Volume 192 - Issue 6
In Other Journals
Author: Alison Williams
Med J Aust 2010; 192 (6): 352. || doi: 10.5694/j.1326-5377.2010.tb03538.x
Published online: 15 March 2010
Published online: 15 March 2010
Childhood obesity and lifespan
Obese children are far less likely to reach old age, according to US researchers. In a cohort of almost 5000 American Indians, they studied the effect of cardiovascular risk factors that were present in childhood on lifespan. A history of childhood obesity more than doubled the risk of dying from causes other than accident, suicide or homicide before the age of 55 years (incidence rate ratio 2.3). Although obesity conferred the strongest association with premature death, there were also significant associations between premature death and both impaired glucose tolerance and hypertension. Interestingly, no association with cholesterol levels was observed. The study was also of note because of its length — participants were followed up for a median of 24 years.
N Engl J Med 2010; 362: 485-493
Ageing hearts
Should octogenarians with acute coronary events undergo per-cutaneous coronary intervention (PCI)? The elderly are generally underrepresented in trials, but a recent Dutch study provides some insights. Of all patients with ST elevation myocardial infarction (STEMI) admitted to one institution for PCI, the proportion of octogenarians treated more than doubled over the 11-year study period, indicating that this is likely to be an ongoing dilemma. Unfortunately, mortality was high in this age group and did not improve (mortality at 30 days was 21.4% compared with 9.4% among 60-79-year-olds). As well as having more comorbidities, the octogenarians were less likely to have successful restoration of coronary perfusion — although this did improve over the study period, possibly reflecting better technology.
Heart Online 4 Dec 2009
Haiti quake
In two dispatches from Haiti, medical staff describe their experiences working in a collapsed infrastructure. While trying to restore a semblance of order, staff were faced with a lack of fuel, electricity and communication as well as threats of violence, with thousands of prisoners having escaped from the nearby national penitentiary. Hospitals across the city had varying capacities to provide services, with an urgent call for a centralised system informing people where to go for appropriate care. Meanwhile, another hospital about 60 km from the epicentre remained intact, allowing surgical teams to respond while operating rooms in Port-au-Prince were incapacitated. The acute management of the enormous number of injuries inflicted by this disaster is expected to evolve into wound care, fitting of prostheses and rehabilitation.
N Engl J Med 2010; 362: 575-777
N Engl J Med 2010; 362: e19 (1)-e19 (2)
The long and the short of it
Are short babies really more likely to be shorter and weigh less when they grow up? A study involving almost 600 Israeli army recruits indicates that final adult height (at age 17 years) can be predicted by length at birth. In this retrospective study, those babies born short for gestational age (less than 48 cm at birth) were significantly more likely to be shorter and weigh less at their conscription medical than those with a normal birth length. This finding was apparent for both sexes.
Arch Dis Child 2009; 94: 959-961
Pregnancy and pandemic flu
Advanced pregnancy appears to be associated with an increased risk of severe complications of H1N1 influenza, according to analysis of the outcomes in 43 pregnant women with confirmed infection admitted to Melbourne hospitals during the 2009 pandemic. Of these, 65% were in the third trimester (of whom about half were at term), with 30% in their second trimester and only 5% in the first. Although about half had at least one associated comorbidity (including asthma, diabetes and obesity), half had no other risk factors. Antiviral therapy was prescribed in 77% and 8 women required admission to ICU. Median length of stay was 2 days, and 8 were hospitalised for more than 7 days.1
Although the mechanism by which pregnancy increases flu severity is unclear, a related study may shed some light. After finding a low level of IgG2 in one pregnant woman with severe H1N1 infection, levels were assessed in 39 other patients with confirmed infection (9 of whom were pregnant). Pregnant patients with H1N1 were found to have significantly lower levels compared with healthy pregnant controls, suggesting a possible role of IgG2 deficiency in the pathogenesis of H1N1 infection in pregnancy.2
1. Clin Infect Dis 2010; 50: 686-690
2. Clin Infect Dis 2010; 50: 672-678