20120630 IMJ Medical Pearls

7/31/2019 20120630 IMJ Medical Pearls

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The

Internet Medical Journal

June, 2012

Tom Heston, MD

Editor


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Cost of pain management in the U.S. is

approximately $600 Billion annually - J Pain. 2012 May 16.

Hemodynamic compromise is decreasedwith manual removal of the placenta at 10minutes after delivery compared to 15minutes after delivery. - Am J Perinatol.2012 May 7.

1 mmol/L reduction in LDL cholesterolappears to reduce the risk of major vascular events by about 11 per 1000 people over 5years. - Lancet. 2012 May 16.

Occipital nerve stimulation therapy appearsto be safe and effective in the treatment of

chronic migraine and medication overuse
http://www.jpain.org/article/PIIS1526590012005597/abstract?rss=yeshttp://www.jpain.org/article/PIIS1526590012005597/abstract?rss=yeshttps://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0032-1311985https://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0032-1311985https://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0032-1311985http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60367-5/abstracthttp://www.jpain.org/article/PIIS1526590012005597/abstract?rss=yeshttp://www.jpain.org/article/PIIS1526590012005597/abstract?rss=yeshttps://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0032-1311985https://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0032-1311985http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60367-5/abstract


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headache - Pain Physician. 2012

May;15(3):245-53.

Singletons pregnancies after in-vitrofertilization / intracytoplasmic sperminjection are associated with higher risks of obstetric and perinatal complications whencompared with spontaneous conception. -

Hum Reprod Update. 2012 May 19.

Childbirth in the lateral position resulted inless perineal trauma when compared withchildbirth in the lithotomy position, evenafter correcting for parity and birth

attendant. - Birth (2012).

It is estimated that a 3.9 to 4.3% increase

across crime categories would result from a
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20% increase in neighborhood alcohol

establishment density. - Alcohol Clin Exp Res. 2012 May 15.

The likelihood of completing


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pulsed light alone with minimal and

tolerable side effects and less recurrencerates. - Dermatol Ther. 2012 Jan;25(1):86-91.

Less than half of Medicaid-insuredcolorectal cancer survivors received acolonoscopy in 3 to 18 months after colorectal resection. Improvements inscreening in this high-risk population should

be the target of future interventions to

reduce the probability of recurrence. - Am J Clin Oncol. 2012 Jun;35(3):205-11.

For women in their 50s to 80s withoutclinical depression, increased total physicalactivity is correlated with improved current

and future health. - J Epidemiol Community
http://onlinelibrary.wiley.com/doi/10.1111/j.1529-8019.2012.01427.x/abstracthttp://onlinelibrary.wiley.com/doi/10.1111/j.1529-8019.2012.01427.x/abstracthttp://journals.lww.com/amjclinicaloncology/Abstract/2012/06000/Screening_Colonoscopy_Among_Colorectal_Cancer.1.aspxhttp://journals.lww.com/amjclinicaloncology/Abstract/2012/06000/Screening_Colonoscopy_Among_Colorectal_Cancer.1.aspxhttp://jech.bmj.com/content/early/2012/04/26/jech-2011-200850.short?rss=1http://onlinelibrary.wiley.com/doi/10.1111/j.1529-8019.2012.01427.x/abstracthttp://onlinelibrary.wiley.com/doi/10.1111/j.1529-8019.2012.01427.x/abstracthttp://journals.lww.com/amjclinicaloncology/Abstract/2012/06000/Screening_Colonoscopy_Among_Colorectal_Cancer.1.aspxhttp://journals.lww.com/amjclinicaloncology/Abstract/2012/06000/Screening_Colonoscopy_Among_Colorectal_Cancer.1.aspxhttp://jech.bmj.com/content/early/2012/04/26/jech-2011-200850.short?rss=1


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Health. 2012 Apr 27.

Chest CT using 3D automatic exposurecontrol was shown to reduce patientradiation exposure from 800 DLP to 200DLP. - Eur J Radiol. 2012 Jun;81(6):1330-4.

This study found atherosclerosis to beassociated with osteoarthritis of the knee andhand joints in women. - Ann Rheum Dis.2012 May 14.

Increasing longevity coupled with a rising

trend of dementia is likely to mean a major shift towards higher nursing home care usein the future. - J Epidemiol Community

Health. 2012 Apr 27.
http://jech.bmj.com/content/early/2012/04/26/jech-2011-200850.short?rss=1http://www.ejradiology.com/article/PIIS0720048X1100307X/abstract?rss=yeshttp://www.ejradiology.com/article/PIIS0720048X1100307X/abstract?rss=yeshttp://ard.bmj.com/content/early/2012/05/14/annrheumdis-2012-201299.short?rss=1http://ard.bmj.com/content/early/2012/05/14/annrheumdis-2012-201299.short?rss=1http://ard.bmj.com/content/early/2012/05/14/annrheumdis-2012-201299.short?rss=1http://jech.bmj.com/content/early/2012/04/26/jech-2011-200756.short?rss=1http://jech.bmj.com/content/early/2012/04/26/jech-2011-200756.short?rss=1http://jech.bmj.com/content/early/2012/04/26/jech-2011-200850.short?rss=1http://www.ejradiology.com/article/PIIS0720048X1100307X/abstract?rss=yeshttp://www.ejradiology.com/article/PIIS0720048X1100307X/abstract?rss=yeshttp://ard.bmj.com/content/early/2012/05/14/annrheumdis-2012-201299.short?rss=1http://ard.bmj.com/content/early/2012/05/14/annrheumdis-2012-201299.short?rss=1http://jech.bmj.com/content/early/2012/04/26/jech-2011-200756.short?rss=1http://jech.bmj.com/content/early/2012/04/26/jech-2011-200756.short?rss=1


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A single ultrasound guided dexamethasone

injection is a safe and effective short termtreatment for plantar fasciitis, but significant pain relief was found to NOT continue beyond four weeks. - BMJ 2012;344:e3260

In Europe and the U.S., 20-40% of womengain excessive weight during pregnancy,which is associated with adverse outcomes.Dietary interventions during pregnancyappear helpful, reducing the risk of pre-

eclampsia and shoulder dystocia. - BMJ 2012;344:e2088

The INHOMESSS mnemonic(impairments/immobility, nutrition, homeenvironment, other people, medications,

examination, safety, spiritual health,
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services) addresses the components of a

comprehensive house call. - Am Fam Physician. 2011 Apr 15;83(8):925-931.

