BMJ 2011: 342: 933 – 984 (30th April)

Another analysis showing increased MI risk in patients taking calcium supplements.  In this re-analysis of the WHI data, calcium supplements, whether with or without Vitamin D, increased the risk of both CVA or MI by about a fifth each.  As before, the results are being contested.  What I’d really like to see at this point is some discussion of how strong or weak the evidence is that they actually do any good.

Yasmin is getting a mixed reception in the medical journals lately.  The latest JFPRHC or whatever the hell their exact acronym is (buggered if I can ever remember) came out with evidence that it gave more scope for missed pills, due to the longer half-life of drosperinone; however, just as I was wondering whether I should switch to making that one the first-line prescription for teenagers who decline LARC, this BMJ issue weighed in with news rather more welcome for those holding the drugs budgets.  It seems there is quite a bit of evidence (although not all pointing in the same direction) that Yasmin may carry more DVT risk than levonorgestrel-containing pills.

When investigating for possible ovarian pathology, remember it’s worth checking a Ca-125 as well as a pelvic ultrasound.  Hmmmm…. I think I’ll actually put that one into practice right away (well, when I get back to work after the Bank Holiday), by ringing the woman I saw a couple of days ago and asking her to arrange a blood test as well as her scan.

And an article on Gilbert’s syndrome might have actually clarified a recent patient result that had me puzzled.  It seems that Gilbert’s syndrome can cause slight rises in conjugated as well as unconjugated bilirubin.  As long as the conjugated bilirubin is still less than 20% of the total, it’s still OK to attribute it to Gilbert’s syndrome.  I’ll recheck the numbers on the patient I’m thinking of to see whether they’d fit with this, but it’s good to have a possible explanation in mind.

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in BMJ, Contraception, Gynaecology, Impact, Liver. Bookmark the permalink.

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