Interesting Articles: A Weekly Review of the "Big Five" Medical Journals

This is a collection of articles I have found interesting in the weekly editions of the "big five" medical journals: NEJM, JAMA, Annals, Lancet and BMJ (a few more journals are included occasionally). The review is a weekly feature of Clinical Cases and Images - Blog. Please see the end of the post for a suggested time-efficient way to stay up-to-date with the medical literature.

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From All Walks of Life — Nontraditional Medical Students and the Future of Medicine.
NEJM, Volume 359:224-227 July 17, 2008 Number 3

"When I entered medical school at 26, I was considered to be a nontraditional student — but I was hardly alone."

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Long-Term Medical and Social Consequences of Preterm Birth: Significant.
NEJM, Volume 359:262-273 July 17, 2008 Number 3

Advances in perinatal care have increased the number of premature babies who survive. There are concerns, however, about the ability of these children to cope with the demands of adulthood. In a cohort of 903,402 infants in Norway, the risks of medical and social disabilities in adulthood increased with decreasing gestational age at birth.

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Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.
NEJM, Volume 359:229-241 July 17, 2008 Number 3

Mediterranean and low-carbohydrate diets (Atkins) may be effective alternatives to low-fat diets. There was a more favorable effects on lipids with the low-carbohydrate diet, and on glycemic control with the Mediterranean diet.

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Moderate-to-Vigorous Physical Activity From Ages 9 to 15 Years: Decreasing.
JAMA. 2008;300(3):295-305.

Decreased physical activity plays a critical role in the increase in childhood obesity. At least 60 minutes per day of moderate-to-vigorous physical activity (MVPA) is recommended. In a study cohort of 1000 children, measured physical activity decreased significantly between ages 9 and 15 years.

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Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study.
The Lancet 2008; 372:224-233.

Whether lipoproteins are better markers than lipids and lipoproteins for coronary heart disease is widely debated. In a study of 12,461 AMI cases, the non-fasting ApoB/ApoA1 ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infarction in all ethnic groups, in both sexes, and at all ages, and it should be introduced into worldwide clinical practice.

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Effect of dimebon on cognition, activities of daily living, behaviour, and global function in patients with mild-to-moderate Alzheimer's disease: a randomised, double-blind, placebo-controlled study.
The Lancet 2008; 372:207-215.

Dimebon was safe, well tolerated, and significantly improved the clinical course of patients with mild-to-moderate Alzheimer's disease. Dimebolin Hydrochloride (Dimebon) is an antihistamine drug which has been used clinically in Russia since 1983.

Ginkgo biloba and fish oils through lecithin and vitamin concoctions supposed to aid concentration, improve memory, and boost IQ. Sadly, a cool look at the evidence suggests that none are particularly helpful.

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Statins for children?
The Lancet 2008; 372:178.

The American Academy of Pediatrics has issued new guidelines on cholesterol screening and treatment recommendations in childhood: a fasting lipid profile is recommended between the ages of 2 and 10 years for children with a family history of high cholesterol or premature heart disease.

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The First Use of Penicillin in the United States.
Ann of Int Med 15 July 2008 | Volume 149 Issue 2 | Pages 135-136

The first use of penicillin in the United States occurred in 1942 and saved a moribund patient who had β-hemolytic streptococcal sepsis.

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Prehypertension during Young Adulthood Leads to Increased Coronary Calcium Later in Life.
Ann of Int Med 15 July 2008 | Volume 149 Issue 2 | Pages 91-99

High blood pressure in middle age is a well-established risk factor for cardiovascular disease, but the consequences of low-level elevations during young adulthood are unknown. Prehypertension during young adulthood is common and is associated with coronary atherosclerosis 20 years later. Keeping systolic pressure below 120 mm Hg before age 35 years may provide important health benefits later in life.

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Bullous pemphigoid and pemphigus vulgaris—incidence and mortality in the UK: Increasing.
BMJ 2008;337:a180.

The median age at presentation for bullous pemphigoid was 80 years, and 61% of patients were female. The median age at presentation for pemphigus vulgaris was 71 years, and 66% of patients were female. Incidences of bullous pemphigoid and pemphigus vulgaris were 4.3 and 0.7 per 100 000 person years. Incidences of bullous pemphigoid and pemphigus vulgaris are increasing. Both disorders are associated with a high risk of death.

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Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study.
BMJ 2008;337:a171.

In this cohort of 970 patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.

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Studying medicine in China.
Student BMJ 2008;16:235 | 18.

A British medical student discovered some surprising similarities on a recent visit.

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Relation of iron and red meat intake to blood pressure: cross sectional epidemiological study. BMJ 2008;337:a258.

Non-haem iron has a possible role in the prevention and control of adverse blood pressure levels. An unfavourable effect of red meat on blood pressure was observed: red meat intake was directly associated with blood pressure; 102.6 g/24 h (2 SD) higher intake was associated with 1.25 mm Hg higher systolic blood pressure.

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A time efficient way to stay up-to-date with medical literature

"How do you eat in elephant? In small bites." The same rule probably applies to staying current with the ever expanding avalanche of medical literature. One can try the following approach:

1. Subscribe to the RSS feeds of the 5 major medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals in your field of interest.


Medical Journals tab: A screenshot of iGoogle with RSS feeds from the major medical journals.

2. Read the journal on the day it is published online, for example, NEJM on Wednesdays.

3. Use text-to-speech to listen to the articles you do not have time to read.

4. Listen to journal podcasts. Click here to subscribe the podcasts of the 4 major journals in iGoogle.

Related:
5 Tips to Stay Up-to-Date with Medical Literature
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.