Subject: Off-Label Use of Linezolid Linked to Increased Death Risk

From: "Medscape Week in Review"<[email-masked]>
Date: Tue, 27 Mar 2007 11:44:22 -0400 (EDT)

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Top Stories

Off-Label Use of Linezolid Linked to Increased Death Risk

FDA Says Plan Limits Advisers' Industry Ties

CME Conference Coverage -- 2007 Gastrointestinal Cancers Symposium

Feature Articles

Instant Poll
NSAIDs in Patients at High Risk for Heart Disease
The American Heart Association recently issued new guidance discouraging the use of both cyclooxygenase 2 (COX-2) inhibitors and other nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with heart disease or those at high risk of developing heart disease. For patients at high risk and in pain, how would you advise? To vote or view results of the poll, click on the title above.

Letters and Editorials
Editorial -- Carotid Screening Guidelines -- Overvalued
Frank J. Veith, MD, Professor of Surgery at NYU Medical Center and the Cleveland Clinic Foundation, discusses whether carotid artery screening can prevent a stroke.
Medscape General Medicine 9(1) 2007

Commentary -- About Intercessory Prayer: The Scientific Study of Miracles
Intercessory prayer implies miracles. Miracles imply the Power of God. The author argues that theology is not within the science or medicine domain and suggests a startling but unambiguous experiment.

Business of Medicine
FDA Says Plan Limits Advisers' Industry Ties
Doctors and scientists with industry ties exceeding $50,000 a year would be banned in most cases from sitting on influential Food and Drug Administration advisory committees under guidelines released on Wednesday.
Reuters Health Information 2007

Disclosure Laws Do Not Fully Reveal Drug Company Payments to Physicians
Laws that mandate disclosure of payments to physicians by pharmaceutical companies provide limited public information, according to a new report.

The Edge Of The Known World
A physician serving poor children with chronic diseases makes full use of his psychopharmacology arsenal while knowing that something else would be much better therapy.

Cardiology
Raising High-Density Lipoprotein Cholesterol: What Are We Learning From the Torcetrapib Experience?
ILLUMINATE was stopped when torcetrapib had more adverse outcomes than the comparator. Why? Was it the drug? The dose? The blood pressure? A leading expert discusses all this, in advance of ACC '07.

Glucose Level Predicts Hospitalization for Congestive Heart Failure
In diabetic patients at risk for congestive heart failure, fasting plasma glucose level was an independent predictor for hospitalization.

Mechanisms of Disease: Genetic Causes of Familial Hypercholesterolemia
The current review categorizes genetic causes of familial hypercholesterolemia and describes their clinical relevance.

Dermatology
A 52-Year-Old Man With a Rash on His Legs and a History of "Walking Pneumonia"
Follow the case of a man who has had a hyperpigmented-to-erythematous rash on his legs for 10 years.

Smoking Increases Aging of Photoprotected Skin
Researchers developed a photonumeric scale to determine photoaging of photoprotected skin; smoking was correlated with degree of skin aging.

Diabetes & Endocrinology
Metabolic Syndrome Highly Prevalent in Dialysis Patients
A retrospective, cross-sectional study of 202 incident dialysis patients showed a 69% prevalence of the metabolic syndrome.
Medscape Medical News 2007

Pheochromocytoma: Recommendations for Clinical Practice from the First International Symposium
This review summarizes the recommendations for testing, localization and treatment of pheochromocytoma, and is based on discussions at the First International Symposium on Pheochromocytoma.

New Mechanisms of Glucose Control: Expanding Therapeutic Options With Incretin Mimetic Therapies
Recognize the pathophysiologic defects in type 2 diabetes, review available treatments and their limitations, understand the incretin system, and discuss incretin therapy as a new approach to diabetes treatment.

Emergency Medicine
Chest Compressions Alone Best for Resuscitation in Cardiac Arrest Patients
Mouth-to-mouth ventilation may do more harm than good when trying to revive people who have an out-of-hospital cardiac arrest, and chest compressions alone will give a better chance of survival.
Medscape Medical News 2007

Family Medicine/Primary Care
Duct Tape and Moleskin Similarly Effective in Treating Common Warts
A double-blind, randomized controlled trial showed no statistically significant difference between duct tape and moleskin for the treatment of warts in an adult population.
Medscape Medical News 2007

Preparticipation ECG Screening Not Required for Competitive Athletes
The American Heart Association does not believe it practical or financially feasible to support a preparticipation screening initiative, which would include 12-lead electrocardiogram testing.

Gastroenterology
Extraintestinal Manifestations of Inflammatory Bowel Disease: Focus on the Musculoskeletal, Dermatologic, and Ocular Manifestations
This article focuses on the clinical implications of extraintestinal manifestations involving the musculoskeletal system, eyes, and skin, including issues in diagnosis and treatment.
Medscape General Medicine 9(1) 2007

Safety of TNF Antagonists in Crohn's Disease
Edward V. Loftus, Jr., MD, explores the expanding data set regarding the relative safety and efficacy of TNF antagonists for Crohn's disease.

General Surgery
Island Hopping: Message from the 2005-2006 SAGES President
No man is an island -- and neither is a society.