The diagnosis of pelvic inflammatorydisease is made clinically; no single test or study is sensitive or specific enough for adefinitive diagnosis. Patients should betreated empirically. Most can be treatedsuccessfully with ceftriaxone or cefoxitinIM plus oral doxycycline. - Am Fam

Physician. 2012 Apr 15;85(8):791-796.

Children with hypertension should be

screened for cardiovascular risk factors suchas diabetes and hyperlipidemia. Alsoevaluate for target organ damage with a

retinal examination and echocardiography.
http://www.aafp.org/afp/2011/0415/p925.htmlhttp://www.aafp.org/afp/2011/0415/p925.htmlhttp://www.aafp.org/afp/2012/0415/p791.html?aafpvlogin=7218668&aafpvpw=&URL_success=http%3A%2F%2Fwww.aafp.org%2Fafp%2F2012%2F0415%2Fp791.htmlhttp://www.aafp.org/afp/2012/0415/p791.html?aafpvlogin=7218668&aafpvpw=&URL_success=http%3A%2F%2Fwww.aafp.org%2Fafp%2F2012%2F0415%2Fp791.htmlhttp://www.aafp.org/afp/2011/0415/p925.htmlhttp://www.aafp.org/afp/2011/0415/p925.htmlhttp://www.aafp.org/afp/2012/0415/p791.html?aafpvlogin=7218668&aafpvpw=&URL_success=http%3A%2F%2Fwww.aafp.org%2Fafp%2F2012%2F0415%2Fp791.htmlhttp://www.aafp.org/afp/2012/0415/p791.html?aafpvlogin=7218668&aafpvpw=&URL_success=http%3A%2F%2Fwww.aafp.org%2Fafp%2F2012%2F0415%2Fp791.html


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Treatment is usually lifestyle changes,

including weight management, a healthy,low-sodium diet, regular physical activity,and avoidance of tobacco and alcohol.Children with symptomatic hypertension,secondary hypertension, target organdamage, diabetes, or persistent hypertensiondespite nonpharmacologic measures should

be treated with antihypertensivemedications. - Am Fam Physician. 2012 Apr 1;85(7):693-700

Asking high-risk patients about suicidalintent leads to better outcomes and does not

increase the risk of suicide. - Am Fam Physician. 2012 Mar 15;85(6):602-5

Use of pharmacologic support during
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smoking cessation (e.g. nicotine

replacement, buproprion, or varenicline) candouble the rate of successful abstinence. - Am Fam Physician. 2012 Mar 15;85(6):591-8

Divalproex (Depakote), valproic acid,carbamazepine, risperidone, quetiapine(Seroquel), and (olanzapine + SSRI) areused in the treatment of bipolar disorder. -

Am Fam Physician. 2012 Mar 1;85(5):483-

93

For elderly individuals without dementia,

increased total daily physical activityresulted in a 50% decreased risk indeveloping Alzheimer's Disease. -

Neurology. 2012 Apr 24;78(17):1323-9.
http://www.aafp.org/afp/2012/0315/p591.htmlhttp://www.aafp.org/afp/2012/0315/p591.htmlhttp://www.aafp.org/afp/2012/0301/p483.htmlhttp://www.aafp.org/afp/2012/0301/p483.htmlhttp://www.neurology.org/content/78/17/1323.abstracthttp://www.aafp.org/afp/2012/0315/p591.htmlhttp://www.aafp.org/afp/2012/0315/p591.htmlhttp://www.aafp.org/afp/2012/0301/p483.htmlhttp://www.aafp.org/afp/2012/0301/p483.htmlhttp://www.neurology.org/content/78/17/1323.abstract


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A city-wide smoking ban in Pueblo,

Colorado resulted in decreased maternalsmoking and preterm births. - J Womens Health (Larchmt). 2012 Jun;21(6):621-7.

Controlling hypertension can reduce the risk of Alzheimer's Disease by decreasing theactivation of a receptor for advancedglycation end products - Hypertension. 2012

May 21.

The American Academy of FamilyPhysicians is recommending against

performing prostate-specific antigen (PSA)-

based screening for prostate cancer inasymptomatic men, a position that is in linewith a final recommendation from the U.S.

Preventive Services Task Force (USPSTF)
http://online.liebertpub.com/doi/abs/10.1089/jwh.2011.3305http://online.liebertpub.com/doi/abs/10.1089/jwh.2011.3305http://hyper.ahajournals.org/content/early/2012/05/21/HYPERTENSIONAHA.112.195511.abstract%0Ahttp://hyper.ahajournals.org/content/early/2012/05/21/HYPERTENSIONAHA.112.195511.abstract%0Ahttp://online.liebertpub.com/doi/abs/10.1089/jwh.2011.3305http://online.liebertpub.com/doi/abs/10.1089/jwh.2011.3305http://hyper.ahajournals.org/content/early/2012/05/21/HYPERTENSIONAHA.112.195511.abstract%0Ahttp://hyper.ahajournals.org/content/early/2012/05/21/HYPERTENSIONAHA.112.195511.abstract%0A


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that was published May 22 in the Annals of

Internal Medicine. - AAFP News Now, Posted 5/22/2012, 4:00 p.m.

