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(2) NEONATAL
AUTOPSIES YIELD VALUABLE
INFORMATION
(3) ALLERGENS
AND VIRUSES ACT TOGETHER TO
WORSEN ASTHMA
(4) RENAL COLIC SHOWS A CIRCADIAN PATTERN
(1) STUDY SUPPORTS
TRIPLE COMBINATION
THERAPY FOR HIV
(Systematic review and meta-analysis
of evidence for
increasing numbers of drugs in antiretroviral
combination
therapy)
http://bmj.com/cgi/content/full/324/7340/757
(Editorial: Initial antiretroviral
regimens: in general three drugs
are better than two are better than
one)
http://bmj.com/cgi/content/full/324/7340/747
New evidence in this week's BMJ supports
the use of up to
three antiviral drugs (triple therapy)
to treat people with HIV.
Researchers in Birmingham reviewed 54 trials
involving over
20,000 patients with HIV infection who
had not already
received antiviral therapy.
Combinations of up to three drugs were
consistently and
significantly more effective, but there
was inadequate
evidence on the effectiveness of quadruple
or higher
combinations. There was also marked variation,
mainly
accounted for by the drugs tested and
issues of quality, say
the authors.
Further work is needed to clarify which
triple combination is
the most effective and to investigate
the effectiveness of
quadruple or higher combinations, conclude
the authors.
Contact:
Dr Chris Hyde, Senior Clinical Lecturer,
Department of
Public Health & Epidemiology, University
of Birmingham,
Birmingham, UK
Email: chrishyde@doctors.org.uk
(2) NEONATAL AUTOPSIES
YIELD VALUABLE
INFORMATION
(Ten years of neonatal autopsies
in tertiary referral centre:
retrospective study)
http://bmj.com/cgi/content/full/324/7340/761
(Editorial: Falling neonatal autopsy
rates)
http://bmj.com/cgi/content/full/324/7340/749
Over a quarter of neonatal autopsies yield
important new
information, finds a study in this week's
BMJ. This should
help parents to make an informed decision
when they are
asked to give permission for their baby
to have an autopsy.
Researchers measured the rate of neonatal
autopsy over the
past decade at a centre in Scotland. They
also examined the
yield of new information in terms of discordance
between
diagnoses before and after death.
They found a general decline in the neonatal
autopsy rate
over the 10 years studied. Over a quarter
of autopsies
yielded important extra information, and
in 3% of cases this
information was crucial for future counselling.
The recent high profile disclosure concerning
organ retention
in the United Kingdom can only have served
to harm the
public's view of autopsies, say the authors.
A concerted
effort will be needed to promote the value
and purposes of
the neonatal autopsy, they conclude.
Contact:
Ian Laing, Consultant Neonatologist, Neonatal
Unit, Simpson
Centre for Reproductive Health, Royal
Infirmary, Edinburgh,
Scotland
Email: Ian.Laing@ed.ac.uk
(3) ALLERGENS
AND VIRUSES ACT TOGETHER TO
WORSEN ASTHMA
(Synergism between allergens and
viruses and risk of hospital
admission with asthma: case-control
study)
http://bmj.com/cgi/content/full/324/7340/763
Common allergens (such as dust mite and
grass pollen) and
viruses may act together to exacerbate
asthma, concludes a
study in this week's BMJ.
Sixty patients (aged 17 to 50) admitted
to hospital over a
year with acute asthma were matched with
two controls:
patients with stable asthma and patients
admitted to hospital
with non-respiratory diseases (inpatient
controls). Skin tests
for dust mite, cat, dog, and grass allergens
were performed
on all patients.
A significantly higher proportion of patients
admitted with
asthma (66%) were both sensitised and
exposed to allergen
causing sensitisation (either mite, cat,
or dog) than patients
with stable asthma (37%) and inpatient
controls (15%).
Viruses were detected in 26% of patients
admitted with
asthma compared to 18% with stable asthma
and 9% of
inpatient controls. This suggests that
patients with asthma may
be more susceptible to viral infections
than patients without
asthma, say the authors.
Allergens and viruses may act together
to exacerbate asthma,
indicating that domestic exposure to allergens
acts
synergistically with viruses in allergic
patients, increasing the
risk of hospital admission, say the authors.
Strategies directed
at viruses and reducing exposure to allergens
are needed,
they conclude.
Contact:
Adnan Custovic, National Asthma Campaign
Senior Clinical
Research Fellow, Wythenshawe Hospital,
Manchester, UK
Email: acustovic@fs1.with.man.ac.uk
(4) RENAL COLIC SHOWS A CIRCADIAN PATTERN
(Circadian pattern in occurrence
of renal colic in an
emergency department: analysis of
patients' notes)
http://bmj.com/cgi/content/full/324/7340/767
Renal colic (spasms of pain in the back
usually caused by
kidney stones) occurs in a circadian pattern,
finds a study in
this week's BMJ.
Researchers reviewed all episodes of renal
colic from 1990
to 1996 in the emergency department of
St Anna Hospital in
Ferrara, Italy.
Over 3,400 episodes of renal colic were
reported. Kidney
stones were found in almost half of patients.
The average age
of patients was 46 years, and the time
(within 30 minutes)
when symptoms started was determined for
3,360 patients.
Episodes of renal colic show a highly significant
circadian
pattern, with a morning peak and an afternoon
low, say the
authors. A similar circadian variation
with a midnight peak,
independent of meal times, has been reported
for episodes of
biliary colic (spasms of pain in the abdomen
caused by
gallstones).
Contact:
Roberto Manfredini, Assistant Professor
of Internal
Medicine, University of Ferrara Medical
School, Ferrara,
Italy
Email: mfr@unife.it
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