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CVD RISK IN RVO

Patients with retinal vein occlusion (RVO) are known from long term follow up to be at increased risk of cardiovascular disease (CVD). In the majority of RVO patients there is no evidence of coronary heart disease (CHD) at the time of presentation. As the reduction of CHD is a primary goal for the Department of Health researchers took 107 unselected RVO patients, excluded 18 on the basis of age, missing data, or pre-existing CVD and calculated the risk of future CVD using the Framingham algorithm (

). The mean 10 year calculated cardiovascular disease risks (cCVDR) was significantly higher than the Framingham standardised risk for all RVOs (20.6% v 15.7%, p = 0.009). Such risk estimates will guide decision making in clinicians about preventative treatment for CVD in RVO patients.

LATE WEIGHT GAIN BRINGS RISK

A longitudinal study of aging men from the greater Boston (MA, USA) area has shown that a low and a high body mass index (BMI) in adult men are associated with asthma. The aim of the study (

) was to try and explain the interesting association between the rising prevalence of asthma and obesity in developing nations. The study involved a cohort of 61 adult men (with 244 matched controls) who developed asthma four years later, with the initial and change in BMI being examined upon the development of asthma. Men with an initially low BMI, but who put on weight in later life seemed to have a greater risk in developing asthma. These results implicate further mechanisms involved in the observational association of obesity and asthma.

SIDS SEARCH CONTINUES

Basic antenatal care is unlikely to detect sudden infant death syndrome (SIDS) and sudden intrauterine death (SIUD) determinants. SIDS has been reduced after much research and public campaigns but there is less understanding of SIUD, the largest cause of perinatal mortality in the developed world. Hospital records and registry data were used to investigate 76 SIUD and 78 SIDS cases in Oslo (

). A non-significant association between maternal proteinuria and high fundal height was observed. The importance of previously described risk factors was confirmed and the authors suggest possible comparisons between SIUD with intrauterine growth retardation and SIDS. They hypothesise that nicotine, subclinical infection, and fetal inflammatory response are important in these vulnerable groups.

MULTIPLE SCLEROSIS IN MALTA

The prevalence of multiple sclerosis in Malta is low in comparison with Sicily and other Mediterranean countries of Europe. A study in 1978 found a remarkably low prevalence (14 patients in total) in Malta. Dean et al studied prevalence rates 21 years on from the original research (

). They investigated prevalence rates using hospital and mortality records along with pharmacist information and links with the Malta Multiple Sclerosis Society. 1 January 1999 was prevalence day. They found a prevalence of 13.2/100 000. Although the prevalence had increased since the 1978 study, it was still very low. The significance of this information is that multiple sclerosis prevalence in Malta may provide an opportunity to ascertain some of the genetic and environmental factors responsible for the disease.

NO COMMON RISK FOR FATAL CHD

Predicting risk for coronary heart disease (CHD) can be useful for healthcare professionals, as well as a source of critical information for individual patients. The Diverse Populations Collaborative Group used data from 16 observational studies to gauge the relation between CHD mortality and age and the four major risk factors (

). The researchers then examined variations of risk functions in three contexts (ordering risk, magnitude of relative risk, and estimation of absolute risk) and whether there was a common risk function which could predict CHD death among the different samples. The investigators found a quantitative heterogeneity of the risk factor-CHD relation among the population groups. The study shows that expert panels should be careful in generalising from one population to another when making clinical guidelines.

JOINT DISEASE IN SWEDEN

The annual incidence of inflammatory joint diseases has been calculated as 115 per 100 000 in a population based study in southern Sweden. An evidence based assessment of the incidence is hoped to have important implications for the planning of health care in rheumatology. The prospective study, lasting one year, identified a total of 151 new cases of inflammatory joint diseases by looking at referrals to the rheumatology department of the local hospital or to the only private rheumatologist, as well as looking at hospital records (

). Of the new cases, 36% had undifferentiated arthritis, while rheumatoid arthritis and reactive arthritis made up 45% of the cases. A follow up study is planned to discover how many patients with undifferentiated arthritis later develop rheumatoid arthritis.

