Decrease in Smoking

The prevalence of smoking in the U.S. has decreased to 20.8% in 2006 from a high of 42% in 1965. [4] Nonetheless, tobacco use is still the most common cause of preventable death and disease in the U.S., accounting for approximately 438,000 premature deaths, 5.5 million years potential life lost and $92 billion in productivity losses annually. [1] [4] Smoking reduces the median survival of smokers on average by 10 years, and beyond the age of 40 each additional year of smoking reduces life expectancy by 3 months. [5] Globally, smoking prevalence is rising in the developing countries, and it is estimated that in the 21st century there will be 1 billion deaths due to tobacco use worldwide unless these trends are reversed. [6] By quitting cigarette smoking, a patient reduces the risk of lung cancer and other diseases by 20% to 90%, and improves survival even among those who quit over the age of 50. [5] Image 2 image Nonetheless, habitual smokers find it extremely difficult to successfully stop smoking. Although 70% of smokers would like to quit, and 40% make at least 1 quit attempt per year, only 3% to 4% of smokers per year are successful in quitting long term on their own. [7]

Significant survival benefit of smoking cessation.2
Adapted from Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service; May 2008.
Referenced Articles

4
Reference
Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults--United States, 2006. MMWR Morb Mortal Wkly Rep. 2007;56:1157-1161.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/17989644 [Full Text] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm

1
Reference
Mokdad A, Marks J, Stroup D, et al. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238-1245. [Abstract] http://www.ncbi.nlm.nih.gov/pubmed/15010446

5
Reference
Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328:1519.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/15213107 [Full Text] http://www.bmj.com/cgi/content/full/328/7455/1519

6
Reference
Peto R, Lopez AD. The future worldwide health effects of current smoking patterns. In: Koop CE, Pearson CE, Schwarz MR, eds. Critical issues in global health. New York, NY: Jossey-Bass; 2001.

7
Reference
Messer K, Pierce J, Zhu S-H, et al. The California Tobacco Control Program's effect on adult smokers: (1) Smoking cessation. Tob Control. 2007;16:85-90.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/17400944 [Full Text] http://tobaccocontrol.bmj.com/cgi/content/full/16/2/85

QOD 11 3 09

QOD 11 3 09

Which one of the following therapies is generally recommended for the treatment of severe norovirus gastroenteritis?
		A.	Interferon.
		B.	Parenteral hyperimmune human immune globulin.
		C.	Rehydration with intravenous fluids alone.
		D.	Ribavirin. The treatment for norovirus gastroenteritis, like that for other diarrheal illnesses, is oral rehydration with fluids and electrolytes, if the patient is alert and able to drink, or with intravenous fluids, if vomiting and dehydration are severe. Antimotility and antisecretory agents can be useful in adults to decrease diarrhea in situations in which a person's performance is critical. Although no antiviral agents have yet been developed, the x-ray crystallographic structures of the viral polymerase and proteases are known, as is the binding site of histo-blood group antigens in particles, and these provide potential targets for the development of drugs. Interferons and ribavirin effectively inhibit replication of Norwalk virus in replicon-bearing cells, and their potential therapeutic value needs to be further evaluated. Among patients receiving immunosuppressive therapy, recognition of norovirus infection could optimize case management with respect to long-term therapy for the primary disease. Administration of hyperimmune human immune globulin parenterally or orally has been suggested, but this therapy has never been studied in a clinical trial. Answer: C

Treating Resistant Hypertension: Cut Out the Salt

Treating Resistant Hypertension: Cut Out the Salt

Treating Resistant Hypertension: Cut Out the Salt

In a small randomized crossover study, a low-salt diet had dramatic effects on blood pressure.

Patients with resistant hypertension — elevated blood pressure that persists despite the use of three or more antihypertensive agents — are frequently encountered in clinical practice. To examine the role of salt sensitivity in resistant hypertension, investigators conducted a randomized crossover evaluation of two 7-day diets, one low-sodium (50 mmol/day) and one high-sodium (250 mmol/day), separated by a 2-week washout period. Twelve adults (mean age, 56; 8 women; 6 black patients) completed the study. At baseline, participants were taking an average of 3.4 antihypertensive medications, and the mean office blood pressure was 145.8/83.9 mm Hg. All participants continued taking their medications during the study.

Mean urinary sodium excretion during the low-salt diet was significantly lower than during the high-salt diet, indicating adherence to the dietary salt intake regimen. Compared with the high-salt diet, mean office systolic and diastolic blood pressures were lower by 22.7 mm Hg and 9.1 mm Hg, respectively, during the low-salt diet. After adjustment for multiple testing, the between-diet differences in office systolic blood pressure and in all 24-hour ambulatory blood pressure measurements remained significant.

Comment: According to this small study, excessive dietary sodium intake is an important contributor to resistant hypertension. We are well reminded that ensuring a reduction in sodium ingestion is a crucial component in the care of hypertensive patients.

— Joel M. Gore, MD

Published in Journal Watch Cardiology September 23, 2009

Citation:
Pimenta E et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: Results from a randomized trial. Hypertension 2009 Sep; 54:475. [Medline® Abstract] [Free full-text article pdf]

Copyright © 2009. Massachusetts Medical Society. All rights reserved.

