Blacks have been reported to have higher levels of serum cotinine than
whites, providing a possible reason why blacks have more prevalent tobacco-related
diseases. Dr Caraballo and colleaguesArticle examined serum cotinine levels in black,
white, and Mexican American adults in relation to their self-reported smoking
habit and environmental tobacco smoke (ETS) exposure. Black smokers had higher
cotinine levels than whites or Mexican Americans, and these levels were not
associated with number of cigarettes smoked or ETS exposure. In a related
study, Dr Pérez-Stable and colleaguesArticle evaluate rates of metabolism
and daily intake of nicotine in black and white smokers. Compared with white
smokers, black smokers had slower total and nonrenal clearances of cotinine
and took in 30% more nicotine per cigarette.
Intensive insulin treatment for type 1 diabetes improves outcomes compared
with conventional insulin therapy, but may also lead to weight gain. Dr Purnell
and colleagues confirm that patients randomized to receive intensive insulin
therapy have greater weight gain than those receiving conventional insulin
therapy, and also developed worse cardiac risk profiles.
In this World Health Organization study of interviews of more than 5000
primary care patients at 15 centers in 14 countries, Dr Gureje and colleagues
find that the combined prevalence of persistent (ie, lasting at least 6 months)
pain was 22%. Persistent pain was associated with anxiety and depressive disorders.
Mibefradil was withdrawn from the US market on June 8 because of multiple
drug-drug interactions, so patients receiving mibefradil must be treated with
new antihypertensive agents. In this report, released by JAMA June 18 because
of public health importance, Dr Mullins and colleagues describe 4 patients
who had been receiving mibefradil and a β-blocker, in whom mibefradil
therapy was stopped and treatment with a dihydropyridine calcium channel blocker
started. All 4 developed severe hypotension and bradycardia requiring intensive
care; 1 patient died. The adverse reaction likely was due to mibefradil's
long half-life. Based on these and other reports, the manufacturer has recommended
a washout period of 7 days before starting most calcium channel blockers and
14 days for felodipine.
Glucocorticoid treatment has been shown to be of no benefit in early
acute respiratory distress syndrome (ARDS), but in this randomized trial of
patients with severe ARDS who had not improved after 7 days, Dr Meduri and
colleagues showed improvement in lung injury scores and reduced mortality
for those treated with high-dose, prolonged methylprednisolone therapy.
"The shapes and colors are in fact so simple as to be profound." Max
Pechstein, Sunset, 1921, German.
Advances in the early detection of prostate and colorectal cancer.
Viagra's no joke, but "sildenafil envy" leads other pharmaceutical firms
to propose alternative erectile dysfunction treatments.
With new section editor Deborah J. Cook, MD, "Caring for the Critically
Ill Patient" succeeds "Concepts in Emergency and Critical Care."
Are current FDA regulations for approval and monitoring of diagnostic
testing devices appropriate and effective?
For your patients: Living with diabetes.
This Week in JAMA. JAMA. 1998;280(2):109. doi:10.1001/jama.280.2.109