PCOS, obesity, croup and fractures

Too busy to read the journals? Let Dr Jonathan Holliday guide you through the latest research.

Polycystic ovary syndrome and glucose tolerance
MJA 2007; 187: 328-31

Polycystic ovary syndrome (PCOS) is the most common endo-crine disorder in women. Women with PCOS are known to have peripheral insulin resistance independent of BMI, and metformin is now commonly used in treatment.

This study looked at the prevalence of glucose tolerance abnormalities in 372 women with PCOS recruited from an infertility clinic in Adelaide. Of these, 4 per cent had diabetes mellitus and 15.6 per cent had impaired glucose tolerance, both prevalences higher than those in the general population of Australian women of similar age.

There was increasing prevalence of diabetes with increasing age, and prevalence of abnormal glucose tolerance was signi-ficantly higher with higher waist circumference, higher BMI, a family history of diabetes or presence of metabolic syndrome.

As GPs we need to be aware of the risk of diabetes and impaired glucose tolerance in women with PCOS, and should consider oral glucose tolerance and lipid testing at diagnosis.

Obesity in children and adolescents
BMJ, doi: 10.1136/bmj.39320.843947.BE

In the face of rising childhood obesity, it seems an attractive thing to do to make young people exercise more. But does it really make any difference? This extensive review of the literature set out to answer that and it makes a disappointing read.

It appears that the outcome among children is more difficult to influence while adolescents, particularly where the home is involved as well, are more rewarding.

They suggest that school-based interventions with family or community involvement, and educational interventions with 'policy and environmental changes' are most likely to effect change. This work is particularly interesting for me, working in a school setting. Fortunately when the authors suggest that more research is needed it is not in the school setting for adolescents that the gaps exist, which at least lets me off the hook.

Humidified air for croup
Family Practice 2007; 24: 295-301

With the approach of winter, GPs will be seeing more cases of croup. Croup can be due to any one of a number of viruses and so there is no specific treatment.

We therefore often recommend humidified air as home treatment in mild-to-moderate cases.

However this review of three studies treating children with croup with either warm or cool humidified air showed no great improvement in symptoms. Unfortunately the authors had no other treatment suggestion to make.

Mortality and hip fractures
New Engl J Med 10.1056/NEJMoa074941

We know that mortality is increased after hip fracture. This was a good-sized study to look at the effect of yearly infusion of zoledronic acid following hip fracture.

The study was a randomised, double-blind, placebo-controlled trial with over 1,000 patients in each arm.

The rates of any new clinical fracture were 8.6 per cent for the zoledronic acid group, and 13.9 per cent in the placebo group, a 5.3 per cent absolute risk reduction.

All-cause deaths were also reduced, at 9.6 per cent in the zoledronic acid group and 13.3 per cent in the placebo group.

Dr Holliday is a GP in Eton, Berkshire

The Quick Study

Polycystic ovary syndrome is associated with increased insulin resistance and related diseases and an oral glucose tolerance test should be considered in these patients.

Obesity in adolescents is easier to influence with exercise than that in children.

Croup shows little improvement when managed with either warm or cool humidified air.

Hip fracture risk is reduced after yearly infusion with zoledronic acid.

Research of the week

Acupuncture in persistent allergic rhinitis
MJA 2007: 187(6) 337-41

I was intrigued by the term 'sham-acupuncture' and had to read this piece of research looking at the effectiveness of acupuncture in persistent allergic rhinitis.

Sham-acupuncture involved the insertion of shorter needles used in a shallow needling technique at insertion sites 1-1.5cm from the classical acupoints used for real treatment.

In this study, 80 patients with persistent allergic rhinitis were assigned to receive either real or sham acupuncture. Treatment was given twice weekly for eight weeks, and the symptoms of nasal obstruction, sneezing, rhinorrhoea and nasal itch were self-assessed daily on a five-point scale.

Improvement of aggregate symptoms was greater with real treatment than sham treatment, as were each of the individual symptoms of rhinitis.

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