Among children and adolescents in a low-income, urban population, supplementingusual care with text messaging wasassociated with an increased rate of influenza vaccination. However, the overallvaccination rate remained low. - JAMA.2012;307(16):1702-1708.

Extremely dense breasts and first degreerelatives with breast cancer were each

associated with at least a 2 fold increase inrisk for breast cancer in women aged 40 to49 years. - Ann Intern Med. 2012 May

1;156(9):635-48.
http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20120522psascreenrec.htmlhttp://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20120522psascreenrec.htmlhttp://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20120522psascreenrec.htmlhttp://jama.jamanetwork.com/article.aspx?articleid=1148197http://jama.jamanetwork.com/article.aspx?articleid=1148197http://www.ncbi.nlm.nih.gov/pubmed/22547473http://www.ncbi.nlm.nih.gov/pubmed/22547473http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20120522psascreenrec.htmlhttp://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20120522psascreenrec.htmlhttp://jama.jamanetwork.com/article.aspx?articleid=1148197http://jama.jamanetwork.com/article.aspx?articleid=1148197http://www.ncbi.nlm.nih.gov/pubmed/22547473http://www.ncbi.nlm.nih.gov/pubmed/22547473


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Young adults are using more sunscreen, butcontinue to get excess sunburns. In 2010,over half of all U.S. adults aged 18-29reported one or more sunburns in the pastyear. Exposure to UV rays from tanning

beds and the sun is the most important preventable risk factor for skin cancer, andsunburns are evidence of too muchexposure. Ongoing public health efforts inthis area are needed. - MMWR 10-May-2012

In 2010, 32 percent of non-Hispanic whitewomen aged 18-21 years reported indoor tanning, with an average of 28 sessions in

the past year. - MMWR 10-May-2012

The teen birth rate of 34.3 births per 1,000

females reflect a 44 percent decline from
http://www.cdc.gov/media/mmwrnews/2012/0510.html#A1http://www.cdc.gov/media/mmwrnews/2012/0510.html#B2http://www.cdc.gov/media/mmwrnews/2012/0510.html#A1http://www.cdc.gov/media/mmwrnews/2012/0510.html#B2


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1990. The increased use of contraceptivesmay be a contributing factor to the declineof teen births. Teen pregnancy can best be

prevented by delaying the initiation of sexual activity. - MMWR 03-May-2012

Elective induction of labour at termgestation can reduce perinatal mortality indeveloped countries without increasing therisk of operative delivery. - BMJ 2012;344:e2838

Women who use transdermal patches or vaginal rings for contraception have a 7.9

and 6.5 times increased risk of confirmedvenous thrombosis compared with non-usersof hormonal contraception of the same age -

BMJ 2012;344:e2990
http://www.cdc.gov/media/mmwrnews/2012/0503.html#A1http://www.bmj.com/content/344/bmj.e2838http://www.bmj.com/content/344/bmj.e2838http://www.bmj.com/content/344/bmj.e2990http://www.cdc.gov/media/mmwrnews/2012/0503.html#A1http://www.bmj.com/content/344/bmj.e2838http://www.bmj.com/content/344/bmj.e2838http://www.bmj.com/content/344/bmj.e2990


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Circuit training after a stroke is as effectiveas standard physiotherapy after a stroke, andmay be better in terms of gait speed atfollow-up. In this study, the circuit trainingconsisted of 90 minute sessions twice aweek for three months. It included eightdifferent workstations in a gym, designed toimprove performance in tasks relating towalking competency. - BMJ 2012;344:e2672

Risk of cardiovascular disease does notappear to be increased with the use of varenicline (Chantix) for smoking cessation.

- BMJ 2012;344:e2856

In men, an abdominal aortic diameter of 25

mm or greater is associated with greatly
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increased morbidity and mortality comparedto those with an abdominal aortic diameter of 24 mm or less. The risk of hospitaladmission, after accounting for smokingstatus, was increased for cerebrovascular disease, atherosclerosis, peripheral arterialdisease, and respiratory disease. The authorsconclude that men can benefit fromundergoing routine abdominal aorticaneurysm screening. - BMJ 2012;344:e2958

Bullying appears to be correlated with non-suicidal self injury for children 12 years old.Bullied children who self-harm were more

likely to have a family history of suicide or suicide attempts, and have concurrentmental health problems. - BMJ 2012;344:e2683


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Compression ultrasonography is as effectiveat ruling out a deep vein thrombosis (DVT)in pregnant or postpartum women ascompared to non-pregnant women. In these

patients, when there is no evidence of a pulmonary embolism, a single compressionultrasound when normal suggests it is safe tofollow these patients without givinganticoagulants. - BMJ 2012;344:e2635

Antihypertensive therapy usually should not

be initiated with diuretics, as this tends toresult in the need for a greater number of medications while not achieving better

blood pressure control. - J Hypertens. 2012 Jun;30(6):1225-32.

Aspirin appears to reduce the risk of cancer
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with distant metastasis by about 30%. Thereis some evidence that aspirin may decreasethe risk of metastases in patients withadenocarcinoma. Aspirin may be

particularly helpful in smokers. A low-dose,slow-release formulation of aspirin designedto inhibit platelets but to have little systemic

bioavailability was found to be as effectiveas higher doses. - Lancet. 2012 Apr 28;379(9826):1591-601.

