Monoaminergic agonists for acute traumatic brain injury.

BACKGROUND: Although there have been considerable gains in understanding the cascade of events that lead to secondary injury after traumatic brain injury (TBI), efforts to translate this understanding into new therapeutic, so-called neuroprotective approaches, have so far proven disappointing. As an alternative, there is growing interest in approaches to enhance brain repair after injury. Animal models suggest that agents enhancing monoaminergic (MA) transmission, particularly amphetamines, promote motor recovery from focal brain injury and it is proposed that this might represent a complementary means of therapeutic intervention in the later post-injury phase. OBJECTIVES: To evaluate the evidence that MAs improve final outcome after TBI. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library, Issue 2, 2005), the Cochrane Injuries Group's Specialised Register (to May 2005), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and the Science Citation Index (1992 to June 2005). We contacted researchers and authors of published and unpublished trials. Searches were updated in May 2005. SELECTION CRITERIA: Randomised controlled trials comparing the use of a MA (together with conventional non-pharmacological rehabilitative therapy) versus conventional non-pharmacological rehabilitative therapy alone. DATA COLLECTION AND ANALYSIS: Two authors independently screened records, extracted data and assessed trial quality. MAIN RESULTS: Although there is a limited clinical literature addressing this topic, none of the studies identified fully met inclusion criteria for this review. AUTHORS' CONCLUSIONS: At present there is insufficient evidence to support the routine use of MAs to promote recovery after TBI.

London--the next battleground for syphilis?

Recent outbreaks of infectious syphilis across England raise concerns about the possibility of similar occurrences in London and highlight the inability of routine surveillance to detect outbreaks in a timely fashion. A rapid assessment exercise involving a cross-sectional survey of all London genitourinary medicine (GUM) clinics was therefore undertaken in April 2001, to confirm recent reports of infectious syphilis and the associated demographic and behavioural risk factors. Between 1999 and 2000, the number of diagnoses of infectious syphilis in London rose by 41% from 154 to 217. Largest rises were seen in homosexual males (38 to 67 diagnoses), and this trend persisted into the 1st quarter of 2001. Nearly half of the male homosexual cases where HIV status was known were HIV positive.