Corticosteroids are just as effective against acute gout as naproxen, according to a Lancet study.
Dutch researchers randomized 120 patients with monoarticular gout to either naproxen or prednisolone for 5 days. (Gout was confirmed in all patients by the presence of monosodium urate crystals.) After 90 hours' treatment, pain and general disability scores as measured on a visual analogue scale were reduced to a similar extent in both groups.
The authors say their study "provides a strong argument to consider prednisolone as a first treatment option in patients with gout."
Tuesday, December 7, 2010
Alpha-Blocker Does Not Ease Symptoms of Chronic Prostatitis
Alfuzosin, an alpha-adrenergic–receptor blocker, does not improve symptoms in men with chronic prostatitis–chronic pelvic pain syndrome, according to a New England Journal of Medicine study.
Some 270 men who were diagnosed with the condition within the preceding 2 years and had never used an alpha-blocker were randomized to receive alfuzosin or a placebo daily for 12 weeks. By the end of treatment, approximately half of the men in each group had achieved clinically significant reductions in a symptom score measuring pain, voiding problems, and quality of life. Similarly, there were no significant differences between the groups in secondary outcomes, such as anxiety and depression.
The authors note that several meta-analyses have led some researchers to recommend alpha-blockers for chronic prostatitis. They conclude: "Our trial does not support these recommendations and should prompt reconsideration of the choice of initial therapy for these patients
Some 270 men who were diagnosed with the condition within the preceding 2 years and had never used an alpha-blocker were randomized to receive alfuzosin or a placebo daily for 12 weeks. By the end of treatment, approximately half of the men in each group had achieved clinically significant reductions in a symptom score measuring pain, voiding problems, and quality of life. Similarly, there were no significant differences between the groups in secondary outcomes, such as anxiety and depression.
The authors note that several meta-analyses have led some researchers to recommend alpha-blockers for chronic prostatitis. They conclude: "Our trial does not support these recommendations and should prompt reconsideration of the choice of initial therapy for these patients
Vapor Rub May Help Relieve Kids' Cold Symptoms
NEW YORK (Reuters Health) Nov 08 - Vapor rub may relieve a kid's nighttime cough and nasal congestion, suggests a new study funded by Vick's, the makers of the old-fashioned topical treatment.
Most children suffer between six and 10 colds every year, according to the National Institutes of Allergy and Infectious Diseases. And parents try lots of different remedies.
"There is no evidence to support the effectiveness of any of the oral over-the-counter cough and cold medicines for kids, even though they are used by one in 10 each week," Dr. Ian M. Paul of Penn State College of Medicine, in Hershey, Pennsylvania, told Reuters Health. "The American Academy of Pediatrics has been pretty clear and consistent on this."
Evidence supporting the use of vapor rub -- a commonly used concoction containing camphor, menthol and eucalyptus oils -- has also been lacking, added Dr. Paul.
After his team's previous research concluded that common cough suppressants and antihistamines (dextromethorphan and diphenhydramine) were no more effective than placebo or honey, Dr. Paul recalled frequent queries from people curious about vapor rub:
So he and his colleagues enrolled 138 children, averaging 6 years old, and randomly assigned each kid to receive petroleum-based Vick's VapoRub, or petroleum jelly without any active ingredients, or no treatment.
Parents in the two topical treatment groups applied vapor rub under their own noses before treating their kids. This way, with parents inhaling the characteristic smell of vapor rub, they wouldn't be able to tell what treatment the child was receiving.
Parents completed surveys at enrollment in the study and within 30 minutes of waking after the one night of study treatment. Results showed that kids receiving vapor rub experienced noticeably less cough, congestion and more restful sleep than kids in the other two groups.
Parents of the vapor-rubbed kids also reported improved sleep themselves, the authors said in their paper, published online today in Pediatrics.
"Kids and their parents slept better, and sleep is such an important thing for everyone, especially for kids that have to go to school the next day and parents who have to work," said Dr. Paul.
The rub didn't seem to relieve runny noses, and it caused mild irritation in nearly half of kids. On the other hand, more serious side effects have been associated with oral over-the-counter cold medicines, ranging from tachycardia to death.