Matthew effect (sociology): the phenomenon in sociology where "the richget richer and the poor get poorer." Based

upon a passage (Matthew 25:29) in the NewTestament: "For unto every one that hathshall be given, and he shall have abundance:

but from him that hath not shall be taken
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60209-8/abstract?rss=yeshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60209-8/abstract?rss=yeshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60209-8/abstract?rss=yeshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60209-8/abstract?rss=yes


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away even that which he hath." - Wikipedia: Matthew Effect

Analyses suggest that children's proceduralanxiety mediates the relation between

parents' anticipatory anxiety and children's procedural pain. Thus, targeting parents preprocedural anxiety might be beneficial tothe parents as well as the childrenundergoing a distressing medical procedure.- J Pediatr Psychol. 2012 May 22.

In obese peoples, modest weight lossreduces arterial stiffness which appears to be

related to improved markers of inflammation. - Diab Vasc Dis Res. 2012 Apr 25.
http://en.wikipedia.org/wiki/Matthew_effecthttp://en.wikipedia.org/wiki/Matthew_effecthttp://jpepsy.oxfordjournals.org/content/early/2012/05/22/jpepsy.jss041.abstracthttp://dvr.sagepub.com/cgi/pmidlookup?view=long&pmid=22535587http://dvr.sagepub.com/cgi/pmidlookup?view=long&pmid=22535587http://en.wikipedia.org/wiki/Matthew_effecthttp://en.wikipedia.org/wiki/Matthew_effecthttp://jpepsy.oxfordjournals.org/content/early/2012/05/22/jpepsy.jss041.abstracthttp://dvr.sagepub.com/cgi/pmidlookup?view=long&pmid=22535587http://dvr.sagepub.com/cgi/pmidlookup?view=long&pmid=22535587


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In patients with advanced heart failure,higher HbA1c levels were associated withimproved outcomes. For every unit HbA1cincrease, there was a 15% decreased hazardratio of death or urgent heart transplantationand all-cause mortality - Amer J Cardiol 29

March 2012.

Breastfeeding for at least 4 months wasfound to be associated with a protectiveeffect on a child's social, attention, and

aggression problems in early adolescence. - Breastfeed Med. 2012 May 21.

Nonvascular deaths, including cancer deaths, are reduced with low-dose aspirin.There were 162 of 7998 (2.02%) and 210 of 8068 (2.60%) cancer deaths among low-
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dose aspirin users versus non-aspirin users,respectively, reported over an averagefollow-up of 2.8 years, a mortality reductionof about 20%. - Am J Med. 2012

Jun;125(6):560-7.

Children who attended schools where soda pop and non-low-fat salty snacks could be purchased were 2 to 4 times more likely to be obese than children at schools where suchitems were not sold. - J Sch Health. 2012

Jun;82(6):285-93.

Poor adult modelling of regular hand

washing and unattractive facilities were seenas important barriers to regular handwashing among children in primary school.- Health Educ Res. 2012 May 22.
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Tigecycline monotherapy is non-inferior to acombination regimen of ceftriaxone plusmetronidazole in the treatment of complicated intra-abdominal infections. -Clin Microbiol Infect. 2010

Aug;16(8):1274-81.

Human papillomavirus infection increasesthe risk of esophageal squamous cellcarcinoma in smokers, but does not increasethe risk in non smoking and non alcohol

consuming people. - Dis Esophagus. 2012 Mar 9.

Patients on statins were found to have a 20%decreased risk of developing C difficileinfection in the hospital. - Gut. 2012 Mar 22.
http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2009.03122.x/abstract;jsessionid=1CF8BAD316355B64D47969A375C07FB8.d03t01?systemMessage=Wiley+Online+Library+will+be+disrupted+on+26+May+from+10%3A00-12%3A00+BST+(05%3A00-07%3A00+EDT)+for+essential+maintenancehttp://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2009.03122.x/abstract;jsessionid=1CF8BAD316355B64D47969A375C07FB8.d03t01?systemMessage=Wiley+Online+Library+will+be+disrupted+on+26+May+from+10%3A00-12%3A00+BST+(05%3A00-07%3A00+EDT)+for+essential+maintenancehttp://onlinelibrary.wiley.com/doi/10.1111/j.1442-2050.2012.01334.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+26+May+from+10%3A00-12%3A00+BST+(05%3A00-07%3A00+EDT)+for+essential+maintenancehttp://onlinelibrary.wiley.com/doi/10.1111/j.1442-2050.2012.01334.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+26+May+from+10%3A00-12%3A00+BST+(05%3A00-07%3A00+EDT)+for+essential+maintenancehttp://gut.bmj.com/content/early/2012/03/21/gutjnl-2011-301378.short?rss=1http://gut.bmj.com/content/early/2012/03/21/gutjnl-2011-301378.short?rss=1http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2009.03122.x/abstract;jsessionid=1CF8BAD316355B64D47969A375C07FB8.d03t01?systemMessage=Wiley+Online+Library+will+be+disrupted+on+26+May+from+10%3A00-12%3A00+BST+(05%3A00-07%3A00+EDT)+for+essential+maintenancehttp://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2009.03122.x/abstract;jsessionid=1CF8BAD316355B64D47969A375C07FB8.d03t01?systemMessage=Wiley+Online+Library+will+be+disrupted+on+26+May+from+10%3A00-12%3A00+BST+(05%3A00-07%3A00+EDT)+for+essential+maintenancehttp://onlinelibrary.wiley.com/doi/10.1111/j.1442-2050.2012.01334.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+26+May+from+10%3A00-12%3A00+BST+(05%3A00-07%3A00+EDT)+for+essential+maintenancehttp://onlinelibrary.wiley.com/doi/10.1111/j.1442-2050.2012.01334.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+26+May+from+10%3A00-12%3A00+BST+(05%3A00-07%3A00+EDT)+for+essential+maintenancehttp://gut.bmj.com/content/early/2012/03/21/gutjnl-2011-301378.short?rss=1http://gut.bmj.com/content/early/2012/03/21/gutjnl-2011-301378.short?rss=1


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Unenhanced CT is the preferredexamination for evaluation of urolithiasis

because of its availability, ease of performance, and high sensitivity. - AJR Am J Roentgenol. 2012 Jun;198(6):W540-7.

