Congenital cardiac disease Br Med Bull 2008; 85: 63-85
Here in Australia I am able to request a few echocardiograms and have noted the odd reporting of a bicuspid aortic valve, which I have seen as nothing more than an oddity until now.
This is the most common congenital cardiac abnormality and can lead to aortic stenosis, regurgitation, infective endocarditis and dissection.
This literature search from the UK and Italy suggests that, especially in athletes, a bicuspid aortic valve should be monitored for deterioration annually - easily said if you have access to the investigation of choice.
Once-daily insulin Lancet 2008; 371: 1,073-84
The APOLLO trial was carried out in Europe and Australia using 418 patients with type-2 diabetes to determine if long-acting once-daily insulin was 'non-inferior' to a three times daily schedule of shorter acting insulin. The trial was randomised and the primary endpoint measured was HbA1c.
The first good piece of news was that the majority of both groups achieved an HbA1c of 7.0 or less. Given that the oral insulins were comparable, the authors concluded that once daily insulin was the superior product with fewer hypoglycaemic episodes and injections, and less monitoring required.
The only fly in the ointment was that the study was funded by the once-daily insulin manufacturer.
Comfort in running shoes Br J Sports Med 2008; 42: 189-93
Are expensive trainers worth the money? This trial from Scotland was designed to see if expensive running shoes provide an objective better cushioning effect and subjective comfort compared to cheaper alternatives from the same brand.
The low brand (£40-45), medium (£60-65) and expensive (£70-75) trainers were bought from three different manufacturers and tested on a treadmill.
An in-shoe pressure device was used to make the measurements. Plantar pressures were no different between the shoes, and subjectively there was also no difference in comfort for the runners.
My only complaint is that at these prices I'm not sure if you are truly comparing Poundstretcher shoes to Nikes.
Weight loss measures Arch Intern Med 2008; 168: 571-80
Weight loss is recommended in all major guidelines for antihypertensive therapy but Dr Sceptical is never convinced that patients heed this advice.
This meta-analysis of randomised controlled trials looked at diets versus drugs versus invasive interventions.
Drugs and diets did better than usual care or placebo. Diets made the best improvement, with a mean BP reduction of 6.3/3.4mmHg. Of the drugs, orlistat gave a reduction of 2.4/2.0mmHg. While sibutramine caused BP increase despite weight loss.
So nothing beats the age old mantra of 'eat less, exercise more' in the context of a supervised weight loss diet, at least when it comes to BP reduction.
MRSA testing for all Ann Int Medicine 2008; 148: 409-18
Until now, no intervention has reduced the frequency of MRSA infection rates. In three American hospitals after a baseline year they screened all patients entering the ICUs for one year and then all admissions the year after. Polymerase chain reaction (PCR)-based nasal surveillance was used.
All positives were placed on contact precautions.
The prevalence density of MRSA infection was 8.9, 7.4 and 3.9 per 10,000 patient-days in years one, two and three, respectively.
Bacteraemia rates did not change during the study but the effect of the reduction in rates continued to drop for 30 days after discharge. Considering all the near-patient PCR tests required, this study was successful but at a cost.
Diabetic risks BMJ 2008; 336: 697-701
This UK trial followed up 527 children, with type-1 diabetes for about 10 years to determine what predicted their risk of developing microalbuminuria and proteinuria.
After 10 years, a quarter of the patients had developed microalbuminuria and the only value that predicted this was HbA1c control. BP and smoking had no bearing on the results.
This should perhaps focus our attention on both education and monitoring of glycaemic control in children and young adults and keeping a close eye on their urine for changes.
Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who reviews the journals
The quick study
- Bicuspid aortic valve is the most common congenital cardiac abnormality and must be monitored for deterioration.
- Oral insulin once daily leads to fewer hypoglycaemic episodes with fewer injections needed.
- Plantar pressures are not significantly different across variably priced running shoes.
- Weight loss through diet makes the most significant improvement to BP.
- MRSA screening reduced serious infection when applied to all admissions but had little effect if limited to ICU.
- Glycaemic control in diabetic children needs to be monitored to check for developing microalbuminuria and proteinuria.