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CARPHOLOGY by Rajendra

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A matched cohort study in adolescents with meningococcal disease recruited at hospital admission finds that being a student, intimate kissing with multiple partners, a history of preceding illness, and preterm birth were all independently associated with higher risk of meningococcal disease. According to the authors altering personal behaviours could moderate the risk, but the development of better vaccines is the key priority.

How safe is nicotine replacement therapy in patients with pre-existing cardiovascular disease? A simple observational study from a general practice database in over 33,000 individuals (of whom 861 had had a myocardial infarct and 506 a stroke) looks at the relative incidence of myocardial infarction and stroke in four 14 day periods before and after the first prescription for nicotine replacement therapy. Overall the risk of myocardial infarction, stroke, or death did not increase in the 56 days after the first prescription. However, the study did find an increased incidence of myocardial infarction and stroke in the 56 days before the first prescription of replacement therapy. This may be because replacement therapy is currently prescribed shortly after myocardial infarction and stroke, say the authors.

A dedicated secondary care clinic dealing with “fits, faints, and funny turns” reports a prospective study of 380 children referred over an eight year period. Only 23% of the children were given a final diagnosis of one of the childhood epilepsies, with about half of these having a specific epilepsy syndrome. Syncope was the commonest cause of a non-epileptic event (syncope and reflex anoxic seizures comprised 42%) but there were a wide variety of other causes. Fourteen per cent were unclassified; these, say the researchers, can be managed expectantly as long as a full initial assessment is performed, follow up is continued until the benign nature of the events is apparent, and agreed channels exist for parents to seek reassessment if the situation changes.

A meta-analysis finds no evidence that melatonin has an effect on sleep onset latency in people with sleep disorders secondary to medical or neurological illnesses. Neither does it find evidence of an effect in those with sleep disorders accompanying sleep restriction, such as jet lag. It also found no evidence of adverse effects with short term use (three months or less). However, none of the participants included in the trials in the meta-analysis was like this carphologist—so he plans to continue using melatonin for jet lag, because it works for him.

Self-monitoring or self-management of anticoagulation sounds like a good idea, but is it? A systematic review finds that it is beneficial for those patients who can do it and will do it. These patients will have fewer serious bleeding complications and a lower mortality than patients who rely entirely on health professionals to do the tests and adjust the dose. The problem is that many patients cannot or will not monitor, or they need a lot of training to use the strips, which anyway are expensive.

Use of a mobile phone, either in the short or medium term, is not associated with an increased risk of glioma according to a population based case control study involving nearly 1000 people aged 18–69 years diagnosed with a glioma. A significant excess risk for reported phone use ipsilateral to the tumour was paralleled by a significant reduction in risk for contralateral use, a difference perhaps due to recall bias according to the authors.

BMJ (online first, published 20 January 2006) doi:10.1136/bmj.38720.687975.55

Acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status and the benefit was sustained for six months. These are the findings of a randomised controlled trial done in an orthopaedic clinic in Taiwan involving 129 patients with chronic low back pain and a single therapist. According to the authors, the effectiveness of any manipulation therapy depends on the therapist’s technique and experience. The use of a single therapist may enhance the trial’s internal validity but imposes a threat to external validity, say the authors.

BMJ (online first, published 17 February 2006) doi:10.1136/bmj.38744.672616.AE

Playing the didgeridoo regularly is an effective treatment well accepted by patients with moderate obstructive sleep apnoea syndrome, finds a randomised controlled trial carried out in 25 patients aged over 18 years with an apnoea-hypopnoea index between 15 and 30 who complained about snoring. Daytime sleepiness and apnoea-hypopnoea index improved significantly in the intervention group and their partners reported less sleep disturbance.

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