The addition of simvastatin to enalapril inhypertensive patients was found to improve

parameters of diastolic function. This islikely clinically relevent because diastolicdysfunction is frequent and increases

mortality. - Atherosclerosis. 2012 Jun;222(2):444-8. Epub 2012 Apr 3.

Statin use is strongly associated withimproved discharge disposition after ischemic stroke. - Neurology. 2012 May22;78(21):1678-83.
http://www.ajronline.org/content/198/6/W540.abstracthttp://www.ajronline.org/content/198/6/W540.abstracthttp://www.atherosclerosis-journal.com/article/PIIS002191501200216X/abstract?rss=yeshttp://www.atherosclerosis-journal.com/article/PIIS002191501200216X/abstract?rss=yeshttp://www.neurology.org/content/78/21/1678.abstracthttp://www.neurology.org/content/78/21/1678.abstracthttp://www.ajronline.org/content/198/6/W540.abstracthttp://www.ajronline.org/content/198/6/W540.abstracthttp://www.atherosclerosis-journal.com/article/PIIS002191501200216X/abstract?rss=yeshttp://www.atherosclerosis-journal.com/article/PIIS002191501200216X/abstract?rss=yeshttp://www.neurology.org/content/78/21/1678.abstracthttp://www.neurology.org/content/78/21/1678.abstract


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In school-aged children with an acuteasthma exacerbation, adding a 3-wk courseof clarithromycin to standard treatmenthelped decrease duration of the exacerbationand increase the number of subsequentsymptom-free days. - Pediatr Allergy

Immunol. 2012 Jun;23(4):385-90.

Beclomethasone/formoterol (Fostair)appears to be less expensive but as clinicallyeffective as fluticasone

propionate/salmeterol (Advair) in adultswith moderate to severe persistent asthma. -Clin Drug Investig. 2012 Apr 1;32(4):253-

65.

Airway responsiveness, lung volumes andasthma severity/control markedly improved
http://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2012.01280.x/abstract;jsessionid=E875D110EFEC4552908043AFBC5953B2.d02t01http://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2012.01280.x/abstract;jsessionid=E875D110EFEC4552908043AFBC5953B2.d02t01http://adisonline.com/druginvestigation/Abstract/2012/32040/Cost_Effectiveness_and_Cost_Utility_of.4.aspxhttp://adisonline.com/druginvestigation/Abstract/2012/32040/Cost_Effectiveness_and_Cost_Utility_of.4.aspxhttp://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2012.01280.x/abstract;jsessionid=E875D110EFEC4552908043AFBC5953B2.d02t01http://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2012.01280.x/abstract;jsessionid=E875D110EFEC4552908043AFBC5953B2.d02t01http://adisonline.com/druginvestigation/Abstract/2012/32040/Cost_Effectiveness_and_Cost_Utility_of.4.aspxhttp://adisonline.com/druginvestigation/Abstract/2012/32040/Cost_Effectiveness_and_Cost_Utility_of.4.aspx


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with weight loss following bariatric surgeryin severely obese patients (BMI ~ 50 kg/m2)- Respir Med. 2012 May;106(5):651-60.

In people with urinary incontinence,associated anal incontinence is common.These authors recommend routinelyscreening for anal incontinence in patientswith urinary symptoms. - Int Urogynecol J.2012 May 15.

Awareness of the breastfeedingrecommendation to breastfeed exclusivelyfor 6 months is an independent positive

predictor of breastfeeding initiation andduration. - Breastfeed Med. 2012 May 8.

Overweight and obese adolescents had 36%
http://www.resmedjournal.com/article/PIIS0954611112000224/abstract?rss=yeshttp://www.springerlink.com/content/u527303h55k77341/export-citation/http://www.springerlink.com/content/u527303h55k77341/export-citation/http://online.liebertpub.com/doi/abs/10.1089/bfm.2011.0052http://www.resmedjournal.com/article/PIIS0954611112000224/abstract?rss=yeshttp://www.springerlink.com/content/u527303h55k77341/export-citation/http://www.springerlink.com/content/u527303h55k77341/export-citation/http://online.liebertpub.com/doi/abs/10.1089/bfm.2011.0052


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and 37% more sick days, respectively, thanadolescents of normal weight. - J Adolesc

Health 24 May 2012.

Serum uric acid level is a significant predictor of cardiac events in patients withdiabetes when using a Cox regressionmodel, however, it does not appear to addadditional information beyond that provided

by N-terminal pro-B-type natriuretic peptidelevels. - Diabet Med. 2012 Jun;29(6):721-

725.

