Cleft palate, condoms and DVT

Running short of time to read the journals? Allow Dr Gwen Lewis to be your guide to the latest findings

More benefits of folic acid in pregnancy
BMJ online doi: 10.1136/bmj.39079.618287.0B 

For some years pregnant women have been advised to take folic acid during early pregnancy to reduce the incidence of neural tube disorders. In this study from Norway, folic acid in early pregnancy was also found to reduce the risk of isolated cleft lip with or without cleft palate by about a third.

The risk of isolated cleft lip was reduced even after adjustments for multivitamin supplements, smoking and other potential confounding factors. The lowest risk of cleft lip was among women with a folate-rich diet containing lots of fresh fruit and vegetables who also took folic acid supplements.

How long to anticoagulate?
BMJ online doi: 10.1136/bmj.39098.583356.55 

Following deep vein thrombosis (DVT) or pulmonary embolus (PE) patients are currently anticoagulated for three months or six months, but how long is optimal?

In this multi-centre study from the UK, 749 patients with DVT, PE or both were divided into two groups receiving either three months or six months’ warfarin treatment following five days of treatment with heparin as well as warfarin initially.

Of those in the group being anticoagulated for three months, two patients died, while three died in those receiving six months’ treatment. There were no fatal haemorrhages in either group but there were eight major haemorrhages in the six months’ treatment and none in the three months’ treatment group.

It was concluded that there is little, if any, advantage in increasing the duration of anticoagulation from three months to six months.

Condoms being used too late
Sex Transm Infect 2007; 83: 68–70 

Condoms provide reasonably effective contraception as well as protection against STIs, but they need to be used correctly to protect.

A group of patients attending sexual health clinics were surveyed to assess the prevalence of and factors associated with vaginal penetration either before condom application or following condom removal, among young people in the UK.

Of those surveyed 6 per cent admitted to applying condoms after penetration and 6 per cent had continued penetration after condom removal. Over a six-month period of reporting 31 per cent had applied a condom late at least once.

Why condoms split
Sex Transm Infect 2007; 83: 71–5 

As GPs we are often consulted by patients requesting emergency contraception after condom breakages. But why do condoms split?

Young men attending an STI clinic were asked about condom breakages, of whom 31.3 per cent reported recent split condoms. The breakage rate was 15 per cent.

Of note was that men who had past history of STI or who reported condom slippage were more likely to report breakage. Not squeezing air from the condom tip was associated with increased likelihood of a split. Splits were found to be common, but could be reduced by educating patients on correct usage of condoms and how to apply them.

Depression screening tools in primary care
BJGP 2007; 57: 144–51 

This study looked at ultra-short screening questionnaires and their accuracy in diagnosing patients with depression.

A one-question test was found to identify only three in 10 patients to whom it was applied while two or three question tests are more accurate, identifying eight out of 10 such patients. What was worrying was the high false-positive rate, with only four out of 10 patients with a positive score actually being depressed. 

Dr Lewis is a GP in Windsor, and a member of our team who regularly review the journals

The quick study

Folic acid during pregnancy may prevent cleft lip and palate.

Anticoagulation for six months has no benefit over a three-month period of treatment.

Condoms are incorrectly used by some young people and often split.

Depression surveys may give false-positive results.

Research of the week 

Fertility treatment in polycystic ovarian syndrome
NEJM 2007; 356: 551–66 

Polycystic ovary syndrome (PCOS) is a common cause of fertility problems. Clomifene has been used to treat the problem for some years although it is now suggested that GPs no longer initiate treatment with it. More recently, metformin has been used as a sole treatment or in combination with clomifene.

In this study of 625 women with PCOS, patients were randomly allocated to receive clomifene and placebo, metformin and placebo or a combination of the two active treatments.

The combination was found to be most successful with 26.8 per cent of women becoming pregnant while 22.5 per cent of the clomifene and placebo group became pregnant and only 7.2 per cent of the metformin and placebo group.

The only problem was the increased rate of multiple pregnancy in those taking clomifene, at 6.6 per cent.

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