19 June 2017

Journal round up: New tech, same neuro issues

Clinical

TMR’s fortnightly pick from the leading medical journals:

Come on, stay with me!

Beta blockers and AMI

Contrary to popular belief, beta-blockers might be useless for certain heart attack patients, according to international research.

The observational study of 179,000 patients who had an acute myocardial infarction without heart failure found that beta blockers provided no benefit in terms of survival up to a year later compared with those who did not use the drugs. The findings were similar for STEMI and non-STEMI patients, at both early and later time points in the study.

A growing body of research suggested routine prescription of beta blockers might not be helpful in acute myocardial infarction patients with normal ejection fraction, the authors said.

J Am Coll Cardiol 2017; online 29 May

New tech, same neuro issues

Despite increasing survival of extremely preterm infants over the last two decades, neurodevelopmental outcomes are as poor as ever, research shows.

A population cohort study of all extremely preterm survivors in Victoria between 1997 and 2005 found that at age eight, rates of major neurosensory disability have remained largely the same since 1991.
The incidence of conditions such as cerebral palsy, low IQ, blindness and deafness had not improved, and there was some evidence academic achievement was worse on average in 2005 than earlier.

The finding that improved perinatal and neonatal intensive care resulted in greater survival, but not neurodevelopmental outcomes, was concerning, the authors wrote.

Pediatrics 2017; online 1 June

poverty pic 400

Stress may speed up puberty

Children growing up in unfavourable socioeconomic conditions are more likely to suffer health problems associated with early puberty.

A study of almost 9,000 children found extreme social disadvantage increased the risk of early puberty by four times for boys and two times for girls.

Early maturation is linked to emotional and behavioural problems in teenagers, as well as reproductive cancer and cardiometabolic diseases in later life.

The mechanisms connecting disadvantage to early puberty could include hormonal responses from early-life stress. “Early chronic adversity may prompt earlier, adult-like (negative) neuroendocrine coupling between hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, which may contribute to early pubertal development,” they authors said.

Pediatrics 2017, online 1 June

3d render medical illustration of the gallblader and pancrease

SGLT2 inhibitor fatal risk

Despite their increasing popularity, prescribers are being warned that SGLT2 inhibitors double the risk of diabetic ketoacidosis in patients with type 2 diabetes, compared with other medications.

The absolute risk was only about one in every 1000 patients taking the new class of drug, but researchers warned doctors to be on the lookout for it in these patients.

Their study of 40,000 patients with type 2 diabetes taking the medication found that over five months, 55 patients had experienced diabetic ketoacidosis compared with 26 in the group taking a DPP4 inhibitor. This risk prompted the FDA to issue a warning about the class of drugs in 2015.

NEJM 2017; online 7 June 

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