Adult Medicine- latest

ADULT MEDICINE
General internal medicinePreventionThe JUPITER trial, a randomized trial of rosuvastatin therapy in healthy men (age ≥ 50) and women (age ≥ 60) with an LDL-C level <130>500 ms; frequent monitoring for QTc 450-500 ms; and avoiding other drugs that prolong the QT or slow methadone elimination .A population-based study evaluated risk factors for unintentional overdose fatality related to prescription drug abuse . Pharmaceutical diversion was associated with 67 percent of deaths.UrologyA randomized trial found no benefit for use of an alpha blocker to treat pain in men with chronic prostatitis/chronic pelvic pain syndrome .Primary care cardiologyThe 2008 POISE trial raised concerns about the use of beta blockers in noncardiac surgery. A subsequent meta-analysis of beta blocker therapy evaluated outcomes in >12,000 patients, including >8000 from POISE . Beta blocker therapy reduced the risk of myocardial infarction (MI) by one-third while more than doubling the risk of stroke, and had no significant effect on all-cause or cardiovascular mortality.A large case-control study in patients receiving clopidogrel after an MI found an association between use of proton pump inhibitors (PPIs) and recurrent MI . PPIs may reduce the effectiveness of clopidogrel in inhibiting platelet function . We no longer recommend routine prophylactic PPI therapy for low risk patients taking clopidogrel and aspirin.In a large randomized trial, irbestan treatment for patients with symptomatic heart failure and a preserved ejection fraction did not improve the primary end point of death from any cause or hospitalization for a cardiovascular cause.Three multicenter studies evaluated the accuracy of 64-slice multidetector computed tomography coronary angiography for detection of coronary artery disease . Sensitivity varied from 95 to 85 percent and specificity varied from 90 to 64 percent.Primary care endocrinologyIn a randomized trial in patients with poorly-controlled type 2 diabetes, there was no difference in cardiovascular outcomes between the intensive (achieved A1C 6.9 percent) and standard (A1C 8.4 percent) groups .In a trial of patients with type 2 diabetes randomly assigned to a low-glycemic index or a high-cereal fiber diet, there was a modest difference in A1C decline from baseline favoring the low-glycemic index group .Updated guidelines for the management of asymptomatic primary hyperparathyroidism recommend parathyroid surgery in patients with a serum calcium 1.0 mg/dL (0.25 mmol/L) above the normal limit, creatinine clearance <60 ml/min, bone density T-score < -2.5, or age <50 years .