Literature Review

Nancy Risser, MN, RN,C, ANP

Mary Murphy, CPNP, PhD
Literature Review Editors

preceded the development of depressive symptoms.

anaphylaxis should be referred to an

allergist, since the potential risk of
anaphylaxis is reduced to 2% in
those receiving immunotherapy.

PSYCHIATRIC CARE

Memory Loss Precedes

Depression

EMERGENCY CARE

Vinkers DJ, Gussekloo J, Stek ML, et al:

Temporal relation between depression and

Insect Sting Allergy

cognitive impairment in old age: prospective

Freeman TM: Hypersensitivity to

population based study. BMJ 2004;329:881-3.

hymenoptera stings. N Engl J Med

Drug Therapy for Heart Failure

The authors studied the temporal relationship between depression and

memory loss by prospectively following all 85-year-old inhabitants of Leiden, Netherlands whose baseline
mini-mental state exam (MMSE) did
not show severe cognitive impairment (score > 19 points of a total 30
points). At baseline, 37% of the 500
participants were men, 67% had no
significant depressive symptoms
(score < 2 points on a geriatric depression scale), and 83% had no serious dementia (score > 24 on
MMSE). Although depressive symptoms and cognitive impairment were
significantly correlated on crosssectional analysis, depressive symptoms at baseline did not predict a
more rapid cognitive decline. On
the other hand, cognitive impairment at baseline was associated with
an accelerated increase of depressive
symptoms over the 4 years of follow-up. In this group of community-based elderly persons,
impairment of memory or attention

2004;351(19):1978-84.

Taylor AL, Ziesche S, Yancy C, et al:

Stings from fire ants, bees, hornets,

wasps, and yellow jackets can lead to
serious consequences. Local reactions to hymenoptera stings can be
treated with nonsteroidal anti-inflammatory agents, antihistamines,
and cold compresses. Epinephrine
by injection is the definitive therapy
for anaphylaxis. Failure or delay in
administering epinephrine to any
patient who has more than a cutaneous reaction increases the chance
of fatal outcome in anaphylaxis. After a sting, the future risk of anaphylactic reactions ranges from 3% in
the general population to 10% in
adults with a large local reaction,
and up to 50% to 60% in adults or
children with previous anaphylaxis.
Any patient who has had an anaphylactic reaction to a hymenoptera
sting should be provided information on avoidance, be advised to
wear a medic alert bracelet, and be
prescribed an epinephrine auto-injector. Patients with a clear history of

Combination of isosorbide dinitrate and

CARDIOVASCULAR CARE

hydralazine in blacks with heart failure. N

Engl J Med 2004;351(20):2049-57.
Hare JM: Nitroso-redox balance in the cardiovascular system. N Engl J Med
2004;351(20):2112-14(editorial).
Bloche MG: Race-based therapeutics. N
Engl J Med 2004;351(20):2035-37(editorial).

African-American patients may have

a lower bioavailability of nitric oxide
than Caucasian patients, increasing
their level of cardiovascular risk. To
test the benefit of a fixed dose of
isosorbide dinitrate and hydralazine
hydrochloride in African-Americans
with severe heart failure, more than
1,000 African-American patients
with left ventricular ejection fractions of < 35%, who were already receiving standard therapy at 161
United States centers, were randomized to receive active drug or placebo.
The study was terminated early after
3 years due to a significantly higher
death rate in the placebo group than
in the therapy group (10.2% vs.

Literature Review offers succinct summaries of articles published in recent clinical journals.
The journals reviewed include: American Family Physician American Journal of Medicine Annals of Internal Medicine Archives of Pediatric and
Adolescent Medicine British Journal of Medicine CA: A Cancer Journal for Clinicians Cancer Clinical Pediatrics Journal of Emergency Medicine
Journal of the American Medical Association Journal of Pediatric Health Care Obstetrics and Gynecology Lancet Mayo Clinic Proceedings MCN: The
American Journal of Maternal/Child Nursing The Medical Letter Morbidity and Mortality Weekly Report New England Journal of Medicine Pediatric
Annals Pediatric Nursing Pediatrics Pediatrics in Review

