eMJA: In Other Journals, 16 August 2004

Three recipients of transplanted organs from a donor who died of a presumptive subarachnoid haemorrhage died a few weeks later themselves — from rabies.1 According to the US Centers for Disease Control (www.cdc.gov) these are the first reported cases of rabies transmission via solid organ transplantation; rabies has been transmitted previously via corneal transplants. Later, it was reported that a segment of iliac artery recovered from the donor had been used in another liver transplantation procedure; the recipient also died of rabies a few weeks after the procedure.

Rabies testing is not part of the routine donor-screening process and rabies had not been suspected in the donor; however, a subsequent public health investigation determined that the donor had reported being bitten by a bat. As of 9 July, rabies postexposure prophylaxis had been initiated in about 20% of the 916 persons assessed for exposures to the organ recipients or the donor.

Photos by mobile phone

Mobile phone use may be eschewed in many medical environments, but for one surgical team at Sydney’s Nepean Hospital mobile phones with photo-messaging capabilities are proving a relatively inexpensive and effective means of enabling telemedicine. Lam and colleagues used two Nokia phones equipped with digital cameras to capture, store and send images of hand trauma from registrar bedside to consultant elsewhere. Over two months, images (including x-rays) for 27 various cases (including compound fractures [see photo], lacerations and tip amputations) were sent by phone, aiding communication and conventional clinical discussion between the team members.

Aust N Z J Surg 2004; 74: 598-602

Joint strategy

A multifaceted, intensive outpatient treatment strategy for active rheumatoid arthritis (RA) can lead to better clinical results than routine outpatient care, say Scottish researchers. They compared these two approaches in a randomised controlled trial involving more than 100 adult patients who had had RA for less than 5 years. The intensive strategy incorporated monthly review, intensive use of intra-articular steroid injections and a structured protocol for escalating disease-modifying drug treatment; neither strategy offered anti-tumour necrosis factor treatment. After 18 months, the intensive strategy resulted in greater improvements in disease activity (including more remissions), physical function and quality of life and less radiographic disease progression — all at no additional overall cost to the NHS.

Lancet 2004; 364: 263-269

Outbreak

While Toronto was coming to grips with the SARS epidemic, another Canadian city, Montreal, was experiencing an outbreak of Clostridium difficile-associated diarrhoea (CDAD), which may have been responsible for about twice as many deaths as SARS in that country, according to a series of articles in CMAJ.1 In recent years, cases of CDAD seem to have become more frequent and more severe, possibly due to a more virulent strain of the organism. One research team has identified proton pump inhibitor use as an independent risk factor for CDAD.2

1. CMAJ 2004; 171: 5; 19-21; 27-29; 45-48 2. CMAJ 2004; 171: 33-38

Soy story

Soy protein supplements may not improve bone mineral density in healthy, older postmenopausal women, according to a Dutch double-blind, placebo-controlled trial. About 200 study participants aged 60 to 75 years were randomised to receive either 25.6 g of soy protein containing 99 mg of isoflavones or 25.6 g of placebo (total milk protein) on a daily basis. After a year of supplementation, not only bone mineral density but also cognitive function and plasma lipid levels did not differ significantly between the soy and placebo groups. However, the researchers acknowledged that findings in the study subgroups, formed according to years since the menopause, supported the idea that it may be easier to prevent than reverse changes or losses after menopause. In the most recently menopausal women, soy supplementation seemed to improve bone mineral density, whereas this effect was absent in late menopause.

JAMA 2004; 292: 65-74

AIDS 2005

In 1995, 500 000 workers with AIDS around the world were too ill to work; by 2005, and without access to antiretroviral drugs, this figure will have grown to two million workers, according to an International Labour Organization report presented at the 15th International Aids Conference held in Bangkok from 11-16 July 2004.1 The resultant economic impact on developing countries is expected to be significant. Research from Tanzania offers some hope for those affected: a randomised trial of multivitamin supplements involving more than 1000 women infected with HIV conducted from 1995 to 2003 has found that daily oral supplementation with vitamin B complex, vitamin C, vitamin E and folic acid delayed the progression of disease compared with placebo.2

1. BMJ 2004; 329: 129 2. N Engl J Med 2004; 351: 23-32

Dr Ann Gregory, MJA

The Medical Journal of Australia eMJA