eMJA: In other journals

Influenza vaccination may do more for the elderly than reduce the odds of hospitalisation for pneumonia and death from all causes. A large US cohort study of 286 000 community-dwelling patients aged 65 years or older compared the health status of the 58% who had received the vaccine with that of the unvaccinated. For the two ’flu seasons studied, the vaccinated also had a lower risk of hospitalisation for cardiac and cerebrovascular disease. The effect was seen in both healthy and high-risk patients. However, the researchers were unable to rule out whether some of the benefit was due to pneumococcal vaccination.

N Engl J Med 2003; 348: 1322-1332

Good odds at ASCOT

One of the first randomised trials of pharmacological lipid-lowering in patients with hypertension — The Anglo-Scandinavian Cardiac Outcomes Trial, Lipid Lowering Arm (ASCOT-LLA) — has been stopped well ahead of schedule. An early analysis revealed significantly fewer coronary events and strokes had occurred in those receiving active treatment, 10 mg atorvastatin, compared with those taking placebo. The 10 305 patients were at fairly high risk: although their baseline total cholesterol was less than 6.5 mmol/L, they had at least three cardiovascular risk factors other than their well-controlled hypertension.¹ However, an accompanying commentary pointed out that the benefit, in absolute terms, was modest.²

1. Lancet 2003; 361: 1149-1158
2. Lancet 2003; 361: 1144-1145

The hole story

Body piercing has been with man for centuries — for example, according to a review in The Lancet, Mayan royalty pierced their tongues and genitals as part of religious bloodletting rituals as early as 700 AD. In our time, the practice of body piercing at all sorts of sites, including the mouth and tongue, genitalia and even the armpit, is on the rise in many Western societies, including Australia, and medical practitioners are seeing related side effects and complications. Local bacterial skin infection and bleeding are more usual; tetanus, leprosy, tuberculosis and endocarditis, as well as possible interference with resuscitation in emergency situations, have also been reported.

Lancet 2003; 361: 1205-1215

Pill fears

A WHO-commissioned systematic review of published evidence has reported that the risk of cervical cancer increases with increasing duration of use of hormonal contraceptives. Findings were similar when adjusted for human papillomavirus infection states. The risk might decline after cessation of use, but the available data relating to this possibility are currently limited.

Lancet 2003; 361: 1159-1167

Pap smears

Conventional Pap smears are more reliable and less likely to give false positive and false negative results than monolayer cervical cytology for low-and high-grade lesions, according to the French Society of Clinical Cytology Study Group. In each of 2585 women, they took a conventional smear and used the remaining material to prepare a monolayer slide (n = 2585) and, when sufficient, went on to papillomavirus testing (n = 1785). A reference method was used for comparison: colposcopy, followed by biopsy if abnormalities were detected.

BMJ 2003; 326: 733-737

Catching cockroaches

Cockroaches may play a role in hospital-acquired infections, say Taiwanese researchers. They set traps to catch cockroaches in clinical and other areas, including drug stores and kitchens, in 90 hospitals. They also set traps in 40 households.

In the total catch of 203 cockroaches from 42 of the hospitals, six non-tuberculous mycobacteria were identified in 12 of 139 American cockroaches (Periplaneta americana). No mycobacteria were isolated in the 64 German cockroaches (Blattella germanica) caught in hospitals. No mycobacteria were isolated from 226 cockroaches of either species caught in half of the households.

J Hosp Infect 2003; 53: 224-228

SARS unmasked

Case series covering the first 10 patients with severe acute respiratory syndrome (SARS) in Hong Kong and in Canada have been published on The New England Journal of Medicine website. All of the Canadian patients who either required intubation or died had underlying medical illnesses, such as type 2 diabetes, or were older than 55 years of age. Smoking may also be a risk factor for more severe SARS, the Canadian report said. At time of posting, the microbiological origins of SARS were unclear, although a novel coronavirus and a human metapneumovirus had been isolated from some of the cases.

http://nejm.org/earlyrelease/sars.asp [accessed 4 Apr 2003]