Preeclampsia and the risk of later life cardiovascular disease It has been widely thought that the effects of hypertension in pregnancy reversed after delivery and hypertension values returned to their pre-pregnancy level as it was seen as a disease of short duration in otherwise healthy young women. However, recent studies have demonstrated the principal underlying abnormality, endothelial dysfunction, remains in women who had preeclampsia and that it is this damage that increases the risk of developing cardiovascular disease in later life. This comprehensive review examines this problem in depth and considers the abnormalities in lipid and lipoprotein metabolism that occur in pregnancy. The authors note that it remains uncertain whether the statins themselves are safe in pregnancy and as always, caution needs to be apparent in any investigation in pregnancy. The authors conclude that although measures to control blood pressure in pregnancy have been in place for several decades, there is little consensus around the treatment of mild to moderate rises and whether treatment in pregnancy contributes to an improvement in overall cardiovascular risk. Targeting early blood pressure and lipid evaluations (annual or bi-annual checks) and appropriate intervention could be recommended to women whose pregnancies are complicated by preeclampsia and gestational hypertension. Heart, Lung and Circulation 2014;23:203-12. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care Does symptom management in patients with acute respiratory tract infections improve when advice is given to use ibuprofen alone or ibuprofen and paracetamol compared with paracetamol alone; to take regular doses rather than as required; and to use steam inhalation compared with no inhalation? This question is examined in this randomised trial carried out in Southampton, England. 889 patients aged 3 years or more (median 30 years) with acute respiratory tract infections were randomised to 5 options take paracetamol; ibuprofen; or both; dosing of analgesia (take as required v regularly); and steam inhalation (no inhalation v steam inhalation). Outcomes sought were symptom severity on days two or four (primary outcome), temperature, antibiotic use, and reconsultations. The researchers report that none of these strategies significantly improved symptom control. Advice to use ibuprofen might help more among those with chest infections and in children but is also associated with more reconsultations with new or unresolved symptoms. BMJ 2013;347:f6041. Expanding role of ultrasonography Diagnostic ultrasonography has replaced auscultation as the primary method of evaluating the mechanics of the heart and peering into the abdomen, vasculature, and uterus without exposing patients or fetuses to ionizing radiation. This perspective paper reviews the future for ultrasonography bearing in mind that ultrasound technology has advanced so much viz ultrasound devices are available that can be carried in the pocket. Some American medical schools now offer ultrasound training early in the undergraduate curriculum. Apart from the fact that these devices are very expensive (about US$10,000) there are other problems. The risk of misdiagnosis is high when diagnostic ultrasound is used by inexperienced practitioners. Another concern is that these devices may distract students from the core principles of physical diagnosis and interpose another layer of technology between doctor and patient. N Engl J Med 2014;370:1083-5. Multitarget stool DNA testing for colorectal-cancer screening? The use of fecal immunochemical test (FIT) for haemoglobin in the stool is well established as a colorectal cancer screening test. This study evaluates whether a multitarget stool DNA test might be superior. They have compared these two tests in 9989 subjects with an average risk for colorectal cancer. The researchers report significantly better results with the DNA test with respect to both colorectal cancer and precancerous lesions. However, specificity was lower with the DNA test resulting in a false positive result in approximately 10% of cases. An editorial commentator applauds the study but notes that the greater expense and lower specificity of the DNA test are an impediment. N Engl J Med 2014:370:1287-97.