This week in the BMJ
Volume 326,
Number 7403,
Issue of 21 Jun 2003
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WHO guidelines for detecting SARS need to be reconsidered
Haematological changes signal outcome in SARS patients
Outcome varies in open spina bifida
Electroconvulsive therapy causes memory loss, say patients
Devising new strategies for AIDS in the developing world
Fluticasone propionate reduces risk of relapse in atopic dermatitis
WHO guidelines for detecting SARS need to be reconsidered
The WHO guidelines for diagnosing SARS have an 83% accuracy in detecting
suspected cases. In an observational study of 556 people screened for SARS in
Hong Kong, Rainer and colleagues
(p 1354) found that
the best predictor of SARS was radiological evidence of pneumonic change,
which often preceded the onset of fever. The main discriminatory symptoms in
the early stages of the disease were fever, chills, malaise, myalgia, and
rigor—not respiratory tract symptoms, as stated in the WHO guidelines.
The guidelines had a specificity of 95% and a sensitivity of 26% for detecting
SARS.
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Haematological changes signal outcome in SARS patients
Abnormal haematological values are common in patients with SARS. In a
retrospective analysis of the haematological changes in 153 patients with
SARS, Wong and colleagues (p
1358) found that lymphopenia was present in 98%, neutrophilia in 82%,
and thrombocytopenia in 87%. Also, low CD4 and CD8 cell counts and a high
concentration of lactate dehydrogenase at presentations were associated with
adverse outcome. Depletion of lymphocytes, which was found in various lymphoid
organs at postmortem examination, may be a good marker of disease
activity.
Outcome varies in open spina bifida
Long term outcome in adults with open spina bifida ranges from apparent
normality to severe disability. Hunt and Oakeshott
(p 1365) present an
update of a community based prospective study of a complete and unselected
cohort of people with open spina bifida at a mean age of 35. Over half of the
original cohort of 117 had died, and 20 of the 54 survivors needed daily care.
Their medical treatment was provided mostly by general practitioners. The wide
range of outcome reflected the extent of the original neurological deficit.
Such information is important for those faced with the dilemmas associated
with termination of affected pregnancies or treatment at birth.
Electroconvulsive therapy causes memory loss, say patients
The levels of perceived benefit from electroconvulsive therapy reported by
patients depend on the methods used to elicit responses. Rose and colleagues
(p 1363)
systematically reviewed 27 studies that ascertained patients' views of
treatment with electroconvulsive therapy. They also found that at least one
third of patients reported persistent memory loss after treatment, but
professional opinion was that memory loss was not clinically
important.
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Devising new strategies for AIDS in the developing world
This issue's Education and Debate section is dedicated to AIDS in the
developing world. On p
1382 Brugha describes antiretroviral treatment in developing
countries and states that only 5% of people who need antiretroviral treatment
receive it. Antiretroviral drugs seem to be getting into informal private
markets, and uncontrolled use of drugs could lead to rapid development of HIV
resistance.
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DIETER TELEMANS/PANOS
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Comparing HIV transmission in five different countries, Pisani and
colleagues (p 1384)
found that patterns of transmission of HIV vary widely. They say that
strategies to fight transmission should be based on an understanding of local
issues.
Bhargava and Bigombe (p
1387) explore the economic factors related to the high mortality
among parents in Africa and the problems faced by orphans. Subsidies for
fostering, which could come from debt relief programmes, can have a beneficial
impact on orphans' school attendance, training, and productivity.
The cost of treating one person with antiretroviral drugs for a year is
equivalent to that of preventing almost 50 cases. Potts and Walsh
(p 1389) state that
the priority should be prevention, not antiretroviral treatment. They explain
the current impact of the epidemic in India and strategies available to
contain it.
Fluticasone propionate reduces risk of relapse in atopic dermatitis
Fluticasone propionate cream or ointment, applied twice weekly as part of
an emollient maintenance treatment, reduces the risk of relapse in patients
with atopic dermatitis. Results from Berth-Jones and colleagues' randomised,
double blind, placebo controlled, parallel group trial
(p 1367) show that
after initial stabilisation treatment, the risk of flares was significantly
lower in the group applying fluticasone propionate twice weekly than in the
placebo group. Median time to relapse was six weeks for emollient alone and
more than 16 weeks for additional fluticasone
propionate.
© 2003 BMJ Publishing Group Ltd
