Glibenclamide, metformin, and insulin for the treatment of gestational diabetesThis report concerns a meta-analysis of the short term relative risks and benefits of insulin, glibenclamide, and metformin for treating women with gestational diabetes requiring drug treatment.The review analysed 15 articles involving 2,509 subjects. The incidence of unfavourable maternal and foetal outcomes for the various medication combinations were collated. Glibenclamide was noted to be associated with unfavourable foetal outcomes.The authors conclude that glibenclamide is clearly inferior to both insulin and metformin and should not be used for treating gestational diabetes if insulin or metformin is available. BMJ 2015;350:h102 Adjunct prednisone therapy for patients with community-acquired pneumoniaIn community-acquired pneumonia, an excessive release of circulating inflammatory cytokines can be harmful and cause pulmonary dysfunction. Theoretically, systemic corticosteroids could attenuate this inflammatory process and improve outcomes in the treatment of pneumonia.This multicentre randomised trial in Switzerland tests this hypothesis. 785 patients, aged 18 years or older, were randomised to receive either prednisone 50mg daily or placebo for 7 days with their antibiotics.Median time to clinical stability was shorter in the prednisone group 3 days versus 4.4 days in the placebo group, facilitating earlier discharge from hospital. Pneumonia complications did not differ between the two groups. Hyperglycaemia needing insulin treatment was seen in 19% of the prednisone group and in 11% of the placebo group. The conclusions were that prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications. Lancet 2015; 385:1511-18 Aerosolised vaccine against measles?A safe and effective injectable measles vaccine has been widely available since 1963. Subsequently, there has been a substantial decrease in measles-related deaths. However, major outbreaks still continue in poorer countries. Aerosolised vaccines might improve the situation as they can be administered by people without clinical training and do not cause injection-associated infections.Data on the immunogenicity of aerosolised vaccine against measles in children are inconsistent. This randomised trial conducted in India aimed to clarify the issue. 1,001 children received the aerosolised vaccine and 1,003 the subcutaneous vaccine. At 91 days, seropositivity was achieved in 85.4% of the aerosol group and 94.7% in the subcutaneous group. Unfortunately, although more convenient, lthe aerosol vaccine was less effective. N Engl J Med 2015:372:1519-29

Glibenclamide, metformin, and insulin for the treatment of gestational diabetesThis report concerns a meta-analysis of the short term relative risks and benefits of insulin, glibenclamide, and metformin for treating women with gestational diabetes requiring drug treatment.The review analysed 15 articles involving 2,509 subjects. The incidence of unfavourable maternal and foetal outcomes for the various medication combinations were collated. Glibenclamide was noted to be associated with unfavourable foetal outcomes.The authors conclude that glibenclamide is clearly inferior to both insulin and metformin and should not be used for treating gestational diabetes if insulin or metformin is available. BMJ 2015;350:h102 Adjunct prednisone therapy for patients with community-acquired pneumoniaIn community-acquired pneumonia, an excessive release of circulating inflammatory cytokines can be harmful and cause pulmonary dysfunction. Theoretically, systemic corticosteroids could attenuate this inflammatory process and improve outcomes in the treatment of pneumonia.This multicentre randomised trial in Switzerland tests this hypothesis. 785 patients, aged 18 years or older, were randomised to receive either prednisone 50mg daily or placebo for 7 days with their antibiotics.Median time to clinical stability was shorter in the prednisone group 3 days versus 4.4 days in the placebo group, facilitating earlier discharge from hospital. Pneumonia complications did not differ between the two groups. Hyperglycaemia needing insulin treatment was seen in 19% of the prednisone group and in 11% of the placebo group. The conclusions were that prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications. Lancet 2015; 385:1511-18 Aerosolised vaccine against measles?A safe and effective injectable measles vaccine has been widely available since 1963. Subsequently, there has been a substantial decrease in measles-related deaths. However, major outbreaks still continue in poorer countries. Aerosolised vaccines might improve the situation as they can be administered by people without clinical training and do not cause injection-associated infections.Data on the immunogenicity of aerosolised vaccine against measles in children are inconsistent. This randomised trial conducted in India aimed to clarify the issue. 1,001 children received the aerosolised vaccine and 1,003 the subcutaneous vaccine. At 91 days, seropositivity was achieved in 85.4% of the aerosol group and 94.7% in the subcutaneous group. Unfortunately, although more convenient, lthe aerosol vaccine was less effective. N Engl J Med 2015:372:1519-29