cholesterol in addition to minimizing sodium, added sugars and alcohol.

The article cites a study on the morbidity and mortality of mothers and infants in vaginal birth after cesarean in the U.S. The repeat cesarean rate for low-risk women of all ages and racial groups is now 88.7 percent, the highest rate since the Centers for Disease Control and Prevention began tracking the statistics in 1989. The study revealed that vaginal birth after cesarean section is not associated with increased risk of maternal or neonatal mortality. However, morbidity is slightly increased due to higher uterine rupture rates and some neonatal outcome measures.

The article offers advice on the dietary modifications indicated for migraines. It is pointed out that migraine frequency, duration, and severity are not increased by dietary choices. They can be decreased by a low-fat diet. Regular supplementation with high-dose riboflavin or magnesium reduces frequency and intensity of migraines. The author also suggests that patients should keep a diary of events surrounding their migraines, identify patterns and experiment with dietary and activity modifications. Today, migraines treatment remains a process of educated trial and error to find the optimal combination of lifestyle modifications and medications.

The article provides an answer to a question of does the presence of a trained support person during labor decrease the likelihood of cesarean section (C-section).

The article provides an answer to a question on what are the risk factors and signs and symptoms associated with coccidioidomycosis.

The article discusses Rhus or plant-induced contact dermatitis. It mentions that the best treatment for it is unclear and can be exacerbated by topical high-potency steroids. It also notes self-controlled cohort studies which indicated the amelioration of its symptoms through the said steroid as well as the reduction of vesiculation, induration and pruritus through the application of a clobetasol propionate ointment.

The article examines treatment approach to intrapartum maternal fever that has the best fetal outcomes. Recommended empiric agents for the treatment of acute chorioamnionitis are a combination of beta-lactam and aminoglycoside antibiotics. It is also found that intrapartum antibiotic treatment is not superior to postpartum antibiotics for reducing neonatal sepsis and pneumonia. This finding is based on patient-oriented and underpowered randomized trials. Other recommendations come from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.

The article discusses the best treatment for cradle cap, a form of seborrheic dermatitis that manifests as greasy patches of scaling on the scalp of infants between the second week and sixth month of life. According to sources, ketoconazole shampoo appears to be safe and effective treatment for infants with cradle cap. Meanwhile, the American Academy of Dermatology has issued a patient-oriented pamphlet which suggests that anti-dandruff or baby shampoo, with or without hydrocortisone lotion or cream, is effective in treating cradle crap.

The article examines whether stopping statin therapy increases the short-term risk of a cardiovascular event. The benefits of statin therapy includes reduction in post-myocardial infarction deaths and reinfarctions. Aspirin and beta-blockers have also been shown to improve early outcomes when started after cardiovascular events. A study revealed that patients with stroke and those with only risk factors for cardiovascular disease showed increased platelet activity when statins are discontinued. Human data suggest that stopping statin treatment increases the risk of recurrence for patients who recently had a primary cardiovascular event.

The article presents a clinical commentary regarding the proper monitoring for patients having Barrett's esophagus. The author believes that patients having Barrett's esophagus are not prone to have esophageal cancer thus, an esophagogastroduodenoscopy every three years is an enough monitoring provided patients do not have occurrence of dysplasia.

The article discusses the concern on whether children can be benefited from blood pressure screening. It notes that the children may not be receiving benefit from screening of blood pressure, but could pay off for adults. It adds that children with high BP are more than 60 percent at risk of being hypertensive as young adult.

The article provides information concerning the evidence of increased risk for major bleeding in elderly patients who fall and are taking warfarin. Based on the study, the risk of intracranial hemorrhage from a fall is much smaller than the benefit gained from reducing risk of stroke in patients taking warfarin for atrial fibrillation. According to the author, major bleeding from a fall also occurs infrequently in patients with a therapeutic internal normalized ratio (INR). However, the author added that bleeding is more common in patients with a supratherapeutic INR.

