Lancet 7 Apr 2007

Just after the editorials comes a short clinical update on essential tremor which usefully summarises the clinical features and how to distinguish this from other tremulous disorders. When it comes to treatment, however, the evidence is generally shaky.

It’s surprising that while few new antibacterial drugs are appearing, good new antiretrovirals continue to be developed. The latest is darunavir, a promising new agent for drug-resistant HIV.

This big observational study from the USA goes a long way towards demonstrating a marked reduction in early childhood pneumonia following the introduction of universal pneumococcal vaccination for infant Americans in 2000. The paper presents its data in somewhat baffling ways with many caveats, but the main message is clear: this vaccine works and may have long-term benefits exceeding the 65% reduction in pneumonia admissions for under-2s which is demonstrated here.

Should all newborn infants be screened for cystic fibrosis? The answer should really depend on the survival benefit, and this has apparently already been demonstrated. Cost savings are a secondary consideration, but according to this study, they also indicate a benefit from neonatal detection.

Yersinia pestis is a pretty recent bug: judging from its DNA, not more than 40,000 years old, perhaps as young as 9,000 years, which would put it alongside the beginning of human agronomy. Here is a good and comprehensive review of the plague. Pneumonic plague is a truly horrifying disease which until the last US outbreak was uniformly fatal: it could indeed be aerosolised and used as a biological weapon, though human-to-human transmission is slight.
Superne Lucerne guberne this pestilens,
Preserve and serve that we not sterve thairin.
From Ane Prayer for the Pest, by Robert Henryson c.1499, when there was an outbreak of plague in Dunfermline

Four German authors give an enthusiastic but rather diffuse account of the renin-angiotensin system and the ways we can tinker with it to reduce cardiovascular risk. For a clearer account of RAAS blockers for the prevention of diabetes, see Saudi Med J 2007;28:91.