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The pursuit of eternal youth—are anti-wrinkle creams the answer? A study compared a high-priced expensive anti-wrinkle cream dispensed in its original packaging and in a neutral jar with the effects from a regular moisturizing face cream in a luxurious jar (Skin Res Technol 2007;13:189–94). Evaluations were made by the subjects, by a trained observer and measurement of skin surface by optical profilometry. While the subjects using luxury jars consumed more cream than those using expensive cream in an ordinary neutral jar, there were no significant differences between the 3 groups relating to the effects on wrinkles and smoothness, nor in subjective assessment of the skin feeling younger or more beautiful.

Go slow in those who need bilateral total knee replacements. A meta-analysis compared the safety of simultaneous bilateral total knee replacement with that of staged bilateral and unilateral total knee replacements (J Bone Joint Surg Am 2007;89:1220–6). Compared with staged bilateral or unilateral total knee replacement, simultaneous bilateral total knee replacement had an almost twice the risk of serious cardiac complications, pulmonary complications and mortality. In fact, the complication rates after the staged bilateral total knee replacements were similar to those in patients who had undergone unilateral total knee replacement.

A man is known by the company he keeps. This applies to obesity as well. Obesity appears to spread from person to person through social ties and networks. Over 12 000 adults of the Framingham Heart Study were evaluated over a period of 32 years for the effect of social network on risk of obesity. It was found that a person’s chances of becoming obese increased by 57% in a given period if a friend became obese, 40% if a sibling did and 37% if a spouse did (N Engl J Med 2007;357:370–9). The effects were seen even if the obese acquaintance lived far away. The accompanying editorial remarks that ‘friends have an even more important effect on a person’s risk of obesity than genes do’.

The anti-soft drink lobby will love this. One soft drink a day raises the risk for metabolic syndrome. The incidence of metabolic syndrome and its components was correlated with soft drink consumption in over 6000 subjects who were free of metabolic syndrome at baseline. Metabolic syndrome was defined as the presence of >3 of the following: waist circumference >35 inches (women) or >40 inches (men); fasting blood glucose >100 mg/dl; serum triglycerides >150 mg/dl; blood pressure >135/85 mmHg; and high-density lipoprotein cholesterol <40 mg/dl (men) or <50 mg/dl (women). The results showed that adults drinking one or more soft drinks a day had a substantially (48%) higher prevalence of metabolic syndrome than those who drank them infrequently. Even the incidence of metabolic syndrome was similarly increased in the cohort over a 4-year follow up. The risk was similar for both regular and diet soda (Circulation 2007 Jul 31; Epub ahead of print).

Here is a new avatar of a lipid marker for heart disease. Just do a random non-fasting serum triglyceride level. Two recent studies measuring triglycerides in the non-fasting state show a strong association between their elevated levels and risk for cardiovascular disease or death. One study followed nearly 14 000 subjects for a mean of 26 years. The other was performed within the Women’s Health Initiative. This one followed some 26 500 women for a median of 11 years. In both the studies, triglyceride levels in the non-fasting state (especially 2–4 hours postprandially) showed a strong, independent association with future risk of heart disease. It was suggested that postprandial triglyceride measurements may be even more predictive than the usual marker LDL-C (JAMA 2007;298:309–16; 299–308).

Micronutrient supplements are often publicized for their therapeutic benefits. But here is some bad news on selenium supplements. They may increase the risk of diabetes. In an analysis from the Nutritional Cancer Prevention study, over a mean follow up of about 8 years, diabetes developed in more people taking selenium than in those on placebo (Ann Intern Med 2007;147:921).

Some delicious but healthy stuff. Small amounts of dark chocolate can modestly lower blood pressure. In a small study, older subjects who had untreated blood pressure in the upper prehypertension range or were in stage 1 hypertension were assigned to eat either
6.3 g of dark or white chocolate daily. After 18 weeks, both the systolic and diastolic blood pressure fell in those eating dark chocolate but did not change in the control group. The authors remarked that the improvements were similar to those seen with comprehensive dietary modifications (JAMA 2007;298:49–60).

Every year dengue and dengue haemorrhagic fever (DHF) create news in India. Severe thrombocytopenia and increased vascular permeability are 2 major characteristics of DHF. Anti-D immune globulin may offer some hope. The interim data of 2 randomized placebo-controlled trials in patients who met WHO criteria for DHF with severe thrombocytopenia reveals that the increase in platelet count with anti-D immune globulin intravenously is more brisk than that in the placebo group (Am J Trop Med Hyg 2007;76:737–42).

Coronary stenting is one of the most highly profiled medical procedures. Neointimal hyperplasia is a major contributor to in-stent stenosis. A randomized study investigated whether pioglitazone reduces neointimal hyperplasia after coronary stenting in non-diabetic patients with metabolic syndrome (Am Heart J 2007;762:e1–e7). Treatment with pioglitazone improved insulin resistance and decreased visceral fat accumulation without significant changes in plasma glucose levels, glycosylated haemoglobin A1c levels and lipid profiles. It also reduced neointimal hyperplasia after coronary stenting.

Assessment of lymph node involvement by the type of cancer is the cornerstone in cancer management. What would be the impact of detecting cancer spread by reverse transcriptase-polymerase chain reaction (RT-PCR) in the sentinel lymph node? A study examined whether melanoma patients with a histologically negative but RT-PCR positive node were at an increased risk for recurrence than their RT-PCR negative counterparts (J Surg Oncol 2007;95:546–54). Surprisingly, sentinel node RT-PCR positivity was unable to stratify histologically negative melanoma patients beyond routine pathological examination in this series.