Natural Orifice Transluminal Endoscopic Surgery (NOTES): A Review
Where does NOTES stand now and how will it be used in the future?

Controversies and Techniques in Inguinal Hernia Repair: Grand Rounds from SAGES
Review these this important Grand Rounds on current issues in Hernia Repair

Hematology-Oncology
Conference Coverage -- 2007 Gastrointestinal Cancers Symposium
Advances in the management of gastroesophageal cancer; a growing role for adjuvant treatment of colorectal cancer; more. Read clinically focused news coverage of key developments from the meeting.

Maximizing Detection of Adenomas and Cancers During Colonoscopy
The importance of maximizing detection of neoplasia during colonoscopy is obvious from a patient's perspective.

ASH 2006: Update on Acute Lymphoblastic Leukemia and Acute Promyelocytic Leukemia
In this report from ASH 2006, Dr. Richard Stone highlights exciting new findings from studies in acute lymphoblastic and acute promyelocytic leukemias.

Infectious Diseases
Off-Label Use of Linezolid Linked to Increased Death Risk
Use of linezolid for gram-negative catheter-related bloodstream infections was linked to a higher mortality risk.
Medscape Medical News 2007

Health Alert Over Tamiflu Issued in Japan
Japanese health officials on Wednesday warned that adolescents may react abnormally when given Tamiflu (oseltamivir) to combat influenza.

New Recommendations for Evaluating and Treating Adult Bacterial Meningitis
Researchers provide diagnostic and therapeutic practices for evaluating and treating adult bacterial meningitis in primary and emergency care settings.

Internal Medicine
More Than 5 Million Have Alzheimer's in U.S.
More than 5 million people in the United States have Alzheimer's disease, and an aging population is likely to fuel a steady rise in new cases, according to a report released by the Alzheimer's Association on Tuesday.
Reuters Health Information 2007

Tonsillectomy Reduces Recurrence of Streptococcal Pharyngitis in Adults
A randomized trial suggests that tonsillectomy reduces further incidence of infection and lessens throat pain in adults with recurrent streptococcal pharyngitis.

Treatment and Prevention of Depression After Surgery for Hip Fracture in Older People: Randomized, Controlled Trials
Does intervention help reduce depression after hip fracture?

Med Students
Inside the "Small World" of Pediatric Oncology
A pediatric fellow in neuro-oncology offers up thoughtful observations on medical ethics, pop culture, and yes - kids with brain tumors.
Medscape Med Students 2007

Nephrology
Anemia Management in Patients With Chronic Kidney Disease
What are some of the issues surrounding management of anemic patients on peritoneal and hemodialysis? Join Drs. Daniel Coyne, Beth Piraino, Jay Wish, and Peter Blake as they discuss.

PD PHYSIOLOGY: The Basics and Comparisons to HD
John Burkart, MD, discusses the physiology of the peritoneal dialysis and hemodialysis system.

Neurology & Neurosurgery
Depression in Epilepsy: A New Look at This Disorder
Learn about the significance of depressive disorders and the importance of their treatment in epilepsy patients.

Urgent Intervention to Reduce Functional Deficits After Postoperative Stroke
The authors describe a patient with acute cardioembolic stroke with minimal infarction in Broca's area and a surrounding region of potentially salvageable, hypoperfused cortex.

Nursing
An Ethical Dilemma Involving a Shy-Drager Patient: A Case Study
The nurse, as patient advocate, must help bridge the gap between the patient's wishes and the physician's decision.
J Neurosci Nurs 38(6) 2006

Home Care Fact Sheet: Influenza
Print out these patient education guidelines on caring for people with influenza and preparing for the possibility of pandemic flu.

Influencing Health Care in the Legislative Arena
Nurses need to be a strong voice actively advocating for positive change.

Ob/Gyn and Women's Health
Epidemiology and Etiology of Premenstrual Syndromes
In the first of a 4 column series, Dr. Ellen Freeman provides an overview of the spectrum of premenstrual syndromes.
Medscape Ob/Gyn

Pine Bark Extract Reduces Symptoms of Endometriosis
A study showed that long-term treatment with pine bark was effective in reducing symptoms of endometriosis, such as pelvic pain and dysmenorrhea.

Dietary Soy May Improve Features of Metabolic Syndrome in Postmenopausal Women
In a small randomized trial, dietary soy, particularly soy nuts vs soy protein, improved short-term glycemic control and lipid profiles in postmenopausal women with metabolic syndrome.

Ophthalmology
Value-Based Medicine and Therapies for Neovascular Age-Related Macular Degeneration
What is the value of AMD therapy? Using a value-based technique, Drs. Melissa and Gary Brown seek to quantify the quality-of-life improvements conferred by different therapies.
Medscape Ophthalmology 2007

Ruboxistaurin May Slow Progression of Diabetic Macular Edema
A subanalysis showed that daily use of 32 mg of ruboxistaurin delays progression to diabetic macular edema when using photographic documentation of progression of macular edema.

