Journals watch: Pregnancy, cardiomyopathy and BP

Running short of time to read the journals? Allow Dr Louise Newson to be your guide to the latest findings

Pregnant women should eat fish
Lancet 2007; 369: 578–85

There has been concern about the concentration of pollutants in fish and seafood that has led to many women restricting their fish intake.

However, control of seafood consumption could actually cause intake of long-chain omega-3 fatty acids to fall below quantities that are adequate for ideal foetal neurodevelopment.

This study showed that children of women who ate more than 340g of seafood a week during their pregnancies had slightly better neurodevelopment at eight years.

Methamphetamine may cause cardiomyopathy
Am J Med 2007; 120: 165–71

Methamphetamine is a chemical that has stimulant properties similar to adrenaline. Chronic use can cause paranoia, hallucinations, and psychosis.

This study shows that methamphetamine use might be a possible cause for unexplained cardiomyopathy in young adults.

In this study, methamphetamine users were found to be 3.7 times more likely to have cardiomyopathy than those who did not take methamphetamine.

Combined antihypertensives
Hypertension 2007; 49: 272–5

Compliance with medication in patients with hypertension is a real problem, especially since the majority of our patients now need to take at least two different medications to reach their target BP.

This study has shown that giving hypertensive patients a capsule that contains a quarter of the standard dose of four antihypertensives — atenolol, bendroflumethiazide, captopril and amlodipine — actually resulted in better BP control than a standard single dose of any one drug.

Normal test results are not always reassuring
BMJ 2007; 334: 352–4

Although we may presume that giving patients normal results after a test is reassuring, research has shown that this is not always the case.

This randomised controlled trial, involving patients being investigated for chest pain by exercise stress testing showed that giving patients information about normal test results before their test, which included a chance to discuss results with a doctor, can actually improve rates of reassurance. It seems logical that providing information to patients about a test and also an explanation of a normal result would also reduce stress levels for other types of tests.

Compliance and low INR levels
Arch Intern Med 2007; 167: 229–35

As more and more INR testing is performed in primary care, we are often confronted with patients having very labile INR levels for no apparent reason.
This study suggests poor compliance might be the reason. It involved 135 patients taking warfarin, of whom over 90 per cent had missed at least one dose or opened an extra bottle. Those who took less warfarin unsurprisingly had lower INR results.

Partners’ role in STI care
BMJ 2007; 334: 354–7

Contact tracing for patients with STIs is a huge problem. There are many methods to improve partner notification by partner referral. This review found that patient-delivered partner therapy and additional information for partners all lead to lower rates of recurrent infections compared to simply referring a patient. Perhaps we should be encouraging patients with STIs to take an active role in the management of their partners.

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