Am J Sports Med.  2006; 34(9):1401-12 (ISSN: 0363-5465)

Beynnon BD; Renström PA; Haugh L; Uh BS; Barker H
Department of Orthopaedics & Rehabilitation, McClure Musculoskeletal Research Center, University of Vermont, Burlington, VT 05405-0084, USA. bruce.beynnon@uvm.edu

BACKGROUND: Acute ankle ligament sprains are treated with the use of controlled mobilization with protection provided by external support (eg, functional treatment); however, there is little information regarding the best type of external support to use. HYPOTHESIS: There is no difference between elastic wrapping, bracing, bracing combined with elastic wrapping, and casting for treatment of acute, first-time ankle ligament sprains in terms of the time a patient requires to return to normal function. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Patients suffering their first ligament injury were stratified by the severity of the sprain (grades I, II, or III) and then randomized to undergo functional treatment with different types of external supports. The patients completed daily logs until they returned to normal function and were followed up at 6 months. RESULTS: Treatment of grade I sprains with the Air-Stirrup brace combined with an elastic wrap returned subjects to normal walking and stair climbing in half the time required for those treated with the Air-Stirrup brace alone and in half the time required for those treated with an elastic wrap alone. Treatment of grade II sprains with the Air-Stirrup brace combined with the elastic wrap allowed patients to return to normal walking and stair climbing in the shortest time interval. Treatment of grade III sprains with the Air-Stirrup brace or a walking cast for 10 days followed by bracing returned subjects to normal walking and stair climbing in the same time intervals. The 6-month follow-up of each sprain severity group revealed no difference between the treatments for frequency of reinjury, ankle motion, and function. CONCLUSION: Treatment of first-time grade I and II ankle ligament sprains with the Air-Stirrup brace combined with an elastic wrap provides earlier return to preinjury function compared to use of the Air-Stirrup brace alone, an elastic wrap alone, or a walking cast for 10 days.

Drinking fruit and vegetable juices may delay the onset of Alzheimer’s disease (AD), according to a population-based study of 1836 Japanese Americans who were dementia-free at baseline (1992-1994) and were followed through 2001. Compared with those who drank juices less than once weekly, the hazard ratio for AD was 0.84 in those who drank juices once or twice weekly and 0.24 in those who drank juices at least 3 times weekly. These effects were greatest in those who were not physically active or were at increased risk for AD. No association was found in this study between risk of AD and dietary intake of vitamin E, C, or beta-carotene or tea consumption.

Dai Q, et al. Fruit and vegetable juices and Alzheimer’s disease: the Kame Project. Am J Med. 2006; 119:751-759.

Smokers who use pills to try to kick the habit should keep trying, even if the drugs do not work at first, a U.S. researcher advised on Saturday.

It can take several weeks for many people to fully wean themselves off tobacco, the researcher at Oregon Health & Science University said in a statement.

“Our recent analysis shows smokers and clinicians should not be discouraged when total abstinence is not achieved in the first weeks of treatment with smoking cessation medications,” said David Gonzales, director of the university’s smoking cessation center.

Gonzales presented his work at a meeting of the Society for Research on Nicotine and Tobacco in Austin, Texas.

Gonzales and colleagues have been studying how well the drugs Chantix or Zyban work, and published one study last year. They analyzed this and another study to see if it took some people longer to quit than others when they used the drugs.

Varenicline, marketed as Chantix by Pfizer and bupropion, marketed as Zyban or Wellbutrin by GlaxoSmithKline, can both help smokers quit and are licensed for that use. Zyban is an antidepressant and Chantix is designed to block nicotine in the brain.

Gonzales and colleagues evaluated Chantix versus Zyban in more than 1,000 smokers from June 2003 to April 2005 and found Chantix worked better to help people quit.

But no one looked at what would happen if those who did not succeed kept trying.

“If smokers on medication don’t quit in the first week or two following their target quit date, clinicians often will instruct their patients to discontinue their medication. Clinicians consider this a failed attempt,” said Gonzales, who has had contracts with Pfizer, Glaxo and several other drug companies.

Researchers found that 24 percent of those taking Chantix were able to quit right away, versus 18 percent taking Zyban and just 10 percent given a placebo.

But an additional 20 percent of those taking Chantix and 11 percent taking Zyban were able to quit if they kept trying through three months.

Most experts agree that tobacco is as addictive as heroin and cocaine, and people often take many tries before they are able to stop.

Copyright © 2007 Reuters Limited.

WASHINGTON (Reuters) - A drug used to treat schizophrenia was mailed to some consumers who had ordered other medications via the Internet, and several users had to seek emergency treatment because they could not breathe, U.S. health officials said on Friday.

The U.S.

Food and Drug Administration said that instead of receiving the products they ordered, some consumers were sent the prescription drug haloperidol. Several patients had to seek emergency care after taking the pills, the agency said without citing a specific number.

Sold legally as Haldol by Johnson & Johnson and in other generic versions, the anti-psychotic drug is know to cause muscle spasms, muscle stiffness, agitation and sedation.

Buying medication online has been controversial.

Sales of drugs from other countries over the Internet is illegal in the United States, and the FDA has repeatedly warned consumers not to buy them that way. At the same time, supporters say reputable pharmacies abroad can offer safe medications at a cheaper price.

In the latest incident, the agency said, packages were postmarked from Greece but it was not known where the pills were manufactured.

Consumers had been trying to order specific drugs online, including Sanofi-Aventis’ Ambien, Pfizer Inc.’s Xanax, Forest Laboratories Inc.’s Lexapro and Ativan, sold by Baxter International Inc. and Biovail Corp..

The agency said those who have received medications from an Internet seller should compare them to photos of the faulty orders, which can be seen on the FDA’s Web site at http://www.fda.gov/bbs/topics/news/photos/haloperidol.html.

“If the tablets received from an Internet seller resemble those in the photos and haloperidol was not specifically ordered, do not take these tablets,” the agency said.

SAN FRANCISCO (Reuters Health) Feb 12 - Florida and Massachusetts have enacted legislation that requires emergency medical service personnel to transport all ischemic stroke patients to the nearest stroke center rather than the nearest medical center. This has resulted in an increase in the use of stroke centers and the use of tissue plasminogen activator (tPA).

Dr. James F. Meschia of the Mayo Clinic in Jacksonville, Florida, presented the results of the Florida Stroke Act of July 1, 2005 at the American Stroke Association’s International Stroke Conference 2007, held here last week.

Compared with the six months prior to July 1, 2005, during the six months following there was an increase of four patients per month to stroke centers, from 62.3 patients per month to 66.2 patients per month.

There were 3.8 patients per month treated with tPA before enactment of the mandate compared with 5.2 patients per month afterward, for a nearly 75% increase in the use of tPA for stroke patients.

“This is a nice closing of the loop, from a grassroots effort to the Joint Commission of the Accreditation of Health Organizations … legislation is having a public health impact,” Dr. Meschia said.

Meanwhile, Dr. Lee Schwamm of Massachusetts General Hospital and Harvard University in Boston reported that “an independent study in Massachusetts is coming up with some of the same conclusions.”

After enactment of the Massachusetts state mandate, 95% of stroke admissions were evaluated for tPA. “The major reason for not giving it, is because the patients were outside the three-hour window…In Massachusetts, we are using telemedicine to decrease evaluation time and to increase the use of tPA.”

Dr. Meschia commented, “The question now is, should this be state-wide or federal legislation? Sometimes, we’re five miles from a stroke center, but it’s

across the state line.”