Pathology & Lab Medicine
Comparison of Apolipoprotein B and Non-High-Density Lipoprotein Cholesterol for Identifying Coronary Artery Disease Risk Based on Receiver Operating Curve Analysis
Data show that clinical studies should analyze the data using an absolute measure of risk such as receiver operating characteristic (ROC) curves rather than just relative indexes.
Am J Clin Pathol 127(3) 2007

Mitotic Rate in Melanoma: A Reexamination
Mitotic rate need not be part of routine reports on cutaneous melanoma, but should continue to be measured in academic centers and other sites that maintain large prospective databases on melanoma.

Pediatrics
Zinc Supplementation May Not Reduce Overall Mortality in Children With Malaria
In a randomized, double-blind trial, zinc supplementation did not reduce overall mortality in children aged 1 to 48 months with malaria.
Medscape Medical News 2007

Parenting-Skills Training Plus Healthy Lifestyle Assists Weight Control in Prepubertal Children
A randomized controlled trial suggests that parenting-skills training combined with promoting a healthy family lifestyle may be effective in prepubertal children, particularly boys.

Newborn Screening: Current Status
Much progress has been made, but the infrastructure needed for comprehensive newborn screening is not yet available.

Pharmacist
FDA Safety Changes: Methadone Diskets, Rapamune
The FDA has approved revisions to the safety labeling for methadone HCl 40-mg dispersible tablets (Methadone Diskets) and sirolimus tablets/oral solution (Rapamune).
Medscape Medical News 2007

Psychiatry
Anxiety Disorders Are Often Untreated, Screening Tests Help With Detection
A study showed that anxiety disorders are prevalent, disabling, and often untreated in primary care; a 7- and 2-item screening test may enhance detection.
Medscape Medical News 2007

The Impact of Stimulant Abuse, Misuse, and Diversion on Clinical Practice
Does exposure to stimulants cause or protect against substance abuse among patients with ADHD? What clinical approaches provide optimal treatment and minimal risk for both?

Emerging Trends for Monoamine Oxidase Inhibition in the Management of Depression: A Patient-Focused, Interactive Program
What recent advances in drug delivery are bringing MAOIs to the forefront in the treatment of depression?

Public Health & Prevention
Outbreaks of Short-Incubation Ocular and Respiratory Illness Following Exposure to Indoor Swimming Pools
Hotel guests were interviewed and questioned in this study to determine the effects of indoor pools on ocular and respiratory illnesses. The study also looks for ways to improve indoor pool areas.
Environ Health Perspect 115(2) 2007

Hair Manganese and Hyperactive Behaviors: Pilot Study of School-Age Children Exposed through Tap Water
Neurotoxic effects are known to occur with inhalation of manganese particulates. However, this study delves into the effects of exposure to manganese in drinking water.

When Paper Is The Enemy
If her asthmatic, troubled junior high patient isn't literate, how can a pediatrician possibly help him acquire health literacy?

Pulmonary Medicine
Smoking Cessation Linked With Reduced Arterial Stiffness
Arteries stiffened by cigarette smoking take more than a decade to revert to arterial stiffness similar to nonsmokers following smoking cessation, an Irish study shows.
Medscape Medical News 2007

Inhaled Short-Acting Beta-Agonist Not Effective Prior to Bronchoscopy in Patients With COPD
A randomized, placebo-controlled trial suggests that use of an inhaled short-acting beta-agonist is not associated with improvement in forced expiratory volume in 1 second after bronchoscopy.

Waist-to-Hip Ratio Is Associated With Pulmonary Gas Exchange in the Morbidly Obese
Morbidly obese individuals may have a pulmonary gas exchange impairment due to the large fat mass surrounding their abdomen

Radiology
From the Editor -- In the Wee Small Hours of Cancer
After surgery for head and neck melanoma in early January of this year, I was told that my condition was much more severe than originally envisioned. The note below was written to some family members.
Medscape Radiology 2007

Rheumatology
Combination Therapy May Be More Effective Than Single-Dose Therapy for RA
In a randomized trial, combination therapy for rheumatoid arthritis produced more rapid disease control and limited joint damage more effectively during the second year of treatment.
Medscape Medical News 2007

Improving RA Outcomes: Patient Case Simulation Series - Program 1
A guideline-driven patient case simulation providing a unique platform, in a risk-free environment, to enable clinicians to learn about the challenges of managing patients with RA.

Urology
Alendronate Increases BMD in Men With Prostate Cancer Receiving Androgen Deprivation Therapy
In men with nonmetastatic prostate cancer who received androgen deprivation therapy, 70 mg of alendronate once weekly prevented bone mass loss and increased bone mineral density.
Medscape Medical News 2007

Prognostic Factors in Squamous Cell Carcinoma of the Penis
This Review considers prognostic factors for penile squamous cell carcinoma and highlights nomograms that have been developed to assist in decision-making for treating patients with penile cancer.

Industry Spotlight
Information from Industry

Humalog Mix50/50 (50% insulin lispro protamine suspension/50% insulin lispro injection [rDNA origin]) - For your patients with diabetes who need the convenience of a premixed insulin and more postprandial glucose (PPG) control. Important Safety Information. Prescribing Information.

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