500
included
comparison. Confounding variables, such
for
socioeconomic, nutritional, and iron
as
measured to confirm good randomisation. Seven tests of cognitive function were given before intervention and repeated about 9 weeks later. Comparison between groups, by multiple linear regression, revealed that in three cognitive tests children who received treatment improved significantly more than those who received placebo (p < 005). Furthermore, on completion of the study the treatment group and uninfected controls no longer differed significantly. The investigators concluded that moderate-to-heavy infections with the human whipworm have a detrimental and reversible impact on a child’s cognitive function. We agree with Callender et al about the need to determine whether the effect of infection on cognitive function has long-term implications for school achievement.
Fig 2-Percentage of female population exposed to oestrogen calcitonin treatment in Imola area by age group in 1990.
or
status were
Department of Biology, Wellcome Research Centre for Parasitic Infections, Imperial College of Science, Technology, and Medicine, London SW7 2BB, UK
C. NOKES D. A. P. BUNDY
1. Nokes C, Grantham-McGregor SM,
year recommended by the pharmaceutical companies rather than any firm evidence from randomised trials. An analgesic effect of calcitonin is widely advertised and this claim also deserves rigorous evaluation; this is not yet an approved indication. The average duration of oestrogen treatment was about 120 days. These data are consistent with another fmding of ours that in Italy almost 30% of drug consumption and of drugs on the market are devoid of proven clinical efficacy.3 The Italian health authorities should use these data as a stimulus for more effective initiatives to control NHS expenditure and improve drug use, and pay attention to those’ who call for a more rational approach to drug registration and drug utilisation. Department of Pharmacology, Interuniversity Research Centre on Pharmacoepidemiology, University of Bologna, 40126 Bologna, Italy
NICOLA MAGRINI ALBERTO VACCHERI NICOLA MONTANARO
1. Calcitonin m osteoporosis treatment/prevention. Scrip 1990; 1565: 28-29. Riggs BL. Practical management of the patient with osteoporosis. In: Riggs BL, Melton JL, eds. Osteoporosis: etiology, diagnosis, and management. New York: Raven, 1988: 481-90. 3. Montanaro N, Magrini N, Vaccheri A, Battilana M. Drug utilization in general practice: prescribing habits of national formulary drugs by GPs of Emilia Romagna (Italy) m 1988 and 1989. Eur J Clin Pharmacol (in press). 4. Garattini S. Public anger at health charges. Lancet 1989; i: 835. 2.
Article and advertisement SiR,—The juxtaposition of an advertisement (Tonometrics, Inc [US edition]) and an endorsing original article (Gutierrez et al) in the issue of Jan 25 seems highly objectionable and should have been
Sawyer AW, Cooper ES, Bundy DAP Parasitic helminth infection and cognitive function in school children. Proc R Soc Lond SerB (in press).
2. Nokes C, Grantham-McGregor SM, Sawyer AW, Cooper ES, Robinson BA, Bundy DAP Moderate to heavy infections of Trichuris trichiura affect cognitive function in Jamaican school children. Parasitology (in press).
Day care for hypertension in pregnancy SIR,-Mr Tufnell and colleagues (Jan 25,
p 224) demonstrate advantages in day-care managment of aproteinuric hypertension in pregnancy. Sadly, the point of the paper cited from my group1 has been lost-ie, the effect was of a domiciliary antenatal care scheme on hospital admissions and not telephonic monitoring of the fetal heart, as stated. This scheme included domiciliary surveillance of hypertensive women much as day care would have provided. Having extended our studies to the highly deprived areas of the south Wales valleys, our chief concern now is with women who are likely to have considerable geographic difficulty as inpatients, or from lengthy journeys by public transport to outpatient departments. Before units consider redirecting resources to setting up day units I would urge them to consider who is really likely to benefit from day units in areas, unlike Glasgow or Leeds, where the mother’s social or health interests may be better served by an alternative approach. Indeed, do aproteinuric hypertensive women need to attend hospital at all?
welcome
Department of Obstetrics and Gynaecology, University of Wales College of Medicine, Cardiff CF4 4XN, UK
ANDREW J. DAWSON
1. Dawson AJ, Middlemiss C, Coles EC, Gough NAJ, Jones ME. A randomised study of a domiciliary antenatal care scheme: the effect on hospital admissions Br J Obstet
Gynaecol 1989, 96: 1319-22.
avoided.
