Earache, HRT and panic attacks

No time to read the journals? Let Dr Alison Glenesk guide you through the latest research.

Penicillin V for earache
Scand J Prim Health Care 2007; 25: 166-71

I find it hard to leave a red, painful ear untreated and am always looking for evidence to vindicate my stance.

Some 179 patients with early otitis media (less than four days) were randomised to receive penicillin V or placebo. The median recovery time was four days in both groups, however the treated patients experienced significantly less pain and took fewer analgesics. There was no difference in the incidence of middle-ear effusions or perforation in the following three months.

The authors conclude that this study supports the current practice of treating otitis media with analgesia only. As a parent, I'm not quite so sure.

Breast cancer risk with HRT
J Fam Plann Reprod Health Care 2007; 33: 237-43

This review looks at the hype that surrounded the publication of the Million Women Study (MWS), and attempts to put it in perspective.

The conclusion is that the MWS overestimated the risk of breast cancer attributable to HRT, partly because it only requested information on the duration of the present HRT regime, and not previous use, at recruitment. Women developing cancer might therefore have been exposed to HRT for much longer than previously thought.

The extra 20,000 breast cancers estimated to have been caused by HRT in the UK in the past 10 years was also considered in the context of alcohol intake, which the researchers estimated could explain at least 16,000 extra cases. Reported excess of deaths in breast cancer patients were considered to be borderline statistical significance and has not been borne out in other trials.

I hope that through reviews like this, HRT will eventually lose the 'dangerous drug' label it has attracted, and resume its place as a useful medication when used sensibly.

HPV DNA versus traditional cervical cytology
N Engl J Med 2007; 357: 1,579-88

Publication of this large study of cervical cancer screening methods was particularly timely, with the recent announcement of the introduction of HPV immunisation for schoolgirls.

The aim was to determine whether testing for DNA of oncogenic HPV is superior to the traditional cytological method in testing for high-grade cervical intraepithelial neoplasia (CIN). The study included 10,154 women and found that the sensitivity of HPV testing for grades 2 and 3 CIN was an impressive 94.6 per cent with HPV testing, but only 55.4 per cent with the Pap method. Using both methods together gave 100 per cent sensitivity with a specificity of 92.5 per cent.

The authors suggest changing to DNA testing would be effective in reducing cervical cancer. But one wonders about the future of the cervical screening programme if we are successful in preventing most HPV infection.

Progress towards a malaria vaccine
Lancet 2007; 17 October: DOI:10.1016/S0140-6736(07)61542-6

There has been little success in producing an effective and safe malaria vaccine. However, one has reached the stage of human testing.

For the study, 214 babies born in Mozambique were randomised to receive either three doses of the RTS, S/AS02D malaria vaccine or a vaccine against hepatitis B up to age 18 weeks. The malaria group produced enough antibody to offer moderate protection during the three months following immunisation.

Although serious illness and two deaths occurred in each group, these were not attributable to the vaccines. The next step is to look at efficacy in more depth.

Dr Glenesk is a GP in Aberdeen, and a member of our team of regular research reviewers

The quick study
Acute otitis media does not resolve faster with penicillin V but pain is reduced.

Breast cancer risk linked to HRT was overestimated by the Million Women Study because it was not based on lifetime HRT exposure.

HPV DNA testing has a much higher sensitivity than conventional cytology for detecting CIN 2 or 3.

Malaria vaccination has come a step closer. A candidate vaccine showed promising efficacy and comparable safety to a hepatitis B vaccine in a human trial.

Research of the week

Panic attacks and CHD
Arch Gen Psychiatry 2007; 64: 1,153-60

This spin-off from the Women's Health Initiative study found a link between panic anxiety and CHD in women aged 51-83.

Over 5.3 years, 10 per cent experienced 'full blown' panic attacks for at least six months. When corrected for confounding factors, they had a hazard ratio of 4.2 for CHD and 3.08 for CHD or stroke. After exclusion of women with a history of cardiovascular or cerebrovascular events, women with panic attacks had a hazard ratio of 1.75 for all-cause mortality.

The mechanism is unclear, though the percentage of women with panic disorder seems very high. The message? Keep calm, especially if you are female, and let's hope our quality framework masters don't get hold of this one.

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