Silver Nitrate for Apthous Ulcers

Original Question:  Patient with apthous ulcer in clinic. 

P- In patients with apthous ulcers

I -does silver nitrate application

C- time (doing nothing)

O- decrease patient discomfort

           

Search terms: apthous ulcer Silver nitrate      

Where searched: "http://www.ncbi.nlm.nih.gov/pubmed/   http://www.aafp.org  https://www.google.com

RESULTS: In the treatment group, 33 of 47 patients (70%) evaluated and in the placebo group, four of 38 patients (11%) evaluated had reduction in severity of pain 1 day after the procedure. The difference was statistically significant (P < 0.001). On the seventh day after the procedure, the ulcers were completely re-epithelialized in 39 patients (83%) in the treatment group and in 34 patients (89%) in the placebo group. The difference was not statistically significant (P = 0.39).

CONCLUSIONS: one application of silver nitrate can decrease the severity of pain in aphthous ulceration without significantly shortening or prolonging healing time. We did not observe any side-effects in our study. The effect is rapid and lasts for the duration of the lesion. The treatment is simple and cost-effective in patients with infrequent recurrences.

Sources: Br J Dermatol. 2005 Sep;153(3):521-5.

Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial.

Alidaee MR, Taheri A, Mansoori P, Ghodsi SZ.

SOR      A  Consistent, good-quality patient-oriented evidence*       

          

Completed By Claude Roofian, M.D.       

Last updated 3/18/2011

Cranberry for UTI Prophylaxis

P: Adult Women

I: Cranberry Supplement

C: No Supplement

O: Prevention of UTI?

 

Most recently in 2001, a randomized, placebo-controlled trial of 150 women over a 12-month period found that cranberry juice and cranberry extract tablets significantly decreased the number of patients having at least one symptomatic UTI per year.

Findings were statistically significant. There was a twenty percent reduction in absolute risk of infection in women receiving cranberry vs those without cranberry prophylaxis. (NNT = 5) 

SOR A

Resources: “Cranberry for prevention of urinary tract infections”. www. AAFP.org

                    www.altmed.creighton.edu

Completd by Erin Griffin DO

Date Last updated 4/14/2011 

Magnets for Pain

Original Question:Does magnetic therapy work for pain relief?

Question in PICO Format:is there evidence that magnetic therapy can improve musculoskeletal pain in adults seeking alternative medicine practices?

Searched Terms:"is there evidence that magnetic therapy can improve musculoskeletal pain in adults seeking alternative medicine" which directed me to Pubmed.gov and a list of similar article topics.

Where searched:bing.com, pubmed.gov

Answer:No, any benefit perceived was non-specific placebo effect. But no evidence of causing harm either.

Source:  Richmond SJ, Brown SR, et al. "Therapeutic effects of magnetic and copper bracelets in osteoarthritis: a randomised placebo-controlled crossover trial." Complement Ther Med. 2009 Oct-Dec;17(5-6):249-56. Epub 2009 Aug 28.

Level of Evidence 2b

SOR:B  Inconsistent or limited-quality patient-oriented evidence*

Completed by:Jodie Calain, D.O.

Date last updated:4/13/2011

Epi for digital blocks

Original Question:We are taught to avoid using epinephrine in body parts with terminal vasculature (lips, fingertips, toes, penis, ears). But, is epinephrine still contraindicated in digital blocks? (It has theoretical use in constricting vessels and allowing anesthetic to stay in tissues longer).

Question in PICO Format:P = patients with digital (fingers/hand) injections

I = lidocaine with epinephrine

C = lidocaine

O = number of ischemic events (digital infarction (tissue/skin loss), use of phentolamine rescue to reverse vasoconstriction)

Searched Terms:lidocaine, epinephrine

Where searched:UpToDate

Answer:**Epinephrine is not contraindicated in digital blocks.**

9 hand surgeons in 6 cities prospectively recorded cases of elective hand (1770) and finger (1340) epinephrine injection (total n = 3110 cases).  Used low-dose epinephrine (1:100,000 adrenaline); 391 received bupivicaine, and remainder received lidocaine.  None produced ischemic event.  (*Elective injection was avoided in uncommon patients with pre-existing vascular problems in hand/fingers).  Interestingly, no authors saw a difference in epi hemostasis from what they had seen with tourniquet hemostasis.  True incidence of finger infarction in elective low-dose epinephrine injection into the hand and finger is likely to be remote.

