croup

Corticosteroids seem to bring quick relief of symptoms.

* THE QUESTION A harsh, barking cough and severe congestion has sent many an anxious parent and sick child to the emergency room late at night. For serious cases of croup, corticosteroids have been proven effective. Should mild forms of the ailment be treated with the same drug?

* THIS STUDY randomly assigned 720 children with mild croup to take cherry-flavored syrup mixed with either dexamethasone, a corticosteroid, or a placebo. Seven percent of the children who took the medicine had returned to the doctor for additional treatment within a week, compared with 15 percent of those who took the placebo. Those who received the drug had less severe symptoms initially, but this difference largely disappeared within three days. Children who took the drug also lost 30 percent less sleep than others.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Children with croup, an inflammation of the larynx and upper airways that is common among those 5 years of age and younger. Symptoms generally worsen at night.

* CAVEATS The authors advise caution in giving corticosteroids to children with immune deficiencies or those recently exposed to chickenpox.

* BOTTOM LINE Parents of a child with croup may want to ask a pediatrician about dexamethasone.

* FIND THIS STUDY Sept. 23 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.

* LEARN MORE ABOUT croup at www.kidshealth.org and www.mayoclinic.com.

metabolic syndrome

Mediterranean diet may ward off heart disease and diabetes.

* THE QUESTION People with metabolic syndrome -- generally overweight, with high blood pressure and glucose intolerance -- have an elevated risk of heart disease and diabetes. Might they benefit from a Mediterranean diet?

* THIS STUDY randomly assigned 180 adults with metabolic syndrome to follow either a normal healthy diet or a Mediterranean-style diet, which emphasizes whole grains, fruit, vegetables, nuts and olive oil. All participants met periodically with nutritionists. After two years, those on the Mediterranean diet had lost more weight, increased their "good" cholesterol, lowered their blood pressure and improved their glucose, insulin, total cholesterol and triglyceride levels more than the other group. In the Mediterranean group, 40 people still had metabolic syndrome, compared with 78 people on the other diet.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with metabolic syndrome, which affects an estimated 47 million adults in the United States.

* CAVEATS Whether the benefits are attributable to individual components of the Mediterranean diet or the combination of foods remains unclear. The study did not determine the mechanism by which the diet delivers its benefits.

* BOTTOM LINE People with metabolic syndrome may want to talk with their doctor about adopting a Mediterranean-style diet.

* FIND THIS STUDY Sept. 22/29 issue of the Journal of the American Medical Association; abstract available online at www.jama.com.

* LEARN MORE ABOUT metabolic syndrome at www.americanheart.org and www.diabetes.org.

heart attack

Medical advances appear to make early surgery desirable.

* THE QUESTION People who have had a heart attack often are given immediate doses of blood-thinning drugs to prevent clotting. As a result, surgery to enlarge or repair an artery generally is delayed by fears of excessive bleeding. Given recent advances in techniques and technology, is this delay still warranted?

* THIS STUDY involved 500 adults given blood thinners after a heart attack. They were randomly assigned either to undergo angioplasty -- in most cases, this included the placement of stents -- within 24 hours of receiving the drugs or to take other medications as needed but not have surgery unless it became urgent to do so. After a month, the rates of heart and bleeding problems were similar in both groups. Those treated conservatively stayed in the hospital longer. A year later, 9 percent of those who had immediate surgery had had another heart attack, had angioplasty or had died, compared with 21 percent of the others.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People given blood thinners for a heart attack.

* CAVEATS High-risk heart patients were excluded from the study. All participants had the same sort of heart attack; how people with other types would fare is unclear. Funding sources for the study included a drug maker and a maker of cardiovascular medical products.

* BOTTOM LINE People hospitalized for a heart attack may want to ask their cardiologist about the pros and cons of immediate angioplasty.

* FIND THIS STUDY Sept. 18 issue of The Lancet; abstract available online at www.thelancet.com.

* LEARN MORE ABOUT angioplasty at www.americanheart.org and www.nhlbi.nih.gov.

-- Linda Searing