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Am Fam Physician. 2001;64(11):1801

Having a broken heart could cause a broken heart. According to a case-control study published in the British Medical Journal, patients who have taken tricyclic antidepressants are at an increased risk for developing ischemic heart disease (IHD). The study matched 933 patients with IHD with 5,516 control patients. Even after adjusting for confounding factors of diabetes, hypertension, smoking and body mass index, the odds ratio was increased in IHD patients who had ever been prescribed an antidepressant before their diagnosis. Repeating the analysis for the three most commonly prescribed tricyclic antidepressants, the odds ratio for dosulepin (not marketed in the United States) remained high after adjusting for confounding factors.

Losing weight isn't always lifesaving. Losing as little as 5 percent of body weight over a three-year period is associated with an increased risk of mortality in older adults. According to study results reported in the University of Pittsburgh Schools of Health Sciences newsletter, older adults who had a weight loss of 5 percent and a lower starting weight had an increased mortality rate over three years of 7.4 percent. Those who gained weight or remained the same had an increased mortality rate of only 2 percent. The weight loss may be associated with serious geriatric illness.

The number and frequency of seizures in children with seizure disorders can be reduced by feeding them a high-fat, low-carbohydrate diet. According to a multi-center study published in Pediatrics, the diet is more effective and better tolerated than many anticonvulsants. After following a ketogenic diet for three to six years, 13 percent of the children in the study were seizure free. An additional 14 percent of the 150 children aged one to 16 had a 90 percent decrease in the number and frequency of seizures.

Survey results published in American Medical News show that more residents entering medical practice are selecting jobs in metropolitan areas. The survey polled 300 final-year primary care and specialty residents. Twenty-five percent of the residents preferred to practice in communities with populations of 250,000 to 500,000. None of the residents wanted to practice in a town of less than 10,000. Geographic location/lifestyle is the main consideration for residents as they search for a job. In addition, 58 percent of those surveyed said educational loan forgiveness also influences their job decision.

Here's new hope for recovery from heroin addiction: in a new procedure called ultrarapid opiate detoxification (UROD), the addicted patient is under anesthesia for four to six hours to avoid painful withdrawal symptoms. UROD causes drastic physical changes that must be managed with an anesthesiologist present. According to research presented at the American Society of Anesthesiologists annual meeting, the procedure is followed by several months of daily treatment with antagonists that block the narcotic's effects.

New baby on board? Be sure the stork also delivers a dog or cat. Children exposed to two or more pets in the first year of life have fewer allergies later on, according to a study published in Family Practice News. A positive skin test for allergies occurred in only 15 percent of the children who grew up with a Fluffy or a Fido. The children who lived in pet-free homes had a 34 percent positive rate on skin testing for allergies.

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Copyright © 2001 by the American Academy of Family Physicians.

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