Source: Lalonde D, Bell M, Benoit P, et al. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005; 30:1061.

SOR: B  Inconsistent or limited-quality patient-oriented evidence*

Completed by:Karen Isaacs MD, MPH

Date last updated:4/14/2011

Diabetic Women and Boric Acid for Vaginal Yeast Infections

Original Question: In diabetic women with recurrent symptomatic vaginal yeast infections...can boric acid play a role in treatment?

P = diabetic women with vaginal yeast infections

I = boric acid

C = diflucan

O = recurrence of symptomatic vaginal yeast infections

Searched Terms: boric acid vaginitis       

 

Where searched: PubMed, AFP        

       

Answer:   Diabetic women are at higher risk of non-albicans Candida species, such as glabrata.  Glabrata has reduced susceptibility to azole drugs. Authors did a randomized trial (open label, non-blinded) comparing single dose po 150mg fluconazole vs 14 days boric acid vaginal suppositories 600mg/day.  n= 112 (DM I and II), 59.9% with glabrata; randomized to treatment after candida species identified. On day 15, statistical significance seen in mycologic cure of glabrata growth in 56.1% of boric acid group, and in 18.7% of fluconazole group (had to adjust for lower mean A1c in boric acid group; but still p = 0.01).  But for overall mycological cure, as well as signs observed/symptoms reported, the clinical difference between the 2 treatment groups is not statistically significant.  Of the women taking boric acid, 2 stopped due to vaginal burning sensation on day 7.  Boric acid alone seems to be helpful in reducing organism burden of candida glabrata in diabetic women, but there is a need for further investigation on the utility of boric acid in combination with other therapy, for symptomatic improvement in acute episodes and also reduction of recurrence through maintenance regimens. (This is disease-oriented evidence).      

http://care.diabetesjournals.org  Ray D, et al. “Prevalence of Candida glabrata and Its Response to Boric Acid Vaginal Suppositories in Comparison with Oral Fluconazole in Patients with Diabetes and Vulvovaginal Candidiasis”. Diabetes Care. Feb 2007, vol 30(2):312-317.

SOR:  C  Consensus, disease-oriented evidence,* usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention, or screening      

                

Completed by:  Karen Isaacs MD, MPH 

Date last updated:12/13/2010                   

Depo Provera and Osteoporosis

original question: Is there an increased risk of osteoporosis while taking Depo Provera?

Population: women taking Depo for contraception

Intervention: Depo

Compared to: No Depo

Outcome: Increased risk of osteoporosis?

Search terms: risk of osteoporosis while on depo?

Where searched: Up-to-date, goggle

Answer:  The best available data show that Depo use does not reduce peak bone mass and does not increase the risk of osteoporosis fracture in later life in women at average risk of osteoporosis. Bone loss occurring with Depo use is reversible and is not likely to be an important risk factor for low bone density and fractures in older women, although data on fracture risk in Depo users are lacking.

Sources:

1. Kaunitz, AM, Arias, R, McClung, M. Bone density recovery after depot medroxyprogesterone acetate inject able contraception use. Contraception 2008; 77:67.
2. ACOG Committee Opinion No. 415: Depot medroxyprogesterone acetate and bone effects.

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice

Obstet Gynecol. 2008;112(3):727-30.

3. ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. ACOG Committee on Practice Bulletins-Gynecology

Obstet Gynecol. 2006;107(6):1453-72.

4. World Health Organization. WHO Statement on Hormonal Contraception and Bone Health 2005; 1-2.

LOE C