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Why do hip replacements need revision? Of 37 adults who underwent revision in one centre, the most common reasons were hip pain, decreased range of motion, and functional disability. All but one patient had radiographic evidence of femoro-acetabular impingement at the time of the revision, and after revision all patients regained some of their lost function within the first year (American Journal of Sports Medicine 2007;35:1918-21 doi: 10.1177/0363546507305097).
Reflux is a common diagnosis in infants—but is it being confused too often with ordinary regurgitation? Of 64 infants who were referred to a paediatric gastroenterology service in the United States, 44 underwent extended monitoring of oesophageal pH; 42 of them were already taking anti-reflux medication. The results showed abnormal acid reflux in eight infants, as well as four cases of hypertrophic pyloric stenosis and one case of renal tubular acidosis. In most of the babies with normal pH results, stopping the anti-reflux medication made no difference (Pediatrics 2007;120:946-9 doi: 10.1542/peds.2007-1146).
Farmers in Hampshire are reporting a new skin disorder around the lambing season (British Journal of Dermatology published online 6 November 2007; doi: 10.1111/j.1365-2133.2007.08279.x). Farmers' ears become hot and itchy and then start to blister and crust—and it all resolves as soon as lambing is over. A letter in various farming magazines about the mysterious affliction drew 69 responses from UK farmers but none from abroad. The aetiology of “lambing ears” remains a mystery, but the biopsies resemble polymorphic light eruption, which occurs after exposure to sunlight.
The authors of a prospective randomised study compared eccentric training of calf muscles, wearing a heel brace containing two interconnected air cells, or both, for chronic Achilles tendinopathy and found that the brace is as effective as the training. They also found that there was no additional benefit in combining the treatments (American Journal of Sports Medicine 2007;35:1659-67 doi: 10.1177/0363546507303558).
The Malawi antiretroviral programme is expanding rapidly. A study reports that healthcare workers in the programme made up 2% of patients in mid-2006. The probabilities for survival with antiretroviral treatment at 6, 12, and 18 months were 85%, 81%, and 78% respectively. The researchers estimate that the lives of 250 healthcare workers had been saved a year after starting treatment, and that currently the staffing required for the programme balances healthcare workers' lives saved (Bulletin of the World Health Organization 2007;85:851-7 doi: 10.2471/BLT.07.041434).
Community acquired strains of methicillin resistant Staphylococcus aureus (MRSA) may be more virulent than hospital acquired strains, according to a paper in Nature Medicine (published online 11 November 2007; doi: 10.1038/nm1656). Community strains seem to secrete higher levels of a cluster of small peptides called phenol soluble modulins (which disable immune cells) than do hospital strains of the bug. Mutant bacteria unable to secrete these peptides were far less virulent in mice.
Minerva recently mentioned garlic's ability to relax blood vessels (BMJ 2007;335:892 doi: 10.1136/bmj.332.7540.558). Now garlic's potential to impair platelet function is under scrutiny. Whole blood from 18 healthy volunteers was analysed before and after they ate tsatsiki containing 4.2 g raw garlic or tsatsiki without garlic in a randomised, crossover, observer blinded, placebo controlled trial (Anesthesia and Analgesia 2007;105:1214-8 doi: 10.1213/01.ane.0000287253.92211.06). Breath may be impaired, but platelet function isn't, by eating garlic.
Does the addition of a long acting β agonist (LABA) inhaler reduce the risk of relapse for patients already taking inhaled or oral steroids who have attended the emergency department with an asthma attack? A study in Academic Emergency Medicine (2007;14:833-40 doi: 10.1197/j.aem.2007.06.020) reports that, for most patients, a short course of systemic steroids in combination with inhaled steroids is adequate. For those already taking inhaled steroids, adding a LABA may reduce relapse and improve quality of life, but the role of LABAs in acute asthma is still not clear.
Despite good intentions, many patients who have ischaemic strokes stop taking their usual drugs, including statins. In a study of 631 consecutive stroke survivors without symptoms of coronary heart disease, all were given a statin on discharge and followed up for 12 months. Within the year, 39% of them had stopped taking the statin. Multivariate analysis indicates that after all the possible confounding factors are taken into account, stopping statins was an independent predictor of all cause mortality at one year (Stroke 2007;38:2652-7 doi: 10.1161/STROKEAHA.107.487017).
A new website, www.equator-network.org, has been developed as part of the EQUATOR (enhancing the quality and transparency of health research) project. It's aimed at researchers, journal editors, peer reviewers, and people responsible for developing guidelines. The steering group says the resources are tailored to meet the needs of the main user groups, and the website offers easy access to standard reporting guidelines, including the CONSORT statement for reporting randomised controlled trials, QUOROM (now known as PRISMA) for reporting systematic reviews and meta-analyses, and the STROBE statement for reporting observational epidemiological studies.