Volume 194 - Issue 7
In Other Journals
Author: Peter Lavelle
Med J Aust 2011; 194 (7): 372. || doi: 10.5694/j.1326-5377.2011.tb03014.x
Published online: 4 April 2011
Published online: 4 April 2011
Trauma deaths delayed
Even if trauma patients don’t die in hospital, they are still at significant risk of death following discharge. So say Davidson and colleagues from the University of Washington, Seattle. They conducted a retrospective cohort study of 124 421 injured adult patients during a 14-year period up to 2008 who were admitted to hospital trauma units in Washington State. Of these, 7243 died before discharge and 21 045 died after discharge. Although in-hospital mortality rates fell from 8% to 4.9% over the period of the study, long-term cumulative mortality rates increased from 4.7% to 7.4%. Hence, in-hospital mortality rates are not reliable indicators of overall mortality rates from trauma, they concluded. Patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death. Other predictors of mortality were advanced age, serious head injury and loss of functional independence.
JAMA 2011; 305: 1001-1007
AF increases stroke dementia risk
Stroke survivors who have atrial fibrillation (AF) may be at increased risk of developing dementia, according to Kwok and colleagues from Norfolk and Norwich University Hospital and University of East Anglia, Norfolk, UK. They conducted a systematic review and meta-analysis of 15 studies reporting on the association between AF and dementia, covering 46 637 participants in all, with a mean age of about 71 years. They found that AF was associated with a significant increase in dementia in stroke patients, increasing the likelihood of dementia by 2.4 times, but the association between AF and dementia was of borderline significance in the general population. Fluctuating cardiac output causing thromboembolism or poor cerebral blood flow may explain these findings, say the researchers. Future studies may help determine whether intervention to treat AF will make a difference in the timing of onset of dementia in people who have had a stroke, they say.
Neurology 2011; 76: 914-922
Gene therapy for parkinson’s
Gene therapy shows promise as a treatment for Parkinson disease, according to LeWitt and colleagues from the Henry Ford West Bloomfield Hospital, Michigan, and other US centres. From 2008 to 2010, they treated 22 patients aged 30-75 years with progressive Parkinson disease with injections of the gene for glutamic acid decarboxylase (GAD) carried within a viral vector into the patient’s subthalamic nuclei. Twenty-three others were given sham surgery as controls. Six months after treatment, the treated group showed a 23% improvement in symptoms, compared to a 12% improvement in the controls. Adverse effects were mild and not related to the gene transfer treatment. The treatment is thought to work by modulating the production of GABA (γ-aminobutyric acid) in the subthalamic nuclei to improve basal ganglia function.
The Lancet Neurology, Early Online Publication 17 March 2011 doi:10.1016/S1474-4422(11)70039-4
Spirits and pancreatic cancer
Alcohol use has been linked to several cancers, including oesophagus, liver, colon and rectum and breast cancers. Heavy alcohol intake also causes acute and chronic pancreatitis; but has not been linked definitively to pancreatic cancer. So Gapstur and colleagues from the American Cancer Society, Atlanta, did a prospective study of about one million US adults aged 30 and over from 1982 to 2006, using data from the Cancer Prevention Study II. After adjusting for confounding factors such as smoking and family history of pancreatic cancer, they found a significant increased risk of pancreatic cancer death in men who consumed three more drinks per day, and in women who drank four or more drinks a day. The association was observed for liquor consumption (ie spirits) but not for beer or wine. Whether the subjects smoked or not made no difference. The findings strengthen the evidence that heavy drinking of liquor contributes to the risk of pancreatic cancer, the researchers say.
Arch Intern Med. 2011; 171: 444-451
Timing of solids linked to obesity
Is the timing of the introduction of solids during infancy a risk factor for obesity? It depends on whether infants are breast or formula fed. That’s the conclusion of Huh and colleagues from the Children’s Hospital, Boston, Massachusetts, and affiliated institutions. They compared the timing of introduction of solid foods with the risk of obesity at 3 years of age in a cohort of 847 children, 67% of whom were breastfed for at least 4 months, and 32% who were never breastfed or stopped breastfeeding before the age of 4 months. At 3 years of age, 9% of the children were obese. Among breastfed infants, the timing of solid food introduction was not associated with a higher risk of obesity. However, among formula-fed infants or those weaned before the age of 4 months, introduction of solid foods before 4 months was associated with a sixfold increase in the chance of obesity at the age of 3 years.
Pediatrics 2011; 127: e544-e551