18, NUMBER 6
Great news for patients with diabetes. The famous Diabetes
Control and Complications Trial (DCCT) had clearly demonstrated
that intensive diabetes therapy aimed at achieving near normoglycaemia
reduces the risk of microvascular and neurological complications
of type 1 diabetes. Now, the 17-year follow up report on the
cohort reveals that intensive treatment reduces the risk of
any cardiovascular disease event including non-fatal myocardial
infarction, stroke or death from cardiovascular disease by
almost half (N Engl J Med 2005;353:2643–53).
The news is abuzz about a religious guru and contamination
of his ayurvedic medicines. Notwithstanding the controversy,
there is some substance in the ancient wisdom. Yoga does work
for chronic low back pain. In a randomized trial comparing
yoga, conventional therapeutic exercise or a self-care book
for patients with chronic low back pain, it was found that
yoga was more effective in improving back-related function
and reducing chronic low back pain. More so, the benefits lasted
for several months (Ann Intern Med 2005;143:849–56).
Grandmothers have been giving oil massages to newborns all
along. A randomized trial looked at the effect of oil massage
on growth and neurobehaviour in very low birth-weight preterm
neonates. The good news is that the weight gain in the oil
massage group was higher. However, there was no additional
improvement in other anthropometric parameters and neonatal
neurobehaviour. Seems a worthwhile intervention, especially
if one could also assess the fun babies must be having with
the massage (Indian Pediatr 2005;42:1092–100).
A stitch in time saves nine. Now, the focus is on kindergarten
students for cardiovascular risk factor modification. The CARDIAC–Kinder
study evaluated an intervention aimed at increasing family
physical activity and parent education about diet and activity
for kindergarten students and issues related to their body
mass index (BMI). The participants in the intervention group
reported that their children were more active and had consumed
fewer sweets than the comparison group, thereby producing desirable
awareness and behavioural changes (Am J Health Behav 2005;29:595–606).
There is a raging controversy regarding the superiority of
bypass surgery over angioplasty for coronary heart disease,
with the former gaining more points in its support. The BASIL
(Bypass versus Angioplasty in Severe Ischaemia of the Leg)
trial examined these two treatment options for rest pain, ulceration
and gangrene of the leg for infra-inguinal severe ischaemic
disease, i.e. peripheral vascular disease (Lancet 2005;366:1925–34).
The primary end-point was amputation-free survival. At the
end of the follow up, almost half of the patients were alive
without amputation and about a third dead without amputation.
The two strategies did not differ significantly in amputation-free
survival and there was no difference in the health-related
quality of life between the two. It would seem that either
approach to severe limb ischaemia is fine and the choice will
rest on cost factors and local expertise.
Medication errors are common among paediatric patients and
more so in emergency departments. Such errors may lead to prolonged
hospitalization, unnecessary diagnostic tests and treatments,
and death. The use of a preprinted structured order sheet was
examined in a randomized study. This practice significantly
reduced (almost by half) the incidence of medication errors
in the paediatric emergency department when compared to the
use of blank order sheets. Further, such a practice would be
significantly less stressful for healthcare personnel (Pediatrics 2005;116:1299–302).
This one is really an unusual set of therapists—dolphins.
A single-blind, randomized, controlled trial evaluated the
effectiveness of animal-facilitated therapy with dolphins,
controlling for the influence of the natural setting, in the
treatment of mild-to-moderate depression and in the context
of the biophilia hypothesis. The therapy was effective in alleviating
symptoms of depression after 2 weeks of treatment. The authors
contend that animal-facilitated therapy with dolphins is an
effective treatment for depression, which is based on a holistic
approach, through interaction with animals (BMJ 2005;331:1231).
Bats and balls—this is not about sports medicine. The
Economist (8 December 2005) reports a study on bats, the mammals,
carried out by Scott Pitnick, of Syracuse University in New
York State, that bigger testes mean smaller brains. There really
is a trade-off between the two organs. The hypotheses were
that in any given species, the average male’s testes
size as a fraction of body weight will depend on the behaviour
of that species’ females—in particular, how promiscuous
those females are and secondly, given that brain tissue and
testis tissue are among the most expensive to maintain physiologically,
bigger balls would result in smaller brains. In the study,
smaller testes were indeed found in bat species where females
were monogamous (though they might be members of harems), while
larger ones were found in species where females mated widely.
And, brain size, by contrast and just as predicted, varied
in the opposite direction.
A word of caution on the use of sedative hypnotics in older
people with insomnia. A meta-analysis quantified and compared
potential benefits (subjective reports of sleep variables)
and risks (adverse events and morning-after psychomotor impairment)
of short term treatment with these agents in the elderly. While
the improvement in sleep with sedative use was statistically
significant, the magnitude of effect was small. On the other
hand, the increased risk of adverse events was not only statistically
significant but also potentially clinically relevant. It seems
that in older people sedative hypnotics may not be advisable
especially for mild insomnia, particularly if the patient has
additional risk factors for cognitive or psychomotor adverse
events (BMJ 2005;331:1169).
Prisons improve obstetric and perinatal outcomes. A systematic
review examined the outcomes of pregnancy among approximately
2000 imprisoned women (Br J Obstet Gynaecol 2005;112:1467–74).
The imprisoned women are more likely to deliver prematurely
and have a low birth-weight baby than the entire population
of control women. However, when compared with a similarly disadvantaged
group, imprisoned women are less likely to have a stillbirth
or low birth-weight baby, suggesting that imprisonment may
have a beneficial effect.