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MENISCAL SURGERY 

Patient holding kneeMeniscal tears are frequently treated with arthroscopic meniscectomy, a common procedure performed close to a million times annually in the U.S. alone. The FIDELITY study, published in 2013, compared meniscectomy to sham surgery in 146 patients with medial meniscal tears. At one year, there was no significant difference between the groups in knee pain or function. Critics of FIDELITY note that the average age of participants was 52 years, and they argue that the results should not be applied to younger active patients. This issue was recently addressed in the DREAM study, where 121 young adults (average age 29 years) with meniscal tears were randomized to meniscal surgery or physical therapy. At 12 months, DREAM also found no benefit from surgery. Primary care providers have no financial incentive to promote surgery and are uniquely positioned to give candid advice to patients who are considering this procedure.

ORAL TESTOSTERONE PRODUCTS

Man holding capsuleWhen absorbed intestinally, testosterone undergoes the first-pass effect in the liver, rendering it inactive. To avoid this, drug manufacturers have developed products that are injected or absorbed through the skin, nose, and oral mucosa. In the past year, two testosterone capsules, Jatenzo and Tlando, have become available. They contain testosterone undecanoate, whose lipophilic properties facilitate its absorption by the intestinal lymphatic system, allowing it to avoid the first-pass effect. Links to information on both products are provided below, along with our review of male hypogonadism.

ACUTE MOUNTAIN SICKNESS STUDIES

Man on mountain peakAcute mountain sickness (AMS), also called altitude sickness, can develop when someone rapidly ascends from near sea level to more than 3000 meters. Symptoms include headache, lightheadedness, nausea, insomnia, and fatigue. AMS is believed to occur from hypoxia-induced respiratory alkalosis. The carbonic anhydrase inhibitor acetazolamide, which promotes renal bicarbonate loss, has been prescribed for years to people who are planning a high-altitude trip. Two recently published studies compared acetazolamide to placebo for the prevention of AMS; one study enrolled healthy adults, and the other involved patients with COPD. Acetazolamide was effective in both studies, although subgroup analyses showed that women saw a much greater benefit.
HELPFUL WEBSITES

QT prolongation warnings have become a common alert from drug interaction checkers. Unfortunately, there is not a lot of definitive guidance on handling these warnings, and it can be difficult to determine which ones are relevant. Two websites that provide information on medication-induced QT prolongation are provided below.
  • CredibleMeds - database of medications that have been associated with QT prolongation along with recommendations for their use
  • MedSafety Scan - app that provides QT prolongation information based on patient history and medication list
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