BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3613 (Published 29 May 2012) Cite this as: BMJ 2012;344:e3613

Researchers measured concentrations of two common cardiac biomarkers—troponin I and N terminal pro-B-type natriuretic peptide—when patients were randomised into the RE-LY study of long term anticoagulation for atrial fibrillation (Circulation 2012;125:1605-16, doi:10.1161/circulationaha.111.038729). Concentrations of biomarkers correlated positively with risk of stroke and death, and seemed better at predicting thromboembolic risk in atrial fibrillation than currently used clinical risk scores such as CHADS2 or CHA2DS2-VASc.

Warm climates, but not humidity, are associated with an increased risk of forming renal stones. In a retrospective study of 599 patients with renal stones, rising ambient temperature was associated with increasing levels of urinary calcium and the supersaturation of calcium oxalate and calcium phosphate, but also with decreasing amounts of urinary sodium (British Journal of Urology International 2012, doi:10.1111/j.1464-410x.2012.11186.x).

In a double blind crossover exposure study, 45 non-smoking young adults were exposed to diesel exhaust maintained at 200 µg/m3 of fine particulate matter and filtered air for 120 minutes, on days separated by over two weeks (Hypertension 2012;59:943-8, doi:10.1161/hypertensionaha.111.186593). Systolic, but not diastolic, blood pressure measurements rose during and after exhaust exposure, with the mean effect peaking between 30 and 60 minutes after exposure began—up by 5.1 mm Hg. Exposure perception, sex, and metabolic syndrome did not modify the effect.

A pilot study of functional magnetic resonance imaging has shown that fat intake influences cerebral blood flow in the homeostatic and gustatory brain areas (American Journal of Clinical Nutrition 2012;95:1342-9, doi:10.3945/ajcn.111.031492). Researchers measured cerebral blood flow in 11 healthy men before and 30 and 120 minutes after intake of high and low fat yoghurts. High fat yoghurt brought about significantly reduced blood flow in the hypothalamus and insular cortex, which correlated with participants’ hunger ratings and could have contributed to efficient energy homeostasis.

In focus group discussions and interviews with doctors who qualified outside the United Kingdom and who registered with the General Medical Council in 2006-08, one topic was consistently discussed: the differences in the ethical, cultural, and legal framework for practising medicine between the UK and their country of qualification, especially around the doctor-patient relationship. Most doctors applying to work in the UK discover these differences only once in practice, and the degree of support received depends on the specialty they work in (Journal of the Royal Society of Medicine 2012;105:157-65, doi:10.1258/jrsm.2011.110256).

The hypothesis that raised levels of glycated haemoglobin correlate with an increased prevalence of frozen shoulder in people with diabetes has not been confirmed in a retrospective review of over 200 000 diabetic patients (Journal of Bone and Joint Surgery 2012;94:919-23, doi:10.2106/JBJS.J.01930). However, increased risk of frozen shoulder was associated with insulin use compared with non-use, use of oral hypoglycaemic drugs compared with diet management only, and duration of diabetes (after controlling for insulin use).

After combining data from 16 studies of the effects of vitamin D supplements in food using a random effects analysis, researchers showed that a person’s mean intake of about 11 µg/day (440 IU/day) from fortified foods increased concentrations of 25-hydroxyvitamin D by 19.4 nmol/L. All the studies included adult participants living in the community. The authors stated that safe and effective food based strategies could prevent vitamin D deficiency, with potential benefits for public health (Journal of Nutrition 2012;142:1102-8, doi:10.3945/jn.112.158014).

Does maternal influenza vaccination affect newborn children? Researchers randomised 430 pregnant women in India to receive either inactivated influenza vaccine or pneumococcal vaccine as control. During the period when influenza virus was circulating, maternal immunisation during pregnancy was associated with a lower proportion of infants who were small for gestational age and an increase in mean birthweight. When the virus was not circulating, vaccination made no difference to neonate size or weight (CMAJ 2012;184:645-53, doi:10.1503/cmaj.110754).

Prescribed drugs worth an estimated £450 (€556; $710) million are thrown away each year in the United Kingdom. About 1% of dispensed items are eventually returned to a pharmacy or dispensing general practice—unused or partly used. Recycling of drugs is regarded as unsafe in the UK, and donations abroad are not encouraged. The World Health Organization’s guidance on medicine donations states that there should be no double standards—recycling is not an option for domestic or overseas use (Drug and Therapeutics Bulletin 2012;50:49, doi:10.1136/dtb.2012.05.0100).


Cite this as: BMJ 2012;344:e3613

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