Itchy eyes, itchy nose

If your patients suffer from allergic conjunctivitis but don’t respond well to local treatment, it might be worth checking to see if they have allergic rhinitis, say Dutch researchers. The study aimed to investigate the role of nasal allergy in seasonal and perennial allergic conjunctivitis, and involved 61 adult patients with allergic conjunctivitis who responded poorly to local treatment. The patients were subjected to nasal challenges with allergens, and the nasal and ocular responses measured. A significant number developed a conjunctival response as well as a nasal reaction to the allergens. The authors comment that there may be two types of allergic conjunctivitis: a primary form with the initial reaction in the conjunctiva, and a secondary type induced by an allergic reaction occurring initially in the nasal mucosa, but with clinical symptoms displayed in the conjunctiva. They suggest performing nasal provocation tests in combination with monitoring the cornea in patients who appear refractory to conventional ophthalmological treatment.

Clin Experiment Ophthalmol 2009; 37: 448-457

Mother’s BMI a weighty issue for baby

There appears to be an association between the body mass index (BMI) of a woman before she becomes pregnant (pBMI) and the weight of her infant at 14 months, according to the results of a large cohort study. Researchers in the Netherlands collected data on BMI prior to pregnancy from over 3000 women and recorded the weight of their babies at 14 months of age. Univariate analysis showed a strong positive association between pBMI and weight of the child at 14 months, with one unit increase in pBMI associated with an increase of 29 g in weight of the child. Other factors associated with weight at 14 months included birthweight, gestational age, sex, maternal age, and ethnicity. The association with pBMI remained significant after adjustment for possible confounding variables: birthweight was apparently responsible for 10 g (1/3) of the pBMI effect. The authors suggest that unknown intrauterine factors not related to birthweight may affect the infant’s weight later in life.

Arch Dis Child 2009; 94: 587-595

Talking about surgery

Doctors and patients may not be on the same page when discussing the risks and outcomes of complex surgery, say Norwegian researchers. In a qualitative study of doctor-patient dialogues before high-risk cardiac procedures, the conversations were analysed to reveal important aspects of the decision-making process. While patients focussed on uncertainty about survival and trusting the doctor’s proficiency, doctors tended to respond to uncertainty by imparting complex information about risk, warnings and recommendations. The authors conclude that, despite the uneven power relations in such a dialogue, most patients showed profound confidence and unconditional trust in their doctor.

Heart 2009; 95: 1245-1249

Aspirin and colon cancer

There is substantial evidence from randomised trials that regular intake of aspirin reduces the risk of colorectal cancer, but little is known about the effect of aspirin on survival in patients with these malignancies. Aspirin inhibits cyclooxygenase 2 (COX-2), which is over-expressed in most human colorectal neoplasias. US researchers have conducted a large, long-term, prospective cohort study involving over 1200 participants with colorectal cancer to assess the impact of aspirin on colorectal cancer-specific and overall mortality. Patients were followed up for a median of 11.8 years, during which researchers observed a lower risk of death from colorectal cancer and lower overall mortality in those who used aspirin regularly. In addition, immunohistochemical assessment was performed on the cancers from 459 patients to determine tumour expression of COX-2. Researchers found that regular aspirin use after diagnosis was particularly associated with reduced mortality in patients whose tumours overexpressed COX-2. The authors comment that, although these findings are biologically plausible and have promise for treatment, further studies including placebo-controlled trials are necessary to determine the benefits versus the risks of aspirin use in this setting.

JAMA 2009; 302: 649-659

Dr Tanya Grassi, MJA

©The Medical Journal of Australia 2009 www.mja.com.au PRINT ISSN: 0025-729X ONLINE ISSN: 1326-5377