Journal of the New Zealand Medical Association, 23-May-2008, Vol 121 No 1274
In March, the US Centers for Disease Control and Prevention announced that more than one in four teenage girls in the US has a sexually transmitted disease. But there is even worse news.
The Lancet quotes data from the 2003–04 National Health and Nutrition Examination Survey in the US which has recently been presented at the 2008 National STD Prevention Conference. It was reported that around 3.2 million American girls aged 14–19 years have an STD, with the most common disease being HPV (affecting 18%), followed by chlamydia, which accounts for 4% of infections. And downstream from HPV is cervical cancer.
Let’s hope our comparable figures are better. Anyway, roll on HPV immunisation.
Health care professionals face a dilemma when a warfarin sodium-treated patient needs to undergo an elective procedure or minor surgery—the risks of haemorrhage versus the risks of thromboembolism. There are 3 tactics—continue or cease warfarin, or cease warfarin and use short-term heparin.
In this prospective study, a total of 1293 episodes of warfarin therapy interruption in 1024 individuals were included. Bridging heparin was used in 8.3% of patients. Length of warfarin withdrawal was 5 days or less in most cases.
And the outcome—only 7 patients (0.7%) experienced post-procedure thromboembolism. 23 patients (2.3%) had significant bleeding. Interestingly, 14 of these 23 had heparin bridging treatment. It would seem that warfarin withdrawal without heparin is the way to go.
Arch Intern Med 2008;168(1):63–9.
Rainy day harvests describe the phenomenon of the collection of haemopoietic stem cells from a patient early in the course of the disease for potential rather than planned use in autologous transplantation later on.
Several randomised and non-randomised studies have confirmed that such treatment is mainstream as part of first-line therapy for relapsed lymphomas and some solid tumours such as germ-cell cancers.
It is known that such cells, properly cryopreserved, can be used without problem up to and possibly beyond 20 years of cryopreservation. Therein lies the rub. In some parts of the world there is an expansile growth of private collection and storage of umbilical cord-derived haematopoietic stem cells for potential autologous use. It is clear that despite extensive advertising and activity worldwide, there is as yet, no evidence whatsoever for any clinical utility for cells collected in this way.
The ethics and practical problems created by this phenomenon are explored in this paper and editorial.
Internal Medicine Journal 2008;38:229–34 & 227–8.
Ezetimibe, a cholesterol-absorption inhibitor, reduces levels of low-density lipoprotein (LDL) cholesterol when added to statin treatment. However, the effect of ezetimibibe on the progression of atherosclerosis remains unknown. Hence this trial—a 2-year randomised trial comparing 80 mg of simvastatin and 10 mg of ezetimibe daily with simvastatin and placebo.
And the results—in patients with familial hypercholesterolaemia, combined therapy with ezetimibe and simvastatin did not result in a significant difference in changes in intima-media thickness, as compared with simvastatin alone, despite decreases in levels of LDL cholesterol and C-reactive protein. Not very encouraging.
An editorial comments that it seems prudent to encourage patients whose LDL cholesterol levels remain elevated despite treatment with an optimal dose of a statin to redouble their efforts at dietary control and regular exercise. Niacin, fibrates, and resins should be considered when diet, exercise, and a statin have failed to achieve the target, with ezetimibibe reserved for patients who cannot tolerate these agents.
Yes, but the final clause is somewhat bewildering.
N Engl J Med 2008;358:1431–43 & 1507–8.
Not another meta analysis. No, a prospective randomised trial comparing 2 years of treatment with 1500 mg of oral glucosamine sulphate or placebo once daily in a cohort of 222 patients with hip osteoarthritis who were recruited by their general practitioner. Patients were eligible if they met the American College of Rheumatology clinical criteria for hip osteoarthritis.
After 2 years of treatment, no clinically significant effect on pain, function, or joint space narrowing was found.
A definitive answer to a controversial topic? Maybe—an accompanying editorial suggests the study may not have used the best glucosamine and that the study was underpowered. And maybe the study should have enrolled more severely affected patients for a longer period. Take your pick.
Ann Intern Med 2008;148:268–77 & 315–6.
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