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Mario Santoro

National EMS Memorial Service Honoree
Mario Santoro New York Presbyterian Hospital New York, New York
When the first aircraft hit the north tower of the World Trade Center, Mario Santoro and his partner were the first emergency medical team assigned to the scene. They were stationed at Church and Fulton Streets. On site the team immediately started treating the numerous patients that were exiting the tower. When the second aircraft hit the south tower they entered it to reach patients and began treatment. When the tower came crashing to the ground all communication with the team was lost.
"They treated the injured and directed other ambulance crews to the place they were needed most. This is the first time in the history of our department where a crew has not come home�It has been a very difficult time," stated co-worker Brian Washburn. Santoro is one of the team dubbed the "elite eight".
Mario Santoro was employed with New York Presbyterian Hospital in New York City, New York as an advanced emergency medical worker. He lost his life when the World Trade Center fell to the ground caused by the terrorist attacks of September 11, 2001. Prior to working with Presbyterian Mario was employed with MetroCare Ambulance.
Honored 2002

Keith Fairben

National EMS Memorial Service Honoree
Keith Fairben New York Presbyterian Hospital New York, New York
As a father looks diligently through the rubble of the fallen World Trade Center, tears fall from the eyes of those around him. They can only grieve as they feel a small part of the pain he must feel within. The father, a volunteer firefighter for 32 years, is searching though the giant heap of twisted metal and sacred dust for a reason. He is looking for a victim lost in the fallen Twin Towers; however, not just any victim, he is looking for his only child, his son.
Keith G. Fairben, 24, lost his life while trying to save others injured in the worst terrorist attack in America on September 11, 2001. He responded to the call minutes after the first plane hit. The elder Fairben called his son on his cell phone: "Dad, I'm really busy. I am at the World Trade Center. I can't talk now." "Be careful", his father said, "Call us later." That was the last he heard from young Keith.
Keith Fairben worked for New York Presbyterian Hospital of New York City, New York. He had worked there as a medic going on four years. Keith had completed an 11-month EMT program at North Shore University Hospital in May 2001. He seemed to have a penchant for saving people. "I know when they find him, he will be with someone. He wouldn't abandon anyone," stated Keith's father.
No truer statement was ever made, that we are to bury our parents, not our children. Many parents have buried their children that were lost in the World Trade Center. However, what a beautiful legacy to quote, "He wouldn't abandon anyone."
Honored 2002

FW: Requested DocAlert: Smokeless Tobacco and Risk of Myocardial Infarction or Stroke: Systematic Review With Meta-Analysis

Smokeless Tobacco and Risk of Myocardial Infarction or Stroke: Systematic Review With Meta-Analysis

Dear Clinician,

Here is the information you requested (sourced from BMJ).

Published 18 August 2009, doi:10.1136/bmj.b3060
Cite this as: BMJ 2009;339:b3060
[Free full-text BMJ article (pdf)] [PubMed abstract]

Research

Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis

Paolo Boffetta, epidemiologist, Kurt Straif, epidemiologist
1 International Agency for Research on Cancer, Lyon, France
Correspondence to: P Boffetta, Genetics and Epidemiology Cluster, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008 Lyon, France boffetta@iarc.fr

Objective To assess whether people who use smokeless tobacco products are at increased risk of myocardial infarction and stroke.

Design Meta-analysis of observational studies from Sweden and the United States.

Data sources Electronic databases and reference lists.

Data extraction Quantitative estimates of the association between use of smokeless tobacco products and risk of myocardial infarction and stroke among never smokers.

Review methods Both authors independently abstracted risk estimates and study characteristics. Summary relative risks were estimated on the basis of random effects models.

Results 11 studies, mainly in men, were included. Eight risk estimates were available for fatal myocardial infarction: the relative risk for ever use of smokeless tobacco products was 1.13 (95% confidence 1.06 to 1.21) and the excess risk was restricted to current users. The relative risk of fatal stroke, on the basis of five risk estimates, was 1.40 (1.28 to 1.54). The studies from both the United States and Sweden showed an increased risk of death from myocardial infarction and stroke. The inclusion of non-fatal myocardial infarction and non-fatal stroke lowered the summary risk estimates. Data on dose-response were limited but did not suggest a strong relation between risk of dying from either disease and frequency or duration of use of smokeless tobacco products.

Conclusion An association was detected between use of smokeless tobacco products and risk of fatal myocardial infarction and stroke, which does not seem to be explained by chance.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://imageb.epocrates.com/mailbot/links?EdID=42356822&LinkID=36943 and http://imageb.epocrates.com/mailbot/links?EdID=42356822&LinkID=48281.

© 2009 BMJ Publishing Group Ltd.

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QOD

Which of the following is not a common complication
of an influenza infection?
a. Otitis media
b. Guillain-Barre syndrome
c. Bacterial pneumonia
d. Acute bronchitis

Numerous potential complications can stem from a primary influenza infection and contribute to the
initial presentation. An example might be the patient who presents with chest pain in the setting of a viral
respiratory illness and is found to have myocarditis as a complication of an influenza infection. Some of the
more common complications include acute bronchitis, bacterial pneumonia, and, in children, otitis media.

Answer: b