BMJ  2004;328:1400 (12 June), doi:10.1136/bmj.328.7453.1400

BMJ family highlights

What's new this month in BMJ Journals

Diclofenac patches are promising in acute sports injuries

A newly developed formulation of diclofenac as an adhesive patch was used in a randomised controlled trial to treat 120 sportsmen and women within three hours of an acute impact injury. By one week, 73% of "patch" patients reported pain resolution compared with fewer than 7% of controls. No systemic adverse events were disclosed, consistent with the patch producing plasma levels of the drug several orders of magnitude lower than standard oral therapy. Minor rashes and irritation were similar in the two groups. The investigators, including representatives of the manufacturers, conclude that diclofenac patches might prove useful for rapid alleviation of pain and limitation of function in sports injuries.

Br J Sports Med 2004;38: 318-23[Abstract/Free Full Text]

Epipen hazard for curious children

Three young people developed local ischaemia when they accidentally injected a finger with epinephrine from an Epipen. Two adolescents were experimenting with a device they had found, and one was playing with his own pen. No treatment seems necessary unless there is poor perfusion at presentation; in such cases the investigators recommend subcutaneous local injection of 1.5 mg phentolamine mesilate in 1 ml of lignocaine (lidocaine) 2%. If the pen does not belong to the child, a needlestick protocol should be followed.

Emerg Med J 2004;21: 387-8[Free Full Text]

Remember zinc for infantile periorifical dermatitis A six month old baby had crusted and vesicular lesions on perioral, perigenital, and perianal skin and intermittent diarrhoea. Her serum zinc was low (3.06 µol/l), leading to a diagnosis of acrodermatitis enteropathica. Oral zinc produced improvement in 48 hours and complete clearing at 1 week. Arch Dis Child 2004;89: 501[Free Full Text]

Patients need support when starting new drugs

When questioned 10 days after being prescribed new drugs for a chronic condition, 30% of 226 patients recruited from community pharmacies were not adhering to their doctors' advised treatment. Telephone interviews found that more than half of the non-adherence was intentional in that patients were concerned about the drug generally, considered they might be experiencing a side effect, or had practical problems with the formulation. Similar figures were obtained at four weeks' follow up. Researchers from the School of Pharmacy in London conclude that neither doctors nor pharmacists provide patients with the information they need. Within days of a new prescription, patients would benefit from a medication review to deal with their concerns; the researchers speculate that this could be incorporated into NHS plans for expanding pharmacy services.

Flies have long been suspected, but never proved, as the vector for Chlamydia trachomatis. Investigators used sticky fly paper to collect one fly from the face of each of 103 children in Ethiopia and used PCR (polymerase chain reaction) to test for C trachomatis DNA. An empty piece of the same paper acted as control. PCR showed positive results in 15 of 103 flies (and no controls), finally incriminating flies as a vector for trachoma. Qual Saf Health Care 2004;13: 172-5[Abstract/Free Full Text]

Vulvovaginal candidiasis may respond to anti-allergy preparation

An open label study on 20 women with recurrent candidal vulvovaginitis has shown potential benefit from treatment with a leukotriene receptor antagonist, zafirlukast. In the preceding year participants had had six episodes or more (at least four microbiologically proved) that responded temporarily to antifungals. Six women responded completely to a 24 week course of zafirlukast 20 mg twice daily and 14 others reported subjective improvement. Seven remained free of symptoms one year after stopping treatment. Surprisingly, atopy was not associated with response, suggesting that the benefit may be related to abnormal Th1 cytokine expression by vaginal epithelial cells. The researchers call for randomised trials comparing zafirlukast with standard antifungal treatments.

Sex Transm Infect 2004;80: 219-22[Abstract/Free Full Text]

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Dr.Nasem A. Qureshi MD, IMAPA, LMIPS
bmj.com, 14 Jun 2004 [Full text]