Physical therapy adequate for knee osteoarthritis
A RANDOMISED multicentre control trial of symptomatic patients with a meniscal tear and imaging evidence of mild-to-moderate osteoarthritis has found no significant differences in outcomes between patients assigned arthroscopic menisectomy with postoperative physical therapy and patients assigned to a standard physical therapy regimen. The research, published in the New England Journal of Medicine, found improvements in functional status and pain at 6 months did not differ significantly between the two groups. However, 30% of the patients assigned to physical therapy did cross over to surgery in the first 6 months. The researchers said the findings would help inform decision making by patients and their physicians. An accompany editorial by Australian epidemiologist Dr Rachelle Buchbinder said the results of the research suggested surgery was not routinely needed for symptomatic meniscal tears in knee osteoarthritis and physical therapy should be adequate initial management.

Risks in pubic hair removal
THE emerging fashion phenomenon of removing pubic hair could be a risk factor for molluscum contagiosum virus (MCV) and other sexually transmitted infections such as papillomavirus, according to a research letter published in Sexually Transmitted Infections. The authors performed a case study of 30 new cases of sexually transmitted MCV presenting to a private clinic in France. Of the six women and 24 men, lesions were centred on the pubis with some cases of extension on the abdomen and legs. Of the 30 cases, 93% used hair removal. “We postulate that, as MCV can spread by self-inoculation (eg, scratching, in children), hair removal (especially shaving) could favour its acquisition, propagation and transmission by micro-traumatisms”, they wrote.

Predicting ED diagnosis not easy
A SUBSTANTIAL number of patients who present to emergency departments (ED) with symptoms and signs indicating a primary care-treatable diagnosis require immediate emergency care or admission to hospital, according to research published in JAMA. The researchers used a modified ED algorithm to determine whether a presenting complaint and discharge diagnosis corresponded sufficiently to support the use of discharge diagnosis as the basis for policies discouraging ED use. They found of nearly 35 000 records analysed only 6.3% of presentations were determined to have a primary care-treatable diagnosis based on discharge diagnosis and the modified algorithm. However, 88.7% of all ED visits had a chief complaint that was the same as a primary care-treatable ED discharge diagnosis. “Attempting to discourage patients from using the ED based on the likelihood that they would have nonemergency diagnoses risks sending away patients who require emergency care”, the researchers wrote. An accompanying commentary said the research indicated that “some intuitive, oversimplified, yet enduring beliefs about nonurgent patients in the ED” should be abandoned. “Attention should be redirected away from penalizing patients, physicians, or hospitals when a condition turns out to be minor”, the author wrote.

Psychological harm in screening
FALSE-positive findings in screening mammography cause long-term psychosocial harm in women, according to a 3-year cohort study, published in Annals of Family Medicine. The research included 454 women aged 50–69 years with abnormal findings in screening mammography over a 1-year period. Each woman in the cohort was compared with two women with normal findings screened on the same day. Women completed a validated questionnaire on the impact of screening encompassing 12 psychosocial outcomes — at baseline, 1, 6, 18 and 36 months. After being declared free of cancer suspicion, women with false positives consistently reported greater negative psychosocial consequences compared with women with normal findings. In the first 6 months after final diagnosis, women with false positives reported changes just as great in existential values and inner calmness as women with breast cancer. “Having a false positive is not harmless and causes undesirable outcomes in the long run”, the authors wrote.

Low-fat milk not an obesity panacea
RESEARCHERS have found that consumption of skim or 1% fat milk among preschoolers was associated with overweight and obesity. The research, published in Archives of Disease in Childhood, included more than 10 000 children whose body mass index (BMI) and overweight/obesity score was measured at ages 2 and 4 years. They found the majority of preschoolers drank whole or 2% milk, with the increasing fat content of the milk inversely associated with the children’s BMI score. They noted that the American Academy of Pediatrics and American Heart Association recommended the use of 1% fat milk for all children under 2 years of age to reduce saturated fat intake. The authors wrote that the prevalence of consumption of 1% fat milk in the 2–4-year age range remained low. “Our data do not support 1%/skim milk consumption as the sole way to restrain gains in BMI among preschoolers. This may mean that efforts towards weight control among overweight/obese preschoolers would be better directed at other interventions with established efficacy”, they wrote.

Caffeine reduces truck crash risk
LONG-DISTANCE truck drivers who consume caffeinated stimulant substances have a significantly reduced risk of being involved in a crash, according to Australian research published in the BMJ. The research involved 530 long-distance drivers of commercial vehicles in NSW and WA who were recently involved in a crash attended by police and 517 control drivers who had not had a crash in the past 12 months. The researchers found 43% of drivers reported consuming substances containing caffeine, such as tea, coffee, caffeine tablets or energy drinks for the express purpose of staying awake. Only 3% reported using illegal stimulants such as amphetamine, methylenedioxymethamphetamine (ecstasy) and cocaine. The researchers found a 63% reduced likelihood of crashing among those taking caffeinated substances compared with drivers who did not. “While comprehensive fatigue management strategies for these drivers should consider the provision for adequate breaks and sufficient sleep and the promotion of regular exercise, the use and influence of caffeinated stimulants should be considered as an effective adjunct strategy to maintain alertness while driving”, the researchers wrote. “The varying extent to which activities such as taking a nap, drinking a cup of coffee, or going for a short walk contribute to subsequent vigilance behind the wheel are not well understood and are therefore recommended for further study.”

Cancer type affects cyropreserved sperm
AN analysis of medical records of 682 men who had cryopreserved sperm cells due to cancer treatment has found that the type of malignancy affects sperm quality. The research, published in the Asian Journal of Andrology, was based at a single treatment centre in Israel and found that over a 20-year period 70 patients withdrew their sperm for fertility treatments, mostly within the first 4 years after cryopreservation. Testicular cancer had been diagnosed in 216 patients, lymphoma in 241 and various other types of cancer in 225. The researchers found that sperm quality indices differed between the different types of malignancies, with testicular cancer having the poorest quality. Conception was achieved in 46 of the 184 assisted reproduction technology cycles (25%), resulting in 36 deliveries. The intracytoplasmic sperm injection (ICSI) method resulted in a “significantly higher” pregnancy rate of 37.4% compared with intrauterine insemination (IUI) at 11.5%. These rates were similar to other groups of infertile couples using these modalities, the authors wrote. However, in vitro fertilisation did not produce any pregnancies. “We recommend beginning with either the simpler treatment mode such as IUI (only if there are enough stored sperm samples and adequate quality), or start with the most efficient treatment mode of ICSI as the first line of treatment”, they wrote.

Posted 25 March 2013

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