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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2002;162:631.
Gastroenteritis-Associated Hyperamylasemia: Prevalence and Clinical
Significance
To evaluate the prevalence of hyperamylasemia among patients with acute
gastroenteritis and the impact of elevated serum amylase levels on disease
course, Ben-Horin et al conducted a retrospective study of amylase results
for 1041 patients hospitalized or discharged from the emergency department
with a diagnosis of gastroenteritis from April through November 1999. Serum
amylase levels were determined in 701 patients and were abnormally elevated
in 66 of them (15 of whom were excluded owing to the presence of other possible
causes of hyperamylasemia). The authors also compared the clinical and laboratory
parameters of hyperamylasemic vs normoamylasemic hospitalized patients with
gastroenteritis. Ben-Horin et al conclude that gastroenteritis is associated
with a mild to moderate elevation of serum amylase levels in a significant
portion of patients and should be included in the differential diagnosis of
hyperamylasemia, but that such elevation does not seem to bear clinical significance
in terms of the severity of disease as judged by the clinical signs and symptoms,
laboratory results, length of hospital stay, and the need for antibiotics.
(SEE ARTICLE)
Q Fever During Pregnancy: Diagnosis, Treatment, and Follow-up
Q fever, caused by Coxiella burnetii, may result
in abortions, premature deliveries, and stillbirths in infected pregnant women.
To evaluate the best treatment strategy for Q fever during pregnancy, Raoult
et al examined the prognosis of 17 pregnant women who developed Q fever with
and without co-trimoxazole (trimethoprim-sulfamethoxazole) treatment. The
outcome of the pregnancy was found to depend on the trimester: abortions occurred
in 7 of 7 insufficiently treated patients infected during the first trimester
vs 1 of 5 patients infected later. Co-trimoxazole given until delivery protected
against abortion (0/4) but not against the development of chronic infections,
and it did not significantly reduce the colonization of the placenta (2/4
vs 4/4). The authors conclude that C burnetii infections
cause abortion and that women who develop Q fever while pregnant should be
treated with co-trimoxazole for the duration of pregnancy, specifically when
infected during the first trimester.
(SEE ARTICLE)
Effect of a Standardized Nurse Case-Management Telephone Intervention
on Resource Use in Patients With Chronic Heart Failure
The effectiveness of a standardized telephonic case-management intervention
in decreasing resource use was tested in patients with chronic heart failure
in a randomized controlled clinical trial. Patients were identified at hospitalization
and assigned to receive 6 months of intervention (n = 130) or usual care (n
= 228). Hospitalization rates, readmission rates, hospital days, days to first
rehospitalization, multiple readmissions, emergency department visits, inpatient
costs, outpatient resource use, and patient satisfaction were measured at
3 and 6 months. The heart failure hospitalization rate was 48% lower (P = .005) at 6 months and inpatient costs were 45.5% lower,
which more than covered the costs of the intervention. Heart failure hospital
days and multiple readmissions were significantly lower in the intervention
group as well. The reductions in resource use achieved with this intervention
were greater than those usually achieved with pharmaceutical therapy and comparable
with other disease management approaches.
(SEE ARTICLE)
Coffee Intake and Risk of Hypertension: The Johns Hopkins Precursors
Study
Klag et al studied the change in blood pressure and risk of hypertension
associated with coffee drinking in 1017 white men followed up for a median
of 33 years. The authors found that coffee drinking was associated with small,
statistically significant increases in blood pressure during the long period
of follow-up. Coffee drinking was also associated with an increased risk of
hypertension, but after taking other confounding variables into account, a
dose-response relation was no longer seen. These results suggest that coffee
drinking does not play an important role in the development of hypertension.
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Incidence of hypertension, by level of coffee intake at baseline
in 1017 white men during a median follow-up of 33 years.
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(SEE ARTICLE)
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