JAMA 4 Apr 2007

This Japanese study breaks new ground in attempting to establish the prevalence of neuraminidase resistance in influenza B viruses. At present it is low, but of course selection pressure could change all that if these drugs were widely used in an epidemic. This has nothing to do, by the way, with H5N1 flu, which is caused by a group A virus. Group As are known to develop resistance to oseltamivir pretty quickly. So keep those contingency plans in a handy place: field hospital in the practice car park; all the most dispensable staff to work on the flu side; special bulk discount with the local undertaker.

Sumatriptan is a serotonin agonist which is very erratically absorbed from the GI tract, and I thought it had more or less gone out of use except as an injection for cluster headache. Now it seems that GlaxoSmithKline is trying to relaunch it as a fixed-combination tablet with naproxen, and JAMA seems willing to abet the attempt by publishing this trial of sumatriptan vs sumatriptan-naproxen in single attacks of migraine. Sure, the naproxen prolongs the relief a bit at the expense of slightly more gut ache. Is this a contribution to medical knowledge?

A couple of people I know are working on a huge international trial of statins in renal failure, and here comes an unconnected study from the USA which shows a completely unexpected benefit – they greatly reduce hospitalisation for sepsis in patients with chronic renal failure. But this is a cohort study, and the real confirmation will come from the big randomised double-blind trial, provided that the investigators have pre-specified this end-point.

It’s only a few years ago that most of us were extolling the cardiovascular benefits of hormone replacement therapy to scores of menopausal women. We’ve since persuaded most of them to come off it, but in fact we may have been right. Or at least not wrong: this analysis of the Women’s Health Initiative shows that women given combined HRT at or soon after the menopause may get a little bit of cardiovascular protection, whereas women given it later may get a tiny bit of added risk – but the numbers don’t reach significance in either group.

Once or twice every year you’ll come across an adult who makes you ask yourself does this patient have septic arthritis? Once or twice in a working lifetime in primary care, the answer will be yes, and you’d better not miss it. So it’s worth skimming through this latest in the Rational Clinical Examination series: always wonderful, always awfully long.