This week in the BMJ
Volume 332, Number 7532, Issue of 7 Jan 2006Role of gastro-oesophageal reflux treatment for chronic cough may be in doubt
Role of gastro-oesophageal reflux treatment for chronic cough may be in doubt
Interventions to reduce chronic cough associated with gastro-oesophageal reflux may be less beneficial than international guidelines suggest because trialists may have misdiagnosed chronic non-specific cough. In a systematic review and meta-analysis of randomised controlled trials, Chang and colleagues (p 11) found that this uncertainty sheds doubt on the effectiveness of proton pump inhibitors for treating cough associated with gastro-oesophageal reflux disease.
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Use of a dummy is associated with reduced risk of SIDS
Infants who died of sudden infant death syndrome (SIDS) were less likely to sleep with dummies (pacifiers) in their mouths than controls. Li and colleagues (p 18) carried out a population based case-control study with mothers or caretakers of 185 babies whose deaths were attributed to the syndrome and 312 randomly selected controls matched for race, ethnicity, and age. After known confounders were adjusted for, the odds ratio for SIDS in infants who used a dummy during their last sleep was 0.08 (95% CI 0.03 to 0.21) compared with infants not given dummies. Use of a dummy may reduce the influence of known risk factors in the sleep environment, say the authors.
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Clarithromycin in stable coronary heart disease may increase mortality
Short term treatment with the macrolide antibiotic clarithromycin in patients with stable coronary heart disease may raise the risk of dying of cardiovascular causes. In a randomised controlled multicentre trial by Jespersen and colleagues (p 22), more than 4300 patients with myocardial infarction or angina pectoris received either clarithromycin 500 mg/day or placebo for two weeks. All cause mortality was higher in the clarithromycin arm (hazard ratio 1.27, 95% CI 1.03 to 1.54), and patients in this group were significantly more likely to have died from cardiovascular causes (1.45, 1.09 to 1.92).
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Let practice nurses tell partners about chlamydia
For people with chlamydia infections diagnosed in primary care, a strategy of practice-based partner notification by trained nurses with telephone follow-up by health advisers may be more effective than specialist referral. In a randomised controlled trial of 140 adults with chlamydia infection, Low and colleagues (p 14) found that 47 out of 72 participants whose partners were notified by practice nurses had at least one partner treated, compared with only 39 partners out of 68 participants referred to a genitourinary clinic, where 21 participants never turned up. The cost was the same for both strategies.
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What works for migraine
Recent advances in clinical research and basic neuroscience are improving our understanding of migraine and are delivering new treatments, says Goadsby on p 25. Though the future seems positive, some unmet needs remain, such as new preventive therapies, treatments for non-vascular acute attack, and new strategies to manage patients with intractable migraine. This clinical review summarises developments in diagnosis, classification, pathophysiological understanding, and treatment strategies for migraine, and discusses strengths and weaknesses of current research.
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