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Which elderly patient should be offered statins? What type For the prevention of cardiovascular disease?
- For primary prevention: age 65-75 for moderate to higher risk with moderate potent statins like atorvastatin 10-20 mg.
- no primary prevention after 75 years.
- Secondary prevention: age 65-82 years with moderate potency and as tolerated.
- Parvastatin not recommended after 65 years because increase cancer incidence in older.
What is metabolic syndrome X?
- Any three of the followings
- 1. abdominal obesity (male >94 cm and female >80 cm)
- 2. TG ≥1.6 mmo;/L
- 3. HDL <1.0 (male) <1.3 (female)
- 4. BP ≥ 130/85 mmHg
- 5. fasting blood glucose ≥5.6 mmol/L
Is treatment with short course antibiotics as effective as a 10-day course of penicillin for children with Group A Streptococcal (GAS) pharyngitis?
In children with GAS pharyngitis, short course antibiotics (versus 10 days of penicillin) have similar clinical responses but higher rates of adverse events, likely due to drug selection. The best evidence for rheumatic fever prevention remains with 10-day penicillin.
Are Z-drugs (zopiclone, zolpidem, and eszopiclone) safe and effective in insomnia?
- Z-drugs help people fall asleep faster (~13-22 minutes) and perhaps get ~5% more time sleeping while in bed.Z-drugs may increase the risk of mild infections (one in 43 patients) and have some inconsistent cognitive effects like reduced verbal memory or attention.
- Compared to benzodiazepines, there is no difference in time to fall asleep, sleep quality or adverse events. Total sleep time may be better with benzodiazepines (23 minutes)
Can I get my cholesterol checked fast (without fasting)?
Minimal differences exist between fasting and non-fasting HDL, LDL,and total cholesterol(TC). Also, non-fasting HDL and non-HDL levels correlate with future CVD events. Therefore,fasting for lipid testing is not required.
Should oral cholera vaccine (Dukoral TM) be routinely recommended to prevent traveler’s diarrhea (TD)?
- Randomized Controlled Trials (RCT) evaluating Dukoral™ for TDdid not show a benefit and routine use is not recommended. Context:
- •Diarrhea, usually from ETEC, affects up to 50% of travelers to developing countries.
- •Risk of cholera is ~1/10,000 to 1/million per month abroad.
- •Cholera toxin subunit in vaccine triggers cross-immunity to ETEC leading to its indication for prevention of TD.
- •Most cases of TD resolve spontaneously in 3–4 days,but taking antibiotics at onset improves 72 hour cure (84% vs.50%, Number Needed to Treat 3).
- •North American guidelines do not recommend oral cholera vaccine for majority of travelers.
- •Vaccine costs ~$90; not covered by any provincial health care plans.