By: PA, The Independent
Friday, 3 October 2008

Diabetes sufferers should not routinely take aspirin to prevent heart attacks, research today suggested.
It had been argued that routine use of the drug could help prevent the risk of suffering a heart attack.

But new research conducted by the British Medical Journal (BMJ) found that people who showed no symptoms of heart disease, received no benefit after regularly taking aspirin.
The study found that aspirin benefited people who have already suffered a heart attack or stroke as the drug could reduce the risk of future related problems by a quarter.

Research; BMJ 13 October 2008.
By: Joakim Dillner, professor, Lund University, Medical Microbiology, University Hospital MAS, 205 02 Malmö, Sweden et al.

This joint analysis of studies across western Europe concludes that, for women with negative cytology and negative HPV testing, such combined screening every six years would be safe.

By: Laura May, PA, The Independent
Friday, 3 October 2008

Employees who take regular periods of long-term sick leave die earlier than their colleagues, a study by the British Medical Journal said today.

Researchers found that workers with more than one absence requiring a doctor’s note on their records were 66 per cent more likely to die prematurely.

And workers who had to stay off work because of psychiatric problems were two and a half more likely to die of cancer.

Those who had to take time off because of circulatory disease were the most likely to die before their healthy colleagues. Researchers found they had a four time higher chance of a premature death.

Source: BMJ, 17 September 2008.

Before Robert Mayer, a GP and family therapist, died earlier this year of pancreatic cancer, he wrote about the cost of treating cancer on the NHS and why patients should be allowed to co-pay for expensive drugs. Read his personal view, as well as extracts from a diary he kept in the last few months of his life.

Clinical Review, by: L Fuccio, research fellow et al, Department of Internal Medicine and Gastroenterology, University of Bologna.
BMJ, 15 September 2008

• The prevalence of H pylori varies widely and is about 50% in international population studies. Helicobacter pylori is one of the most common human infections, and about half of the world’s population carries this organism. Since its discovery in 1984, H pylori has been recognised as a major cause of several upper gastrointestinal diseases.
• Triple and quadruple multidrug regimens are standard treatment
• Resistance to clarithromycin and metronidazole and lack of adherence to treatment are the main predictors of treatment failure
• The choice of the most effective regimen should be based on the prevalence of antibiotic resistance, especially resistance to clarithromycin and metronidazole
• Individualised treatment based on antimicrobial susceptibility has a limited role in H pylori eradication strategies
• The overall risk of reinfection is estimated at 3.4% per patient year in developed countries, rising to 8.7% in developing countries

By: Charles Musters, specialist registrar in perinatal psychiatry, Elizabeth McDonald, consultant in perinatal psychiatry and Ian Jones, senior lecturer in perinatal psychiatry.
BMJ, 8 August 2008

• Postnatal depression occurs after 13% of births.
• The nature of the puerperal trigger is still unknown, but several psychological, social, and biological factors probably play a part. Genetic factors have been implicated
• A previous history of postnatal depression or of any mental illness, poor social support, and depression during the pregnancy all increase the risk of developing the illness
• Postnatal depression needs to be identified and treated promptly and adequately because it can result in a range of lasting adverse outcomes for mother and child
• A range of psychological therapies is effective in treating postnatal depression
• Drugs are also effective and some antidepressants are thought to be safer in breastfeeding mothers than others. But in general the long term outcomes for exposed babies are unknown. Although tricyclic antidepressants have been prescribed for longer, most recent reproductive safety data, which include thousands of exposures, have been for selective serotonin reuptake inhibitors. Because of concerns about toxicity, tricyclics are prescribed less often than selective serotonin reuptake inhibitors for postnatal depression.
• Drugs are recommended for women who decline psychological therapy, or for whom there would be an unacceptable delay in providing non-pharmacological measures.

Thyroxine structure

By: Bijay Vaidya, consultant endocrinologist and honorary senior clinical lecturer and Simon H S Pearce, professor of endocrinology and honorary consultant physician, Newcastle upon Tyne.
BMJ 28 July 2008

Hypothyroidism is one of the commonest chronic disorders in Western populations. In the United Kingdom, the annual incidence of primary hypothyroidism in women is 3.5 per 1000 and in men 0.6 per 1000.

The management of hypothyroidism is generally considered straightforward and is mostly carried out in primary care in the UK. Cross sectional surveys of patients taking levothyroxine have, however, shown that between 40% and 48% are either over-treated or under-treated.

Furthermore, a small but significant proportion of patients continue to feel unwell despite taking levothyroxine.

By: Roger Dobson
BMJ, Published 31 July 2008

Clinically obese people can benefit almost as much as anyone else from knee replacement surgery, research has shown (Annals of the Rheumatic Diseases 2008; doi 10.1136/ard.2008.093229).

The findings show that there is little justification for policies that deny this type of surgery to obese patients on the grounds of their body mass index (BMI).
BMI should not be a contraindication, provided that the patient is sufficiently fit to undergo the short term rigours of surgery.

However: Obesity is obviously a strong risk factor for developing knee osteoarthritis.

BMJ, 17 July 2008
By: John B Winer, consultant neurologist, University Hospital Birmingham, UK.

What are the clinical features?

1. All types of Guillain-Barré syndrome present with acute neuropathy, defined as: progressive onset of limb weakness that reaches its worst within four weeks.
2. Typically there are sensory symptoms but few sensory signs.
3. Reflexes are usually lost early in the illness.
4. The respiratory system is affected in a third of cases, but this may not be associated with clear dyspnoea, which makes it more difficult to assess.

Summary points:

• Guillain-Barré syndrome is a rare but important disease that can lead to life threatening respiratory failure. (Guillain-Barré syndrome is a peripheral neuropathy that causes acute neuromuscular failure).
• Misdiagnosis is common and can be fatal because of the high frequency of respiratory failure, which contributes to the 10% mortality seen in prospective studies).
• Structural similarities between a triggering infectious organism and peripheral nerve tissue are important in its pathogenesis
• Treatment consists of rapid administration of intravenous immunoglobulin or plasma exchange, which shortens the time to recovery
• Around 10% of patients die from respiratory failure, pulmonary emboli, or infection
• Around 20% of patients have residual disability, with weakness or persistent sensory disturbance.

By: Francesco Sofi, clinical researcher, Andrea Capalbo, specialist in sports medicine et al, University of Florence, Italy.
BMJ, 3 July 2008

Participants: 30 065 (23 570 men) people seeking to obtain clinical eligibility for competitive sports.

Exercise ECG showed cardiac anomalies in 1227 athletes with normal findings on resting ECG. At the end of screening, 196 (0.6%) participants were considered ineligible for competitive sports.

Follow-up studies are needed to show if disqualification of such people would reduce the incidence of CV events among athletes.

(Age >30 years was significantly associated with an increased risk of being disqualified for cardiac findings during exercise testing.)