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Now the hospital diet tray should also serve a probiotic drink to reduce antibiotic-associated diarrhoea. In a study, patients who were receiving antibiotics were randomized to consume a probiotic yoghurt drink containing Lactobacillus or a placebo milkshake twice a day (BMJ 2007 Jun 29; Epub ahead of print). Significantly fewer patients in the intervention group than controls developed antibiotic-associated diarrhoea with the number needed to treat to prevent 1 case of antibiotic-associated diarrhoea being 5. The number needed to treat to prevent 1 case of Clostridium difficile-associated diarrhoea was 6. The authors estimated that it would cost US$ 120 to prevent one case of C. difficile-associated diarrhoea, whereas it costs an average of US$ 3700 to treat such a patient in the USA.
   An alternative medicine agent that may indeed be beneficial—this one for common cold. In the US more than 800 products are available that contain Echinacea (a plant). A meta-analysis suggests that Echinacea decreases the odds of developing a cold by more than half and shortens the duration of a cold by 1.4 days. However, before the plant becomes standard treatment for common cold, safety studies and large randomized studies are needed, controlling for the dose, the species of Echinacea used and the quality of its preparation. Echinacea is also an inhibitor of cytochrome P450, and thus may interact with other drugs (Lancet Infect Dis 2007;7:473–80).
   Preventive strategies for cardiovascular diseases should also include prediabetic subjects. A recent study observed that risks for all-cause and cardiovascular-related deaths increase not only with diabetes, but also with milder elevations in blood glucose (Circulation 2007 Jun 18; Epub ahead of print). Among some 10 000 adults examined at baseline and followed for a median of about 5 years, all-cause mortality was higher among those with known diabetes, impaired fasting glucose or impaired glucose tolerance than among those with normal glucose tolerance. While the mortality risk was doubled in diabetics, it was 50%–60% higher in those with ‘prediabetes’ compared with those with normal glucose tolerance.
   A brief look at the health of the world from the WHO report on Global Health Statistics. Life expectancy at birth in 2005 ranged from 37 years in Sierra Leone to 80 in San Marino for men and from 37 in Swaziland to 86 in Japan for women. The leading causes of death in 2030 are projected to be cancers, ischaemic heart disease, stroke, HIV/AIDS and chronic obstructive pulmonary disease. Tobacco-related deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030. Ten per cent of the world’s children under 5 years of age are wasting due to malnutrition. Interestingly, depression accounted for 4.5% of the total burden of disease worldwide (World Health Statistics 2007, WHO).
   Good news for the obese. Go for topical fat reduction therapy. A study examined if aminophylline cream application to the waist will reduce waist circumference by lowering the local lipolytic threshold (Diabetes Obes Metab 2007;9:300–3). Adults with a waist-to-hip ratio more than average were randomized to application of aminophylline cream to the waist twice a day or no treatment. All subjects were instructed to follow a 1200 kcal balanced diet, participate in a walking programme and return biweekly to encourage compliance. After 12 weeks, significantly more reduction in waist circumference was observed in the treatment group.
   All of us have experienced local warmth/heat after using a cellphone. In a study healthy subjects were submitted to 900 MHz (2 W) and 1800 MHz (1 W) cellular phone radiofrequency (RF) exposure. The temperature signals were recorded continuously in both ear canals before, during and after the 35-minute process by using small-sized thermistors placed in the ear canals (Clin Physiol Funct Imaging 2007;27:162–72). The results showed that RF exposure while using a cellphone with its maximal allowed antenna power increases the temperature in the ear canal. The rise in the ear canal temperature is a consequence of mobile phone battery warming and not the RF fields emitted from mobile phones.
   Is there a relation between platelet counts and coronary outcomes? Despite the well-recognized role of platelets in the pathogenesis of acute myocardial infarction (AMI) and in the vascular responses to angioplasty, the relation between platelet count and outcomes after primary percutaneous coronary intervention (PCI) in AMI is unknown. This fact was examined in the CADILLAC trial cohort (Am J Cardiol 2007;99:1055–61). Angiographic results and outcomes at 30 days and 1 year were stratified by platelet count at baseline. A higher baseline platelet count in patients with AMI was a powerful independent predictor of death, reinfarction and reocclusion within the first year after primary PCI.
   Bronchial thermoplasty for asthma. In this investigational techni-que, controlled thermal energy is used to reduce airway smooth-muscle mass. In a randomized trial patients were assigned
to either maintenance therapy or 3 sessions of bronchial thermoplasty. On a follow up over 12 months, the mean rate of exacerbations was less in the thermoplasty group compared with the control group (N Engl J Med 2007;356:1327–37).
   An unfortunate death! In New York, a teenager died because of overuse of common over-the-counter muscle creams (such as Bengay or Icy Hot). The body of the teenager contained high levels of methyl salicylate, an anti-inflammatory commonly found in the creams. It is possible that chronic use coupled with heat and exercise led to an increased absorption of the drug into the body to dangerous levels (Associated Press, 15 June 2007).
   Yet another instance of trouble with items available for common use. The US Food and Drug Administration (FDA) has advised consumers to discard any toothpaste manufactured in China after it found a component of antifreeze in several products made in China (FDA News, P07-97, 1 June 2007). Antifreeze (diethylene glycol; DEG) is usually not listed in the ingredients on the package. There have been reports of deaths from DEG-contaminated products such as cough syrup though none from toothpastes yet. Chronic exposure to DEG would be of concern particularly in children and people with kidney or liver disease.

 

GOPESH K. MODI