This week in the BMJ
Volume 331, Number 7509, Issue of 16 Jul 2005Chromosome analysis in miscarriages could be more selective
Chromosome analysis in miscarriages could be more selective
Multiple factors influence the probability of structural chromosome abnormalities in a couple trying to conceive. In a nested case control study that included 279 carrier couples (cases) and 428 non-carrier couples (controls), Franssen and colleagues (p 137) identified additional independent factors: low maternal age at the time of second miscarriage, a history of three or more miscarriages, and a history of two or more miscarriages in siblings or parents of either partner. Selective chromosome analysis could reduce the number of chromosome analyses by 18%, thus lowering the costs.
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Treating ocular hypertension and glaucoma pays off
Reducing intraocular pressure in patients with ocular hypertension or manifest glaucoma reduces the risk of visual impairment in the long term. In a systematic review and a meta-analysis of randomised controlled trials, Maier and colleagues (p 134) showed that 12 patients need to be treated for ocular hypertension in order to prevent one case of progression to glaucoma (hazard ratio 0.56, 95% confidence interval 0.39 to 0.81, compared to non-treatment). Treating seven patients with hypertensive or normotensive manifest glaucoma significantly delayed deterioration of visual field in one patient (0.65, 0.49 to 0.87).
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Give antibiotics even if urine dipstick is negative
Women with symptoms of uncomplicated urinary tract infection but with a urine dipstick test negative for nitrites and leukocytes may still benefit from antibiotic treatment. In a prospective, double blind, randomised placebo controlled trial including 59 women, Richards and colleagues (p 143) found that 300 mg of trimethoprim daily for three days reduces the duration of dysuria and constitutional symptoms (feverishness, shivers) when compared with placebo. The number needed to treat was four. The authors say their results support the practice of empirical antibiotic use guided by symptoms.
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Intelligence doesn't make older people (un)happy
In people without dementia, cognitive ability at age 11 and at age 79, as well as changes in cognition during their lifetime, are not associated with satisfaction with life in old age. Gow and colleagues (p 141) used the Moray House test to assess cognition and the satisfaction with life scale to assess satisfaction with life in the Lothian birth cohort 1921, 550 people who are now elderly. Although intelligence doesn't predict happiness, other factors might need to be better understood in order to promote successful ageing, say the authors.
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Treating ophthalmic herpes zoster in general practice
On p 147, Opstelten and Zaal outline the main points that general practitioners should keep in mind when faced with a case of ophthalmic herpes zoster. As one in 100 people contract the condition during their lifetime, doctors are relatively often faced with dilemmas about the initial diagnosis and deciding which patients need to be referred to a specialist or given antiviral treatment. The authors present an evidence based policy for treating immunocompetent patients.
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Re-examining SSRIs for depression
In a clinical review on page 155, Moncrieff and Kirsch take a close look at available evidence for and against the use of selective serotonin reuptake inhibitors (SSRIs) in treating depression. Current approaches to depression should be re-evaluated, they say, and alternatives to drug treatment should be developed further. Since antidepressants have become society's main response to distress, the authors say that expectations raised by decades of use will also need to be addressed.
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