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01-07-2012 | Article

Medical News in review: June 24‑29, 2012

MedWire News: A roundup of select stories of interest to US physicians from the Merck Medicus Medical News wire.

Hospitalization, delirium worsen Alzheimer's outcomes

Individuals with Alzheimer's disease (AD) who are hospitalized are at risk for adverse outcomes including institutionalization, cognitive decline, and death, and the risk is higher still if the patient develops delirium, show study results.

Tamara Fong (Institute for Aging Research, Boston, Massachusetts) and colleagues found that almost half of community-dwelling AD patients enrolled in a local US patient registry had at least one hospitalization during a 1-year period, and a quarter developed delirium.

After adjustment for potentially confounding factors, hospitalization increased the risk for death 4.7-fold in these patients, and when combined with delirium, this risk increased further, to 5.4 times that for nonhospitalized AD patients, they report in the Annals of Internal Medicine.

The study cohort included 771 AD patients aged a median 77 years who had a mean symptom duration of 3 years. During the study period, 25% of patients were hospitalized with delirium and 22% without.

At least one adverse outcome occurred in 32% of the nonhospitalized group compared with 55% of the hospitalized group and 79% of the hospitalized group who had delirium, highlighting the incremental effect of delirium on negative outcomes in this population, note Fong and colleagues.

The most common adverse outcome was institutionalization, which occurred in 43% of hospitalized patients, followed by death, in 24% of those hospitalized, and then cognitive decline, which was experienced by all, in view of AD's trajectory.

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Just don't breathe, kid

More evidence, if any is needed, of the harmful effects of smoking: parental smoking is associated with symptoms of asthma in exposed children, report researchers who found the more parents smoked, the greater the asthma risk to their children.

Edwin Mitchell (The University of Auckland, New Zealand) and colleagues examined the association between maternal and paternal smoking and symptoms of asthma, eczema, and rhinoconjunctivitis in 58 countries. The parents or guardians of 220,407 children aged 6‑7 years completed written questionnaires about their child's allergy symptoms and their own smoking in the child's first year of life. In addition, 350,654 adolescents aged 13‑14 years self-completed the questionnaires on their symptoms and whether their parents currently smoked.

Maternal and paternal smoking was associated with an increased risk for symptoms of asthma, eczema, and rhinoconjunctivitis in both age groups, although the magnitude of the odds ratio (OR) was higher for symptoms of asthma (OR=1.11‑1.44) than the other outcomes (OR=1.04‑1.20).

For asthma symptoms there was a clear dose relationship (1‑9 cigarettes/day, OR=1.27; 10‑19 cigarettes/day, OR=1.35; and ≥20 cigarettes/day, OR=1.56).

Maternal smoking was associated with higher ORs than paternal smoking and maternal smoking in the child's first year of life was associated with a greater risk for symptoms for all outcome categories than current maternal smoking, the investigators report in Thorax.

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Dutch docs: Lose steam as cold remedy

Steam inhalation as a remedy for a blocked nose or sinuses in children can be dangerous due to a high scalding risk, a study suggests.

Writing in the British Journal of General Practice, Martin Baartmans (Maastad Hospital, Rotterdam, the Netherlands) and colleagues report that three people a year or more are admitted to Dutch burn units with serious burns related to steam inhalations, the large majority of whom are children.

The researchers found that the total economic cost for burn center and emergency department treatment of these injuries was high, at a total equivalent to $ 145,275 across three centers in Beverwijk, Groningen, and Rotterdam between 1998 and 2007.

In total, 31 people were admitted to the centers with steam-inhalation related scalds or burns during the study period. Of these, 29 were due to the hot water being spilled, and two were due to the steam itself.

Of the patients with steam-inhalation related scalds or burns, 19 (61%) were under the age of 16 years.

The mean total body surface area burned was 5.8% and the most common areas affected were thigh, lower abdomen, and the genital area, largely due to the bowl of water being overturned onto the lap of the person in question.

