AFP Clinical Answers
Coronary Syndrome, HPV Vaccination, Acute Sore Throat, Food Allergies, Breastfeeding
Am Fam Physician. 2019 Jun 15;99(12):737.
Is a cardiac troponin I concentration of less than 5 ng per L useful in identifying adults with acute coronary syndrome at low risk of myocardial infarction or death?
A systematic review found that a cardiac troponin I concentration of less than 5 ng per L in adults who present with potential acute coronary syndrome has a negative predictive value of at least 99.9% for cardiac death at 30 days and at one year.
Is prophylactic vaccination against HPV safe and effective in preventing infection and cervical cancer precursors?
Human papillomavirus (HPV) vaccination in women 15 to 26 years of age prevents the development of cervical intraepithelia l neoplasia 2 and 3 in women regardless of previous HPV exposure (number needed to treat = 39). Short-term local adverse effects (pain, erythema, or swelling at the injection site) were more common in women who received the vaccine vs. those who did not, but no serious adverse effects were observed. There was no increased risk of miscarriage among women who became pregnant during the trials. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends prophylactic HPV vaccination for all girls 11 to 12 years of age, with catch-up vaccination for girls 13 to 26 years of age for the primary prevention of cervical cancer.
What are the benefits of a single dose of an oral corticosteroid in patients with acute sore throat?
In patients five years and older with acute sore throat, corticosteroids increase the likelihood of symptom resolution at 48 hours. However, they do not considerably reduce the severity or duration of pain or improve other patient-oriented outcomes (e.g., time off from work or school, risk of relapse).
What exposures should physicians ask about in patients with suspected food allergy?
Patients with suspected food allergy should be asked about exposure to cow's milk, hen's eggs, soy, fish, shellfish, tree nuts, wheat, and peanuts, because these are responsible for most food allergies.
What are the infant and maternal benefits of breastfeeding?
Infant benefits include decreased risk of atopic dermatitis and gastroenteritis, as well as higher IQ later in life. Maternal benefits include decreased risk of breast cancer, ovarian cancer, cardiometabolic disease (type 2 diabetes mellitus, hypertension, and cardiovascular disease), and postpartum depression.
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