Vicks VapoRub costs about $5 for 1.75 oz. There are also generic versions available.
How the concoction relieves cold symptoms is not entirely clear. The researchers suggest that the cooling sensation of menthol triggers the perception of improved airflow. But they aren't certain just how that might translate into improved symptoms.
"Parents want to give something. Pediatricians want to recommend something," Dr. Paul said.
"I think we've given them something to try, and evidence that it works," he added. "For kids ages 2 and up vapor rub is a generally safe and effective therapy."
The entire article is available online at no charge, at the URL listed below.
Pediatrics. Posted online November 8, 2010. Abstract
Most children suffer between six and 10 colds every year, according to the National Institutes of Allergy and Infectious Diseases. And parents try lots of different remedies.
"There is no evidence to support the effectiveness of any of the oral over-the-counter cough and cold medicines for kids, even though they are used by one in 10 each week," Dr. Ian M. Paul of Penn State College of Medicine, in Hershey, Pennsylvania, told Reuters Health. "The American Academy of Pediatrics has been pretty clear and consistent on this."
Evidence supporting the use of vapor rub -- a commonly used concoction containing camphor, menthol and eucalyptus oils -- has also been lacking, added Dr. Paul.
After his team's previous research concluded that common cough suppressants and antihistamines (dextromethorphan and diphenhydramine) were no more effective than placebo or honey, Dr. Paul recalled frequent queries from people curious about vapor rub:
So he and his colleagues enrolled 138 children, averaging 6 years old, and randomly assigned each kid to receive petroleum-based Vick's VapoRub, or petroleum jelly without any active ingredients, or no treatment.
Parents in the two topical treatment groups applied vapor rub under their own noses before treating their kids. This way, with parents inhaling the characteristic smell of vapor rub, they wouldn't be able to tell what treatment the child was receiving.
Parents completed surveys at enrollment in the study and within 30 minutes of waking after the one night of study treatment. Results showed that kids receiving vapor rub experienced noticeably less cough, congestion and more restful sleep than kids in the other two groups.
Parents of the vapor-rubbed kids also reported improved sleep themselves, the authors said in their paper, published online today in Pediatrics.
"Kids and their parents slept better, and sleep is such an important thing for everyone, especially for kids that have to go to school the next day and parents who have to work," said Dr. Paul.
The rub didn't seem to relieve runny noses, and it caused mild irritation in nearly half of kids. On the other hand, more serious side effects have been associated with oral over-the-counter cold medicines, ranging from tachycardia to death.
Vicks VapoRub costs about $5 for 1.75 oz. There are also generic versions available.
How the concoction relieves cold symptoms is not entirely clear. The researchers suggest that the cooling sensation of menthol triggers the perception of improved airflow. But they aren't certain just how that might translate into improved symptoms.
"Parents want to give something. Pediatricians want to recommend something," Dr. Paul said.
"I think we've given them something to try, and evidence that it works," he added. "For kids ages 2 and up vapor rub is a generally safe and effective therapy."
The entire article is available online at no charge, at the URL listed below.
Pediatrics. Posted online November 8, 2010. Abstract
Vicks VapoRub May Cause Respiratory Distress in Infants, Animal Study Suggests
Parents may ask about a Chest study suggesting that Vicks VapoRub may act as an airway irritant in very young children.
When an 18-month-old child was brought to an emergency room in severe respiratory distress after a grandparent applied Vicks VapoRub directly under her nose, clinicians investigated whether the ointment — a mixture of camphor, menthol, and eucalyptus oil — was at fault. (The product is not recommended for application to the nostril or for children under age 2 years.)
Their studies in healthy ferrets, which have an airway anatomy similar to humans, showed that mucus secretion increased and ciliary activity decreased in the presence of the ointment.
The authors conclude that the effect "may be of little physiologic consequence in older children and adults, but in infants and small children this potentially can lead to respiratory distress."
