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In This Issue of Archives of Internal Medicine
April 8, 2002

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2002;162(7):741. doi:10.1001/archinte.162.7.741
Lack of Penicillin Resensitization in Patients With a History of Penicillin Allergy After Receiving Repeated Penicillin Courses

Penicillin is the most commonly reported medication allergy. While up to 10% of patients report a history of penicillin allergy, more than 80% of these individuals lack penicillin-specific IgE antibodies. Penicillin skin testing is highly accurate in identifying who can safely receive the antibiotic at the time of testing, but its predictive value for future courses is unknown because it is uncertain whether patients with a history of penicillin allergy are at risk of becoming resensitized. To determine the rate of resensitization, 53 patients with negative penicillin skin test results and convincing histories of penicillin allergy were challenged over several months with 3 consecutive 10-day courses of oral penicillin. None of the patients who completed the protocol converted from a negative to a positive skin test result, yielding a resensitization rate of 0%. The results indicate that a negative penicillin skin test result is predictive for subsequent oral administration of penicillin beyond the time of testing.

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Smoking and Alanine Aminotransferase Levels in Hepatitis C Virus Infection

Smoking and drinking alcohol are independently associated with elevated alanine aminotransferase levels among individuals who are seropositive for anti–hepatitis C virus antibody but not among those who are seropositive for hepatitis B surface antigen. Patients who are seropositive for anti–hepatitis C virus antibody are strongly advised not to smoke and drink alcohol to reduce the possible risk of aggravating the liver dysfunction.

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Patient and Hospital Characteristics Associated With Recommended Processes of Care for Elderly Patients Hospitalized With Pneumonia

In a retrospective cohort analysis, Fine et al examined the patient and hospital factors associated with performance of processes of care for patients with pneumonia that have been linked to improved likelihood of survival. Performance of blood culture collection within 24 hours of hospital arrival and initial antibiotic administration within 8 hours were positively associated with higher nurse-bed ratios and fever on presentation and were negatively associated with hospital location in the southern region of the United States. Timely antibiotic administration was also negatively associated with nonwhite race. Awareness of the variations in care associated with these patient and hospital characteristics may assist medical providers seeking to improve the quality of care.

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Association Between Thyroid Dysfunction and Total Cholesterol Level in an Older Biracial Population

Using data gathered from 2799 participants in the Health, Aging and Body Composition Study (a prospective cohort study of well-functioning black and white men and women aged 70-79 years), researchers found that the overall prevalence of previously unidentified thyroid dysfunction was low (5.8%). Subclinical hypothyroidism was the most common abnormality, which was most prevalent in white women. Black women had equally low rates of subclinical hypothyroidism compared with white and black men. A similar association between thyrotropin and cholesterol existed for both racial groups: an elevated thyrotropin level was associated with a 9-mg/dL (0.23-mmol/L) increase in cholesterol, and a suppressed thyrotropin level was associated with a 19-mg/dL (0.49-mmol/L) decrease in total cholesterol.

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A Community-Wide Survey of Physician Practices and Attitudes Toward Cholesterol Management in Patients With Recent Acute Myocardial Infarction

Current attitudes and practices toward the management of high total and low-density lipoprotein cholesterol levels in patients with recent acute myocardial infarction (AMI) are examined in this community-wide survey of physicians from the Worcester (Mass) Standard Metropolitan Statistical Area. Older physicians were less likely to implement recommended guidelines for the treatment of high cholesterol levels in patients with recent AMI. Physicians reported that they would treat younger patients with recent AMI more aggressively with dietary changes and lipid-lowering drug therapies than older patients. Internal medicine and cardiology physicians reported being more aggressive with the use of lipid-lowering drug therapy, initiating treatment at lower total serum and low-density lipoprotein cholesterol levels compared with other physician specialties. Surveyed physicians identified several physician and patient factors associated with the nonuse of lipid-lowering medications. These findings suggest that educational- and practice-based efforts remain necessary to remove potential barriers to the implementation of effective long-term cholesterol management in patients with recent AMI.

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