Highlights

Reducing the harm of leftover drugs

Leftover prescription drugs may be misused for recreation or self-medication. They also pose a danger if ingested accidentally by a small child. The National Prescription Drug Drop-Off Day on May 10, 2014, was an opportunity for the safe disposal of unused medications; however, unused medications can be returned to pharmacies or disposed of safely any time. See Commentary, page 815

Febrile seizures after MMRV vaccine

The risk of febrile seizures was twice as high among children 12–23 months of age given measles–mumps–rubella– varicella vaccine as those given separate measles–mumps–rubella and varicella vaccines on the same day, during the peak risk period (7–10 days after vaccination). Although the incidence of seizures was low, the potential increase in convenience and acceptability with the single combination vaccine must be balanced against the small increased risk of seizures, say the authors. See Research, page 824

CAPITAL STEM MI randomized trial

Four days of granulocyte colony-stimulating factor therapy for patients with moderate ventricular impairment following acute MI was less effective than placebo at improving left ventricular ejection fraction at 6 weeks, and at 6 months patients in the treatment group had poorer ventricular function. The authors of this RCT of 86 patients advise careful monitoring of clinical outcomes to ensure safety. See Research, page E427

Cerebrospinal venous insufficiency and MS

Venous outflow abnormalities consistent with ultrasound criteria proposed to represent chronic cerebrospinal venous insufficiency were no more common in patients with multiple sclerosis than in healthy controls. In this prospective study, 120 patients from a multiple sclerosis clinic and 60 controls underwent extracranial Doppler ultrasonography and gadolinium-enhanced magnetic resonance venography. The findings challenge the authenticity of the diagnosis of chronic cerebrospinal venous insufficiency, say the authors. See Research, page E418

Drug therapy for multiple sclerosis

In the last two decades, treatment of MS has moved forward substantially, with many treatment options available for different disease subtypes. The authors review evidence for the efficacy and safety of MS treatments. See Review, page 833

Parents in the neonatal ICU

The neonatal intensive care unit is highly stressful for parents who are physically separated from their infants. Can their role be expanded to include most of their child’s care? Lee and O’Brien think so. See Practice, page 845

Polycystic ovarian syndrome

A 28-year-old woman reports irregular menstrual cycles, weight gain and hirsutism since stopping an oral contraceptive pill three years earlier. Does she have polycystic ovarian syndrome, the most common endocrine condition among women of reproductive age, or something more uncommon? What clues on history, examination and investigations can help make the diagnosis? Boyle and Teede tell us more about the implications of this condition. See Practice, page 850

Carpal tunnel syndrome

Does using a computer keyboard or mouse increase the risk of carpal tunnel syndrome? The association isn’t clear, say Squissato and Brown, in their overview of this condition. In addition, the syndrome may be less common among people working in office settings or high-risk occupations than traditionally thought. See Practice, page 853

Wegener granulomatosis

A 63-year-old woman had a two-month history of intermittent epistaxis associated with a sensation of fullness and progressive hearing loss in her left ear. Findings on nasal endoscopy consistent with Wegener granulomatosis were confirmed by biopsy. Up to 95% of patients with Wegener granulomatosis will present with otorhinolaryngologic findings as the first sign of the disease, say the authors. See Practice, page 854