Does digoxin decrease morbidity for those in sinus rhythm with heart failure?

In patients with congestive heart failure due to systolic dysfunction who are in normal sinus rhythm, digoxin therapy reduces rates of hospitalization, as well as clinical deterioration, defined as worsening New York Heart Association (NYHA) classification or an increase in clinical signs and symptoms (strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCT]). These benefits appear to be more pronounced for men. Patients treated with digoxin are at increased risk of developing supraventricular dysrhythmias and second- or third-degree atrioventricular block (SOR: A, large RCT). It is unclear if patients with diastolic dysfunction experience similar benefits or harms (SOR: A, systematic review of RCTs). Digoxin has not been shown to have any effect on mortality for men with congestive heart failure in sinus rhythm (SOR: A, systematic review of RCTs). Digoxin use for women may be associated with an increased risk of mortality (SOR: B, extrapolation from RCT)

Does tight control of blood glucose in pregnant women with diabetes improve neonatal outcomes?

In pregnant women with preexisting type 1 diabetes mellitus, maintaining near-normal blood glucose levels decreases the rate of major congenital anomalies (defined as those causing death or a serious handicap necessitating surgical correction or medical treatment). Prolonged preconception control of blood sugar to near normal levels reduces the rate of major congenital anomalies close to those seen in women without diabetes (strength of recommendation [SOR]: A, based on prospective cohort studies and randomized controlled trial [RCT]). Intensive management reduces the risk of congenital anomalies more than conventional therapy, and lowers the risk of neonatal hypoglycemia (SOR: B, based on RCT). Very tight control does not reduce clinically significant neonatal morbidity but does increase the risk of maternal hypoglycemia (SOR: B, based on a systematic review)

Is there a role for theophylline in treating patients with asthma?

With adults, oral theophylline may help lower the dosage of inhaled steroids needed to control chronic asthma. It offers no benefit for acute asthma exacerbations. For children, intravenous aminophylline may improve the clinical course of severe asthma attacks. Side effects and toxicity limit use of these medications in most settings. (Grade of recommendation: A, based on systematic reviews and randomized control trials [RCTs])

What treatments relieve painful heel cracks?

Emollient cream may alleviate pain and dryness and improve the appearance of heel cracks (strength of recommendation [SOR]: B, one small randomized trial). Foot soaks followed by mechanical debridement and topical petrolatum may decrease the depth of cracks and thickness of calluses in patients with leprosy (SOR: C, 1 small cohort study). Keratolytic agents, such as salicylic acid, may reduce hyperkeratosis, cracks, and pain (SOR: C, one case-control study). Cyanoacrylate tissue adhesives, such as Superglue or Krazy Glue, may reduce pain and speed closure of heel cracks (SOR: C, one case series). Maintenance therapy with emollients and appropriate footwear also may help heel cracks (SOR: C, expert opinion)

Does pneumococcal conjugate vaccine prevent otitis media?

Yes, if the pneumococcal conjugate vaccine (PCV) series is given before 12 months of age. Vaccination before 12 months is associated with a statistically significant reduction in the incidence of both acute (AOM) and recurrent (ROM) otitis media (strength of recommendation [SOR]: A, a systematic review of randomized controlled trials [RCTs] and a large retrospective cohort trial). The benefit disappears if the series is started after 12 months (SOR: B, a systematic review of RCTs with inconsistent results). PCV reduces tympanostomy tube placement for ROM (SOR: A, a large RCT and retrospective cohort trials)