Antidepressants and benzodiazepines are in

general safe regarding survival in heartfailure patients, with the possible exceptionof fluoxetine. - Int J Cardiol. 2012 Apr 14.
http://www.jahonline.org/article/PIIS1054139X12001486/abstract?rss=yeshttp://www.jahonline.org/article/PIIS1054139X12001486/abstract?rss=yeshttp://www.ingentaconnect.com/content/bsc/dme/2012/00000029/00000006/art00006http://www.ingentaconnect.com/content/bsc/dme/2012/00000029/00000006/art00006http://www.ncbi.nlm.nih.gov/pubmed/22507552http://www.jahonline.org/article/PIIS1054139X12001486/abstract?rss=yeshttp://www.jahonline.org/article/PIIS1054139X12001486/abstract?rss=yeshttp://www.ingentaconnect.com/content/bsc/dme/2012/00000029/00000006/art00006http://www.ingentaconnect.com/content/bsc/dme/2012/00000029/00000006/art00006http://www.ncbi.nlm.nih.gov/pubmed/22507552


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This study found that the most commonlyused anti-diabetic oral medication wasmetformin, followed by repaglinide(Prandin), DPP4 inhibitors (e.g. sitagliptin /Januvia), and sulphonylureas (mostcommonly glimepiride). Measuring renalfunction in diabetics is helpful in modifyingmedications, since at low GFRs it may be

beneficial to change from metformin toanother agent. - Nefrologia. 2012 May14;32(3):367-373.

Metformin appears to be associated with alower risk of liver cancer in patients with

type 2 diabetes. - J Clin Endocrinol Metab.2012 Apr 20.

Quetiapine and quetiapine XR are valuable
http://www.revistanefrologia.com/modules.php?name=articulos&idarticulo=11244&idlangart=EShttp://www.revistanefrologia.com/modules.php?name=articulos&idarticulo=11244&idlangart=EShttp://www.ncbi.nlm.nih.gov/pubmed/22523334?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/22523334?dopt=Abstracthttp://www.revistanefrologia.com/modules.php?name=articulos&idarticulo=11244&idlangart=EShttp://www.revistanefrologia.com/modules.php?name=articulos&idarticulo=11244&idlangart=EShttp://www.ncbi.nlm.nih.gov/pubmed/22523334?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/22523334?dopt=Abstract


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additions to the first-line treatments for bipolar depression. A common side-effectappears to be clinically relevant increases in

blood glucose or lipid parameters. - CNS Drugs. 2012 May 1;26(5):435-60.

Subcutaneous sumatriptan is effective as anabortive treatment for acute migraineattacks, quickly relieving pain, nausea,

photophobia, phonophobia, and functionaldisability, but is associated with increased

adverse events. - Cochrane Database Syst Rev. 2012 Feb 15;2:CD009665.

Oral diclofenac potassium 50 mg is aneffective treatment for acute migraine, providing relief from pain and associatedsymptoms, although only a minority of
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patients experience pain-free responses.Adverse events are mostly mild andtransient and occur at the same rate as with

placebo. - Cochrane Database Syst Rev.2012 Feb 15;2:CD008783.

Divalproex sodium, sodium valproate,topiramate, metoprolol, propranolol, and

timolol are effective for migraine preventionand should be offered to patients withmigraine to reduce migraine attack

frequency and severity. - Neurology. 2012 Apr 24;78(17):1337-45.

Prochlorperazine (Compazine) is superior or equivalent to all other classes of medicationsin rescue therapy for acute migraine painrelief. - Headache. 2012 Mar;52(3):467-82.
http://www.ncbi.nlm.nih.gov/pubmed/22336852http://www.ncbi.nlm.nih.gov/pubmed/22336852http://www.ncbi.nlm.nih.gov/pubmed/22529202?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/22529202?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/22529202?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/22404708http://www.ncbi.nlm.nih.gov/pubmed/22336852http://www.ncbi.nlm.nih.gov/pubmed/22336852http://www.ncbi.nlm.nih.gov/pubmed/22529202?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/22529202?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/22404708


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Alternative acute and preventive agentsshould always be explored since opioids donot work well clinically in migraine. -

Headache. 2012 May;52 Suppl 1:30-4.

Tramadol hydrochloride 37.5 mg withacetaminophen 325 mg has been shown to

be most effective in patients with mild to

moderate pain and has a lower risk of serious adverse events. The combinationappears more effective than tramadol alone.

- Drugs Today (Barc). 2011 Oct;47(10):763-72.

In the long-term (1h and 24h after administration), dexamethasone 8 mg IVreduces the severity of acute migrantheadache more than morphine 0.1 mg/kg IV.
http://www.ncbi.nlm.nih.gov/pubmed/22540203http://www.ncbi.nlm.nih.gov/pubmed/22076491http://www.ncbi.nlm.nih.gov/pubmed/22076491http://www.ncbi.nlm.nih.gov/pubmed/22540203http://www.ncbi.nlm.nih.gov/pubmed/22076491http://www.ncbi.nlm.nih.gov/pubmed/22076491http://www.ncbi.nlm.nih.gov/pubmed/22303641http://www.ncbi.nlm.nih.gov/pubmed/22303641


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- Pak J Biol Sci. 2011 Jun 15;14(12):682-7.

Cathinone is a naturally occurring beta-ketone amphetamine analogue found in theleaves of the Catha edulis plant. Syntheticcathinones ("Bath Salts") are derivatives of this compound that have emerged as drugsof abuse. The effect is similar to

amphetamines and MDMA. - J Med Toxicol. 2012 Mar;8(1):33-42.

Vegetable intake is inversely associated withallergic asthma and moderate/severe airwayhyper-responsiveness. - Pediatr Pulmonol.

2012 May 24.

Side effects were fewer with exercisetreadmill testing combined with

d d d
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regadenoson, compared to regadenosongiven with the patient supine. - J Nucl Cardiol. 2012 May 8.

In painful diabetic neuropathy, duloxetineand amitriptyline have similar efficacy.Good, moderate, and mild pain relief wasachieved in about 55%, 20%, and 10% of

patients, respectively. Dry mouth wassignificantly more common in theamitriptyline group. Patients preferred

duloxetine over amitriptyline, however, thisdifference was not statistically significant. - Diabetes Care. 2011 April; 34(4): 818 822.

