Journals Watch - Petechiae and erectile dysfunction

Not had time to catch up on the latest research? Dr Lizzie Croton brings you up to date on the journals.

Petechiae in well infants are common and no further investigation is needed for fewer than four lesions (Photograph: SPL)
Petechiae in well infants are common and no further investigation is needed for fewer than four lesions (Photograph: SPL)

Petechial spots in well infants - Arch Dis Child 2010; 95: 518-20
When in primary care should we worry about petechial spots in young children? This helpful Iranian paper aims to provide an answer.

The authors examined 500 well and afebrile infants aged one to 12 months for petechiae.

They noted the sites and the parental explanation for the lesions. Their findings revealed that 10 per cent of infants had petechiae, with 6.6 per cent having one lesion and 3.4 per cent more than one.

In 42 per cent, the spots were distributed on the head and neck area as well as the upper and lower extremities. They were more common in infants over six months of age (68 per cent against 32 per cent p<0.05).

During a three-week follow-up period, all infants remained well. The conclusion was that petechiae are common and no further investigation is required when fewer than four isolated lesions are found (even if not confined to one body area) and the infant is well and afebrile.

STIs among users of erectile dysfunction drugs - Ann Intern Med 2010 153: 1-7
Prescription of erectile dysfunction (ED) drugs has increased among middle-aged and older men. This retrospective cohort study examined the incidence of STIs in men using and not using these medications.

The subjects were 33,968 men with at least one prescription for an ED drug and 1,376,838 without a prescription. Users of such drugs had a higher rate of STIs (particularly HIV infection) than non-users (105 against 65 annually per 100,000 persons; p=0.004).

This rate was higher in both the year before and year after using these drugs.

The researchers suggest the higher rates of STIs may be due to the type of patients using ED drugs rather than a direct effect of ED drug availability on STI rates.

In conclusion, it is important to discuss safe sexual practices with patients when prescribing these drugs and consider offering STI testing to these patients.

BP control in patients with diabetes and coronary artery disease - JAMA 2010; 304: 61-8
Current guidelines suggest treating BP to 130mmHg systolic for patients with diabetes but data is lacking for patients with coronary artery disease (CAD) as well.

The patient subset was 6,400 participants over the age of 50 years with both diabetes and CAD. They were recruited from 862 sites in 14 countries between 1997 and 2000, and were followed up until 2003 with an extended follow-up to 2008 for US patients.

The patients received first-line control of either a calcium antagonist or beta-blocker followed by an ACE inhibitor or diuretic or both.

Patients were categorised as having tight control if the systolic was <130mmHg, usual control if it was 130-140mmHg and uncontrolled if it was >140mmHg systolic.

Primary outcomes were all-cause mortality, non-fatal MI or nonfatal stroke. During follow up, 12.7 per cent of tight control, 12.6 per cent usual control and 19.8 per cent of uncontrolled groups suffered a primary outcome event.

The all-cause mortality rate was 11 per cent in the tight control group against 10.2 per cent in the usual control group which was not statistically significant. This remained so when extended follow-up of the US patients was taken into account.

In conclusion, tight control of BP in patients with diabetes and CAD was not associated with improved cardiovascular outcomes when compared with usual control of BP.

Cycling, walking and weight gain in premenopausal women - Arch Intern Med 2010; 170: 1050-6
This study assessed the association between cycling, walking and weight control in premenopausal women. The design used data from the Nurses' Health Study II and followed up 18,414 women for 16 years.

The primary outcome was weight change between 1989 and 2005 and the odds of gaining more than 5 per cent of baseline body weight was a secondary outcome.

At the commencement of the study, only 39 per cent of the subjects walked briskly and 1.2 per cent cycled for more than 30 minutes per day. With a 30 minute per day increase in activity between 1989 and 2005, weight gain was significantly less in those brisk walking and cycling but not slow walking.

The researchers concluded that both cycling and brisk walking were associated with less weight gain. Normal weight women who cycled for more than four hours per week in 2005 had lower odds of gaining more than 5 per cent of their baseline body weight compared with those who did not cycle.

Rectal bleeding in patients with haemorrhoids - Fam Pract 2010; 27: 260-2
Rectal bleeding is a common symptom in primary care and is frequently caused by haemorrhoids. However, coincidental pathology remains a worry especially in older patients.

This prospective study examined 290 patients presenting with rectal bleeding and haemorrhoids on proctoscopy. They all went on to have endoscopic investigation of their GI tract.

Coincidental findings were noted: namely diverticuli, polyps, cancer, angiodysplasia, varices and colitis. These patients were then divided into two groups. Group 1 (n=129) with 41.1 per cent males had a mean age of 53.6 +/- 12.7 years.

This group had only haemorrhoids found at endoscopy. Group 2 (n=161) with 46.6 per cent male had other coincidental findings at endoscopy as well as haemorrhoids. It is worth noting that the members of this group were also older (mean age 67.3+/-13.7 years).

The authors conclude that coincidental pathology occurs in a large number of patients presenting with rectal bleeding and haemorrhoids, and omitting endoscopy in such patients could lead to diagnostic delay.

  • Dr Croton is a GP in Birmingham and a member of our team who regularly review the journals
The Quick Study

Petechial spots in well infants are of no concern if there are fewer than four lesions.

STIs are more common in patients using erectile dysfunction drugs.

Tighter BP control in patients with diabetes and CAD does not reduce cardiovascular events when compared with usual BP control.

Weight gain in premenopausal women was shown to be lower in women who regularly cycled and walked briskly.

Rectal bleeding and haemorrhoids often have coincidental GI pathology present.

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