Research Articles

Acute skin toxicities in patients receiving adjuvant breast radiotherapy

Credit: IAEA Imagebank

doi:10.7244/cmj.2015.08.002
P Boothroyd, E Lee , E Sweet, A Stillie, E Cameron, Y Cao, A MacArthur, H Zakaria, J Cameron

Adjuvant breast radiotherapy (RT) is associated with acute skin toxicities including erythema and desquamation that may be associated with a detrimental impact on patients’ quality of life. Management of radiation-induced skin reactions (RISR) is contentious due to conflicting literature. There is a lack of evidence for the use of aqueous cream although this is commonly used in UK cancer centres. Alternative preparations such as Moogoo udder cream® are more expensive and may be more efficacious. The aim of this study was to investigate patient experience of RISRs and determine whether they would be willing to purchase a cream not provided on the NHS, should one be demonstrated to be more efficacious.

Detection of Coeliac Patients at Risk of an Osteoporotic Fracture: A Two-Cycle Clinical Audit

doi:10.7244/cmj.2013.11.001
A Nunn, D Patterson

Patients diagnosed with Coeliac disease are known to be at higher risk of suffering a low-impact fracture, and even as children it is important to detect and correct malabsorption due to Coeliac since this may have a lasting impact on their lifelong fracture risk. The British Society of Gastroenterologists recommends that those Coeliac patients with two or more additional risk factors for osteoporotic fracture undergo a dual X-ray absorptiometry (DEXA) scan to determine their bone density. This audit addressed the question of whether this standard was being adhered to in a general practice setting in the south-east of England. The capture of cases represented a prevalence of 1:275 (similar to previously reported figures for the prevalence of this condition). The rate of DEXA scanning in this population was disappointingly low (only 37%), and since many of those Coeliac patients who should have been scanned, and were not, possessed ‘minor’ risk factors such as smoking or female gender, the low pick-up rate may be attributable to a lack of awareness of the small but significant risk that these factors pose. Of those DEXA scans performed, the bone mineral densities of the patients concerned was inversely proportional to the number of risk factors they possessed, supporting the stance of the BSG. Practitioner education alone was not sufficient to improve the rate of scanning, which actually declined following a period of raising awareness of the need for such scans.

Safety of SSRIs in Pregnancy

Image credit: tipstimes.com/pregnancy

doi:10.7244/cmj.2013.07.003
Sian-Lee Ewan

A recent study, Jensen et al 2013 [1], sought to differentiate the effects of exposure to maternal depression from the effects of antidepressants in their contribution to a reduction of Apgar scores. They collected data regarding diagnosis of depression, use of antidepressants in pregnancy, and Apgar scores at 5 minutes from all pregnancies in Denmark from 1996 to 2006 using national databases. This gave information on 668,144 births. Pregnant women were divided into 8 risk groups depending on their exposure to antidepressants during pregnancy, their exposure to antidepressants before pregnancy, and a diagnosis of depression before the end of pregnancy. Logistic regression analyses were applied with Apgar score <7 as the outcome and risk group as the variable of interest. Apgar score of <7 at 5 minutes was used as the outcome because it has been associated with an increased risk of low IQ at age 18, individuals being less likely to have no income from work, and neurological disability [1]

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