This is Journal Watch, a medical-literature
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  Contents copyright 1994, Mass. Medical Society.

Journal Watch Summaries for December 13, 1994

FOLIC ACID ALLAYS METHOTREXATE'S TOXICITY.
  Ann Intern Med 1994 Dec 1; 121:833-41.

NICOTINE NASAL SPRAY WORKS.
  Arch Intern Med 1994 Nov 28; 154:2567-72.

ERYTHROMYCIN-RESISTANT PERTUSSIS.
  MMWR 1994 Nov 11; 43:807-10.

DENGUE FEVER AMONG U.S. TROOPS IN HAITI.
  MMWR 1994 Nov 25; 43:845-8.

LOW USE OF POST-MI BETA-BLOCKERS AT COMMUNITY
HOSPITALS.
  J Gen Intern Med 1994 Nov; 9:599-605.

CERVICAL INFLAMMATION AND PRETERM DELIVERY.
  J Am Board Fam Pract 1994 Nov/Dec; 7:465-71.

SIMPLE REMINDERS BOOST CHILD IMMUNIZATION RATES.
  J Am Board Fam Pract 1994 Nov/Dec; 7:472-7.

FOLIC ACID ALLAYS METHOTREXATE'S TOXICITY.
   The folic-acid antagonist methotrexate is now commonly
used to treat rheumatoid arthritis. This randomized, double-
blind trial examined whether folic-acid supplementation
reduces methotrexate toxicity without compromising its
efficacy against arthritis.
   Ninety-four rheumatoid arthritis patients starting
methotrexate therapy received either folic acid (5 or 27.5
mg per week) or placebo; 79 patients remained compliant and
were followed for one year. The three groups showed similar
degrees of improvement in arthritis. However, methotrexate
toxicity scores were significantly lower in the two folic-
acid groups than in the placebo group. Moreover, within the
placebo group, high dietary folate intake appeared to
protect against toxicity. (The toxicity score was a
composite of systemic and gastrointestinal symptoms,
abnormal liver and renal function tests, cytopenias, and
pulmonary toxicity.)
   Comment: This study strongly suggests that folic-acid
supplementation mitigates methotrexate's toxicity in
patients with rheumatoid arthritis, and does not interfere
with methotrexate's therapeutic benefit. --AS Brett.
   Citation: Morgan SL; et al. Supplementation with folic acid during
methotrexate therapy for rheumatoid arthritis: a double-blind, placebo-
controlled trial. Ann Intern Med 1994 Dec 1; 121:833-41.

NICOTINE NASAL SPRAY WORKS.
   Nicotine gum and patches clearly help people stop
smoking. However, both are absorbed slowly, the gum is
contraindicated in persons with peptic ulcer, and patches
may exacerbate skin conditions. This double-blind trial
evaluated an alternative: nicotine nasal spray.
   About 250 smokers in Sweden were randomized to receive
placebo or nicotine spray, 1.0 mg per dose (two sprays).
Patients were allowed a maximum of five doses per hour and
40 doses per day. In addition, all participated in eight
counseling sessions over six weeks.
   Significantly more patients in the nicotine group than in
the placebo group quit smoking within two weeks, and more
remained abstinent at six weeks (53 vs. 27 percent) and at
one year (27 vs. 15 percent). A majority of patients in both
groups had mild to moderate side effects, such as sneezing,
runny nose, watery eyes, and throat irritation, but these
symptoms were significantly more common in the nicotine
group.
   Comment: Despite its irritant effects, the nicotine spray
was tolerated by most patients. It appears to be a reasonable
alternative to gum and patches, although its efficacy as compared
with the latter has not yet been determined. --CD Mulrow.
   Citation: Hjalmarson A; et al. Effect of nicotine nasal spray on
smoking cessation. Arch Intern Med 1994 Nov 28; 154:2567-72.