Snuff and
Department of Medical Education, Abbott Northwestern Hospital,
recurring pulmonary infiltrations in chronic renal failure
Minneapolis, Minnesota 55407, USA
CLAUS A. PIERACH
*** Dr Pierach has good cause for complaint. The juxtaposition does mark a new Lancet policy-more a lapse of concentration.-
not
ED. L.
Trichuris trichiura infection and mental development in children SIR,-Ms Callender and colleagues (Jan 18, p 181) report the effects of severe whipworm (Trichuris trichiura) infection on mental development, and suggest that future work should explore the effects on childrert of moderate loads of infection. This has been examined with respect to the impact of T trichiura on cognitive function in children, in a double-blind placebo controlled clinical trial. 1,2 Jamaican children aged 9-12 years, with moderate-to-heavy burdens of T trichiura (n = 103; > 2000 eggs per g faeces) randomly assigned antihelminthic treatment with three 400 mg doses of albendazole or placebo. A third, randomly selected, group of uninfected controls (n = 56) was also given placebo and worm
were
SIR,-Recurring pulmonary infiltrations associated with renal failure usually demand many diagnostic procedures to define systemic diseases with vasculitis, Goodpasture’s syndrome,l,2 or an infectious agent. Additionally, end-stage kidney disease is often accompanied by deficient cellular defence mechanisms,3 and several bacterial, viral, and fungal infections could show a fulminant clinical course.
We report a 60-year-old man, who was admitted in October, 1990, because of progressive renal failure and for a Cimino shunt operation. Glomerulonephritis had been diagnosed more than 10 years ago, since when he had hypertension. He did not report any other serious diseases; he had been a non-smoker for more than 20 years. During the past few months he had received several antibiotics because of recurring bronchial infections. The current treatment consisted of digitoxin, frusemide, allopurinol, and clonidine. He had peripheral oedema and mild dyspnoea, but neglected signs of acute infections, cough, and chest pain. His temperature was normal, and no lymphadenopathy or tenderness of the temporal arteries or the paranasal sinuses were detected. He
included
comparison. Confounding variables, such
for
socioeconomic, nutritional, and iron
as
measured to confirm good randomisation. Seven tests of cognitive function were given before intervention and repeated about 9 weeks later. Comparison between groups, by multiple linear regression, revealed that in three cognitive tests children who received treatment improved significantly more than those who received placebo (p < 005). Furthermore, on completion of the study the treatment group and uninfected controls no longer differed significantly. The investigators concluded that moderate-to-heavy infections with the human whipworm have a detrimental and reversible impact on a child’s cognitive function. We agree with Callender et al about the need to determine whether the effect of infection on cognitive function has long-term implications for school achievement.
Fig 2-Percentage of female population exposed to oestrogen calcitonin treatment in Imola area by age group in 1990.
or
status were
Department of Biology, Wellcome Research Centre for Parasitic Infections, Imperial College of Science, Technology, and Medicine, London SW7 2BB, UK
C. NOKES D. A. P. BUNDY
1. Nokes C, Grantham-McGregor SM,
year recommended by the pharmaceutical companies rather than any firm evidence from randomised trials. An analgesic effect of calcitonin is widely advertised and this claim also deserves rigorous evaluation; this is not yet an approved indication. The average duration of oestrogen treatment was about 120 days. These data are consistent with another fmding of ours that in Italy almost 30% of drug consumption and of drugs on the market are devoid of proven clinical efficacy.3 The Italian health authorities should use these data as a stimulus for more effective initiatives to control NHS expenditure and improve drug use, and pay attention to those’ who call for a more rational approach to drug registration and drug utilisation. Department of Pharmacology, Interuniversity Research Centre on Pharmacoepidemiology, University of Bologna, 40126 Bologna, Italy
NICOLA MAGRINI ALBERTO VACCHERI NICOLA MONTANARO
1. Calcitonin m osteoporosis treatment/prevention. Scrip 1990; 1565: 28-29. Riggs BL. Practical management of the patient with osteoporosis. In: Riggs BL, Melton JL, eds. Osteoporosis: etiology, diagnosis, and management. New York: Raven, 1988: 481-90. 3. Montanaro N, Magrini N, Vaccheri A, Battilana M. Drug utilization in general practice: prescribing habits of national formulary drugs by GPs of Emilia Romagna (Italy) m 1988 and 1989. Eur J Clin Pharmacol (in press). 4. Garattini S. Public anger at health charges. Lancet 1989; i: 835. 2.