Elevated serum glucose levels on admissionto the hospital is associated with anincreased risk of death in patients with

i i d i i h
http://www.ncbi.nlm.nih.gov/pubmed/22565239http://www.ncbi.nlm.nih.gov/pubmed/22565239http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064034/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064034/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/22565239http://www.ncbi.nlm.nih.gov/pubmed/22565239http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064034/?tool=pubmed


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community acquired pneumonia without pre-existing diabetes - BMJ 2012;344:e3397

Women with atrial fibrillation have amoderately increased risk of strokecompared with men, and thus, female sexshould be considered when makingdecisions about anticoagulation treatment.

However, women younger than 65 years andwithout other risk factors have a low risk for stroke, and do not always benefit from

anticoagulant treatment. - BMJ 2012;344:e3522

Pioglitazone in type 2 diabetics is associatedwith a 1.2 increased risk of bladder cancer.The absolute risk of bladder cancer in thisstudy of type 2 diabetics was 0.9 per 1000

ti t With t l t 2 f


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patient years. With at least 2 years of pioglitazone use, the risk increased to 1.2 per 1000 patient years. The number neededto harm was approximately 750 for acumulative pioglitazone use of 28,000 mgand 1100 for a cumulative pioglitazone useduration of more than 24 months.Rosiglitazone does not appear to be

associated with an increased risk of bladder cancer. - BMJ 2012;344:e3645

Daily consumption of dark chocolateappears to be of benefit to patients withmetabolic syndrome. - BMJ

2012;344:e3657

In preschool children with an acutewheezing episode presenting to the

emergenc department sing 4ml of


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emergency department, using 4ml of hypertonic saline 5% mixed with 0.5 ml of albuteral for nebulizer treatments, ascompared with using normal saline mixedwith the albuterol solution, significantlyshortened length of stay and lowered theadmission rate. - Pediatrics. 2012

Jun;129(6):e1397-403.

In 12 to 17 year olds with 2 to 8 migraines per month for ?6 months, treatment of an

acute attack with an oral sumatriptan andnaprox combination pill was effective for pain relief. The 85/500 dose was no more

effective than lower doses (as low as 10/60).This suggests that 1/2 of a tablet of the85/500 strength formula (Treximet) is aseffective as a whole tablet in this population.

Pediatrics 2012 Jun;129(6):e1411 20
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- Pediatrics. 2012 Jun;129(6):e1411-20.

In people with chronic kidney disease, the benefits of antiplatelet therapy are uncertainand potentially outweighed by bleedinghazards. Antiplatelet therapy appears to haveuncertain effects on cardiovascular hardevents and mortality, while increasing

bleeding hazards. - Ann Intern Med. 2012 Mar 20;156(6):445-59.

Manual therapy in chronic low back painappears to be beneficial in terms of improving range of motion. - Man Ther.

2012 May 31.

After fortification of grain products withfolic acid in the U.S. in 1996 - 1998, the

incidence of Wilms tumor and primitive
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incidence of Wilms tumor and primitiveneuroectodermal tumors were significantlyreduced. - Pediatrics. 2012

Jun;129(6):1125-33.

Lithium treatment can reduce the attack frequency in episodic cluster headache. Inthis study where lithium blood levels were

periodically monitored, adverse drugreactions from the lithium were mild andaffected about 15% of patients. - Headache.

2012 Jun 1.

Doubling the clopidogrel dose was not

effective to reduce high on-treatment platelet reactivity in almost half of the study patients with coronary artery disease, pointing to the need of a more powerful

platelet inhibitor Cardiovasc Revasc Med
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platelet inhibitor. - Cardiovasc Revasc Med.2012 May;13(3):159-66.

Danshen dripping pill (DSP) is a popular Chinese medicinal product and oftencompared with isosorbide dinitrate (ISDN)in treating coronary heart disease angina

pectoris. This meta-analysis found that DSP

was more effective than ISDN in treatingangina pectoris. - Int J Cardiol. 2012 Jun14;157(3):330-40.

Preoperative statin administration isassociated with early reductions in mortality

among patients undergoing isolated valvular heart surgery, leading to improved latesurvival. - Ann Thorac Surg. 2012

Jun;93(6):1881-7.

BMI is an independent predictor of CV
http://www.cardiorevascmed.com/article/PIIS1553838912001157/abstract?rss=yeshttp://www.cardiorevascmed.com/article/PIIS1553838912001157/abstract?rss=yeshttp://www.internationaljournalofcardiology.com/article/PIIS0167527310011332/abstract?rss=yeshttp://www.internationaljournalofcardiology.com/article/PIIS0167527310011332/abstract?rss=yeshttp://ats.ctsnetjournals.org/cgi/content/abstract/93/6/1881http://ats.ctsnetjournals.org/cgi/content/abstract/93/6/1881http://ats.ctsnetjournals.org/cgi/content/abstract/93/6/1881http://www.cardiorevascmed.com/article/PIIS1553838912001157/abstract?rss=yeshttp://www.cardiorevascmed.com/article/PIIS1553838912001157/abstract?rss=yeshttp://www.internationaljournalofcardiology.com/article/PIIS0167527310011332/abstract?rss=yeshttp://www.internationaljournalofcardiology.com/article/PIIS0167527310011332/abstract?rss=yeshttp://ats.ctsnetjournals.org/cgi/content/abstract/93/6/1881http://ats.ctsnetjournals.org/cgi/content/abstract/93/6/1881


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BMI is an independent predictor of CVmortality but waist circumference is not. -

Nutr Metab Cardiovasc Dis. 2012 May 25.

