New Eng J Med Vols 352/353
2477 Borderline gestational diabetes, with peak sugars <11, is worth taking seriously. This trial found better maternal and fetal outcomes with tight control than with usual care.
2508 The first case report of an unvaccinated patient who survived rabies, albeit with residual disability: she was put into coma and given antiviral drugs until her own immune system took over.
2571 Spooky pictures of the Marburg and Ebola viruses which emerge from the African forests to kill scores of people, partly because of poor health practices.
2598 News of a monoclonal antibody capable of stopping the autoimmune destruction of insulin-producing cells — early days, but exciting.
2721 All you need to know about the cheap, easily manufactured recreational drug γ-hydroxybutyric acid (GHB) — addictive and dangerous, especially taken with alcohol. For other clubbing drugs, see Lancet (2137).
Lancet Vols 365/366
2024 Back pain is mostly better after a month, with no difference in this trial between physiotherapy and a brief pain-management programme.
2041 The ubiquitous Epstein-Barr virus is associated with nasopharyngeal cancer in South East China.
2098 Two big cohort studies (see 29 below) drive home the message that transient ischaemic attacks (TIAs) need to be considered as medical emergencies in the same way as unstable angina.
2179 Endovascular repair of abdominal aneurysms proves to have the same mortality as the big bloody open operation.
2201 Sad dads are bad for lads: fathers who get postnatal depression have adverse effects on their children, especially boys.
29 The Oxford ABCD score for risk assessment in TIA — A for age, B for blood pressure, C for clinical features, and D for duration.
37 If you don't treat conjunctivitis, it gets better by day 7, whether it's viral or bacterial. Even at day 3, there was little difference between chloramphenicol drops and placebo.
JAMA Vols 293/294
2865 A big meta-analysis trying to decide whether we should be taking a selective or blanket approach to early invasive treatment for acute coronary syndromes. No clear answer, as there is a higher immediate mortality from early intervention, balanced by better long-term outcomes.
3003 Triple vaccine for all adults? This study proves that it is safe and immunogenic, and may eliminate the 25% of persistent coughs caused by pertussis.
3029 An important study from British primary care examining outcomes in acute uncomplicated lower respiratory infections in healthy adults, randomised to antibiotic, no antibiotic, or delayed antibiotic. There was no significant difference.
Other Journals
Arch Intern Med (165: 1246) reports that a milky diet seems to reduce premenstrual syndrome. To avoid hypertension, lose weight: data from Framingham on page 1298 showing that dropping a stone in middle age reduces the risk by over 30%. For treating hypertension, ALLHAT comes out in favour of thiazides, even in diabetes or impaired glucose tolerance (page 1401), and a systematic review of 27 trials (page 1410) confirms equivalence among drug classes. Ann Intern Med (142) ends June with a supplement looking at the challenges faced by systematic reviewers in a wide spread of topic areas, including complementary and alternative medicine. A trial of acupuncture for fibromyalgia found, once again, that sham treatment works as well as real (143: 10). The Chinese population probably derives greater benefit from soy beans than from needles — a study from the People's Republic (143: 1) demonstrates a drop in blood pressure. By contrast, a sham-controlled trial of acupuncture in Obstet Gynecol (106: 138) finds that it may help women with overactive bladders. Arch Dis Childhood (90: 733) reviews the role of cystography in 108 children who had a urinary tract infection in the first year of life, and found that this unpleasant investigation has little value. The message of Mayo Clin Proc (80: 728) is to avoid long-haul flights before major surgery: they increase your risk of venous thromboembolism. Med Humanit (31: 23) brings a robust defence of evidence-based medicine: ‘EBM is a necessary condition for clinical freedom, not a threat to it.’ Just as some dogs look like their owners, some journals resemble their subjects. The Journal of Individual Differences contains a quirky scattering of topics; the International Journal of Obesity keeps gets fatter; and the Journal of Near-Death Studies has not appeared since Fall 2004, prompting fears that it may have crossed to the Other Side.
Plant of the Month: Hydrangea sargentiana
If you have a big damp shady space, this handsome hairy giant will reward you with mauve-blue lacecap flowers, whatever your soil.
- © British Journal of General Practice, 2005.