Journals Watch - Acne, breast cancer and smoking

Not had time to catch up on the journals? Let Dr Alison Glenesk bring you the latest research.

Severe acne was shown to be associated with increased suicide risk (Photograph: SPL)

Association of suicide attempts with acne and treatment with isotretinoin
BMJ 2010; 341: c5812

This study aimed to identify whether the risk of attempted suicide was increased in patients with severe acne, before, during and after exposure to isotretinoin.

It included 5,756 patients treated with isotretinoin in Sweden between 1980 and 1989. Data was obtained from hospital discharge and cause of death registers regarding events in the three years leading up to, during and following treatment. In total, 128 patients were admitted to hospital for attempted suicide.

During the year before treatment, the standardised incidence ratio for attempted suicide was raised: 1.57 for all (including repeat) attempts and 1.36 counting only first attempts.

The incidence ratio during and up to six months after treatment was 1.78 for all attempts and 1.93 for first attempts. Three years after treatment stopped, the number of attempts was close to the expected number and remained so during the 15 years of follow-up.

Severe acne is, therefore, associated with increased suicide risk, and this is perhaps further increased by isotretinoin.

Reducing gastroenteritis occurrences in schools with alcohol-based hand-sanitiser
Pediatr Infect Dis J 2010; 29 (11): 994-8

This study was carried out in two primary schools in France, over a 17-week period, with children aged six to 10 years.

The objective was to ascertain if simple hand-sanitisation could reduce GI infection incidence. Two schools of similar socio-economic status were selected.

The teachers of the 261 children in school A were taught hand washing techniques and supervised their pupils washing their hands with an alcohol-based hand-sanitiser four times daily and at toilet breaks.

The 217 children in the control school B did no extra hand washing.

The primary outcome was the proportion of children without any gastroenteritis during the study period.

Sixty-four children in school A had at least one occurrence of gastroenteritis compared with 91 in school B. This suggests that alcohol sanitiser is effective.

Trends in delayed presentation of patients with non-ST-segment elevation MI
Arch Intern Med 2010; 170 (20): 1834-41

Trends associated with delay-time from symptom onset to hospital presentation are known for patients with ST-segment elevation MI (STEMI) but not for non-STEMI patients.

This US study aimed to identify whether trends were similar and also to see any association between delay in presentation and in-hospital mortality. In total, 104,622 patients with non-STEMI presenting to 568 hospitals were included.

The median delay from onset of symptoms until admission was 2.6 hours. In some patients, the time to hospital presentation was more than 12 hours.

Factors associated with longer delay were older age, female sex, non-white, diabetes or a smoker.

As expected, the picture with STEMI and non-STEMI presentation is similar. It appears, however, that publicity about the significance of chest pain has had no effect, particularly among the more at-risk groups.

Effects of aqueous cream on stratum corneum in vivo
Br J Dermatol 2010; 163 (5): 954-8

Aqueous cream is cheap and commonly prescribed. However, it contains sodium lauryl sulphate, a known skin irritant, which is blamed for some of its adverse effects.

The objective of this study was to characterise and assess barrier function and effects on the stratum corneum in healthy skin after one-month application. The right and left side of the volar surface of the arm in six healthy volunteers was studied, with cream being applied to one side but not the other twice daily. The skin was then tape-stripped to assess thickness, and transdermal water loss was measured.

In 16 out of 27 sites being actively treated, water loss increased and the stratum corneum thinned. Although no long-term follow-up was carried out, this casts some doubt over the suitability of aqueous cream for use in dry skin conditions.

Effect of anastrozole and tamoxifen as adjuvent treatment for breast cancer
Lancet Oncol 2010; doi: 10.1016/S1470-2045(10)70257-6

This trial compared the safety and efficacy of anastrozole 1mg with tamoxifen 20mg daily as adjuvent treatment for early-stage breast cancer in post-menopausal women. This paper gives data after a median follow-up of 10 years.

A proportional hazards model was used to assess the primary end-point of disease-free survival, and the secondary end-point included time to recurrence and overall survival.

There were 3,125 women in the anastrozole group and 3,116 women in the tamoxifen group.

In the anastrozole group, all patients showed significant improvements for disease- free survival (hazard ratio 0.91), time to recurrence (0.84) and time to distant recurrence (0.87).

In hormone receptor-positive patients, absolute differences between time to recurrence increased over time and recurrence rates remained significantly lower in the anastrozole group, even after treatment completion.

This study confirms the superior efficacy of anastrozole over tamoxifen up to 10 years after completion of treatment.

Midlife smoking, apolipoprotein E and risk of dementia
Dement Geriatr Cogn Disord 2010; 30: 277-84

The correlation between smoking and dementia has always been unclear, with some studies showing an inverse relation. This Finnish study aimed to investigate this relationship.

The study population was selected from population-based samples originally studied in middle-age. After an average of 21 years, 1,449 people aged 65-79 took part in a re-examination at which their apolipoprotein E (APOE e4) status was also assessed.

APOE e4 is a lipoprotein implicated in Alzheimer's disease, and mapped to chromosome 19.

It was found that smoking in midlife increased risk of dementia in APOE e4 carriers, but not among non-carriers.

  • Dr Glenesk is a GP in Aberdeen and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning


These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Carry out a hand washing survey in the practice. How often do people actually wash their hands? Do they carry alcohol gel?
  • Survey a section of patients with recent MI or stroke. What made them call for help when they did?
  • Discuss use of emollients with your practice pharmacist. Do they think there is evidence to suggest using a particular emollient?

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