MORTALITY RISK OF ACUTE URINARY RETENTION
BMJ 2007; 8 November. doi:10.1136/bmj.39377.617269.55
Acute urinary retention is a common problem in men, but it is not usually regarded as a fatal one. However, this study showed that of the 176,046 men aged 45-54 years admitted to hospital with acute urinary retention between 1998 and 2005 in England, 4.1 per cent died in the following year. In older age groups (75-84) the death rate in one year was 12.5 per cent in those with no co-morbidity and 28.8 per cent if there was co-morbidity.
The causes of increased mortality risk are unclear from this study, although there are defined risks from catheterisation and anaesthesia. The four most common co-morbidities were CHD, diabetes, COPD and malignancy. These were thought to contribute to mortality.
Acute urinary retention is a significant medical event and should lead to investigations for co-existing illnesses. Once detected, these conditions should be treated to reduce the risk of death.
HOW SAFE IS THE HPV VACCINE?
CMAJ 2007; 177(10): 1,169-70
HPV vaccine is to be introduced for UK teenagers from next year to prevent carcinoma of the cervix.
In Canada, where immunisation programmes are already in progress and there has been careful scrutiny for adverse effects, there were 82 reports of problems after 162,000 doses. Given that the vaccine is being administered to young people this rate seems high and I hope that more information about the real risks is made available before the UK programme begins.
OBESITY REDUCES MORTALITY
Am J Med 2007; 120: 863-70
Obesity is widely believed to be a risk factor for cardiovascular mortality. This is thought to be mediated through the combination of associated diseases. However, this study of 22,576 patients suggests that obesity can protect against non-fatal MI, non-fatal stroke and death in patients with hypertension and CHD.
This effect has also been noted in patients with heart failure. It is now termed the 'obesity paradox'. One explanation is that leaner patients with heart failure produce more inflammatory cytokines which damage the myocardium. Another is that obese patients are more readily identified and so more likely to receive or seek treatment than lean patients. Also, obese patients with hypertension have a high cardiac output and lower systemic vascular resistance, giving a lower risk.
Probably most importantly, BMI is no longer thought to be a helpful measurement for health risk. Better measures are now accepted as being waist-to-hip ratio and visceral fat measurement.
SLE AND RISK OF FRACTURE
J Rheumatol 2007; 34: 2,018-23
Women with systemic lupus erythematosus (SLE) have an increased risk of fracture compared with the normal population. The 304 patients in this study had a 10 per cent increase in fracture risk for each year that they had the disease, after accounting for age and corticosteroid use.
Several theories were advanced for this finding. Young women developing the disease may fail to reach optimal bone mass.
They also might have fractures because of effects of SLE on bone in a different way since there was a poor link between bone mineral density and fracture risk. There was even a link between increased fracture risk and the use of osteoporosis treatments.
As GPs, we should be aware of this risk in our patients and consider other measures to protect them, perhaps through falls prevention strategies.
THE QUICK STUDY
Urinary retention is associated with considerable mortality in men.
HPV vaccination for adolescents needs to be proven safe following Canadian data showing high complication rates.
Obesity can protect against MI and stroke in patients with CHD and hypertension.
SLE raises fracture risk by 10 per cent for each year of the disease.
RESEARCH OF THE WEEK
Dietary supplement raises fertility hopes
New Scientist 2007; 27 October: 12
Many women wishing to become pregnant are willing to try an unproven medication that might help them.
Dehydroepiandrosterone (DHEA) is one such product. It is a naturally occurring hormonal, precursor of oestrogen and androgen. A US pilot study of 27 women showed that women taking supplements of the hormone were more likely to become pregnant.
The hormone is cheap to buy in the US, but it has not been fully researched. It is important to know that the supplement exists, and to warn patients that it should not be taken until it has been more thoroughly evaluated.
It may not be too long before it plays a part in the treatment of infertility.