Journals Watch - Genetics, wheeze and diabetes

Too busy to read the journals? Let Dr Bryan Palmer bring you up to date on the latest research.

Locus on chromosome 12p13 linked to increased stroke risk N Engl J Med 2009; 360: 1,718-28
Genetics is one area of medicine that appears to have almost exponential growth.

The authors of this study carried out an analysis of genome-wide association data generated from four large cohorts composing the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium.

Polymorphisms on chromosome 12p13 were associated with stroke (SPL)

This included 19,602 Caucasians in whom 1,544 incident strokes developed over an average follow-up of 11 years, a cohort of 2,430 black patients with 215 incident strokes, another cohort of 574 black patients with 85 incident strokes, 652 Dutch patients with ischaemic stroke and 3,613 unaffected people.

They discovered two intergenic single-nucleotide polymorphisms on chromosome 12p13 is associated with an increased risk of stroke.

Finding unmodifiable risk factors allows us to focus on modifiable risk factors in those most at risk.

Preventing ongoing wheeze post infection BMJ 2009; 338: b897
Fads in medicine come and go. Once upon a time, treatment for viral-induced wheeze was supportive but now various strategies are tried.

This Dutch study looked at the effectiveness of a three-month inhaled steroid regimen in children who had been discharged from hospital after respiratory syncytial virus infection.

Being a randomised double-blind placebo-controlled trial involving 243 children, the results should be meaningful.

The active treatment group received beclometasone 200 microgram twice daily. The primary outcome was the reported number of days of wheeze in the three months post hospital admission.

In both groups about 60 per cent of children were reported to have had days of wheeze post discharge.

Fluoroscopic injections for trochanteric pain BMJ 2009; 338: b1,088
Trochanteric pain is a relatively common problem in general practice and most patients will be treated with an injection, but what is the best method to deliver this? These authors from the USA and Germany set out to compare fluoroscopic guided injections versus 'blind' (using landmarks) injections.

Outcomes were assessed by pain scores, disability scores, pain relief taken and patient satisfaction at one and three months. The results showed little difference between the two groups with about 45 per cent having a positive outcome.

The researchers concluded that the only thing fluoroscopy added was cost and it was better to go 'blind' with your patients.

Resuscitation at birth associated with lower IQ Lancet, 21 April doi: 10.1016/S0140-6736(09)60244-0
Mild cerebral injury might cause subtle defects in cognitive function that are only detectable as the child grows older.

To review this, the British authors looked at three cohorts of children from the Avon Longitudinal study of parents and children.

One group had required resuscitation at birth but no further treatment, one group who were resuscitated and had treatment for encephalopathy and a third group had required no resuscitation.

They chose the age of around 8.5 years to study and a low IQ was determined as <80. IQ scores were obtained for 5,953 children with a shortened version of the Weschler intelligence scale for children.

Results were adjusted for clinical and social covariates. Almost 6,000 children were tested and they found that any child resuscitated had a higher risk for a lower IQ, whether or not they showed any signs of encephalopathy post resuscitation. Looking at ways to prevent the need for resuscitation would be surely of benefit for future generations.

Voglibose reduces progression to diabetes Lancet, 22 April doi: 10.1016/S0140-6736(09)60222-1
Trying to prevent impaired glucose tolerance progressing to type-2 diabetes is going to be big business in the future (apart from the options of lifestyle modification and possibly metformin).

This study from Japan looked at voglibose, an alpha-glucosidase inhibitor, as a treatment in 1,780 patients who were either randomised to the treatment or placebo and followed for up to three years.

The results were quite impressive on two fronts. The medication reduced the progression to type-2 diabetes by about 50 per cent. However, 90 per cent had an adverse effect on the voglibose - matched by 85 per cent on the placebo.

In my opinion the best bet is to change lifestyle to avoid the prediabetes stage in the first place.

Severe hypoglycaemia associated with dementia JAMA 2009; 301(15):1,565-72
It is known that hypoglycaemia in children causes cognitive impairment, but what about in adults? The authors conducted this longitudinal cohort study from 1980 to 2007 in 16,667 patients with type-2 diabetes and a mean age of 65 years, who were members of an integrated healthcare delivery system in northern California.

They followed them for 27 years and defined a major episode of hypoglycaemia as requiring hospitalisations.

The results showed that at least one episode of hypoglycemia was diagnosed in 1,465 patients (8.8 per cent) and dementia was diagnosed in 1,822 patients (11 per cent) during follow-up; 250 patients had both dementia and at least one episode of hypoglycemia (16.95 per cent).

They concluded that a major episode was associated with dementia but didn't study more minor episodes and hence the effect of this on memory impairment is unknown. It would seem prudent not to aim for too tight control of the Hb1Ac in patients with type-2 diabetes until more is known.

  • Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who regularly review the journals

The Quick Study

  • Stroke risk is increased for those with a genetic polymorphism on chromosome 12p13.
  • Post-viral wheeze was present regardless of intervention with inhaled steroids.
  • Fluoroscopic guided injections were no more beneficial than 'blind' ones for trochanteric pain.
  • Resuscitation at birth is associated with a higher risk for a future lower IQ.
  • Type-2 diabetes may be prevented by an alpha-glucosidase inhibitor, but with a high incidence of adverse effects.
  • Hypoglycaemia is associated with dementia.

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