The article focuses on the suitable treatment for impetigo, which include topical mupirocin, fusidic acid, and gentamicin. Topics discussed include the 2003 meta-analysis of 16 studies which evaluate the efficacy of topical antibiotics and placebo in treating impetigo in children and adults, 2008 randomized, double-blind study regarding retapamulin which reveals that it produces more clinical response compared to placebo, and efficacy of topical antibiotics compared to disinfectant solutions.

The article provides an answer to a question regarding the safety relief of low-back pain for pregnant women.

This article looks into the duration on the safety of expectant management in first-trimester miscarriage. It is noted that expectant management is successful within 2 to 6 weeks without increased complications in 80 percent to 90 percent of women with first-trimester incomplete spontaneous abortion and 65 percent to 75 percent of women with first-trimester missed abortion or anembryonic gestation. The evidence summary presented in this article gives clear information on outcomes that physicians can share with their patients; however, most women quickly know what they want regarding retained products of conception.

Insufficient evidence exists to determine which specific combinations most effectively decrease cardiovascular morbidity and mortality, although combinations of hypertension medications at lower doses generally reduce cardiovascular outcomes (stroke, coronary heart disease) more than monotherapy (strength of recommendation [SOR]: A, large meta-analyses).The combination of benazepril and amlodipine reduces the composite endpoint of cardiovascular events and deaths more than benazepril plus hydrochlorothiazide with similar rates of adverse effects (SOR: A, randomized controlled trial [RCT]).Combining an angiotensin converting enzyme inhibitor (ACE-I) with a thiazide, ß-blocker, or calcium channel blocker produces side effects similar to monotherapy, as does combining an angiotensin receptor blocker (ARB) with a thiazide or calcium channel blocker (SOR: A, meta-analyses). However, an ACE-I combined with an ARB increases the risk of renal complications and death more than monotherapy (SOR: A, RCT)..

Low-carbohydrate diets raise high-density lipoprotein (HDL) cholesterol levels by approximately 10%; soy protein with isoflavones raises HDL by 3% (strength of recommendation [SOR]: C, based on meta-analysis of physiologic parameters). The Dietary Approaches to Stop Hypertension (DASH) diet and multivitamin supplementation raise HDL 21% to 33% (SOR: C, based on single randomized trial each measuring physiologic parameters). No other dietary interventions studied raise HDL (SOR: C, based on meta-analysis of physiologic parameters).

Some patients who have been diagnosed with Barrett's esophagus will develop dysplasia and, in some cases, esophageal carcinoma (strength of recommendation [SOR]: A, based on consistent cohort studies). Endoscopic surveillance is recommended for all patients with Barrett's esophagus as it is superior to other methods for detecting esophageal cancer (SOR: B, based on systematic review). The degree of dysplasia noted on biopsy specimens correlates with the risk of esophageal carcinoma development and should guide the frequency of subsequent evaluations (SOR: B, based on consistent cohort studies). The optimal frequency of endoscopy has yet to be determined in any randomized trial. Recommendations from the 2002 American College of Gastroenterology (ACG) Practice Guideline provide guidance as to the frequency of endoscopy surveillance but were not based on an explicit systematic review of the literature (SOR: C, based on expert opinion).

More than 80% of women with a first-trimester spontaneous abortion have complete natural passage of tissue within 2 to 6 weeks with no higher complication rate than that from surgical intervention (strength of recommendation [SOR]: A, based on multiple randomized controlled trials [RCTs] and cohort studies). Expectant management is successful within 2 to 6 weeks without increased complications in 80% to 90% of women with first-trimester incomplete spontaneous abortion and 65% to 75% of women with first-trimester missed abortion or anembryonic gestation (presenting with spotting or bleeding and ultrasound evidence of fetal demise) (SOR: B, based on multiple cohort studies). There is no difference in short-term psychological outcomes between expectant and surgical management (SOR: B, based on RCT). Women experiencing spontaneous abortion with unstable vital signs, uncontrolled bleeding, or evidence of infection should be considered for surgical evacuation (SOR: C, expert opinion).