When an 18-month-old child was brought to an emergency room in severe respiratory distress after a grandparent applied Vicks VapoRub directly under her nose, clinicians investigated whether the ointment — a mixture of camphor, menthol, and eucalyptus oil — was at fault. (The product is not recommended for application to the nostril or for children under age 2 years.)
Their studies in healthy ferrets, which have an airway anatomy similar to humans, showed that mucus secretion increased and ciliary activity decreased in the presence of the ointment.
The authors conclude that the effect "may be of little physiologic consequence in older children and adults, but in infants and small children this potentially can lead to respiratory distress."
FDA Issues Alert on Topical Anesthetics
An FDA public health advisory reminds patients and physicians of potentially serious side effects from the improper use of topical anesthetics, including lidocaine, tetracaine, benzocaine, and prilocaine.
The latest advisory was prompted by a small study that tested whether lidocaine reduced discomfort during breast mammography. No serious adverse events were noted. However, the FDA remains concerned about the potential for seizures, irregular heartbeat, and breathing problems when topical anesthetics are applied over a large area or are covered by plastic wrap or a heating pad. Two deaths were previously reported in women using the anesthetics before laser hair removal.
The FDA urges patients to use the products sparingly in the weakest effective formulations
The latest advisory was prompted by a small study that tested whether lidocaine reduced discomfort during breast mammography. No serious adverse events were noted. However, the FDA remains concerned about the potential for seizures, irregular heartbeat, and breathing problems when topical anesthetics are applied over a large area or are covered by plastic wrap or a heating pad. Two deaths were previously reported in women using the anesthetics before laser hair removal.
The FDA urges patients to use the products sparingly in the weakest effective formulations
Escitalopram and Sertraline Top Comparison of 12 Newer Antidepressants
Escitalopram and sertraline seem the best choices in starting treatment for major depression, according to a meta-analysis published online in Lancet.
Researchers analyzed 117 randomized trials — comprising some 26,000 patients — of 12 new-generation antidepressants. The drugs were evaluated for efficacy and patient acceptability at the 8-week mark.
Among the conclusions:
Escitalopram, mirtazapine, sertraline, and venlafaxine were the most efficacious.
Escitalopram and sertraline showed the "best possible balance between efficacy and acceptability."
Given cost considerations, sertraline seemed the better of the two.
An editorialist, noting that the study protocol and data set are free online, writes: "A new gold standard of reliable information has been compiled for patients to review
Researchers analyzed 117 randomized trials — comprising some 26,000 patients — of 12 new-generation antidepressants. The drugs were evaluated for efficacy and patient acceptability at the 8-week mark.
Among the conclusions:
Escitalopram, mirtazapine, sertraline, and venlafaxine were the most efficacious.
Escitalopram and sertraline showed the "best possible balance between efficacy and acceptability."
Given cost considerations, sertraline seemed the better of the two.
An editorialist, noting that the study protocol and data set are free online, writes: "A new gold standard of reliable information has been compiled for patients to review
no mortality benefit from PSA testing meta analysis
BMJ has published two studies suggesting that less routine use of prostate-specific antigen (PSA) testing for cancer screening may be beneficial.
One study — a meta-analysis of six randomized controlled trials comprising almost 400,000 participants — finds no mortality benefit from PSA testing, with or without digital rectal exam.
The other study, using blood samples from nearly 1200 Swedish men at age 60 in 1981, finds that PSA levels at age 60 correlate very closely with the risk for metastatic cancer or death from prostate cancer by age 85. In fact, levels under 1 ng/mL were associated with a low likelihood of suffering prostate cancer metastases (0.5%).
An editorialist says that "elderly men and those with low risk of disease could be tested less often, if at all."
One study — a meta-analysis of six randomized controlled trials comprising almost 400,000 participants — finds no mortality benefit from PSA testing, with or without digital rectal exam.
The other study, using blood samples from nearly 1200 Swedish men at age 60 in 1981, finds that PSA levels at age 60 correlate very closely with the risk for metastatic cancer or death from prostate cancer by age 85. In fact, levels under 1 ng/mL were associated with a low likelihood of suffering prostate cancer metastases (0.5%).
An editorialist says that "elderly men and those with low risk of disease could be tested less often, if at all."
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