This week in the BMJ

Volume 332, Number 7537, Issue of 11 Feb 2006

[Down]Babies of HBsAg positive mothers should be immunised
[Down]Fondaparinux reduces thromboembolism in elderly medical patients
[Down]Primary care has to be considered in STI surveillance
[Down]Displaced survivors of tsunami had reduced mortality
[Down]Case reports of suspected adverse drug reactions are of limited value

Babies of HBsAg positive mothers should be immunised

Hepatitis B vaccine and immunoglobulin, solely or in combination, reduce hepatitis B occurrence in newborn infants of mothers seropositive for hepatitis B surface antigen (HBsAg). In a meta-analysis of 29 randomised controlled trials on newborns with vaccination or immunoglobulin in their first month of life, Lee and colleagues (p 328) found that immunisation against hepatitis B reduced the occurrence of infection. They found no significant differences between low dose and high dose vaccine nor recombinant and plasma derived vaccine, but vaccine plus immunoglobulin was superior to vaccine alone.


Figure 1
 Credit: MARK THOMAS/SPL

 



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Fondaparinux reduces thromboembolism in elderly medical patients

Fondaparinux, a selective factor Xa inhibitor, is effective and safe for preventing venous thromboembolism in acutely ill, medical inpatients at moderate risk. In a double blind, randomised, placebo controlled trial, Cohen and colleagues (p 325) allocated more than 800 bedridden medical patients aged 60 or older to either 2.5 mg fondaparinux or placebo given subcutaneously daily for 6-14 days. Drug treatment reduced patients' relative risk of venous thromboembolism by 47% at no increased risk of major bleeds.


Figure 1
 Credit: CHRIS PRIEST/SPL

 



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Primary care has to be considered in STI surveillance

A substantial number of sexually transmitted infections (STIs) in the UK are diagnosed and treated in primary care. Cassell and colleagues (p 332) compared data from a primary care database during 1990-2000 with genitourinary medicine clinic surveillance data. They found that 23% of female chlamydia cases and 49% of cases of male non-specific urethritis and urethral discharge were diagnosed and treated in primary care. In order to understand the true impact of STIs in UK health care, information mustn't be based only on surveillance of genitourinary medicine clinics, say the authors.



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Displaced survivors of tsunami had reduced mortality

The 2004 tsunami in the Indian Ocean didn't cause additional mortality among the internally displaced survivors. Nishikiori and colleagues (p 334) conducted a household survey of more than 3500 people from the eastern coastal district of Sri Lanka displaced into 13 camps. Of the total 446 reported deaths, 99% occurred within three days after the tsunami, and none was reported after the first week of the 11 week study period. The authors explain this finding in terms of a "harvesting" effect (the tsunami leaving only the strongest and fittest alive) and possibly successful aid activities.


Figure 1
 Credit: ERANGA JAYANARDENA/AP

 



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Case reports of suspected adverse drug reactions are of limited value

Published case reports of suspected adverse drug reactions are of questionable value, as the suspected reactions are seldom subjected to further verification. Loke and colleagues (p 335) carried out a systematic follow-up of 63 adverse drug reaction reports published in 1997 in five medical journals and found that the vast majority (83%) of the suspected reactions had not been subjected to additional rigorous evaluation after five years. Details of the suspected reactions also failed to be consistently incorporated into commonly used drug information sources.


Figure 1
 Credit: PHOTOS.COM

 



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