Statins role in CAD

The chiropractor for whom my mom works tried to dissuade my dad from continuing to take statins based off an article: "Dr. Julian Whitaker's Health & Healing-Your Definitive Guide to Wellness Medicine".
Dr. Whitaker's claim is that MI's are caused from inflammation and have nothing to do with cholesterol. Recent research is finding that the role of inflammation is much more involved than originally thought. So Dr. Whitaker has some validity in his claims.
http://content.nejm.org/cgi/content/abstract/336/14/973
http://circ.ahajournals.org/cgi/content/full/105/9/1135

However extensive research still shows that cholesterol plays a role in CAD.

http://jama.ama-assn.org/cgi/content/abstract/285/4/430
http://content.nejm.org/cgi/content/abstract/344/26/1959
http://jama.ama-assn.org/cgi/content/abstract/282/24/2340

The last link is a meta-analysis of Medline articles from 1966 to 1998 on CAD and statins.

Furthermore, Dr. Whitaker's references are a bit concerning: Business Week, 2 science articles-1 from Biofactors and 1 from Circulation (seemingly valid), and a book.

Finally, statins not only help reduce cholesterol, but also help reduce inflammation, which could be another factor in which they are helping to reduce MI's. So be it cholesterol or inflammation, research has shown that statins continue to lower MI's.


"Dr. Julian Whitaker's Health & Healing-Your Definitive Guide to Wellness Medicine". June 2008. Vol. 18; no. 6; pp. 1-3

Soy Beans

So remember studying for Step 1 and having to know that vegetarians are at an increased risk for B12 deficiency? Well, I came across an article talking about the benefits of soy beans. If fortified w/cobalamin as some soy products are, it looks like being a vegetarian isn't so "risky" and actually beneficial.
To make this article peds related...I found it interesting that babies on soy formula can have decreased absorption of iron or thyroid hormone supplementation. Furthermore, soy contains tyramine so could cross react with MAOI's.
Key points from article:

Advantages:
-reduce cholesterol, LDL, and TG levels.
-reduce menopausal hot flashes
-reduce bone turnover-->improve bone mineral density
Disadvantages:
-diarrhea (common)
-Rare:menorrhagia, amenorrhea, HA, dizziness, MSK complaints


Article from American Family Physician, Vol 79, No. 1, Jan. 1, 2009
Michelfelder, Aaron J., MD. "Soy: A complete Source of Protein", pp. 43-47

Burnout and Suicidal Ideation among U.S. Medical Students

I came across this article in the Annals a few months ago. I have been tapped to lead an electronic journal club in January, and this is the article that I will be using. If anyone has any input that they want included in the discussion, lets hear it.
Linky
I know the authors from medical school and have a great deal of respect for them. I exciteded to give it a critical read and will post my thoughts here soon. I will say though, that I know these are huge issues for some medical students.

Cats, Toxoplasmosis, and Pregnancy

The other night, my vet student roommates lectured me that we "human medicine" doctors need to stop scaring people about pregnant women getting toxoplasmosis from changing garfield's litter box. They claimed that kittens are the only ones to shed it in their feces. So I had to find some proof and here are the articles supporting their claim. In the limited time I spent, I didn't find an article specifically talking about kittens vs. cats, but this is just some of the articles that popped up on OMIM.

Sources of toxoplasma infection in pregnant women: European multicentre case-control study

This was a case control study performed in 6 European cities using 252 pregnant women w/either acute infection or w/IgM for anti-Toxoplasma gondii and 858 controls. Risk factors for infection included undercooked lamb, beef, or game, contact with soil, and travel outside Europe and the United States and Canada. Contact with cats was not a risk factor.

Article found on: http://www.bmj.com/cgi/content/full/321/7254/142?view=full%26pmid=10894691

Prevention of toxoplasmosis in pregnancy: knowledge of risk factors.Kravetz JD, Federman DG.

Study was done to compare the knowledge of ocer 100 ob's, internists and fp's when counseling expectant mothers on risk factors for toxoplasmosis. It was found that ob's were more likely to give the appropriate information, but all groups "inappropriately advised avoidance of all cat contact".

Article found on OMIM taken from Infect Dis Obstet Gynecol. 2005 Sep;13(3):161-5.

palivizumab for RSV

Tis the season. We spend a lot of time and money getting Synagis (Polivizumab) for our most at-risk patients. How much benefit is there to be gained here?

Two trials, one from the IMpact-RSV Study Group published in Pediatrics in September of 1998, and one from the Cardiac Synagis Study Group, lead author, our own Timothy Feltes, established the role of polivizumab in preventing morbidity in high risk pediatric populations.

1. IMpact-RSV trial Cliff's Notes

• Palivizumab is a humanized mouse monoclonal IgG antibody against the F protein of RSV.

• In the study, 15 mg/kg IM polivizumab or placebo was administered monthly for 5 months to infants with GA less than or equal to 35 weeks who were <6 mos of age or infants <24 mos with BPD.
  

• It was double blinded and placebo controlled.

• They showed a 55% reduction in hospitalizations for all comers.

• For premature infants, this reduction was 78%, and for the BPD group it was 39%.

2. Feltes paper Cliff's Notes

• Congenital Heart disease had been excluded from the original polivizumab studies.

• The last drug for RSV (RSV-IGIV) had increased mortality in congenital heart disease patients.

• This was hypothesized to be secondary to increased viscosity.

• Study patients were hemodynamically significant CHD patients <24>

• This was a double blinded placebo controlled trial.

• Relative reduction in rate of hospitalization of 45% was shown in the polivizumab group.

• Duration of hospitalization and duration of oxygen therapy during hospitalization were also shown.

• No associated adverse events were noted.

Congenital Heart Disease

Anybody know any good congenital heart disease web resources?
I've found Yale's to be helpful.

Strong enough to get your ring around the collar, but not to cause dermatitis.

Little has been published on the effects of laundry detergents. However, physicians and Uncle Buck always ask if you have changed laundry detergent when you get a rash. So a multicenter study was conducted to evaluate the validity of this old adage. The study for allergic contact demratitis (ACD) involved the placement of 2 patch tests-a granular detergent and a liquid one. Reactions to other chemicals like fragrances and nickel were compared to the laundry detergent reactions. Over 700 patients volunteered, but only 5 had a postitive patch test to either or both detergents. 2 of these 5 patients could be evaluated further. Further testing showed that in 1 of the 2, reduplication of the dermatitis could not be elicited. Meanwhile, the other had a reaction to the controls and the detergents. For more details on the study and others like it, check out the citations below.

Information from:

Allergic contact dermatitis to detergents: a multicenter study to assess prevalence.

Belsito DV, Fransway AF, Fowler JF Jr, Sherertz EF, Maibach HI, Mark JG Jr, Mathias CG, Rietschel RL, Storrs FJ, Nethercott JR.

Division of Dermatology, University of Kansas Medical Center, Kansas City, KS 66160-7319, USA.

Study can be found at:

J Am Acad Dermatol. 2002 Feb;46(2):200-6. Links

Comment in: