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By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim.
MI: Try to have it Monday Thru Friday
Hospital legends about the relative availability (or unavailability) of services/personnel on weekends vs weekdays often lead to jocularity about the wisdom of choosing one's day to be admitted to the hospital carefully! Yet, whether such issues as calendar timing (being admitted on the weekend vs weekday) really make a difference is largely unknown.
Using a database comprised of more than 59,000 patients admitted to New Jersey hospitals for an acute MI between 1999-2002, an appraisal of the relationship between day of admission and outcomes was performed.
The relative risk of 30-day mortality was 8% greater for persons admitted on a weekend than during the week (12.9% vs 12.0%). Similarly, utilization of services such as cardiac catheterization within 48 hours was remarkably lower if admitted on a weekend (odds ratio for catheterization by day 2 = 0.51). The authors reflect that "our study suggests that a hospital workweek of Monday through Friday is not optimal for the care of patients with acute MI."
Kostis WJ, et al. N Engl J Med. 2007;356:1099-1109
Can MRI Provide Better Clarity About Contralateral Breast Cancer?
Amongst the population of women who are diagnosed with and treated for breast cancer (BCA), an additional cancer is detected in the contralateral breast in as many as 10% of cases (identified by clinical examination, mammography, or both). Mammography has generally been considered the "gold standard" in this regard.
MRI is more sensitive than mammography for detection of primary BCA. The American College of Radiology Imaging Network conducted a trial of women diagnosed with BCA who had already been examined with negative mammography of the contralateral breast (n = 969). MRI diagnosed thirty of these women (3.1%) to have biopsy-confirmed BCA that had been missed by both mammography and clinical examination. More than half of the occult cancers were invasive, and (fortunately), all were node-negative at the time of discovery.
Although current costs of MRI do not favor its utilization for routine screening, in the higher-risk group of women with known BCA, it has superior performance in diagnosing disease in the contralateral breast than mammography.
Lehman CD, et al. N Engl J Med. 2007;356:1295-1303.
Dapsone Gel 5% for Acne
Dapsone (DAP) is a sulfone that possesses both antimicrobial and anti-inflammatory activity, but its use systemically is limited by substantial toxicity, including methemoglobinemia and hemoloysis. In the recent past, consideration of DAP as a topical agent was limited by the poor solubility of DAP in traditional vehicles. Recently, a gel formulation with adequate DAP delivery has been developed.
DAP 5% gel was studied in persons greater than age 12 with acne (n = 3,010). Two identical placebo-controlled, double-blind trials were performed using DAP 5% twice daily vs placebo gel.
DAP produced statistically significant and clinically relevant improvements in acne at the 12 week endpoint of the study; a divergence between placebo and DAP was visible beginning as early as two weeks into the study. Subjects with G-6-PD deficiency (who are particularly sensitive to hemolysis) were proactively included in the trial and monitored for hemoloysis.
DAP was well tolerated with no evidence of serious adverse effects. The overall adverse effect profile was not statistically different from placebo.
In an era of increasing Propionibacterium acnes (the primary causative bacterium for acne) resistance to many of the antibacterial agents commonly used for acne treatment, DAP may offer a new therapeutic alternative.
Draelos ZD, et al. J Am Acad Dermatol. 2007;56:439-447.