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CMAJ. 2010 October 19; 182(15): 1595.
PMCID: PMC2952000

Highlights

Treating cutaneous warts in primary care

Cryotherapy with liquid nitrogen produced a better cure rate for warts than either salicylic acid or a “wait and see” approach. In this randomized controlled trial involving 240 patients in 30 primary care practices, Bruggink and colleagues compared cure rates after 13 weeks of treatment. The results were most promising for warts anywhere except on the soles of the feet. See Research, page 1624

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Effect of early surgery after hip fracture on mortality and complications

People who receive surgery early following a hip fracture have lower long-term mortality and lower rates of pneumonia and pressure sores than those whose surgery is delayed. Simunovic and colleagues base their findings on a systematic review of 16 observational studies describing 13 478 patients. The results suggest that reducing delays in surgery may reduce complications and mortality. See Research, page 1609

Influenza vaccination, pneumococcal vaccination and risk of acute myocardial infarction

Heart attacks occurred less frequently in people who had had a recent influenza vaccination than in those who had not, but the same could not be said for pneumococcal vaccination. Siriwardena and colleagues found this association in a case–control study using a large database of general practice patients in the United Kingdom. If influenza vaccination does have the added benefit of reducing heart attacks, then it may be important to vaccinate early in the season. See Research, page 1617

ACCOMPLISH and hypertension

The ACCOMPLISH trial confirms the benefit of combination therapy for high-risk hypertensive individuals. As such, it supports the recommendation from the Canadian Hypertension Education Program to start with combination therapy for patients with systolic blood pressure 20 mm Hg above target blood pressure. See Commentary, page 1600

Treatment of acute hyperkalemia

Intravenous insulin has the fastest onset of action in the treatment of acute hyperkalemia, whereas β2-adrenergic agonists have a longer duration of action, say Elliott and colleagues. Although each of these agents is effective at reducing the serum potassium level, the combination is more effective than either treatment alone. The authors caution that the evidence for the use of sodium bicarbonate is weak and equivocal. See Review, page 1631

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Registration of observational studies

Compulsory registration of clinical trials improves access to information and addresses publication and reporting biases. Observational studies could likewise benefit from registration. Williams and colleagues state that researchers, regulators and others need to assess the scope and specific implementation-related issues of systematic registration of observational studies. See Analysis, page 1638

Urine opiate screening: false-positive result with levofloxacin

A urine toxicology screen was found to be falsely positive for opiates in a 96-year-old woman who had been given levofloxacin for aspiration pneumonia. Several commonly used medications can cross-react with enzyme immunoassay tests used for urine toxicology screening, say Shafiq and Mutgi. They emphasize that confirmatory testing with a nonimmunologic technique should be performed if the result of a drug screen is unexpectedly positive. See Practice, page 1644

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Diabetic retinopathy

Patients with type 2 diabetes should be referred for funduscopic examination with pupil dilation at the time of diagnosis, say Noble and Chaudhary. Nearly 30% will already have diabetic retinopathy. See Practice, page 1646


Articles from CMAJ : Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association