Statins and surviving pneumonia
It is accepted that the beneficial effects of statins on cardiovascular disease are not solely due to lipid lowering, but that these drugs have anti-inflammatory effects and alter the body’s immune response. It has been observed that patients already taking statins are less likely to develop or die of sepsis if they contract pneumonia.
This study from Canada aimed to determine whether statins reduce mortality or need for admission to intensive care in patients admitted to hospital with pneumonia.
Of 3,415 patients admitted to hospital with pneumonia, statin users (15 per cent) were less likely to die or be admitted to an intensive care unit than non-users, once other factors relating to previous general health had been taken into account.
Self management of hypertension
Br J Gen Pract 2006; 56: 842–7
This study aimed to determine if encouraging patients to manage their hypertension would improve their care. Patients would be given clear clinical guidelines and encouragement to become involved in their own care and to voice their concerns if appropriate.
During a period of one year, 294 hypertension patients (aged over 18 years and with a systolic BP recorded >150mmHg) were randomised to two groups. The first group has given a standard information booklet from the British Hypertension Society, and the second group received the booklet and additionally a detailed guidelines and record cards, plus additional information .
The results showed no clinical or statistical significance differences between intervention and control group. However statin and aspirin use improved throughout the course of the study in both groups. The authors question the cost-effectiveness of patient guidelines which are planned for chronic diseases.
Stroke in non-bacterial thrombotic endocarditis
CMAJ October 2006; 175: 1,055–6
This case study illustrates an interesting presentation of non-bacterial thrombotic endocarditis (NBTE).
The patient presented with cognitive decline followed by strokes. A heart murmur was detected and further investigation revealed a mass on the mitral valve, which was due to adenocarcinoma of the lung.
Several cancers may present in this way, including lung, breast, prostate, ovary, thyroid stomach, colon and pancreas. Sadly most of these are widely disseminated before the NBTE is clinically apparent so that treatment is usually palliative rather than curative.
Prophylactic antibiotics in measles
Half a million people die each year from measles. This study from Guinea Bissau, west Africa, aimed to investigate whether prophylactic antibiotics could prevent the complications of measles.
During an epidemic in Bissau in 1998, 84 patients (median age 5.4 years) were randomly assigned to either co-trimoxazole or a placebo for seven days.
The results showed one patient in the antibiotic group developed pneumonia (a complication of measles), compared with six in the placebo group. The antibiotic group also developed less conjunctivitis, diarrhoea, severe fever, oral thrush and stomatitis, compared to the placebo group.
Children in the treated group had less weight loss. It is clear that the use of antibiotics had a benefit in these children whose general health would have been impaired by poverty.
The study ended early because of civil war.
Dr Merriman is a GP in Oxford and a member of our team who regularly review the journals
Research of the week
Angioedema without urticaria
CMAJ October 2006; 175: 1,065–70
Facial swelling due to angioedema usually occurs at the same time as urticarial flares. It is usually responsive to antihistamines and corticosteroids.
Sometimes it occurs on its own and is not responsive to antihistamine and lasts longer. Some of these cases are due to C1 esterase inhibitor deficiency.
This Italian study looked for the causes.
Between 1993 and 2003, 929 consecutive patients were examined for recurrent angioedema unaccompanied by urticaria. In 41 per cent of 776 cases, no cause was found.
Three groups of causes were found in patients who did not have C1 esterase inhibitor deficiency; external causes such as a drug, insect bite or foodstuff were most frequent (16 per cent), followed by treatment with an ACE inhibitor (11 per cent), and finally patients with an autoimmune disease or infection (7 per cent).
Pneumonia mortality is lower in statin users.
Patient compliance with medication improved in hypertensives given self-care advice.
Some malignancies may present as nonbacterial thrombotic endocarditis.
Measles complications may be reduced by prophylactic antibiotics.