A 15-minute massage applied with almondoil during pregnancy reduced thedevelopment of striae gravidarum. - J Clin

Nurs. 2012 Jun;21(11-12):1570-6.

This study demonstrated a slight advantageof breastfed infants on cognitive

development compared with formula-fedinfants. - Pediatrics. 2012 Jun;129(6):1134-40.

Limiting access to pharmaceuticalrepresentatives can have the unintendedeffect of reducing appropriate changes in

prescribing habits This means patients of
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prescribing habits. This means patients of physicians with limited access were putthrough greater potential risks compared to

patients being treated by more open-access physicians. - J Clin Hypertens (Greenwich).21 MAY 2012.

Exercise stress test-induced ST-segment

depression in asymptomatic subjects withnormal coronary arteries cannot beconsidered as a simple false-positive result,

because it can be related to coronarymicrovascular dysfunction. - Am J Cardiol.2012 Jun 15;109(12):1705-10.

Patients with nonvisualization of theappendix on ultrasonography, but otherwisenormal scans, are at significantly lower risk

for appendicitis, either perforated or
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for appendicitis, either perforated or nonperforated. Active clinical observationshould be considered in these patients, rather than direct referral for CT. - J ClinUltrasound. 2012 May 25.

There is growing evidence that oxidativestress may play a role in psychiatric

disorders, including depression, and thatantioxidants such as N-acetyl-cysteine may

be useful in the prevention and treatment of

depression. - CNS Drugs. 2012 Jun1;26(6):477-90.

This study found that the prevalence of smoking in Chinese urban areas was 30%.Tobacco advertising was associated withincreased smoking, whereas workplace and

household smoking bans were associated
http://www.ncbi.nlm.nih.gov/pubmed/22638942http://www.ncbi.nlm.nih.gov/pubmed/22638942http://adisonline.com/cnsdrugs/Abstract/2012/26060/Antioxidants_as_Antidepressants__Fact_or_Fiction_.2.aspxhttp://adisonline.com/cnsdrugs/Abstract/2012/26060/Antioxidants_as_Antidepressants__Fact_or_Fiction_.2.aspxhttp://www.ncbi.nlm.nih.gov/pubmed/22638942http://www.ncbi.nlm.nih.gov/pubmed/22638942http://adisonline.com/cnsdrugs/Abstract/2012/26060/Antioxidants_as_Antidepressants__Fact_or_Fiction_.2.aspxhttp://adisonline.com/cnsdrugs/Abstract/2012/26060/Antioxidants_as_Antidepressants__Fact_or_Fiction_.2.aspx


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household smoking bans were associatedwith decreased smoking rates. - Drug

Alcohol Depend. 2012 Jul 1;124(1-2):121-7.

The CDC is proposing HCV screening for all people born from 1945 through 1965 inaddition to testing people at high risk or

recent possible exposure. Thisrecommendation to screen all BabyBoomers is contrary to recommendations

from U.S. Preventive Services Task Forceand the American Academy of FamilyPhysicians. - AAFP News Now, posted 6/6/2012.

Monotherapy with metformin wasassociated with durable glycemic control in

approximately half of children and
http://www.drugandalcoholdependence.com/article/PIIS0376871611005588/abstract?rss=yeshttp://www.drugandalcoholdependence.com/article/PIIS0376871611005588/abstract?rss=yeshttp://www.drugandalcoholdependence.com/article/PIIS0376871611005588/abstract?rss=yeshttp://www.drugandalcoholdependence.com/article/PIIS0376871611005588/abstract?rss=yeshttp://www.regulations.gov/#!documentDetail;D=CDC-2012-0005-0001http://www.regulations.gov/#!documentDetail;D=CDC-2012-0005-0001http://www.drugandalcoholdependence.com/article/PIIS0376871611005588/abstract?rss=yeshttp://www.drugandalcoholdependence.com/article/PIIS0376871611005588/abstract?rss=yeshttp://www.drugandalcoholdependence.com/article/PIIS0376871611005588/abstract?rss=yeshttp://www.regulations.gov/#!documentDetail;D=CDC-2012-0005-0001http://www.regulations.gov/#!documentDetail;D=CDC-2012-0005-0001


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pp yadolescents with type 2 diabetes. Theaddition of rosiglitazone, but not anintensive lifestyle intervention, was superior to metformin alone. - N Engl J Med. 2012

Apr 29.

Maternal vitamin D deficiency and

insufficiency is prevalent among gravidwomen and is associated with markers of altered glucose homeostasis. - J Obstet

Gynecol Neonatal Nurs. 2012;41(3):328-338.

While every attempt has been made to
http://www.nejm.org/doi/full/10.1056/NEJMoa1109333#t=abstracthttp://www.nejm.org/doi/full/10.1056/NEJMoa1109333#t=abstracthttp://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2012.01366.x/abstract;jsessionid=456D0AA057A1168494A2DCC5EE75663B.d03t04http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2012.01366.x/abstract;jsessionid=456D0AA057A1168494A2DCC5EE75663B.d03t04http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2012.01366.x/abstract;jsessionid=456D0AA057A1168494A2DCC5EE75663B.d03t04http://www.nejm.org/doi/full/10.1056/NEJMoa1109333#t=abstracthttp://www.nejm.org/doi/full/10.1056/NEJMoa1109333#t=abstracthttp://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2012.01366.x/abstract;jsessionid=456D0AA057A1168494A2DCC5EE75663B.d03t04http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2012.01366.x/abstract;jsessionid=456D0AA057A1168494A2DCC5EE75663B.d03t04http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2012.01366.x/abstract;jsessionid=456D0AA057A1168494A2DCC5EE75663B.d03t04


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