Clinical Briefs
By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim.
Doxycycline Hyclate 20 mg Tablets and Metronidazole 0.75% Topical Lotion in the Treatment of Rosacea
The treatment of rosacea (ROS) is based upon antibacterial therapy, usually either metronidazole or a member of the tetracycline family (eg, tetracycline, oxytetracycline, doxycycline, or minocycline). The use of full-dose tetracycline, although often effective in rosacea is also associated with adversities such as induction of skin photosensitivity or, in women (the group most commonly affected by ROS), yeast vaginitis.
Recent trials in adult acne have indicated that subantimicrobial doses of doxycycline (ie, 20 mg PO b.i.d.) have a favorable effect on acne, without altering GI, GU, or skin flora; hence, clinicians may capitalize upon an anti-inflammatory effect without unwanted alterations in microflora.
A trial of topical metronidazole 0.75% lotion plus either doxycycline 20 mg b.i.d. or placebo for 16 weeks was undertaken in 40 adults with rosacea.
At the conclusion of the trial, combination therapy was found superior to metronidazole alone for the total number of inflammatory lesions (the primary end point of the trial) and clinician's global severity score. Subantimicrobial doses of doxycycline enhance outcomes when added to topical metronidazole for management of rosacea.
Sanchez J, et al. J Am Acad Dermatol. 2005;53:791-797.
Left Atrial Radiofrequency Ablation During Mitral Valve Surgery for Continuous Atrial Fibrillation
Radiofrequency ablation (RFA) is intended to prevent successful propagation of re-entrant circuits by creating lines of scar tissue between the pulmonary veins and the annulus of the mitral valve. This intervention is increasingly frequently offered to persons with atrial fibrillation who undergo mitral valve surgery, although it has not yet been subject to a large enough prospective randomized trial to derive a conclusive data set.
To that end, a randomized double blind trial was performed in the United Kingdom of patients (n = 97) with chronic (> 6 months) continuous atrial fibrillation. Mitral valve surgery alone was compared with mitral valve surgery plus RFA.
The primary end point was sustained sinus rhythm, which was attained in 44.4% of patients who received RFA, vs 4.5% of those who did not. Similarly, RFA was associated with more favorable BNP (brain natriuretic peptide) levels and improved exercise capacity. The additional procedure was not associated with any increased risks: postoperative complications and mortality were the same in both groups.
For persons with chronic continuous atrial fibrillation undergoing mitral valve surgery, RFA improves likelihood of sustained sinus rhythm, without adding to the morbidity or mortality burden.
Doukas G, et al. JAMA. 2005;294:
2323-2329.
Comorbid Depression with Mortality in Patients with DM
Diabetes mellitus (DM) has recently been recognized as comparable to having sustained an MI as a predictor of cardiovascular risk. Depression (DEP) has been shown to increase mortality, with up to a 6-fold increase in post-MI mortality seen in depressed vs non-depressed patients. Data on patients with DM have shown a high incidence of DEP, with resonant consequences; eg, persons with DM and DEP are likely to take less rigorous care of their DM, and hence have worse outcomes, and likewise, persons suffering morbid consequences of their DM are more likely to become depressed. Some longitudinal studies of DM and DEP have highlighted the consequences of their comorbidity, but are limited by such flaws as self-reporting, inadequately documented DM, and small numbers of patients.
The Pathways Study includes almost 5000 DM patients in a Seattle Washington HMO. A study of comorbid DEP and DM with consequent impact upon mortality was evaluated over 3 years. The mortality picture was clearly divergent: 3-year mortality was 8.3% in diabetics without DEP, 13.6% with comorbid minor DEP, and 11.9% with comorbid major depression. When adjusted for age, sex, and ethnicity, major DEP was associated with a statistically significant greater than 2-fold increase in mortality compared to diabetics without DEP. Whether treatment of DEP in DM improves mortality outcomes has not been determined.
Katon WJ, et al. Diabetes Care. 2005;28:2668-2672.
Doxycycline Hyclate 20 mg Tablets and Metronidazole 0.75% Topical Lotion in the Treatment of Rosacea; Left Atrial Radiofrequency Ablation During Mitral Valve Surgery for Continuous Atrial Fibrillation; Comorbid Depression with Mortality in Patients with DMYou have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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