Journals watch: Cryotherapy versus curettage, IBD and Gout

Too busy to read all of the journals? Dr Lizzie Croton selects papers of interest to primary care.

Seborrhoeic keratoses: currettage and cryotherapy are both effective
Seborrhoeic keratoses: currettage and cryotherapy are both effective

Cryotherapy versus curettage for seborrhoeic keratoses 

JAMA Dermatol 2013; 149(10): 108-9

This small study (25 adults aged 52-75 years) randomised patients for removal of their seborrhoeic keratoses by curettage or cryotherapy.

At six weeks and at >12 months, more patients preferred cryotherapy to curettage. The increased preference for cryotherapy was apparently due to the decreased wound care and pain experienced by patients who had cryotherapy.

There was a greater tendency for redness at six weeks and hypopigmented scar formation at >12 months with curettage.

The study concluded that both methods were effective means of removal in seborrhoeic keratoses, with different, but highly satisfactory, cosmetic outcomes.

Diarrhoeal episodes in travellers with inflammatory bowel disease 

Frontline Gastroenterol 2012; doi: 10.1136/flgastro-2012-100265

This retrospective case-controlled study involved 78 patients with inflammatory bowel disease (IBD) and their healthy travelling companion controls.

Sixteen (20.5%) patients with IBD developed diarrhoea when abroad, compared with one healthy control.

Five patients had a flare-up of their disease requiring medication.

The authors suggest a pre-travel consultation for individuals with IBD incorporating the following clinical areas: the stability of the individual's IBD, vaccination against travel-associated vaccine-preventable diseases, information about reducing waterborne infections, and advice regarding the possibility of traveller's diarrhoea.

Telephone assessment and advice from a physiotherapist

- BMJ 2013; 346: f43

This RCT compared usual care (joining a waiting list for a face-to-face physiotherapy consultation) with telephone assessment and advice provided by an experienced physiotherapist (from PhysioDirect).

The study subjects were patients aged ≥18 years who were referred by GPs, or who self-referred.

The study concluded that half of patients contacting PhysioDirect could potentially be managed by telephone, reducing waiting times and non-attendance rates.

There were no adverse effects with the PhysioDirect service and it was deemed as clinically effective as usual care. However, reduced delays were not associated with improved patient satisfaction and overall satisfaction with PhysioDirect was slightly lower when compared with usual care.

Use of low-dose aspirin and recurrent gout attacks

- Ann Rheum Dis 2013 doi:10.1136/ann rheumdis-2012-202589

Many patients with gout have other comorbidities, including CHD, and will be taking low-dose aspirin.

Aspirin is known to affect the renal handling of uric acid in an inverse dose-dependent manner.

Of the 724 subjects involved in this study, 40.5% were taking aspirin ≤325mg/day in the two-day hazard period before the episode of gout.

When compared with no aspirin use, the adjusted OR of gout attacks increased by 81% (OR 1.81, 95% CI 1.30-2.51) for ≤325mg/day aspirin use on two consecutive days.

The corresponding ORs were stronger with lower doses (≤100mg).

Concomitant use of allopurinol nullified the detrimental effects of aspirin and the authors suggest its use should be considered in patients taking low-dose aspirin and experiencing recurrent gout.

UTI in acutely unwell children

- Br J Gen Pract 2013; 63 (607): e156-64

UTI in children may be associated with long-term complications that could be prevented with prompt treatment.

Absence of an alternative source of infection, or a history of fever, were not associated with UTI.

The probability of UTI in children older than three years without frequency or dysuria was 2% (≥5% in other age groups). Urine sampling based on clinical suspicion alone would have missed 80% of UTIs and sampling based on guidelines would have missed 50%.

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

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

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

  •  In practices offering minor surgery and cryotherapy, consider removing two separate seborrhoeic keratoses by curettage and cryotherapy, and giving the patient the choice of which method they would prefer for the removal of further lesions.
  •  Invite all patients with IBD presenting for travel advice or vaccinations to a pre-travel consultation concentrating on the prevention of IBD-associated traveller's diarrhoea.
  •  In patients taking low-dose aspirin, presenting with recurrent gout, consider starting concomitant allopurinol.

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