21 July 2003

Sorting out SARS

The global effort to understand SARS continues, with researchers in Frankfurt suggesting that a component found in liquorice roots, glycyrrhizin, may be effective in treating the condition. Glycyrrhizin was the most active of five compounds, including ribavirin, assessed for antiviral activity against clinical isolates of SARS-associated coronaviruses.1 Closer to the crisis, Hong Kong authors say WHO criteria for suspected SARS were only met by one in four cases of the disease admitted via a screening clinic early in the outbreak.2 They studied the onset of symptoms in 141 patients admitted after screening to Hong Kong's Prince of Wales Hospital; of this group, 97 patients had SARS subsequently confirmed by anti-coronavirus IgG antibody detection in saved serum samples.

In the early stages of SARS, the main discriminatory symptoms were systemic — fever, chills, malaise, myalgia and rigors — rather than respiratory ones; but a documented fever of more than 38oC occurred in only about one-in-four cases. Radiological evidence of pneumonic change often preceded fever and the authors stated that chest radiography should be mandatory for all patients being screened for SARS. Hong Kong researchers also reported haematological findings in 157 patients with SARS.3 Lymphopenia and a transient prolonged activated partial thromboblastin time occurred commonly. Advanced age, high lactate dehydrogenase levels and an early, notable drop in CD4 and CD8 lymphocyte counts were associated with a poorer outcome.

1. Lancet 2003; 361: 2045-2046
2. BMJ 2003; 326: 1354-1358
3. BMJ 2003; 326: 1358-1362

Out of Africa

Human monkeypox, a smallpox-like virus, has hit North America for the first time. It has similar but less severe manifestations than smallpox. The 50 non-fatal cases of the disease reported in the USA ranged in age from four to 48 years and all had contact with sick prairie dogs purchased as pets from exotic pet stores. Some of the dogs have died from the disease. Previously, sporadic cases had been reported in remote African villages, although an outbreak, with a case-fatality rate of about 10%, occurred in the Congo in the late 1990s. Smallpox vaccination appears to be able to prevent monkeypox; the CDC is looking at its potential role post-exposure.

CMAJ 2003;169: 44-45.

Fun down under

Western Australian researchers report that the Funhaler — a low-volume spacer device that self-reinforces effective technique in young patients by using incentive toys, like a spinner and a whistle — can improve compliance in parents as well as children. They also found that, compared with a conventional spacer, this innovative device did not compromise the aerosol output of the two drugs tested, salbutamol and beclomethasone dipropionate. They hypothesise that use of the Funhaler may lead to improved clinical outcome measures.

Arch Dis Child 2003; 88: 579-581

Screening smoking

An expert commentator says cigarette smoking portrayed in a movie should automatically garner the film an adult content or "R" rating.1 Hopefully, this would have the effect of encouraging studios to stop putting smoking in movies aimed at teenagers. The recommendation followed a New England study of 2603 mainly white, rural adolescents, which found that viewing smoking in movies promoted smoking initiation in this group.2 The researchers did point out that not all initiates will go on to become established smokers.

1. http://image.thelancet.com/extras/03cmt159web.pdf
2. http://image.thelancet.com/extras/03cmt1353web.pdf

Use it or lose it?

Seniors should be encouraged to read, play board games and musical instruments, and go ballroom dancing, says a US author.1 These activities may do more than enhance quality of life; they may also provide protection against dementia. The Bronx Aging Study found that participation in leisure activities requiring mental effort was associated with a reduced risk of dementia in a cohort of elderly subjects who resided in the community.2 Mere physical activity, such as climbing stairs, was not linked to reduced risk.

1. N Engl J Med 2003; 348: 2489-2490
2. N Engl J Med 2003; 348: 2508-2516