62 The Nurse Practitioner Vol. 30, No. 2

www.tnpj.com

Literature Review
6.2%, p =0.02). A dose of 75 mg hydralazine and 40 mg of isosorbide
three times daily led to a 43% reduction in 1-year mortality compared to
standard therapy. Growing evidence
supports the concept that nitric oxide protects against myocardial and
vascular remodeling. Isosorbide has a
vasodilatory effect by donating nitric
oxide, and hydralazine prolongs the
vasodilatory effects by preventing
degradation of nitric oxide to superoxides. Because the population in
this study was narrowly specified, it
remains unknown whether these two
drugs in combination with an angiotensin-converting enzyme (ACE)
inhibitor would improve survival
among patients with heart failure in
general or among patients in other
racial groups beyond that achieved
by ACE inhibitor alone.
Glycosated Hemoglobin and
Renal Function: New Cardiovascular
Risk Factors
Khaw K, Wareham N, Bingham S, et al:
Association of hemoglobin A1C with cardiovascular disease and mortality in adults: The
European Prospective Investigation into

rates of cardiovascular disease and

all-cause mortality. For an increase in
1% in hemoglobin A1C, the relative
risk for death was 1.24 in men and
1.28 in women.
Cardiovascular risk is also elevated when there are mild degrees of
renal dysfunction even when serum
creatinine is in the normal range. As
part of the Valsartan in Acute Myocardial Infarction Trial, Anavekar
and colleagues studied 14,527 patients with known serum creatinine.
Glomerular filtration rate (GFR) at
baseline was estimated. A GFR of 75
mL/min/1.73m2 corresponds to a
serum creatinine between 0.8 and 1.0
mg/dL. Below 81 mL/min/1.73m2,
each reduction in GFR by 10 units
was associated with a hazard ratio for
death and nonfatal cardiovascular
outcomes of 1.10. These studies illustrate the increase in risk that is associated with measures of
hyperglycemia and renal impairment. On a population basis, lifestyle
changes that will normalize glucose
and kidney function are likely to
have a significant impact on future
cardiovascular disease incidence.

Cancer in Norfolk. Ann Intern Med

2004;141(6):413-20.
Anavekar NS, McMurray JJV, Velazquez
EJ, et al: Relation between renal dysfunction
and cardiovascular outcomes after myocardial infarction. N Engl J Med
2004;351(13):1285-95.

PEDIATRIC/ADOLESCENT CARE

Gerstein HC. Glycosated hemoglobin:

finally ready for prime time as a cardiovas-

Pediatric Cardiology

cular risk factor. Ann Intern Med

Pham P, Silberbach M: Whats new in pedi-

2004;141(6):475-6(editorial).

atric cardiology. Pediatr Rev 2004;

Hostetter TH: Chronic kidney disease

predicts cardiovascular disease. N Engl J
Med 2004;351(13):1344-6(editorial).

Cardiovascular risk increases with

higher levels of hemoglobin A1C, even
when diabetes is not present. Khaw
and colleagues prospectively followed a group of 10,000 subjects 45
to 79 years of age. Persons with hemoglobin A1C < 5% had the lowest
www.tnpj.com

25(11):381-6.

This article briefly reviews some of

the advances in cardiac development,
pathogenesis of heart disease, and
current diagnostic and therapeutic
interventions. There are advances in
noninvasive imaging and treatment
of congenital heart disease. Children
with complex congenital cardiac lesions can undergo precise and mini-

mally invasive transesophageal

echocardiography before risking
surgery. Transesophageal echocardiography is multiplane imaging that
can be used on infants weighing as
little as 1,500 g. Continuing genetic
research suggests that many cardiac
malformations begin as genetic defects. Gene linkage studies, modifier
genes, and single gene mutations
suggest the prognostic value of family genetic screening and prenatal
counseling.
Head Injuries in Children
Limbos MA, Ramirez M, Park LS, et al:
Injuries to the head among children enrolled
in special education. Arch Pediatr Adolesc
Med 2004: 158(11):1057-61.

This small study found head injury

rates among special education students were similar to rates for children without disabilities between
20% and 39%. Reviewing 697 events
from 6,769 students enrolled in 17
special education schools, the authors found children with emotional/mental disabilities had the
lowest rates (1.4 per 100 student
years), and boys were slightly higher
than girls (1.4 to 1.1 per 100 student
years). Injuries were classified by type
(abrasions, bruises, cuts, lacerations,
punctures), external causes (falls, collisions, other students), associated
activity (before or after school, physical education,
recess, classroom, toileting, transporting), and school location (playground, classroom, bathroom, bus,
hallway).
Results show most injuries were
from falls during physical education
or recess. The authors suggest that
the risk of head injuries in this population might be reduced by padding
furniture edges and floor surfaces in
the classroom, padding toileting and
changing areas, using helmets, and
maximizing supervision in bathrooms and playgrounds.
The Nurse Practitioner February 2005 63