Fourteen patients (nine children) needed a bladder catheter and six (five children) needed a skin graft as a result of their injuries.

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Short-term UTI therapy

A 7-day course of ciprofloxacin is as effective as a 2-week course at treating women with acute pyelonephritis, show study findings.

Both regimens successfully treated infected individuals, at both short- and long-term follow up, including older women with more severe infection, report Torsten Sandberg (Sahlgrenska University, Gothenburg, Sweden) and team.

In a clinical trial including 156 women, 500 mg ciprofloxacin was as effective at treating the infection, whether it was administered over 14 days or only 7 days.

At a short-term follow-up assessment (10‑14 days after treatment), the 7-day course had cured 71 (97%) patients, while the 14-day course had cured 80 (96%) patients.

At long-term follow-up (4‑8 weeks after treatment), the corresponding rate of clinical cure was 93% for both treatment groups.

Positive blood cultures indicated more severe illness in 42 (27%) of the women. Patients with positive blood cultures were older than those with negative cultures, at a median age of 58 versus 35 years.

However, no differences were noted in cure rates between patients with or without a positive blood culture (95 vs 97%) or in patients with positive blood cultures who were treated for 7 or 14 days (94 vs 96%).

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Lose weight, gain CVD

Women who follow an Atkins-style diet ‑ heavy on the protein, light on the carbohydrates ‑ have a significantly increased risk for cardiovascular disease (CVD), experts warn.

Pagona Lagiou (University of Athens, Greece) and team estimate that an extra four to five cases of CVD occur per year for every 10,000 women who follow a low-carbohydrate, high-protein diet. This translates to a 28% higher risk for ischemic heart disease, stroke, and peripheral arterial disease among such women, relative to those who do not follow this diet.

The researchers measured diet on the low carbohydrate-high protein (LCHP) score where a score of 2 corresponded to very high carbohydrate and low protein consumption and a score of 20 corresponded to very low carbohydrate and high protein consumption.

They found that each one-tenth decrease in carbohydrate intake or increase in protein intake was associated with a significantly increased risk for CVD overall, at an incidence risk estimate of 1.04. The equivalent 2-unit increase in LCHP score was associated with a 1.05-fold increased CVD incidence.

As reported in the BMJ, unadjusted analysis revealed that compared with an LCHP score of 6 or less, CVD risk increased by 13% for women who had a score of 7‑9, 23% for those with a score of 10‑12, 54% for those with a score of 13‑15, and 60% for those with a score of 16 or higher.

After adjustment for other CV risk factors, there was a 5% increase in the likelihood for a CV event or death with each 2-point increase in the LCHP score. The authors say that this increase was attributed to a daily reduction in carbohydrates of 20 g, which is equivalent to a small bread roll, and a daily increase in protein of 5 g, which is equivalent to one boiled egg.

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Kick the habit, pocket some dough

Rewarding drug-dependent pregnant women with money each time they cut down on or stop smoking is an effective way to reduce smoking levels in this population, say researchers in Addiction.

Nearly half (48%) of pregnant methadone-maintained women who received monetary incentives for target reductions in cigarette smoking (defined as contingent management) cut their smoking levels by 75% after 10‑11 weeks.

Moreover, one-third (31%) of women had completely abstained from smoking by week 12 of the study.

By contrast, none of the women who received incentives independently of their smoking levels (noncontingent management) met either the 75% smoking-reduction or abstinence targets, while only 2% of women who received information about smoking risk during pregnancy but no incentives met just the former target.

Although women who received monetary reward for curbing their smoking habit had fewer preterm births and fewer babies with low birthweight than the other two groups of women, these differences were not statistically significant.

This could be due to the fact that the reductions in smoking started too late in the pregnancy (mid-second trimester) to have an effect on neonatal outcomes, suggest Michelle Tuten (Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA) and team. Alternatively, greater reductions in smoking may be needed to improve birth outcomes.

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By Neil Osterweil