Cystic fibrosis, acne and tattoos

Too busy to catch up on the research? Let Dr Simon Hunter update you on recent papers.

Lung transplantation in cystic fibrosis

N Engl J Med 2007; 357: 2,143-52

Lung disease causes about 80 per cent of deaths in cystic fibrosis, with the median age at death being 25 years. The most aggressive therapy for this end-stage lung disease is lung transplantation.

This study aimed to assess the effects of lung transplantation on survival and quality of life in children with cystic fibrosis. Over a 10-year period, the effect on survival was assessed for all lung transplants performed in the US. The results were pretty grim reading.

There were about 500 children on the waiting list and half of these received a transplant. Of these only five showed a clear improvement in survival. One has to question whether the trauma of this procedure is justified.

Tattoos and heart risk

Arch Dis Child 2007; 92: 1,013-4

Other than the risk to good taste, body art, such as tattooing and piercing, carries a risk of endocarditis to those with congenital heart disease.

In this study, patients attending a paediatric cardiac clinic were asked about the presence of body art and their knowledge of its risks. It was found that 62 per cent were unaware of any risk.

Of those who had asked for specific advice either from a cardiologist or a non-cardiologist, they were given varying advice ranging from 'it's OK' to 'it's OK if sterile precautions are used', to being advised against it. It seems that this is one area where a bit of education would not go amiss, for clinicians and patients but, more importantly, for tattooists and piercers.

Nitrofurantoin for UTI

Arch Int Med 2007; 167(20): 2,207-12

In the US, the recommended treatment for an uncomplicated UTI is trimethoprim-sulphamethoxazole (co-trimoxazole) although more doctors use fluoroquinolones, such as ciprofloxacin, as their first-line treatment, leading to concerns of resistance.

A three-day course of trimethoprim-sulphamethoxazole was compared with five days of nitrofurantoin 100mg twice daily. The nitrofurantoin had an 84 per cent cure rate at 30 days, compared with 79 per cent in the trimethoprim-sulphamethoxazole group. The authors' recommendation was to use nitrofurantoin rather than a fluoroquinolone if you are not going to use trimethoprim.

What surprised me about this study was the cure rate around 80 per cent, suggesting that 20 per cent of patients could stand having a UTI for 30 days.

Fixed-dose combination for the treatment of acne

J Am Acad Dermatol 2007; 57: 791-9

Acne vulgaris is a complex disorder involving hyperkeritinisation, increased sebum production, bacterial proliferation and inflammation. No existing therapy has an effect on all four of these factors. Combination therapies, with complementary effects, are often used, for example a topical retinoid and a systemic antimicrobial.

Recently, a new combination of benzoyl peroxide with adapalene has been formulated. This study evaluated the efficacy of this new combination. A total of 517 patients were randomised in a double-blind controlled study to receive adapalene-benzoyl peroxide, adapalene, benzoyl peroxide or vehicle for 12 weeks.

The results showed the adapalene-benzoyl peroxide combination was significantly more effective than either agent alone. Beneficial effects were reported as early as one week.

Adverse events and tolerability were similar to adapalene alone.

- Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our team who regularly reviews the journals

The quick study

Cystic fibrosis patients may not gain the anticipated improvement in survival from lung transplantation.

UTI responds better to nitrofurantoin than trimethoprim-suxamethoxazole.

Tattoos and body piercing carry a risk of endocarditis in patients with congenital heart disease, but many healthcare professionals are unaware of this risk.

Acne may be better treated with a benzoyl peroxide-adapalene combination product than with either agent alone.

Research of the week

Zero end preference in BP

Br J Gen Pract 2007; 57: 897-903

All recommendations for measuring BP state that it should be read to the nearest 2mmHg. This is not always done, instead rounded to the nearest 10mmHg.

In treatment algorithms involving BP as one of the factors, for example the 10-year cardiovascular risk calculator, if BP is rounded it could affect whether treatment is started.

Using real cases, accurately measured BPs were rounded to the nearest 10mmHg and the effect noted. The researchers found that 60 per cent of BPs recorded had zero as the last digit, and of those ending in another digit, rounding them led to one patient in 41 being misclassified using the Framingham 10-year CVD risk algorithm.

The cautionary message is that rounding can have a genuine effect on treatment.

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