5 minutes of International Medicine from BMJ Group

TB or not TB?

The good news is that tuberculosis (TB) rates may be falling across the world. The bad news is that resistance to isoniazid, rifampicin and multidrugs is growing. More than half a million people in over 45 countries had multidrug resistant TB in 2006. The problem is worse in high TB and HIV areas. In most cases, primary infection with a resistant strain is the cause, not inadequate treatment. A global approach to prevention, detection and treatment is called for.

Source: BMJ, doi:10.1136/ bmj.39560.630613.80

Speech after stroke

Patients whose speech is affected by a stroke want to know when and if they will recover. This study says that –

  • Most recovery happens in the first three months.
  • Age, education, severity of aphasia and lesion size don’t reliably predict recovery as we previously thought
  • There are probably other factors that predict recovery and are not yet well understood
  • The degree of neuroinflammation may affect recovery

Source: Journal of Neurology, Neurosurgery
and Psychiatry 2008;79:530-534 619

Do children get ME?

It wouldn’t occur to me to diagnose a child under 12 as having chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Well, I’m wrong. This review describes characteristics of 178 people under 18 years old presenting to a specialised CFS/ME service over 2.5 years. The researchers found:

  • 16% were under 12 when assessed. The youngest child was just 2
  • Kids under 12 were very disabledd – mean school attendance was just 2 days a week
  • They tended to have high levels of fatigue, anxiety, functional disability, and pain
  • Most of the children met the stricter criteria for diagnosis of adult CFS/ME
  • The primary school kids had similar symptoms to older children

Source: Archives of Disease in Childhood 2008; 93:419-421

Statin aches

We know that statins can cause acute muscle pains and raised creatine phosphokinase (CK). But can they also trigger serious chronic muscle diseases like dermatomyositis and polymyositis?
This study is too small to answer the question but it found that:

  • Of 37 patients aged over 50 with chronic muscle disease, 41% had been taking statins, compared to 20% of controls
  • Many of those on statins had also taken proton pump inhibitors (PPI) like omeprazole
  • Some people were diagnosed with late-onset genetic muscle disease after getting symptoms and persistent raised CK while taking statins
  • There was no association with fibrates
  • Bigger, better studies are needed to find out whether there is an association between statins or PPIs and chronic muscle disease


Source: Annals of the Rheumatic Diseases 2008; 67:614-619

Bright eyes

The commonest cause of vision loss in older people in the developed world is age-related maculopathy (ARM). Individual susceptibility, smoking, and age are factors. Lifelong exposure to sunlight is another, according to this study of rural Japanese men over 50. Sun exposure was measured by videoing their faces and measuring their wrinkles. The more wrinkled men had an increased risk of late onset ARM. Sunglasses with UV protection would presumably help if avoiding the sun is impossible.

Source: British Journal of Ophthalmology 2008; 92:630-634