Clinical Effects of Cigarette Smoking: Epidemiologic Impact and Review of Pharmacotherapy Options

Cigarette smoking-a crucial modifiable risk factor for organ system diseases and cancer-remains prevalent in the United States and globally. In this literature review, we aim to summarize the epidemiology of cigarette smoking and tobacco use in the United States, pharmacology of nicotine-the active constituent of tobacco, and health consequence of cigarette smoking. This article also reviews behavioral and pharmacologic interventions for cigarette smokers and provides cost estimates for approved pharmacologic interventions in the United States. A literature search was conducted on Google Scholar, EBSCOhost, ClinicalKey, and PubMed databases using the following headings in combination or separately: cigarette smoking, tobacco smoking, epidemiology in the United States, health consequences of cigarette smoking, pharmacologic therapy for cigarette smoking, and non-pharmacologic therapy for cigarette smoking. This review found that efficacious non-pharmacologic interventions and pharmacologic therapy are available for cessation of cigarette smoking. Given the availability of efficacious interventions for cigarette smoking cessation, concerted efforts should be made by healthcare providers and public health professionals to promote smoking cessation as a valuable approach for reducing non-smokers' exposure to environmental tobacco smoke.

Prescribing Patterns of Metformin in High-risk Patients with Prediabetes

AIMS

The primary objective of this study is to examine the rates of metformin prescribing in patients with prediabetes who are either less than 60 years of age, have a BMI greater than 35 kg/m2, or women with a history of gestational diabetes mellitus (GDM). Secondary objectives include: 1) examination of the time from diagnosis of prediabetes to the initiation of metformin and 2) if metformin initiation status and length of time correlates to the patient having any other additional diabetes mellitus (DM) risk factors.

METHODS

This was a single center, retrospective cohort study. This study included all patients with prediabetes, defined as having hemoglobin A1c (HbA1c) of 39 through 46 mmol/mol (5.7-6.4 percent), who were patients at the Interim LSU Hospital and Clinics from January 2012-September 2013.

RESULTS

There were a total of 13 patients out of 160 patients in the study population who were prescribed metformin for an overall metformin initiation rate of 8.1 percent. The metformin initiation rate for the three individual groups; history of GDM, aged less than 60 years, and BMI greater than 35 kg/m2 were 0 percent, 9.0 percent, and 17.5 percent respectively.

CONCLUSION

Metformin initiation rates in patients with prediabetes are not in accordance with current recommendations, and provider education is necessary to increase rates to delay or prevent the progression of prediabetes to type 2 Diabetes Mellitus.

The reliability of three sagittal reference planes in the assessment of Class II treatment

This investigation evaluated the reliability and validity of three anteroposterior skeletal measurements using the maxillary-mandibular (MM) Bisector, the functional occlusal plane (FOP), and the bisected occlusal plane (BOP) as reference planes in the assessment of anteroposterior discrepancies. Comparisons were made between these measurements in both treated and control samples of Class II Division 1 patients. The data were collected from pretreatment, posttreatment, and 2 years posttreatment lateral cephalograms of 36 Class II Division 1 subjects whose treatment was nonextraction with low or straight pull headgears. Comparisons were made to an untreated control group of 15 Class II Division 1 subjects. The MM Bisector was found to be a highly reproducible reference plane whose greater stability was demonstrated by a lack of change in its cant during growth or during growth and treatment, compared with the BOP or FOP. With the ANB angle used as a standard, and MM Bisector anteroposterior measure was a more reliable and valid indicator of the skeletal anteroposterior relationship of the jaws, especially longitudinally during growth and treatment, than the Wits appraisals made with either the FOP or BOP.