Journals watch - Depression, antibiotics and coronary artery disease

Too busy to read all of the journals? Dr Simon Hunter selects research papers of interest to GPs.

Narrowed coronary artery: a new diagnostic test is being studied (Photo: ZEPHYR/SCIENCE PHOTO LIBRARY)
Narrowed coronary artery: a new diagnostic test is being studied (Photo: ZEPHYR/SCIENCE PHOTO LIBRARY)

Depression in the elderly

Age Ageing 2013; 42: 173-80

Depression is known to occur commonly in the elderly, but few studies have looked at the over-75s.

This group is important because they have more potential risk factors such as bereavement, loneliness, somatic illness and functional impairment. As numbers of the elderly increase, knowledge of incidence and risk factors can help planning.

This study from Germany involved 3,327 general practice patients without dementia over the age of 75 and looked at incidence of depression at various ages compared against social and medical factors.

Some of the findings were unexpected. Living alone, income and marital status made no difference.

Depression increased in frequency with age - almost double in the over-85s compared with the over-75s. One in 13 of the over-85s were depressed. The incidence in women was slightly higher than in men.

Factors that increased incidence were mobility and visual impairment, mild cognitive impairment (even if subjective) and smoking.

Of these, mobility impairment had the greatest effect with a hazard ratio of 2.53. Somatic illness had no effect either way, perhaps surprisingly, because it was a QOF domain for several years.

Antibiotics in children who have acute rhinosinusitis

Arch Dis Child 2013; 98: 299-303

This study looked at what we would routinely call sinusitis, but because the mucosa of the nasal passages and the sinuses are congruous, and sinusitis usually develops from a viral infection of the nasal mucosa, the preferred term is rhinosinusitis. 'Acute' here means less than 30 days.

In the UK, current guidance recommends a conservative approach to treating acute rhinosinusitis, avoiding antibiotics whatever the cause. The US guidance tries to identify bacterial cases and treat those with antibiotics.

This paper was a systematic review of RCTs of antibiotics versus placebo in children with acute rhinosinusitis. The researchers found four suitable trials but there were significant differences in methodology and difficulties with the actual diagnosis.

The overall NNT for rhinosinusits seemed to be eight, comparable to otitis media, and there did seem to be some benefit from using antibiotics, but given the weakness of the data, the researchers found it difficult to make a solid assessment. They suggest continuing with the current guideline, a conservative approach.

A new method for diagnosing coronary artery disease

Am J Cardiol 2013; 111: 786-92

I love it when I discover something novel, or a radically new way of doing something. This study did just that.

The researchers looked at the effectiveness of acoustic cardiography. Coronary artery microbruits, subaudible bruits inaudible to the 'naked ear', coming from stenosed coronary arteries, were recorded using an electronic stethoscope. The sound was recorded over nine different places overlying the heart for 40 seconds each, taking about 15 minutes, and the noises analysed in conjunction with a four-lead ECG recording.

The study compared the accuracy of acoustic cardiography with CT angiography (another non-invasive test with good reliability) in 161 patients referred with a variety of cardiological problems. Forty per cent of the patients were obese.

The researchers were looking for a greater than 50% stenosis. They found acoustic cardiography had a sensitivity of 89.5% and a specificity of 57.7%. As it develops, this could be a very useful non-invasive test.

Non-alcoholic fatty liver disease developing in children

J Pediatr 2013; 162: 496-500

A condition I was rather unaware of until now is non-alcoholic fatty liver disease (NAFLD) in children. We are all aware of the rising levels of obesity and cases of type 2 diabetes, but children can also have NAFLD.

NAFLD can lead to cirrhosis and is a risk factor for cardiovascular disease and liver cancer.

This US study compared levels of NAFLD for 1988-94 with levels in 2007-10 in nearly 13,000 children. The data came from the National Health and Examination Survey, a survey looking at diet and health. NAFLD was diagnosed with an ALT of more than 25.8 in boys and more than 22.1 in girls.

The researchers found that the prevalence of NAFLD more than doubled over 20 years from 3.9% to 10.7%. They found that half of obese male children have NAFLD. They also discovered that the rise in the proportion of obese children having NAFLD suggests there are causative factors other than purely weight - probably high-sugar diets.

Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Audit your patients aged over 85 to assess depression prevalence.
  • Case review children with a diagnosis of sinusitis to see if there is routine prescribing of antibiotics.
  • When seeing obese children, carry out a brief intervention about high-sugar drinks and diet.

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