Clinical reviews

Women using an online telemedicine service for medical termination of pregnancy (MTOP) reported good outcomes, a study has found.Women using an online telemedicine service for MTOP reported good outcomes, a study has found. The study authors analysed data on all women from the Republic of Ireland and Northern Ireland who contacted the Women on Web telemedicine helpdesk, between January 2010 and December 2012. (In both countries termination is not available through the formal healthcare system except in restricted circumstances).

Daily tea consumption was associated with an 8% relative risk reduction in ischaemic heart disease and a 10% relative risk reduction in major cardiac events, in a large prospective study from China.

The prevalence of gestational diabetes mellitus (GDM) has been increasing over the past three decades, a large retrospective cohort study from the US has shown.

A randomised controlled trial comparing insulin pump use with multiple daily injections suggests that when patients are engaged with intensive self-management, insulin pump therapy may not add significant extra benefits in adults.

Common variants in genes related to folic acid, homocysteine and glutathione/transsulfuration metabolic pathways are associated with an increased risk of congenital heart disease in the offspring of women who take SSRIs in the periconceptual period, a US case control study has found.

A UK primary care study comparing the use of the levonorgestrel-IUS (LNG-IUS) with usual medical treatments for heavy menstrual bleeding (HMB) showed both to have very good outcomes.

Patients with paroxysmal atrial fibrillation (AF) treated with catheter ablation first line showed significantly better improvement than those treated initially with drug therapy in a multicentre, randomised, unblinded trial. The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial compared radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment for paroxysmal AF.

The rise in the use of e-cigarettes in England has been associated with an improvement in the success of quit attempts, a study in the BMJ has found.

A recent meta-analysis has confirmed that interventions in patients with pre-diabetes reduce the rate of progression to overt diabetes, but found that the screening tests used to identify pre-diabetes are inaccurate. The study was commissioned by policy makers in a London borough who wanted to identify an effective screen and treat policy in an area of high diabetes prevalence. The UK investigators trawled through Medline, PreMedline and Embase for eligible papers evaluating the accuracy of tests for pre-diabetes, and controlled studies of interventions (lifestyle changes or metformin) in pre-diabetes patients identified by screening. A total of 2,874 titles were scanned and 148 eligible papers reviewed. The final analysis included 49 studies of screening tests and 50 intervention trials.

Preventing hypertension, obesity and diabetes in middle age improves morbidity and mortality related to heart failure, a pooled analysis of data from the United States has shown.

Systolic blood pressure (BP) below 135 mmHg was associated with greater mortality in patients, aged 80 and over treated for hypertension, in an observational primary care study.

Frequent self-monitoring of blood glucose had a significant effect on HbA1c only when combined with frequent on-line reporting, in a study from Canada.

Almost half of men who have sex with men (MSM) with positive cultures for gonorrhoea from the pharnyx also had positive saliva samples, in a study from Australia, suggesting that saliva may act as a vehicle for transmission of the infection.

Moderate tea consumption was associated with a slower progression of coronary artery calcium and lower incidence of major cardiovascular events, a study published in the American Journal of Medicine has found. Regular coffee consumption had neither protective nor adverse effects.

Whole body hyperthermia (WBH) shows promise as an effective treatment for depression, a randomised double-blind,sham-controlled trial, published in JAMA Psychiatry, has concluded.

Current guidelines advise treating paroxysmal AF in the same way as sustained AF but the evidence is weak, with only one retrospective analysis comparing the risk of stroke in patients with paroxysmal AF vs chronic AF (analysis of the SPAF trials, performed 15 years ago and limited to patients treated with aspirin). The ACTIVE W trial showed that warfarin is more effective than aspirin plus clopidogrel for the prevention of vascular events (stroke, embolism, MI and vascular death) in patients with AF. A recent substudy of this trial looked at the risk of stroke in 1,202 patients with paroxysmal AF compared with 5,495 with sustained AF, and the effectiveness of thromboprophylaxis in these patients. ' This substudy has shown that the risk of stroke is similar, irrespective of whether AF is paroxysmal or sustained, and that anticoagulation therapy is equally effective in both groups. Other factors, such as age and cardiovascular comorbidity, remain central to the ultimate choice of thromboprophylaxis in these patients.'