Controlled trial of medical treatment of active chronic otitis media Active chronic otitis media is a common condition affecting 0 6%,' of adults in the United Kingdom. Initial management is usually by general practitioners, who annually prescribe systemic and topical antibiotics on at least 178 000 and 73 000 occasions respectively (unpublished observations). Despite this there have been few studies of the efficacy of antibiotics,'-4 and no study has included a control group of untreated patients or of patients treated solely by aural toilet. We undertook a controlled study comparing appropriate systemic or topical antibiotic treatment with weekly aural toilet and insufflation of boric acid and iodine powder.

White coat hypertension (WCH) is characterised by an elevated clinic blood pressure (BP) with normal ambulatory or home BP. It is well recognised in clinical practice and occurs in approximately one-third of untreated patients with elevated clinic BP. Current evidence suggests that WCH is associated with cardiovascular risk factors, including the development of sustained hypertension and the presence of target organ damage. However, its effects on cardiovascular outcomes remain a matter of debate. There is also insufficient evidence from randomised controlled trials to determine whether WCH warrants treatment. This narrative review aims to provide an update on the current understanding of WCH. It focuses on the clinical characteristics and potential implications of WCH, its relationship to cardiovascular risk and the evidence regarding treatment. Gaps in existing research are also highlighted.

Fifty-five consecutive admissions to an acute geriatric unit were studied prospectively. Individuals were classified according to the obvious presence or absence of an active disease process on admission and their serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured then and five days later. There was no significant difference between the ESR values in the two groups either on admission or at day 5, nor was there any significant change between admission and day 5. In contrast, CRP values were very significantly higher in the active than in the non-active group and there were marked changes over the 5-day period corresponding to changes in clinical condition. These results indicate that the serum CRP concentration is superior to the ESR as an objective, non-specific marker for disease activity in the elderly.

No abstract

Objectives: The risk profile of white-coat hypertension/ effect (WCH/E) remains unclear. This study aimed to investigate the relationship between WCH/E, markers of cardiovascular risk and cerebrovascular events.Methods: This is a sub-group analysis of The Arterial Stiffness In lacunar Stroke and Transient ischemic attack (ASIST) study, which recruited 96 patients aged at least 40 years old with a diagnosis of transient ischemic attack or lacunar stroke in the preceding 14 days. Thirty-two patients with target blood pressure (clinic blood pressure <140/ 90 mmHg and daytime ambulatory blood pressure <135/ 85 mmHg) and 30 patients with WCH/E (clinic blood pressure !140/90 mmHg and daytime ambulatory blood pressure <135/85 mmHg) were included in the analysis.Results: Patients with WCH/E were older and had a higher BMI. Central SBP (145 AE 13 vs. 118 AE 8 mmHg, P < 0.001) and DBP (82 AE 8 vs. 76 AE 7 mmHg, P ¼ 0.004) were higher in those with WCH/E. They also had higher arterial stiffness measured by carotid-femoral pulse wave velocity (11.9 AE 3.0 vs. 9.6 AE 2.3 m/s, P ¼ 0.002) and cardio-ankle vascular index (10.3 AE 1.3 vs. 9.4 AE 1.7, P ¼ 0.027). Regression analysis showed an independent relationship between WCH/E and both measures of arterial stiffness. Lacunar strokes were more prevalent in those with WCH/E (47 vs. 22%, P ¼ 0.039) and individuals in this group were more likely to have had a lacunar stroke than a transient ischemic attack (odds ratio 9.6, 95% CI 1.5-62.6, P ¼ 0.02). Conclusion:In this cohort of patients with lacunar stroke and transient ischemic attack, WCH/E was associated with elevated markers of cardiovascular risk and a higher prevalence of lacunar stroke. These results suggest that WCH/E is associated with adverse cardiovascular risk.