eMJA: In Other Journals, 21 August 2006

Chronic otitis media may be due to recurrence of infection rather than re-infection, say US and German researchers. They detected bacterial biofilms — adherent clusters of bacteria enclosed in a matrix — on most middle ear mucosa biopsy specimens taken from children with chronic otitis with effusion or recurrent otitis media; however, they found none on similar specimens from uninfected control patients who were to have cochlear implantation. Further, the bacterial species involved in the mucosal biofilms were the same pathogens commonly associated with otitis media. Biofilm bacteria provide a physical barrier to host defences; also, they are more antibiotic resistant than single cells in suspension.

No magic bullet

Raloxifene, a non-steroidal selective oestrogen-receptor modulator (SERM), led to an increased risk of death from stroke in women taking it in the Raloxifene Use for The Heart (RUTH) study, warns a health and drug alert in the Canadian Medical Association Journal (CMAJ).1 The RUTH study was designed to determine whether raloxifene reduced the risk of coronary heart disease in postmenopausal women.2 More than 10 000 such women at risk of, or with established, coronary heart disease, enrolled from 177 sites in 26 countries, were randomly assigned to receive either 60 mg raloxifene or placebo daily on a long-term basis. At follow-up more than 5 years later, those in the raloxifene group had a reduced risk of invasive breast cancer and vertebral fracture but an increased risk of venous thromboembolism and, as reported in CMAJ, fatal stroke. An editorialist said that, for now, there is no magic bullet that can reduce the risk of major health problems related to oestrogens and ageing without introducing other potentially serious health concerns.3

1. CMAJ 2006; 175: 147-148

2. N Engl J Med 2006; 355: 125-137

3. N Engl J Med 2006; 355: 190-192

A web of herbal nephropathy

A 30-year-old Chinese man in the UK has end-stage renal failure and is preparing for renal replacement therapy after taking the Chinese herb Longdan xieganwan for at least 5 years to “enhance” his liver. The herb contains aristolochic acid, which is well recognised as being nephrotoxic, leading to a non-inflammatory interstitial fibrosis which can progress to renal failure. It is also a potential urological carcinogen linked with transitional-cell carcinoma, which also occurred in this patient. Aristolochic acid is banned in many countries, including the UK and Australia; however, as the report’s authors point out, aristolochic acid continues to be available over the Internet.

Lancet 2006; 368: 338

Gender gap closing now . . .

In 1970, only 5.9% of first authors and 3.7% of senior (last listed) authors of original US research papers published in six prominent medical journals were women.1 By 2004, this proportion had risen to 29.3% of first authors and 19.3% of senior authors. Two journals, one focused on paediatrics and the other on obstetrics and gynaecology, had the highest proportions. According to an accompanying editorial (co-authored by four women), women compose a larger proportion of faculty members overall in these two fields.2 The editorialists say the authorship gender gap is only likely to narrow substantially when more women reach senior faculty positions.

1. N Engl J Med 2006; 355: 281-287

2. N Engl J Med 2006; 355: 310-312

Fat adolescent

Sibutramine therapy may have a role in managing the severely overweight adolescent who cannot otherwise lose weight, suggests a US expert.1 Dietz was commenting on a multicentre US study conducted over 1 year in about 500 overweight adolescents aged 12 to 16 years whose body mass index (BMI) was above the 95th percentile.2 The study found that, when added to a behavioural therapy program, sibutramine reduced BMI and body weight more so than placebo. For example, the average change in BMI was just over −3 kg/m2 in the sibutramine group compared with −0.3 kg/m2 in the placebo group. Sibutramine also improved several metabolic risk factors. However, the long-term risks (or benefits) of drug therapy in children or adolescents remain unknown.

1. Ann Intern Med 2006; 145: 145-146

2. Ann Intern Med 2006; 145: 81-90

Rickets returns

Major paediatrics centres in Sydney have seen a dramatic increase in the presentation of young children with vitamin D deficiency rickets, according to Australian authors. Robinson and colleagues reported a case series of 126 cases of vitamin D deficiency and/or rickets seen in these centres from 1993 to 2003. A steady increase in numbers of cases had occurred each year, with a doubling between 2002 and 2003. Patients presented most commonly with hypocalcaemic seizures and bowed legs. Almost all cases occurred in children in families who had recently immigrated to Australia or first generation offspring of immigrant parents, especially from the Indian subcontinent, Africa and the Middle East. Among suggested measures to reverse the trend, the authors specified screening as well as education of at-risk immigrant groups about the need for some sun exposure.

Arch Dis Child 2006; 91: 564-568

Dr Ann Gregory, MJA

The Medical Journal of Australia eMJA