The NMJI

Dietary fibre may reduce the risk of coronary heart disease through a variety of mechanisms such as improving blood lipid profiles, lowering blood pressure and improving insulin sensitivity and fibrinolytic activity. However, according to the results of a recently published pooled analysis, fibre from fruits and cereal, but not from vegetables, provides this benefit. The benefit may be as much as 30% decreased risk of death due to coronary heart disease for each 10 g/day increment of fibre consumed (Arch Intern Med 2004;164:370–6).

Routine comprehensive health check-ups, with fancy names such as ‘executive health check’ are in vogue, especially in commercial set-ups. However, in its revised screening guidelines for coronary heart disease, the US Preventive Services Task Force (USPSTF) recommends against routine screening for severe coronary artery stenosis in asymptomatic low-risk individuals (younger adults, i.e. men <50 years of age and women <60 years of age, who have no other risk factors, viz. high blood pressure, smoking, abnormal lipid levels, diabetes, obesity and sedentary lifestyle). Screening procedures included an electrocardiogram, treadmill test or electron-beam computed tomo-graphy (EBCT) scanning for testing the level of coronary calcium. Further, there is insufficient evidence to recommend for or against such screening for individuals with increased risk of coronary heart disease (Ann Intern Med Epub 17 Feb 2004).

Some instances of recurrent pregnancy loss may be due to platelet disorders. Factor V Leiden and prothrombin gene (G20210A) mutations are the most common types of hereditary thrombophilias, but are usually undiagnosed because most carriers are asymptomatic. A meta-analysis evaluated the association between hereditary thrombophilias and recurrent pregnancy loss, and found that carriers of Factor V Leiden or prothrombin gene mutations have double the risk of experiencing 2 or more miscarriages compared with women without thrombophilias (Arch Intern Med 2004;16:558–63).
There is more than one reason to keep lipid levels under control. Increased dietary fat or cholesterol has been reported to be a risk factor for the development of certain cancers. It may also be a determinant of the risk of metastasis. A study (Br J Surg 2004;91:191–8) reported the rate of lymph node metastasis to be significantly higher in men with early gastric cancer who had hypercholesterolaemia (total cholesterol >220 mg/dl) or hyper-triglyceridaemia (triglyceride >150 mg/dl).

Many children consume non-pathogenic live bacteria in food, particularly in the form of yoghurt. What about the tolerance and safety of consuming these probiotic bacteria in infant formulas? A prospective, double-blind, randomized, placebo-controlled study of healthy infants 3–24 months of age evaluated formulas containing two levels of probiotic supplementation in the form of Bifidobacterium lactis and Streptococcus thermophilus. Interestingly, long term consumption of these formulas was safe, well tolerated and resulted in adequate growth, reduced reporting of colic or irritability, and a lower frequency of antibiotic use (Am J Clin Nutr 2004;79:261–7).

The diagnosis of kala-azar may become simpler by polymerase chain reaction (PCR). A team of investigators at the Calcutta Medical College and Hospital, India has developed a simple, specific and sensitive PCR-based assay for detecting visceral leishmaniasis. The results of PCR conducted using blood samples taken from 20 suspected kala-azar patients were compared with those of the Leishman–Donovan (LD) body test in bone marrow, immunodiffusion assay and direct agglutination test. Only 5 patients were found to be positive using all the four tests. PCR was positive in 12 samples and, among these, only 10 were positive for LD bodies in the bone marrow smears. PCR may be a 100% sensitive test for primary screening of blood samples of patients suffering from kala-azar-like symptoms, especially in endemic areas (Med Sci Monit 2004;10:MT1-MT5).

Whole body imaging may remarkably simplify and speed up the staging work up in oncology. Magnetic resonance imaging (MRI) and a combined modality including positron emission tomography (PET) and computed tomography (CT) can provide whole-body tumour staging in a single session. In a randomized comparison, the overall TNM stage was correctly determined in 77% of patients with PET/CT and 54% with MRI. Separate assessment of T-stage found PET/CT to be accurate in 80% and MRI to be accurate in 52% of patients. The N-stage was correctly determined in 93% of patients with PET/CT and in 79% with MRI (JAMA 2003;290:3199–206).

Nosocomial Staphylococcus aureus infections are a major medical problem and S. aureus nasal carriage is a major risk factor for these infections. Intranasal mupirocin can prevent nosocomial surgical site infections but seems ineffective in non-surgical patients. In a large study on culture-proven S. aureus carriers hospitalized in non-surgical departments, therapy with mupirocin 2% nasal ointment did not affect the rates of nosocomial S. aureus infections, mortality or duration of hospitalization (Ann Intern Med 2004;140:419–25).

Vitamin E may, after all, turn out to be a good placebo and beneficial only to researchers and manufacturers. A prospective, randomized, placebo-controlled clinical trial titled ‘Vitamin E, cataract and age-related maculopathy trial’ reported that vitamin E given for 4 years did not reduce the incidence or progression of cataracts (Ophthalmology 2004;111:75–84).

Acute calculus cholecystitis—to operate or not. A recent meta-analysis of 12 prospective randomized trials concludes that early operation (open or laparoscopic) does not carry a higher risk of mortality and morbidity compared to delayed operation and should be the preferred surgical approach for patients with acute lithiasic cholecystitis. More than 20% of patients referred for delayed surgery failed to respond to conservative management or suffered recurrent cholecystitis during the interval period. The total hospital stay was also significantly shorter in the early surgery group (Am J Gastroenterol 2004;99:147–55).

There may be some wisdom in getting rid of the wisdom tooth. Data from case–control studies suggest that the presence of a lower third molar may double the risk of an angle fracture of the mandible due to trauma. This could be due to reduced bone mass at the mandibular angle when a third molar is present (J Can Dent Assoc 2004;70:39–43)

Jyoti Nath