CHLAMYDIA TESTING

A new test for diagnosing Chlamydia trachomatis is quicker and more cost effective than current tests, and has the potential to reduce complications and transmission to sexual partners. 

Lourdes Mahilum-Tapay and colleagues – 30 November 2007

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ME: a QUICK guideline for busy GP’s

Many GP’s and other healthcare professionals don’t know much about ME. (Myalgic Encephalomyelitis [WHO ICD-10:G93.3])

They think it is the same as tiredness and that impression is further reinforced by the recent NICE guidelines that proclaim that tiredness and a sore throat or headache equals ME. Nothing is further from the truth. Here is a quick guideline for BUSY GP’s about ME.

“Many GPs believe ME doesn’t exist or is a form of hysteria. But this is very wrong, just as we were with MS, when we called it hysteria, and with many other medical conditions. So here are some usefull tips when dealing with patients who might have ME.

Tip ONE: if a patient comes to the surgery, have a look at the size of his docs, if he has never been, or only rarely, with real problems, than he is not a malingerer or a hypochondriac.

Tip TWO: there are a lot of differences between hysteria and ME but two easy ones are: Belle indifference and shallowness of affect.

Tip THREE: hysteria has been binned from the DSM when they realised they made a big mistake naming MS hysteria. If you encounter a psychiatrist who still uses the term hysteria you have to be careful because in that version of the DSM homosexuality is still a psychiatric illness.

Tip FOUR: ask how long someone with fatigue needs to recover from even a simple task. Patients with ME don’t recover from simple tasks like healthy people, something you don’t see with (most) other forms of fatigue.

Tip FIVE: discuss CBT, if it cures the patient your diagnosis of ME was wrong.

Tip SIX: ME patients have the so called threshold phenomenon, meaning that they can’t increase their stamina like healthy people. If they can or if GET helps to improve their stamina then again, the diagnosis of ME was wrong.

Tip SEVEN: ask about muscle pain. If they have it, it is so extreme and completely different from a bit of pain after a strenuous run that NSAIDs look like smarties and have the same effect.

Tip EIGHT: have a look at page SIX of the South Australian guidelines where you can find an easy to use tick chart of symptoms to distinguish ME from other illnesses with fatigue. This will help a lot because there is no cure at present for ME but for many other illnesses with fatigue there is. And the patient will be cured and grateful. Print it to have it ready when needed; or >>>>> CLICK HERE FOR PROPER AND UP TO DATE GUIDELINES……….

Tip NINE: take a proper history, examine the patient and do lab tests. This might sound obvious but very often this doesn’t happen and the sooner you diagnose the problem, like with any other (serious) medical problem, the easier it is to cure or deal with. Might also give you a happier patient and one who is less likely to sue you.

Tip TEN: diagnose ME (if so), explain that the body will cure itself in many patients but that it is difficult to say how long that will take, and you have answered all important questions, and your patient will not only be grateful for that, but you won’t have a difficult patient, because he knows what is what. So help him and yourself by using this simple guide.

Last TIP: remember, even if you don’t believe ME exists, you might still get it yourself.

There are studies suggesting that teachers and healthcare workers/doctors are more at risk.”

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US makers of joint replacements are fined for paying surgeons to use their devices

Janice Hopkins Tanne – 23 November 2007

Five US manufacturers of hip and knee replacements have settled with the federal government after being accused of paying orthopaedic surgeons to use their products.

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ACUTE BRONCHIOLITIS

Andrew Bush, professor of paediatric respirology. BMJ  2007;335:1037-1041 (17 November).

Acute bronchiolitis is a clinical diagnosis. It “is a seasonal viral illness, characterised by fever, nasal discharge and dry, wheezy cough. On examination, there are fine inspiratory crackles and/or high-pitched expiratory wheeze.

Summary points:

• Bronchiolitis caused by respiratory syncytial virus is an important and seasonal cause of respiratory morbidity in the first year of life

• No effective preventive or therapeutic strategies exist, and supportive management is offered

• Unnecessary investigations and ineffective treatment must be avoided

• Many infants have medium to long term post-bronchiolitic symptoms, which should not be confused with true asthma and which do not respond to any current treatments

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High mortality after acute urinary retention in men over 45

James N Armitage and colleagues – 9 November 2007

A database analysis reported by James N Armitage and colleagues shows that mortality in men admitted to hospital with acute urinary retention is high and increases strongly with age and comorbidity – as many as one in four men admitted to hospital with acute urinary retention will die within a year.

Katia M C Verhamme and Miriam C J M Sturkenboom, in an accompanying editorial, say that since the increased mortality seen in men admitted to the hospital for acute urinary retention is probably the result of comorbid conditions and frailty, multidisciplinary care is warranted in these men.

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DEATHS IN US FROM RISKY BEHAVIOUR

BMJ  2007;335:639 (29 September).  

The US has a dismal record on health, despite outspending by a considerable margin every other developed nation in the world.

 Americans and their elected politicians are generally complacent about this sorry state of affairs, writes one leading doctor. Healthcare professionals are probably the best people to unite and shake them out of their complacency.

To do nothing is to accept the US position at the bottom of the league tables on health, when in so many other areas only first place will do.

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Triglycerides have an independent effect on risk of heart disease

BMJ  2007;335:639 (29 September) NEWS:

Serum concentration of triglycerides is an independent risk factor for coronary heart disease.

Because triglycerides are so closely linked to obesity (p 425). Losing weight and taking more exercise is one of the best ways to keep triglycerides under control. In this study, lower concentrations were also associated with eating a decent breakfast.

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INFERTILITY AND POLYCYSTIC OVARIES

BMJ  2007;335:663-666 (29 September).

Managing anovulatory infertility and polycystic ovary syndrome

BY: Adam H Balen, professor of reproductive medicine and surgery, Anthony J Rutherford, consultant in reproductive medicine and surgery.

Summary points

• Polycystic ovary syndrome is the most common endocrine problem affecting women and the most common cause of anovulatory infertility
• Oral clomifene citrate remains the first line treatment to induce ovulation
• Gonadotrophin treatment needs careful monitoring to reduce risk of multiple pregnancy
• Despite early promise, the role of metformin and insulin lowering agents is unclear in the management of anovulatory polycystic ovary syndrome

Anovulation is the cause of infertility in about a third of couples attending infertility clinics, and polycystic ovary syndrome accounts for 90% of such cases.

The definition of polycystic ovary syndrome recognises obesity as an association and not a diagnostic criterion. Only 40-50% of women with the syndrome are overweight.

Obesity has a profound effect on both natural and assisted conception—it influences the chance of becoming pregnant and the likelihood of a healthy pregnancy. Obesity is associated with increased rates of congenital anomalies (neural tube defects and cardiac defects), miscarriage, gestational diabetes, hypertension, problems during delivery, stillbirth, and maternal mortality.

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German doctors may have to report patients who have piercings and beauty treatments

Plans to introduce a law in Germany that would force doctors to notify a patient’s health insurance company if medical treatment is for a complication of a beauty operation or piercing have been heavily criticised by doctors and welfare organisations. BMJ 2 November 2007.

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Exercise is an important treatment for type 2 diabetes

BMJ  2007;335:638 (29 September). 

We know that regular exercise can help people with type 2 diabetes achieve better glycaemic control. Aerobic activities such as cycling or resistance training with weights can bring down serum concentrations of glycated haemoglobin.

But these activities are even more effective when combined, according to a randomised trial. Participants exercised three times a week for six months.

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