Highlights

Pregnancy and antidepressants

The use of antidepressants during pregnancy was associated with an increased risk of spontaneous abortion. Nakhai-Pour and colleagues come to this conclusion from their nested case–control study based on data from the Quebec Pregnancy Registry. Physicians who care for women of child-bearing age, including those who are pregnant, may wish to discuss the risks and benefits of taking antidepressants with their patients, say the authors. See Research, page 1031

If there is a true increased risk of spontaneous abortion associated with the use of antidepressants during pregnancy, it is small, says Einarson. See Commentary, page 1017

Is it myocardial infarction?

The thrombolysis in myocardial infarction (TIMI) risk score can be used in emergency departments to identify patients with chest pain who are at high or low risk of acute coronary syndromes. This conclusion is based on a systematic review of 10 cohort studies with over 17 000 patients. The TIMI score can be used to aid clinical decisions, say the authors, but the score is not accurate enough to be used as the sole method for planning care. See Research, page 1039

Developing, reporting and evaluating guidelines

This is the first of two studies designed to improve the AGREE (Appraisal of Guidelines, Research and Evaluation) instrument used to develop, report and evaluate practice guidelines. Brouwers and colleagues analyze the performance of a new seven-point response scale, explore the usefulness of the AGREE items and systematically identify ways in which the items and supporting document could be improved. See Research, page 1045

Heat-related illnesses

People over the age of 60 years and those with obesity, cardiovascular disease, pulmonary disease or long-standing diabetes are at increased risk of heat-related illness during heat waves. This vulnerability is increased in those who have a homebound lifestyle, lack of contact with other people and have decreased mobility. See Reviews, page 1053

Frozen plasma

Pinkerton and Callum lament the poor quality of evidence that underpins guidelines for the use of frozen plasma in clinical practice. See Commentary, page 1019

Sickle cell disease, fever and headache

A five-year-old girl with sickle cell disease who presented with a two-day history of left frontal headache and mild fever later develops facial edema. She has signs of meningeal irritation and tenderness over the dorsal vertebrae. Which tests should you perform? What is your diagnosis?See Practice, page 1069

Janeway lesions

A 52-year-old man presented with fever, lightheadedness and myalgia of one week’s duration and a previous history of endocarditis. He had Janeway lesions on his big toe. See Clinical images, page 1075