Volume 193 - Issue 7
In Other Journals
Author: Alison Williams
Med J Aust 2010; 193 (7): 424. || doi: 10.5694/j.1326-5377.2010.tb03977.x
Published online: 4 October 2010
Published online: 4 October 2010
Hair-raising stress levels
Hair samples may provide insight into stress levels preceding myocardial infarction (MI), according to a Canadian study. Although the association between acute stress and MI is well recognised, research into the role of chronic stress has been limited by recall bias and lack of a reliable biological marker. The stress hormone cortisol, which accumulates in hair, may be just such a marker. As hair grows at a rate of about 1 cm per month, the researchers measured cortisol levels in the proximal 3 cm of scalp hair to reflect stress levels in the previous 3 months. The study, claimed to be the first to use hair samples for this purpose, found that median cortisol levels were significantly higher in the 56 MI patients (P = 0.006) compared with controls. On multivariate analysis, hair cortisol levels had a stronger correlation with MI than other risk factors such as body mass index and cholesterol levels (OR, 17.4; 95% CI, 2.15-140.5). Patients with raised hair cortisol levels may therefore benefit from more aggressive management of cardiovascular risk factors.
Stress 2010 online. doi:10.3109/10253890.2010.511352
Warts and all
Treatment options for warts include cryotherapy with liquid nitrogen, topical salicylates and sometimes a “wait and see” approach, due to their benign natural course — but which is best? A Dutch study has shown that cryotherapy is the most effective, at least for common warts. The study randomised participants to one of three arms — cryotherapy every 2 weeks, topical salicylic acid (40%) or a “wait and see” approach, which allowed the use of over-the-counter treatments only. At 13 weeks, cure rates for common warts were 49% (95% CI, 34-64), 15% (95% CI, 7-30) and 8% (95% CI, 3-21) respectively. However, there was no difference between any of these treatments for plantar warts, which tended to be more difficult to treat, especially in adolescents and adults, where the best cure rate was only 5%. Despite better treatment outcomes for common warts with cryotherapy, it was associated with a higher incidence of side effects such as pain and blistering.
CMAJ 2010. doi:10.1503/cmaj.092194
Double take on D-dimers
Elevated D-dimer levels (normal range, < 500 ng FEU[fibrin equivalent units]/mL) are routinely used to help exclude venous thromboembolism (VTE), but may also indicate underlying malignancy in patients without VTE, according to a UK study. The incidence of underlying malignancy was found to be 27.5% in those with very high levels (> 8000 ng FEU/mL). D-dimer levels over 8000ng FEU/mL were also associated with reduced overall survival (35 months v 65 months). Although expressing caution related to poor standardisation of assays, the study authors suggest that the presence of a very high D-dimer level in the absence of VTE should alert for the presence of underlying malignancy.
J Clin Pathol 2010; 63: 818-822 doi:10.1136/jcp.2010.076349
Adherence a sticky issue
Medication adherence can be a challenging problem in children and adolescents with chronic illness. In a systematic review of 17 trials, Queensland researchers have found that adding behavioural interventions — such as monitoring, goal-setting, reward, problem solving and linking medication taking with established routines — were more likely to improve medication adherence than education alone. These findings suggest that adherence may be improved by incorporating strategies such as regular follow-up and simple behavioural techniques into existing practice. However, few of the trials included patients with established adherence problems.
Arch Dis Child 2010: 95; 717-723 doi 10.1136/adc.2009.175125
Need for needle exchange
Yale researchers have found that hepatitis C virus (HCV) can survive for up to 2 months in contaminated syringes. The series of experiments using a newly developed assay replicated common injecting practices among drug users, and tested two types of syringes loaded with HCV spiked blood; an insulin syringe with a permanently attached needle containing a low void volume of blood, and a tuberculin syringe with a detachable needle, with a high void volume. Syringes with a high void volume were considered more likely to transmit HCV, as a result of increased viral load and longer survival. Temperature also played a role, with lower temperatures (4°C) tending to preserve viability of the virus, especially in the low void volume syringes. HCV was found to survive for as long as 63 days in the high void volume syringes. Such findings underscore the importance of needle-exchange programs in reducing the spread of hepatitis C among injecting drug users, and suggest that exchange programs should encourage the use of low void volume syringes.
J Infect Dis 2010: 202; 984990. doi:10.1086/656212