Article and advertisement SiR,—The juxtaposition of an advertisement (Tonometrics, Inc [US edition]) and an endorsing original article (Gutierrez et al) in the issue of Jan 25 seems highly objectionable and should have been
Sawyer AW, Cooper ES, Bundy DAP Parasitic helminth infection and cognitive function in school children. Proc R Soc Lond SerB (in press).
2. Nokes C, Grantham-McGregor SM, Sawyer AW, Cooper ES, Robinson BA, Bundy DAP Moderate to heavy infections of Trichuris trichiura affect cognitive function in Jamaican school children. Parasitology (in press).
Day care for hypertension in pregnancy SIR,-Mr Tufnell and colleagues (Jan 25,
p 224) demonstrate advantages in day-care managment of aproteinuric hypertension in pregnancy. Sadly, the point of the paper cited from my group1 has been lost-ie, the effect was of a domiciliary antenatal care scheme on hospital admissions and not telephonic monitoring of the fetal heart, as stated. This scheme included domiciliary surveillance of hypertensive women much as day care would have provided. Having extended our studies to the highly deprived areas of the south Wales valleys, our chief concern now is with women who are likely to have considerable geographic difficulty as inpatients, or from lengthy journeys by public transport to outpatient departments. Before units consider redirecting resources to setting up day units I would urge them to consider who is really likely to benefit from day units in areas, unlike Glasgow or Leeds, where the mother’s social or health interests may be better served by an alternative approach. Indeed, do aproteinuric hypertensive women need to attend hospital at all?
welcome
Department of Obstetrics and Gynaecology, University of Wales College of Medicine, Cardiff CF4 4XN, UK
ANDREW J. DAWSON
1. Dawson AJ, Middlemiss C, Coles EC, Gough NAJ, Jones ME. A randomised study of a domiciliary antenatal care scheme: the effect on hospital admissions Br J Obstet
Gynaecol 1989, 96: 1319-22.
avoided.
Snuff and
Department of Medical Education, Abbott Northwestern Hospital,
recurring pulmonary infiltrations in chronic renal failure
Minneapolis, Minnesota 55407, USA
CLAUS A. PIERACH
*** Dr Pierach has good cause for complaint. The juxtaposition does mark a new Lancet policy-more a lapse of concentration.-
not
ED. L.
Trichuris trichiura infection and mental development in children SIR,-Ms Callender and colleagues (Jan 18, p 181) report the effects of severe whipworm (Trichuris trichiura) infection on mental development, and suggest that future work should explore the effects on childrert of moderate loads of infection. This has been examined with respect to the impact of T trichiura on cognitive function in children, in a double-blind placebo controlled clinical trial. 1,2 Jamaican children aged 9-12 years, with moderate-to-heavy burdens of T trichiura (n = 103; > 2000 eggs per g faeces) randomly assigned antihelminthic treatment with three 400 mg doses of albendazole or placebo. A third, randomly selected, group of uninfected controls (n = 56) was also given placebo and worm
were
SIR,-Recurring pulmonary infiltrations associated with renal failure usually demand many diagnostic procedures to define systemic diseases with vasculitis, Goodpasture’s syndrome,l,2 or an infectious agent. Additionally, end-stage kidney disease is often accompanied by deficient cellular defence mechanisms,3 and several bacterial, viral, and fungal infections could show a fulminant clinical course.
We report a 60-year-old man, who was admitted in October, 1990, because of progressive renal failure and for a Cimino shunt operation. Glomerulonephritis had been diagnosed more than 10 years ago, since when he had hypertension. He did not report any other serious diseases; he had been a non-smoker for more than 20 years. During the past few months he had received several antibiotics because of recurring bronchial infections. The current treatment consisted of digitoxin, frusemide, allopurinol, and clonidine. He had peripheral oedema and mild dyspnoea, but neglected signs of acute infections, cough, and chest pain. His temperature was normal, and no lymphadenopathy or tenderness of the temporal arteries or the paranasal sinuses were detected. He