BAD ODDS FOR MALAWIAN BOYS

Male children are twice as likely as their female counterparts to die between the age of 1 and 2 years in rural Malawi. Sex differences in childhood mortality are often ascribed to behavioural causes and were previously considered rare in Sub-Saharan Africa. Ashorn et al used a prospective study of 795 women enrolled in a government clinic to investigate mortality in the first 36 months of life (

). The increased male mortality (p = 0.04) was not associated with any confounding variables. The authors suggest that small community studies may unmask local differences not seen in larger data collections and permit more effective planning. Different strategies may be required to improve child health in areas with large sex differences in mortality.

ASTHMA AND ATOPY

Asthmatics are more likely to be atopic than other people with wheeze. Over one third of those with wheeze and one fifth of asthmatics are not atopic. This is of relevance as the role of atopy may have been overemphasised in the aetiology of asthma. The 1995–6 Health Survey of England asked if subjects had experienced wheezing in the past year and if they were diagnosed asthmatics (

). Serum IgE and house dust mite specific IgE were measured. Of those with wheeze and raised house dust mite IgE levels, 41.8% were not diagnosed asthmatics. Women and young people are more likely than current smokers to be diagnosed with asthma. Other aetiological factors such as genetics and diet in non-IgE mediated asthma should be considered.

SIMPLE THINGS HELP HEAD INJURY

Simple emergency treatment and follow up measures may help facilitate both short term prognosis and long term surveillance of head injury patients, suggests a multicentre randomised controlled CRASH trial (

). The researchers aimed to assess the efficacy of a simple head injury treatment option like short term corticosteroid infusion and the outcome measures for follow up. They studied 1000 patients and analysed short and long term outcomes after a randomised placebo controlled trial of 48 hour corticosteroid infusion, started within eight hours of injury. By using simple outcome measures like age, Glasgow Coma Scale (GCS), and postal information, the researchers obtained 99% of the short term and 93% of long term results; including 34% good recovery result after six months. They recommended implementation of simple measures for both emergency management and follow up of head injury cases.

DRY EYES IN SUMATRA

The prevalence of dry eye syndrome in the tropical region of Sumatra, Indonesia is double that expected from comparable communities (27.5% of adjusted sample having one or more symptoms often or all the time). A poorer quality of life is considered inevitable with symptoms ranging from mild and transient irritation to burning pain and visual disturbances. Data were collected using a six item questionnaire of ocular complaints symptomatic of dry eye. This study adds a strong positive association with pterygium—shown to be significant in the prevalence of dry eye (

). The authors acknowledge increased temperature and sunlight exposure as promoters for the high frequency of dry eye in equatorial regions and advise the evaluation of dry eye treatment as the next approach to the community’s high prevalence of symptoms.

IMPROVING OUTCOMES IN SLE

German immunologists have identified a typical clinical and serological phenotype at disease onset of systemic lupus erythematosus (SLE), which has a high risk of poor outcome. Survival rate of SLE patients has increased in the past 40 years but mortality still remains about three times as high as in an age and sex matched control group. A total of 338 white German patients with SLE were followed up from 1985 to 1999 by the University of Erglan-Nuremberg (

). Five year survival was 96.6%; common reasons for death were cardiovascular (37%) and infectious diseases (29%). The most important risk factors identified for poor outcome are male sex, advancing age, low creatinine clearance, nephritis, heart disease, and CNS disease. Identification of patients with severe outcome of SLE may be aided by these data, leading to the use of optimum therapeutic regimens, including early aggressive immunosuppressive drugs, to benefit patients.

SOCIOECONOMIC STATUS DETERMINES SYMPTOMS

Socioeconomic status is largely responsible for difference in respiratory symptoms between “Dutch” and “non-Dutch” children in the first two years of life. Allergic disease is more common in the Western world but is unclear whether ethnic differences in rates of allergic disease in developed countries are attributable to socioeconomic status. The PIAMA study is examining allergic disease and possible interventions among a cohort of 4146 children in Holland (

). Runny nose with itchy watery eyes was independently associated with having a non-Western mother (adjusted odds ratio 2.89). Respiratory symptoms were also more common in this group, largely attributable to socioeconomic status. Continued observation will hopefully establish whether these symptoms are associated with increased risk of allergic disease.

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