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BMJ 2008;336:36-40 (5 January). Clinical review
by: Sarah A E Logan, specialist registrar, Eithne MacMahon, consultant Infection and Immunology:

• Bacterial and viral meningitis cannot reliably be differentiated clinically, and all suspected cases should be referred to hospital
• Viral meningitis is most common in young children; the incidence decreases with age
• Enteroviruses are the most common cause at all ages
• Although most cases are self limiting, morbidity may be considerable
• Herpes simplex virus causes viral meningitis, which may recur
• Genital herpes infection may be acquired from a partner after many years within a monogamous relationship
• Meningitis is a feature of HIV seroconversion
• In the absence of associated encephalitis, the prognosis is usually good

BMJ 2008;336:2-3 (5 January).
Proton pump inhibitors have been a tremendous therapeutic advance and have transformed the lives of patients with previously intractable symptoms, say editorialists Ian Forgacs and Aathavan Loganayagam. But the drugs are being overused, and side effects - although rare - should not be overlooked.

Rapid Response by Dr Raymond C Seidler, GP, NSW, Australia:

• “Perhaps it would be salutary to consider how rare it is now to see patients with perforated ulcers or even serious gastric or duodenal ulceration.
• These were commonplace in my early days of general practice 25 years ago. The proton pump inhibitors as a class are effective.”

BMJ  2007;335:470-471 (8 September):

News

Proliferation of firearms is growing global health problem

John Zarocostas

The growing number of civilians holding firearms is fuelling gun crime worldwide and is putting healthcare systems, especially in poor countries, under stress, an expert report says. Gun crime kills about 250 000 people a year and injures many more.

BMJ  2007;335:786 (20 October).

Two papers have recently been published on bmj.com on the treatment of osteoarthritis of the knee.

Acupuncture has no additional benefit in people taking a course of exercise.

Research, BMJ, doi:10.1136/bmj.39367.495995.AE (published 6 November 2007)
 

What is already known on this topic

• Increased body mass index is known to increase the risk of adenocarcinoma of the oesophagus, endometrial cancer, kidney cancer, and postmenopausal breast cancer in women
• Body mass index has also been associated with the risk of other, rarer, cancers, but the findings are not yet conclusive

What this study adds

• High body mass index in women may increase the risk of multiple myeloma, leukaemia, pancreatic cancer, non-Hodgkin’s lymphoma, and ovarian cancer
• Menopausal status seems to affect the relation between body mass index and risk of breast cancer, endometrial cancer, and colorectal cancer
• Among postmenopausal women in the UK, 5% of all cancers (about 6000 annually) are attributable to women being overweight or obese
• Around half of all cases of endometrial cancer and adenocarcinoma of the oesophagus in postmenopausal UK women are attributable to women being overweight or obese

Clinical Review, BMJ  2007;335:929-932 (3 November).

Summary points

• A favourable outcome depends on early, aggressive, treatment
• Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
• Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
• Subtle signs of organ hypoperfusion should be sought in physically robust patients
• The role of activated protein C and low dose steroids remains to be clarified
  

BMJ 21 December 2007

With the festive season in full swing, Ian Gilmore and Nick Sheron urge the implementation of policies to curb excess drinking to reduce the harms of alcohol in the UK (read more), whereas Christopher Cook and colleagues consider a classical Greek text that makes it obvious that drunkenness has a long tradition in Western civilisation (Classically intoxicated), and A&E doctor Robert J Douglas from Australia recommends CHAMPAGNE as the safer choice for celebrations.

BMJ 21 December 2007;

Organised marathons are not associated with an increased risk of sudden death, despite the media attention they attract. In fact, marathons lower the risk of fatal motor vehicle crashes that might otherwise have taken place if the roads had not been closed

Editorials, BMJ  2007;335:897 (3 November).

The possible influence of diet on the risk of cancer is constantly topical. The subject is important because people can change their diets, and even a moderate effect on risk could prevent several thousand cancers each year in a country the size of the United Kingdom. However, apart from the confirmed adverse effects of alcohol and obesity on the risk for some types of cancer, progress in understanding has been slow and the evidence remains confusing.