The Internet for healthcare professionals

The Internet is a useful clinical tool for information and communication. Resources that are available on the Internet include the Medline index, full-text articles, patient handouts, discussion lists, continuing education, medical and pharmaceutical texts, and case studies. This article summarizes the different types of resources available and teaches the basic skills for using the Internet to find medical information. Otolaryngology sites are listed and described.

Atovaquone and proguanil for Plasmodium falciparum malaria

BACKGROUND

The increasing spread of multidrug-resistant Plasmodium falciparum malaria emphasises the urgent need for alternative treatment regimens. The objective of the study was to establish the efficacy of a novel drug combination. We compared a combination of atovaquone and proguanil with amodiaquine in the treatment of acute uncomplicated P falciparum malaria in Lambaréné, Gabon.

METHODS

142 adults were randomly allocated either a combination treatment of atovaquone 1000 mg daily and proguanil 400 mg daily for 3 days or treatment with amodiaquine 600 mg on admission, 600 mg 24 h later, and 300 mg after a further 24 h. Symptoms and clinical signs were recorded and giemsa-stained thick blood smears were done every 12 h until patients had been symptom-free and aparasitaemic for 24 h. 126 patients were followed up for 28 days or until recrudescence.

FINDINGS

In the atovaquone plus proguanil group 62 (87%) of 71 patients were cured and only one had recrudescent infection. By contrast, the cure rate was significantly lower (p=0.022) with amodiaquine (51 [72%] of 71; there were 12 recrudescences in the amodiaquine group). Eight patients in each group were lost to follow-up. Patients treated with atovaquone plus proguanil complained of nausea (33%) and vomiting (29%), and the most commonly reported adverse effects of amodiaquine were pruritus (43%) and insomnia (27%).

INTERPRETATION

Atovaquone and proguanil was a highly effective and safe drug combination in patients with acute uncomplicated P falciparum malaria in Gabon.

A study to compare ibuprofen effervescent granules with ibuprofen tablets in the treatment of acute dental pain

PURPOSE OF STUDY

To compare both the speed of onset and efficacy of the analgesia produced by the effervescent granule formulation with that produced by the conventional-release tablet formulation of ibuprofen in patients suffering acute dental pain and to record the incidence and severity of any adverse events.

POPULATION STUDIED

Dental out-patients of either sex and over 16 years of age requiring surgical removal of unilateral or bilateral lower third molar teeth under general anaesthesia as day cases.

METHODS

A total of 50 patients received the effervescent granules formulation of ibuprofen 600 mg (Brufen Granules) as study treatment and 50 received the 600 mg tablet formulation in this investigator-blind, parallel-group multiple-dose study. Surgery was performed under general anaesthesia by one or two dental surgeons. Patients received either one sachet of ibuprofen granules or one tablet of ibuprofen at six-hourly intervals for up to 24 hours once post-operative pain became moderate to severe.

FINDINGS

Both treatments were shown to be efficacious in treating post-operative dental pain. The granules were found to give significantly better pain relief in the first 30 minutes following the first dose. This may be owing to a more rapid absorption from the granules formulation in these patients and/or a local action of ibuprofen in solution in the mouth.

CONCLUSION

The effervescent soluble form of ibuprofen (Brufen Granules) is preferable to the conventional tablet form in managing the immediate dental pain experienced post-operatively by most patients because of its faster onset of action.

Tailoring nicotine addiction treatments for chemical dependency patients

The growing scientific evidence for addressing nicotine addiction in chemical dependency (CD) treatment programs is reviewed. This evidence provided the impetus for a survey of smoking patterns and quitting motivation and barriers among CD patients to identify ways to tailor standard nicotine addiction treatment methods and goals to their needs. Smoking history questionnaires were administered to 118 consecutive patients in a residential CD treatment program. The 66% of patients who smoked were predominantly heavy smokers, highly addicted (mean 25 cigarettes per day, 76% smoking within 30 minutes of waking). Although 63% of patients were "precontemplators," most of the sample had a history of one or more serious quit attempts, most reported strong beliefs in smoking harms and quitting benefits, and almost half reported a strong desire to stop smoking. Major quitting barriers included the usual psychological and physical sequelae of tobacco abstinence in addition to being around other smokers. Surprisingly, very few patients expressed concerns that quitting smoking would threaten drug or alcohol sobriety. Treatment implications are discussed. In addition, a pilot 4-session group treatment program is described. This program was geared to motivating smokers in "precontemplation" and "contemplation" stages of change to move ahead into the "action" stage (i.e., taking steps to quit).

A whole blood control for blood count analysers, and source material for an external quality assessment scheme

An inexpensive and simple to prepare stable whole blood control material for blood count analysers has been evaluated. The material has been used for an external quality assessment scheme for 3 years, and during part of this period as a calibrant for two aperture impedance devices.

Squamous cell cancer of the larynx in an intravenous drug user with AIDS

We present the case of a 29-year-old intravenous drug user with AIDS and squamous cell cancer of the larynx. Profound immunosuppression was evident by an OKT4:OKT8 ratio of 0.1. Simultaneous treatment of the laryngeal cancer by laser vaporization and treatment of immunosuppression with zidovudine resulted in no tumor recurrence after one year.