eMJA: In other journals - 20 January 2003

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In Other Journals

20 January 2003

Anyone can do it

A study in Scotland has shown that dermatologists, plastic surgeons and general surgeons all do an equally good job of excising primary malignant melanomas. The surgical background of the person removing the primary tumour had no bearing on the outcome or survival of 4159 patients who had their lesions excised between 1979 and 1998 and were followed up for an average of 10 years. Dermatologists treated the highest proportion of thin melanomas, and general surgeons treated more ulcerated lesions, but this was adjusted for in the analysis. Cosmetic outcome was not considered. The authors thus recommend referring melanoma patients according to shortest surgical waiting time rather than "surgical" specialty.

BMJ 2002; 325: 1276-1277

Deadly side effects

US researchers, using a national Food and Drug Administration database of adverse drug events, have found an alarming number of serious or fatal reactions in children under two years of age. Of 5976 adverse events reported in this age group over a three-year period (1997–2000), 1873 occurred in the first month of life. The number of events decreased with increasing age. There was an average of 243 medication-related deaths each year. In 24%, exposure to the drug was via the mother, during pregnancy, delivery or lactation: anti-HIV drugs were responsible for a quarter of these reactions. Seventeen drugs accounted for over half of all serious/fatal events, including two drugs for prophylaxis against respiratory syncytial virus (RSV) disease, six antibiotics and two analgesics. Palivizumab, a monoclonal antibody against RSV, was the top "offender" (28% of serious/fatal events); the analgesic acetaminophen was implicated in 413 reports and ranked seventh for serious/fatal events.

Pediatrics 2002; 110: e53

Beware the zebra

A study in the United States has found that elderly people are more likely to be struck by a motor vehicle when using a marked crossing than when crossing at an unmarked site. Between February 1995 and January 1999 researchers obtained police reports of all collisions between motor vehicles and pedestrians aged 65 years and over, within 30 feet of an intersection, in six cities in Washington and southern California. Some sort of a crossing was marked in 181 of 282 cases. Trained observers recorded environmental characteristics, traffic flow and speed, and pedestrian use at the accident sites and 564 matched sites (based on a classification of how major each road was) at the same day and time as when each accident occurred. After adjusting for all these factors, the presence of a marked crossing was associated with a more than twofold risk of being struck. The danger was greatest (3.6-fold) where the marked crossings had no traffic signals or stop signs.

JAMA 2002; 288: 2136-2143

Staple poison

The problem of arsenic contamination of tube-well water encompasses far more than what people drink, say researchers who have examined arsenic levels in samples of rice in order to quantify the problem of chronic arsenic exposure in Bangladesh. In an on-site experiment, the researchers asked two people to cook 500 g of rice in their usual way, which traditionally involves boiling it in a large amount of water and discarding the water after cooking. They then measured arsenic concentrations in the raw rice, the cooking water, the cooked rice and the discarded water, and calculated that the arsenic concentration in the cooked rice was actually higher than that of the raw rice and the adsorbed water combined. Given that Bangladeshi men consume an average of 1500 g of rice per day, high concentrations of arsenic in this staple food are likely to be contributing to the arsenic-related cancers and other symptoms suffered by tens of thousands of Bangladeshis.

Lancet 2002; 360: 1839-1840

Toxic choices

Most doctors sleep easier since the introduction and widespread use of the "newer antidepressants", which are up to 10 times safer in overdose than tricyclic antidepressants. But as the choice of drugs broadens, Australian researchers using UK data have found that safety in overdose is not necessarily a class effect. Using mortality and prescription data, the researchers derived a "fatal toxicity index" (FTI, deaths per million prescriptions) for 34 drugs used in treating depression. Overall, the serotoninergic drugs were much safer than the tricyclic antidepressants and monoamine oxidase inhibitors (FTIs 1.6, 34.8 and 20.0, respectively). However, one serotoninergic drug, venlafaxine, had an FTI of 13.2 — higher than all the other drugs in its class and similar to some of the less toxic tricyclic antidepressants. The researchers questioned the wisdom of using venlafaxine as a first-line drug for patients with suicidal ideation and stressed the need to consider toxicity based on individual drugs rather than drug class.

BMJ 2002; 325: 1332-1333

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