Clinical Inquiry: Do statins increase the risk of developing diabetes?

Statin therapy produces a small increase in the incidence of diabetes: one additional case per 255 patients taking statins over 4 years.

Clinical inquiry: does frenotomy help infants with tongue-tie overcome breastfeeding difficulties?

No evidence exists for improved latching after frenotomy, and evidence concerning improvements in maternal comfort is conflicting. At best, frenotomy improves maternal nipple pain by 10% and maternal subjective sense of improvement over the short term (0 to 2 weeks).

Clinical Inquiry: which oral antifungal works best for toenail onychomycosis?

Terbinafine, 250 mg daily for 12 to 16 weeks, produces higher clinical cure rates than either pulsed-dose itraconazole or weekly fluconazole. Daily oral dosing is more effective than pulsed-dose terbinafine.

Clinical Inquiry: Do venlafaxine and gabapentin control hot flashes in women with a history of breast cancer?

Venlafaxine reduces hot flashes more than placebo in women with a history of breast cancer; adverse effects include dry mouth and constipation.

Clinical Inquiry: What treatments relieve painful heel cracks?

Emollient cream may alleviate pain and dryness and improve the appearance of heel cracks.

Clinical Inquiry. Multivitamins for healthy children: what are the true benefits?

The benefits appear to be limited. It's doubtful that multivitamin with mineral (MVM) supplementation improves IQ in healthy, low-risk children.

Clinical Inquiry. Do inhaled steroids reduce bone mineral density and increase fracture risk?

No, except perhaps at high doses. Inhaled corticosteroids at low to medium doses (<1500 mcg beclomethasone hydrofluoroalkane per day) for asthma and chronic obstructive pulmonary disease don't increase the risk of significant bone loss or fracture at 2 to 3 years follow-up. Higher doses, however, may raise the risk of nontraumatic fracture over 1 to 4 years of follow-up.

Clinical inquiries. Intranasal steroids vs antihistamines: which is better for seasonal allergies and conjunctivitis?

Intranasal steroids provide better relief for adult sufferers, according to nonstandardized, nonclinically validated scales. Steroids reduce subjective total nasal symptom scores (TNSS)--representing sneezing, itching, congestion, and rhinorrhea--by about 25% more than placebo, whereas oral antihistamines decrease TNSS by 5% to 10% (strength of recommendation [SOR]: B, systematic review of randomized controlled trials [RCTs], most without clinically validated or standardized outcome measures). Intranasal steroids improve subjective eye symptom scores as well as (or better than) oral antihistamines in adults who also have allergic conjunctivitis (SOR: A, systematic review, RCTs).

Clinical inquiries. Which regimen treats vitamin D deficiency most effectively?

Several vitamin D replacement regimens are effective. Cumulative dosing may be more important than frequency of dosing (strength of recommendation [SOR]: C, inconsistent results from randomized controlled trials [RCTs] of disease-oriented outcomes).Vitamin D3 (cholecalciferol) may increase serum 25-hydroxy vitamin D (25[OH]D) concentrations more effectively than vitamin D2 (ergocalciferol) (SOR: C, a single RCT of disease-oriented outcomes).

Clinical inquiry. Postcholecystectomy diarrhea: what relieves it?

A trial of a bile acid binder such as cholestyramine or colestipol may benefit patients with postcholecystectomy diarrhea.

Clinical inquiry: what's the best way to relieve mastitis in breastfeeding mothers?

Frequent breast emptying helps both infectious and noninfectious mastitis. Antibiotics may be useful for women with positive milk cultures, but their utility for treating undifferentiated mastitis is unknown. Consider prescribing antibiotics for women whose mastitis symptoms don' t improve after 12 to 24 hours of frequent breast emptying.

Clinical Inquiry. What is the prognosis for patients with chronic urticaria?

The prognosis for chronic urticaria in primary care is unknown; studies in dermatology clinics in multiple countries report complete resolution in approximately one-third of patients with idiopathic chronic urticaria over 1 to 5 years and partial improvement in another third. Patients younger than 30 years with more severe symptoms, or symptoms with physical causes, fared less well (strength of recommendation: B, cohort studies).