Journals Watch - Miscarriage and Parkinson's disease

Not had time to read the journals? Let Dr Gwen Lewis bring you up to date with the latest research.

Coronary atherosclerosis: parents of women with recurrent miscarriage were more likely to have IHD (Photograph: SPL)
Coronary atherosclerosis: parents of women with recurrent miscarriage were more likely to have IHD (Photograph: SPL)

Recurrent miscarriage and family history of IHD
BJOG 2011; 118: 557-63

This retrospective cohort study from Scotland looked at whether women experiencing recurrent miscarriage have a higher incidence of family history of IHD. The study involved 74,730 women during their first birth whose parents were then studied for evidence of IHD by hospital admissions and death certification.

There was found to be an increase in the incidence of IHD in the parents of women who had recurrent miscarriage. This increase was higher in the parents of women who had suffered three or more miscarriages compared with those whose daughters had only experienced two miscarriages.

The authors concluded that parents of women who experience recurrent miscarriage are more likely to have IHD. The reason is unknown but it was suggested that recurrent miscarriage and IHD may have common physiological pathways and genetic predisposition.

Genital warts and loss of quality of life
Sex Transm Infect 2011; doi:10.1136/sti 2009.039982

Genital warts are known to be a risk factor for cervical dysplasia and development of cervical carcinoma but they are also upsetting for the patient. This Canadian study looked at the emotional aspect of genital warts in 270 patients. The mean age was 31.5 years. Females made up 53.5 per cent of the study group, 93.5 per cent were heterosexual and 66 per cent were in a stable relationship.

The quality of life lost associated with genital warts was estimated by the difference between participants' scores on a standardised questionnaire and the age and gender population norms. Genital warts were associated with an increase in anxiety and depression, and also in pain and discomfort and a diminishing of their usual activities.

Drugs for type-2 diabetes
Ann Intern Med 2011; Epub ahead of print

The incidence of type-2 diabetes is increasing. This review of 140 trials and 26 observational studies of monotherapy or combination therapy in diabetes was undertaken in the US.

The benefits and harms of metformin and sulfonylureas, as well as those of the newer drugs, thiazolidinediones, dipeptidyl-peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 receptor agonists, were studied.

Most medications produced a lowering of HbA1c by 1 percentage point and most two-drug combinations caused similar reductions. Metformin was more effective than DPP-4 inhibitors in lowering HbA1c, and compared with thiazolidinediones or sulfonylureas, the mean differences in body weight were about -2.5kg.

Metformin produced a lowering of LDL-cholesterol compared with pioglitazone, sulfonylureas and DPP-4 inhibitors. Sufonylureas had a four-fold higher risk for mild or moderate hypoglycaemia than metformin, although the combination of these two drugs caused a five-fold higher risk for hypoglycaemia.

This study confirms that metformin should remain as first-line treatment.

Nitroglycerin in postmenopausal women
JAMA 2011; 305 (8):800-7

This Canadian study involved 243 postmenopausal women with lumbar spine T scores of between zero and -2.0. The patients were randomised to use either nitroglycerin ointment (15mg per day) or placebo at bedtime for 24 months.

At two years, the nitroglycerin group had increases in areal bone mineral density (BMD) at the lumbar spine (from 1.05 to 1.14g/cm2 versus 1.06 to 1.08g/cm2 in placebo), with modest changes at the total hip and femoral neck.

Nitroglycerin also increased volumetric trabecular BMD, cortical thickness and periosteal circumference. Bone-specific alkaline phosphatase increased by 34.8 per cent and urine N-telopeptide decreased by 54 per cent.

Incidence of adverse events did not differ between the nitroglycerin and placebo groups. In those treated for 24 months, headaches were reported by 35 per cent in the nitroglycerin group and 5.4 per cent in placebo group during the first month.

Factors associated with recurrent depression
Fam Pract 2011; 28: 22-8

Depression has a high rate of recurrence. Determining the factors which may be associated with recurrent depression over a long period may help to target those patients most at risk.

In this study, 1,094 patients were recruited from 23 family practices in Estonia and were followed up at six and 12-month intervals.

Major depression was diagnosed in 13 per cent of the patients and of those 28 per cent had a recurrent episode of depression 12 months later.

Recurrence was higher for patients with history of drug abuse, those who had experienced discrimination and in those who had experienced childhood abuse.

Gene therapy in advanced Parkinson's disease
Lancet Neurol 2011; 10 (4): 309-19

Although the number of patients involved in this US study is small, the results may provide some hope for patients with advanced Parkinson's disease.

Sixteen patients with advanced Parkinson's disease underwent bilateral delivery of glutamic acid decarboxylase (GAD) gene therapy in the subthalamic nucleus via an adeno-associated viral vector (AAV2), while 21 patients underwent sham surgery.

Effects of the treatment on symptoms of Parkinson's disease were noted at the endpoint of six months. It was found that the AAV2-GAD group showed a greater improvement from baseline in clinical scores than the sham surgery group.

The most common side-effect of treatment was headache. This may give hope for gene therapy in neurological disorders.

  • Dr Lewis is a GP in Windsor, Berkshire 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 an audit of patients who have had recurrent miscarriages. Do they have a family history of IHD? Share your findings with colleagues.
  • Discuss the management of genital warts at a practice meeting. How can you make sure that patients are getting the support that is needed?
  • Review the evidence base for treatment of type-2 diabetes and produce an information leaflet to share with patients.

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