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At the heart of general practice since 1960

Overturn new GP pension plan? 'Almost no chance'

Hormone replacement therapy increases the risk of stroke, a large meta-analysis of published trials suggests.

University of Nottingham researchers analysed 28 previous trials involving 40,000 people and assessed the risk of stroke by type, severity and outcome. Among users of HRT, the overall risk of stroke was increased by 29 per cent. HRT was also associated with greater stroke severity, with the risk of death or disability from stroke rising by 56 per cent among users.

BMJ 2004 early online publication

SSRIs cut tamoxifen effectiveness

Antidepressants may reduce the effectiveness of tamoxifen, US researchers suggest.

Their study examined the influence of SSRIs on effective plasma concentrations of tamoxifen in women of different genotypes.

Among women homozygous for the wild-type CYP2D6 gene, which encodes a tamoxifen-metabolising enzyme, plasma endoxifen concentrations were 58 per cent lower in women taking SSRIs than in those not on the drugs.

Journal of the National Cancer Institute 2005;97:30-39

Retinopathy predicts heart failure

Retinopathy is an independent predictor of congestive heart failure, according to an Australian study. Researchers took retinal photographs in 11,612 patients aged from 49 to 73 and assessed retinopathy.

Incidence of congestive heart failure over the following seven years was 15.1 per cent in patients with retinopathy but just 4.8 per cent in those without the condition.

After controlling for cardiovascular risk factors, the risk of congestive heart failure was doubled. The risk was increased threefold in patients without pre-existing coronary heart disease, diabetes or hypertension.

JAMA 2005; 293:63-69

Neurological disability in pre-terms

Extreme pre-term birth can cause neurological and developmental disability in school-age children, according to a UK study.

Researchers studied 308 children born at 25 weeks or earlier. They used standardised cognitive and neurological assessments to evaluate development at early school age. Some 21 per cent of children born extremely pre-term showed cognitive impairment compared with 1 per cent of the population as a whole.

NEJM 2005;352:9-19

Urea breath test best for H. pylori

The urea breath test appears to be the most useful non-invasive diagnostic test for H. pylori infection in patients with chronic renal failure.

Spanish researchers conducted a cross-sectional study on 86 patients having dialysis for kidney failure, with each patient having a battery of tests including the urea breath test, serology and three faecal assays.

The urea breath test was the most reliable, with sensitivity and specificity of around 95 per cent. Serology had a sensitivity of 97 per cent, but a specificity of just 64 per cent, while faecal tests also performed less well.

Helicobacter 2004;9:674-680

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