This week in the BMJ
Volume 333, Number 7570, Issue of 30 Sep 2006Severe anaphylaxis due to contrast media is rare and prophylaxis unhelpful
Severe anaphylaxis due to contrast media is rare and prophylaxis unhelpful
Premedication may not be helpful in preventing serious anaphylactic reactions due to iodinated contrast media. Tramèr and colleagues (p 675) conducted a systematic review of nine trials testing the efficacy of antihistamines and corticosteroids. Life threatening anaphylaxis after receiving contrast media was rare, and the authors conclude that, although an oral double dose of methylprednisolone may avert such reactions, its usefulness is doubtful because of the large numbers of patients who would have to be treated to prevent one reaction.
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Public health can't always wait for RCTs
Effective interventions should not be delayed just because data from randomised controlled trials are not available. Potts and colleagues (p 701) use three historic examples from developing nations to illustrate their point—the use of oral rehydration therapy for childhood diarrhoea, the role of male circumcision in preventing HIV transmission, and taking misoprostol for postpartum haemorrhage. Delays in the implementation of such interventions come at an enormous cost to public health. If the science is good, we must act on it, the authors argue.
Congenital malformations may be linked to infertility
Children born to previously infertile couples, whether or not after infertility treatment, are more likely to have congenital malformations than children of fertile parents. Zhu and colleagues (p 679) conducted a large scale longitudinal study of three groups of liveborn children and their mothers—singletons and twins born of fertile couples and those born of previously infertile couples who either conceived naturally or after infertility treatment. Hormonal treatment for infertility seems to increase the risk of genital malformations, but this association, say the authors, may be confounded by the underlying reason for infertility.
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Bullying is rife at US medical schools
Most US medical students report having been bullied during medical school. In a longitudinal survey Frank and colleagues (p 682) asked more than 2800 medical students from the class of 2003 in 16 US medical schools for their perceptions of having been harassed or belittled at three different stages in their studies and evaluated their demographics and mental health. By their senior year, 42% of the students reported having experienced harassment, and 84% reported belittlement during medical school. Poor mental health and low career satisfaction were significantly associated with being harassed or belittled.
Meningococcal disease is a paediatric emergency
Any child with a non-blanching rash, especially if ill and feverish, should be suspected of having meningococcal disease. In their clinical review Hart and colleagues (p 685) emphasise that the disease more often presents as septicaemia than meningitis. Antibiotics must be given within 30 minutes of recognition, and shock must be promptly treated with fluids and inotropic drugs. Adequate neurological follow-up and providing accurate information to the parents are also important, the authors say.
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