Do insulin-sensitizing drugs increase ovulation rates for women with PCOS?

Short-term use of metformin (Glucophage) improves ovulation rates for women with polycystic ovary syndrome (PCOS) (strength of recommendation [SOR]: A, based on systematic reviews of randomized controlled trials [RCT]). Metformin also decreases menstrual irregularities (SOR: B, extrapolated from a systematic review). When added to clomiphene, metformin increases ovulation and pregnancy rates when compared with clomiphene alone (SOR: A, systematic review). Thiazolidinediones (TZDs) improve ovulation rates as well (SOR: B, based on low-quality RCTs). Research of longer duration including the key outcomes of pregnancy and birth rates, is needed to clarify the appropriate use of insulin-sensitizing drugs for PCOS

Effects of Soy Protein-Based Formula in Full-Term Infants

There are no significant long-term detrimental effects associated with the use of currently available, commercially produced, isolated soy protein-based formula in full-term infants. (Strength of Recommendation: B, based primarily on cohort studies). The number of well-controlled, long-term studies is limited

Is neurosurgery referral warranted for small brain aneurysms?

The risk of rupture of a small cerebral aneurysm (<10 mm) is very low in asymptomatic patients who have never had a subarachnoid hemorrhage. Because the risk of morbidity and mortality from surgical intervention significantly exceeds that of nonsurgical monitoring for this group, primary care physicians do not need to refer patients with this condition to a neurosurgeon for clipping (strength of recommendation [SOR]: B, based on cohort and case-control studies). For patients managed conservatively, annual office follow-up and imaging evaluation should be considered, and is necessary if a specific symptom should arise (SOR: C, based on expert opinion)

What are the indications for meningococcal vaccination?

Routine vaccination with the meningococcal conjugate vaccine MCV4 (Menactra) is indicated for all US adolescents entering high school and for college freshmen living in dormitories (strength of recommendation [SOR]: B, based on observational studies). Routine vaccination of infants and toddlers with conjugate vaccine may be more cost- effective than targeting adolescents, but conjugate meningococcal vaccine for this age group is not yet available in the US (SOR: B, based on cohort studies)

Is there much risk in using fluoroquinolones in children?

Arthralgias and myalgias have been observed clinically in children and adolescents exposed to fluoroquinolones, but they're transient, disappear when the drug is discontinued, and appear to be no more prevalent than with other antibiotics (strength of recommendation [SOR]: B, 1 structured review and 2 prospective cohort studies). No apparent long-term risk of developmental skeletal growth delay is associated with fluoroquinolone exposure (SOR: B, 1 prospective controlled study)

What precautions should we use with statins for women of childbearing age?

Statins are contraindicated for women who are pregnant or breastfeeding. Data evaluating statin use for women of childbearing age is limited; however, they may be used cautiously with adequate contraception. Pravastatin may be preferred based on its low tissue-penetration properties. Cholesterol-lowering with simvastatin 40 mg/d did not disrupt menstrual cycles or effect luteal phase duration (strength of recommendation: C)

What are the risks and benefits of elective induction for uncomplicated term pregnancies?

Elective induction of labor for term, singleton, uncomplicated pregnancies appears safe for both the mother and infant (strength of recommendation [SOR]: B). The benefit of elective induction for nonmedical reasons is unclear (SOR: B)

How useful are autoantibodies in diagnosing thyroid disorders?

Thyrotropin receptor antibodies (TRAb) may be mildly elevated in a variety of thyroid disorders, but a TRAb level >10 U/L increases the probability of Graves' disease by a moderate to large degree (strength of recommendation [SOR]: B, cross-sectional study). A positive or negative thyroid peroxidase antibody (TPOAb) test increases or decreases the probability of autoimmune thyroid disease by only a small to moderate degree (SOR: B, 3 cross-sectional studies)

Corticosteroids for presumed pneumocystis pneumonia in patients with HIV infection

Adjunctive corticosteroids decrease mortality in patients with HIV infection who have moderate to severe hypoxemia and suspected or confirmed pneumocystis pneumonia. Corticosteroids lead to a higher incidence of herpetic lesions, but not other opportunistic conditions. (Strength of recommendation: A, based on a systematic review of randomized controlled trials [RCTs].

What is angular cheilitis and how is it treated?

Cheilitis is a broad term that describes inflammation of the lip surface characterized by dry scaling and fissuring. Specific types are atopic, angular, granulomatous, and actinic. Angular cheilitis is commonly seen in primary care settings, and it specifically refers to cheilitis that radiates from the commissures or corners of the mouth. Other terms synonymous with angular cheilitis are perlèche, commissural cheilitis, and angular stomatitis. Evidence reveals that topical ointment preparations of nystatin or amphotericin B treat angular cheilitis (strength of recommendation [SOR]: A, 2 small placebo-controlled studies). Improving oral health through regular use of xylitol or xylitol/chlorhexidine acetate containing chewing gums decreases angular cheilitis in nursing home patients (SOR: B, 1 cluster randomized, placebo-controlled trial)