Journals Watch - Psoriasis, statins and flu vaccine

Not had time to read the journals? Let Dr Simon Hunter bring you up to date on the latest research.

Male patients with psoriasis were shown to have a higher incidence of erectile dysfunction (Photograph: SPL)
Male patients with psoriasis were shown to have a higher incidence of erectile dysfunction (Photograph: SPL)

Psoriasis and erectile dysfunction
Br J Dermatol 2011; 164: 103-9

There is emerging evidence suggesting a link between psoriasis, metabolic syndrome and atherosclerosis. The authors of this study posited a theory that there might therefore be a link between psoriasis and erectile dysfunction (ED).

They performed the international index of erectile function (IIEF-5) questionnaire on patients attending the dermatology clinic with psoriasis and also other skin conditions.

They found there was an increased incidence of ED in those with psoriasis, though not when controlling for hypertension and age. Part of this disparity could be from the psychological aspects of psoriasis.

These considerations aside, 58 per cent of patients with psoriasis reported ED compared with 49 per cent of controls. The authors suggest ED screening in all dermatology patients.

Radiation and ultrasound scans and risk of childhood cancer
BMJ 2011; 342: d472

This study examined childhood cancer risk associated with exposure to radiation and ultrasound scans in utero and in early infancy.

A total of 2,690 childhood cancer cases and 4,858 controls were included. The outcome measures were risk of all childhood cancer, leukaemia, lymphoma and CNS tumours.

The study found no evidence of increased risk of all cancers with in utero exposure to ultrasound scans. However, there was a non-significant slight increase in risk after in utero and early infancy exposure to X-ray for all cancers and leukaemia, as well as an increased risk of lymphoma after exposure to X-ray in early infancy.

These findings indicate possible risks of cancer from radiation, suggesting the need for cautious use of diagnostic radiation imaging procedures to the abdomen/pelvis during pregnancy and in infants.

Statin therapy and CRP
Lancet 2011; 377: 469-76

Inflammation is thought to be part of the process of CHD. Therefore the inflammatory marker CRP could be used in the assessment of who to treat. Indeed it has been suggested that statins might be ineffective in patients with a normal CRP.

This study examined that hypothesis using more than 20,000 high-vascular risk men and women.

They were randomised to 40mg simvastatin or placebo and were stratified by six levels of CRP ranging from <1.25 to="" 8mg="" l="" the="" endpoint="" was="" a="" major="" vascular="" event="" overall="" simvastatin="" reduced="" events="" by="" 24="" per="" cent="" p="">

As for the original aim, there was no variation in efficacy of simvastatin in the six CRP level groups. Moreover, within these groups there was also no variation in effect depending on the LDL level.

These results seem to negate the theory that statins do not work in patients with a low CRP, and thus we should carry on prescribing where appropriate.

Flu vaccine and COPD
J Epidemiol Community Health 2011; 65: 157-9

Despite the proven benefit of the influenza vaccine on prevention of exacerbations in COPD patients, there are patients who are reluctant to have this intervention for fear of triggering an exacerbation.

This study compared the records of 293 pairs of GP patients with known COPD. Half of the patients received the influenza vaccination and the other half were controls. Patients were matched according to age, sex, severity of COPD and comorbidities.

The authors looked at COPD exacerbations following administration of the vaccine. There were 21 exacerbations in the non-vaccinated group compared with 11 in the vaccinated group; this was a non-significant difference. These results can be used to reassure patients who are reluctant to have a flu vaccine.

Cholesterol testing in general practice
Br J Gen Pract 2011; 61: e81-e88

In the current economic climate we are all encouraged to save public money. This paper looks at an aspect of our clinical behaviour which could be targeted for savings.

Many patients are taking a statin and this paper looked at doctors' cholesterol monitoring habits over the past couple of decades.

Not surprisingly, the authors found there was a 15-fold increase in the number of lipid tests requested over the past two decades.

After a small decline in the early 1990s, testing rose steadily after publication of several large statin trials, particularly tests requested in primary rather than secondary care.

The authors estimated that between 42 and 79 per cent of all tests between 2005 and 2007 were unnecessary.

There seems to be huge scope for reducing testing, costs, patient inconvenience and GP workload.

Tomato paste to protect against UV radiation
Br J Dermatol 2011; 164: 154-62

Tomato paste contains lycopenes, which are renowned as being protective against prostate cancer. Lycopene is the most powerful of the carotenoid antioxidants and found mostly in tomatoes.

Sun damage to skin and the erythema of sunburn is due to oxidants generated by UV radiation. It is thought that lycopenes can protect against UV radiation damage.

In this study, 20 healthy women ingested either olive oil or tomato paste (55g) in olive oil daily for 12 weeks and then had UV light shined at the skin on the buttocks, looking for erythema and evidence of damage on biopsy.

They found that the tomato paste protected against immediate irritation and also found evidence that it could protect against long-term photodamage as well.

  • Dr Hunter is a GP in Bishop's Waltham, Hampshire, 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

CPD IMPACT: EARN MORE CREDITS

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

  • Consider inviting a local dermatologist to a practice meeting to discuss management of patients with psoriasis in relation to sexual functioning.
  • Review the evidence base for the benefits of flu vaccination for patients with COPD. Collate all the relevant information and produce a patient information leaflet.
  • Discuss lipid testing with colleagues and develop a practice protocol to reduce unnecessary testing.

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