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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2006;166:1437.
Presymptomatic Neuromuscular Disorders Disclosed Following Statin Treatment
Statin therapy is known to affect muscular tissue adversely and in rare cases seems to be associated with the disclosure of presymptomatic metabolic myopathy. This report aims to support this association and to describe other neuromuscular disorders that can also be revealed following statin intake. The presented cases of myotonic dystrophy type I, myophosphorylase deficiency, mitochondrial myopathy, and Kennedy disease illustrate that statins may act as unmasking agents in asymptomatic patients with a latent neuromuscular disorder. It may be postulated that statin intake could be a sufficient insult to precipitate symptoms and increase muscle enzymes in presymptomatic patients with an abnormal neuromuscular substrate. Muscular symptoms or increased serum creatine kinase levels persisting after the discontinuation of statin therapy should therefore alert the clinician to search further for potential underlying neuromuscular diseases.
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Complementary and Alternative Therapies for the Management of Menopause-Related Symptoms
Women are seeking complementary and alternative therapies for the management of menopausal symptoms in record numbers. This systematic review outlines the current state of evidence, as reported in randomized, controlled clinical trials, of the effectiveness of alternative therapies for treatment of hot flashes, night sweats, vaginal dryness, and insomnia. While large numbers of different modalities have been studied, results are mixed and confusing, making conclusions difficult. Further research is warranted in improved clinical trials of these treatments for this widespread clinical concern of women at midlife.
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Cognitive-Behavioral Therapy for Somatization Disorder
This study examined the efficacy of cognitive-behavioral therapy (CBT) for somatization disorder (SD). Eighty-four participants with SD were randomly assigned to 1 of 2 conditions: (1) standard medical care augmented by a psychiatric consultation intervention or (2) a 10-session, manualized, individually administered CBT regimen added to the psychiatric consultation intervention. Fifteen months after baseline, patients treated with CBT manifested less severe somatization symptomatology, incurred lower health care costs, and reported better physical functioning compared with patients treated with only standard medical care augmented by the psychiatric consultation letter. The data demonstrate that CBT for SD may produce clinical benefits beyond those that result from the current state-of-the-art treatment.
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Clinical Prognostic Rules for Severe Acute Respiratory Syndrome in Low- and High-Resource Settings
Using data from Hong Kong, Cowling et al derived clinical prognostic rules for patients with severe acute respiratory syndrome based on information available at the time of admission. The clinical prognostic models assigned numerical scores for each characteristic, and summing the scores for an individual patient allows accurate quantitative estimation of the risk of case fatality. In a basic model designed for low-resource settings, predictors for mortality included older age, male sex, and the presence of comorbid conditions. In a full model designed for high-resource settings, additional predictors included haziness or infiltrates on chest radiograph, less than 95% oxygen saturation on room air, high lactate dehydrogenase level, and high neutrophil and low platelet counts. The models performed well on internal and external validation on Toronto data and could be useful in assessing prognosis for patients who are infected with reemergent severe acute respiratory syndrome.
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Obesity, Physical Activity, and Mortality in a Prospective Chinese Elderly Cohort
Obesity is usually associated with increased mortality in young and middle-aged people. However, in older people, higher body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) is apparently protective, which casts doubt on whether obesity is a significant public health concern. A possible explanation for the observed relationship between BMI and mortality in older people is reverse causality, because BMI in this age group is the result, not the cause, of underlying illness. In this case, BMI in older people would be a predictor of mortality as a marker of aging and health status, and the association of BMI with mortality would be expected to differ with health status. In a prospective study of 54 088 older people, Schooling et al showed that the association between BMI and mortality varied with health status. In the small minority (9%) of healthy older people who have never smoked, higher BMI (>25) was associated with higher mortality compared with normal BMI; however, in unhealthy older people, higher BMI was associated with lower mortality.
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The Kaplan-Meier estimate of the 3-year mortality rate by number of morbidities in the 12-item index.
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