eMJA: In Other Journals, 19 November 2007

Human papillomavirus (HPV) testing appears to have a greater sensitivity for the detection of cervical intraepithelial neoplasia when compared with conventional Pap testing, according to a Canadian randomised controlled trial. Both tests were performed in a randomly assigned sequence on 10 154 women aged 30 to 69 years presenting for cervical screening. Participants with a positive Pap or HPV screening test were referred for colposcopy, as were a proportion of those with negative tests. HPV testing was more sensitive by 39.2% and only 2.7% less specific than Pap testing for the detection of cervical intraepithelial neoplasia grades 2 or 3. The authors note that testing for HPV has entered a new era, with the introduction of HPV vaccines changing how women will be tested in the future. They suggest that the HPV DNA test may prove useful in screening those women who undergo screening less frequently.

Maternal mortality — sad statistics

Maternal mortality rates remain high in sub-Saharan Africa despite a worldwide trend of decreasing maternal deaths, a global study has found. Although research efforts have been hampered by lack of records and varying data collection methods between areas, the multinational Maternal Mortality Working Group has summarised available data on maternal deaths by country. The researchers estimated that there were 535 900 maternal deaths worldwide in 2005, with most deaths concentrated in sub-Saharan Africa and Asia. This corresponds to a ratio of 402 deaths per 100 000 live births. All countries with data showed a decrease of 2.5% per year between 1990 and 2005, but no such reduction was seen in the African nations. To put these figures in perspective, the estimated maternal mortality ratio for Australia in 2003 was 4 per 100 000 live births. In Niger in 2005, it was 1800. As the authors note, “progress is slow”.

Lancet 2007; 370: 1311-1319

Antioxidants disappointing for AMD

Dietary antioxidants may not be as effective in the prevention of age-related macular degeneration (AMD) as previously thought, a systematic review and meta-analysis has suggested. Data from 12 studies involving over 149 000 participants were pooled, evaluated and analysed by the Australian research team in an effort to judge the effect of antioxidants such as vitamins A, C, and E, zinc, and β-carotene. Preventive therapy with antioxidants has been based on the susceptibility of the retina to oxidative damage. Whereas previous studies have suggested a protective effect of antioxidants on the progression of intermediate to advanced AMD, the evidence for the usefulness of such therapies in the prevention of early AMD is not conclusive. Although the current review indicated that a range of antioxidants have little or no effect on the development of early AMD, vitamin E had a borderline protective effect.

BMJ Online, 8 Oct 2007

Battling Bell’s palsy

Early treatment of idiopathic facial paralysis (Bell’s palsy) with corticosteroids appears to significantly improve the outcome for affected patients, but the usefulness of anti-viral agents is questionable, according to Scottish researchers. A total of 496 patients were assessed in the double-blind, placebo-controlled, randomised trial. All participants were recruited within 72 hours of developing Bell’s palsy, and were randomly assigned into four groups treated with prednisolone, aciclovir, both agents, or placebo. Recovery of facial function at 3 months was the primary outcome. Early treatment with prednisolone appeared to significantly improve the chance of recovery of facial function (83%, compared with 64% in those not receiving prednisolone). Aciclovir alone or in combination with a corticosteroid did not show any benefit.

N Eng J Med 2007; 357: 1598-1607

Stateside superbugs

Invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States are no longer confined to a health care setting, and their incidence is increasing, according to a population-based study. Almost 9 000 observed cases of invasive MRSA in nine geographic sites were reported over the 18-month surveillance period. The authors extrapolate these findings to estimate that close to 95 000 such infections occurred in the US in 2005, with almost 19 000 deaths due to the infection. Although the majority of invasive infections occurred outside the hospital setting, most of these individuals had established risk factors for MRSA, such as a relatively recent (within the past 12 months) history of hospitalisation. Molecular analysis of isolates from these patients suggests a health care origin for the pathogen responsible.

JAMA 2007; 298: 1763-1771

Dr Tanya Grassi, MJA

The Medical Journal of Australia eMJA