Spotlight on inborn errors of metabolism

28th February is Rare Disease Day. This guest blog has been written by Nikki Jahnke and John Walter for the IEM team at the Cochrane Cystic Fibrosis and Genetic Disorders Group.

Rare Disease Day gives us an opportunity to highlight the area of inborn errors of metabolism, or IEMs for short. These cover a wide range of genetic disorders which are relatively rare but can be an important cause of illness and death in young babies if not diagnosed and treated in the first few weeks of life. A study in Canada by Applegarth estimated a total of 40 cases of any IEM in every 100,000 live births, a more recent Italian study found a similar rate.

Intervention reduces atrial fibrillation after heart surgery

Atrial fibrillation (AF) is the most common rhythm disturbance of the heart. It involves the top two chambers of the heart quivering (fibrillating) rather than beating effectively. This can lead to three potential problems: Firstly, without the top two chambers pumping properly the heart becomes less effective at pumping. This can make some patients feel tired or more breathless during exercise. Secondly, in some cases, the bottom two chambers of the heart try their best to keep up with the fast quivering of the top two chambers, leading them to beat faster than they normally would. This can make some people feel their heart pounding in their chest (palpitations), or tired or breathless on exertion. Thirdly, patients are more likely to have a stroke. This is because the blood moves more sluggishly through the quivering chambers and has an increased tendency to form blood clots. These can lodge in arteries in the brain, starving that area of blood and oxygen.

Non-removable casts are better than dressings or removable casts for helping diabetes-related foot ulcers heal

Key message: Non-removable, pressure-relieving casts are more effective in healing diabetes-related plantar foot ulcers than removable casts, or dressings alone

Diabetes is a serious chronic disease that’s on the rise, thanks to ever more sedentary lifestyles, changes in our diet and people living longer. Since the mid-1990s, the number of people with diabetes in the UK has risen from 1.4 million to 2.9 million and it’s estimated that 4 million of us will be diabetic by 2025.

Can ‘red flags’ help clinicians diagnose vertebral fracture in patients with low-back pain?

Key message:  Based on the small number of studies included in this review, the use of many red flags to screen for vertebral fracture is not supported by the available evidence.

Many people suffer from low-back pain (LBP) and, whilst it is second only to the common cold as a cause of lost working days and can be pretty disabling, for most it is not caused by serious underlying disease. But how can clinicians identify the 1% to 5% of patients presenting with LBP who do have underlying disease (vertebral fracture, malignancy, infection or inflammatory disease) needing further investigation and treatment?

Guest blog: Slum upgrading – improving health and wellbeing?

This guest blog was written by Dr Ruhi Saith, a Research Fellow based in New Delhi and an author of the review from the Cochrane Public Health Group on which this blog is based.

Globally over one billion slum dwellers reside in informal housing and according to UN predications this figure will increase to 1.4 billion by 2020. Whilst progress towards the UN millennium goals, which aim to improve the lives of slum dwellers, is being made, slum improvements have failed to keep pace with the growing ranks of the urban poor.

Statins save lives in patients undiagnosed with heart disease

Given that February is National Heart Month (cue Valentine’s Day), I thought I would blog about a recent Cochrane review by the Cochrane Heart Group which has just been published, all about statins. Statins are a family of medicines prescribed for lowering cholesterol. They are one of the most commonly prescribed medicines, particularly by us cardiologists and our GP colleagues. The number of prescriptions and cost to the NHS of these drugs has grown significantly in the last few years, from £20 million in 1993 to £500 million in 2006. They are frequently prescribed for preventing further heart attacks and strokes when a patient has already had one (called secondary prevention by us doctors) but the evidence of benefit when given to patients to prevent a first heart or stroke (called primary prevention) is less clear. This review aimed to assess the effects, both harms and benefits, of statins in people with no history of cardiovascular disease.