The NMJI

VOLUME 18, NUMBER 6

NOVEMBER / DECEMBER 2005

Masala   [PDF]

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.
 

GOPESH K. MODI

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