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Paget’s Disease: Risedronate Best Pyridinyl bisphosphonate: Actonel Cost $772.80 for full Rx of 2 mo at 30 mg/day. Others more $ (alendronate-Fosamax $832, tiludronate (Skelid) $1353, calcitonin $1468-2311) or cumbersome (pamidronate IV $655) or less effective (etidronate-Didronel). Med Let 8/28/98. Pap Smear: Every 3 Years OK: Ob & Gyn 8/00 U Calif article of 125,000 women in clinics found smears up to every three years OK. Peanuts: Curing & Roasting Increases Allergens: 1.5 million Americans peanut allergy. Curing at less than 60 C (often done at 70 C) and avoiding high roasting which is routinely done at 320 F would create fewer allergens as well as some change in harvesting. June, 2003, Journal of Agricultural and Food Chemistry. The Chinese boil their peanuts as do some Americans in the southern states. This results in far fewer allergens and the peanuts are much less likely to cause allergies. Pedophilia: Carbamazepine & Clonazepam Case: One patients with shame for pedophilia treated carbamaz 300 mg/day & clonazepam 2 mg/day with marked decrease in pedophiles' cognitions and behavior. Maintained on 200/d and 1/d. Varela, AJP 7/92;159:1245 Peripheral Arterial Occlusive Disease: Gingko Helps Walking Distance: Nine DB PC studies were found. In the majority, there was an advantage of EGb 761 in the increase of pain-free walking distance compared to placebo. For 7 studies, the advantage was found to be statistically significant. Ginkgo biloba special extract EGb 761 in the treatment of peripheral arterial occlusive disease--a review based on randomized, controlled studies. Horsch S, Walther C. Koln, Germany. Int J Clin Pharmacol Ther. 2004 Feb;42(2):63-72 Pesticides: Cause Non-Hodgkins Lymphoma in Kids: Children in homes with pesticide use had 3-7 times the amount of NHL. Case-control retrospective study of 268 cases. Cancer 12/1/00. Pharmaceutical: Inexpensive or Free Medicine: An internet website linking to 177 other websites for subsidized medications, often by pharmaceutical companies = NeedyMeds.com; also http://www.phrma.org/pap/ and http://www.medicare.gov/Prescription/home.asp and for transplant meds http://www.unos.org and also http://www.rxassist.org Pharyngitis Strep A Not Helped by Penicillin in Children Except Decrease Sequelae: 15-30% of children with sore throats have strep throats. Penicillin has been shown to help adults with strep throats. A DB PC study in the Netherlands of 156 children 4-15 with sore throats and two of the four (fever, no cough, tonsillar exudate, or swollen, tender anterior cervical nodes) were treated with 7 days or 3 days of penicillin or placebo. No difference in recovery was seen even in the 96 who tested positive for Strep. Sequelae were seen in 1, 2, and 8 children in the three groups. Nine had an imminent quinsy (unable to drink), one scarlet fever, and one impetigo. These sequelae can safely be treated at the moment of occurrence, and their prevention is not a specific indication for antibiotic treatment in sore throat. Carrier rates for Strep A in the region were 30% for children and 7% for adults. 3 days of treatment actually did worse than placebo, possibly due to blocking natural immune response but not eradicating the pathogen. Treat children having an acute sore throat only when they are severely ill (unable to drink, an imminent quinsy) or at high risk (history of rheumatic fever, having an anatomical or immunological disorder, high incidence of streptococcal infections in the community). Penicillin for acute sore throat in children: randomised, double blind trial. Sjoerd Zwart, Maroeska M Rovers, Ruut A de Melker, Arno W Hoes Brit Med J 2003;327:1324 (6 December) Post Polio Syndrome: Symptoms: fatigue (90%), joint and muscle pain (70% each), weakness in previously affected muscles (69%) weakness in other muscles (50%), atrophy and cold intolerance (30% each). Meds don’t help although suboptimal exercise does. Occurs most often in individuals with adolescent or adult polio and with muscle symptoms. Occurs in 25-50%. JAMA 7/26/00 Postural Hypotension: Pyridostigmine Effective: Mayo Clinic research says this myasthenia gravis drug which blocks cholinesterase and thus inhibits the breakdown of cholinesterase, appears idea since it does not raise blood pressure. Brand name Mestinon. Contraindicated in mechanical intestinal or urinary blockade and with caution with asthma. Mayo Clinic news release 9/24/03 J Neurol Neurosurg Psychiatry Premature Ovarian Failure: Addison’s Disease More Common: An adrenal antibody test is an effective way to determine if women with POF are at risk for primary auto-immune adrenal insufficiency. V.K. Bakalov screened 123 women with POF. Three different testing mechanisms to screen for the disease: 1) the adrenocorticotrophic hormone (ACTH) stimulation test (the standard test for diagnosing adrenal insufficiency); 2) the adrenal antibody test; and 3) the morning cortisol test. Four (3.2 percent) of the 123 women with POF had previously undetected adrenal insufficiency, but none of the common symptoms of adrenal insufficiency, such as unusual tiredness and weakness, dizziness when standing, loss of appetite, darkened skin, and craving for salt. The rate of adrenal insufficiency among women with POF in this study is 300 times higher than the 1 in 10,000 rate seen in the general population. The adrenal antibody test was most effective in detecting adrenal insufficiency in women with POF. ACTH test should be reserved for use as a diagnostic test. 2002. Puberty: Low Birth Wt May Be a Cause of Premature Puberty: Spanish study found. 11/00. Normal menarche age 12 in U.S. tho 50% blacks and 15% whites signs of early puberty at age 8. Pruritis Ani: Capsaicin for Intractable Works: 9/03 Gut. Topical capsaicin is known to be effective and safe in the treatment of pain and itching. J. Lysy, Hadassah. Capsaisin exercises an active depressant effect in the synthesis, storage, transport, and release of substance P. DB, crossover study involving two four-week treatment phases separated by a one-week washout, 44 patients with chronic, intractable pruritis ani received either active capsaicin (0.006%) or placebo (menthol 1%) ointment. 31 had relief of itching during capsaicin treatment but not during menthol treatment, and only one responded to menthol but not to capsaicin (P < .0001). Subjects in both the menthol and capsaicin groups experienced perianal burning on application of the two creams. There were no other reported adverse events or complications. During a mean follow-up of 10.9 months, 29 responders needed repeated applications of capsaicin to remain symptom-free or nearly symptom-free. Interval of reapplication ranged from 0.5 to 7 days. Using a combination of increased dietary fiber, hygiene, steroid creams, and drying agents, the subjects in the Daniel study responded to treatment 89% of the time. Radiation: Low Level Radiation Increases Longevity: British radiologists have 27% less cancer and 30% lower deaths from other causes than other male physicians. A study of 28,000 nuclear shipyard workers with highest radiation exposure showed 24% lower cancer and death rates compared to 32,000 other shipyard workers. Cameron, U Wisc, Brit J Radiology 7/02. Runny Nose: Spray Works for Skiing, etc: Two squirts of ipratropium bromide 45 minutes before skiing or eating spicy food will be effective. Clifford Bassett from the New York University School of Medicine. nerves connect to the nasal glands, using a chemical neurotransmitter called acetylcholine, and this leads to a runny nose. BBC News 12/19/02 Thomas E. Radecki, M.D., J.D. |