Cryptorchidism linked to cancer
BOYS with cryptorchidism are three times more likely to develop testicular cancer as adults than unaffected boys, according to a meta-analysis published in Archives of Diseases of Childhood. The case–control studies in the review included 2281 cases and 4811 controls, with more than 2 million boys included in cohort studies and 345 boys developing testicular cancer during a total length of follow-up of 58 270 679 person-years. The researchers said cryptorchidism was the most common congenital genitourinary abnormality in males, affecting about 6% of all newborn male infants. The pooled relative risk from the review was 2.90 (95% CI, 2.21–3.82) with significant heterogeneity (P < 0.00001; I2 = 89%). The authors said the study offered clinicians a “generalisable estimate” for the relative risk for boys with cryptorchidism of developing testicular malignancy.

Triglyceride link to acute pancreatitis
A POPULATION-based study of more than 67 000 Scottish patients over 15 years has found a significant dose–response relationship between triglyceride concentration and incident acute pancreatitis (AP). The research letter, published in the Archives of Internal Medicine, found the use of statins, antibacterial drugs, diuretics or musculoskeletal joint drugs was associated with a lower risk of AP. The researchers said the risk of incident AP increased by 4% for every 100 mg/dL increase in triglyceride concentration. They wrote that observational studies were the only realistic approach to study the association given the low incidence of AP, which was about one per 1000 person-years of follow-up. “Our findings that statins were associated with reduced risk of incident AP are consistent with the results of a recent meta-analysis of 28 randomized controlled trials of lipid-modifying drugs”, they wrote.

Surgery risks higher for RA patients
A META-analysis has found strong evidence that patients with rheumatoid arthritis (RA) are at higher risk of dislocation following total hip replacement and higher risk of infection following total knee replacement compared with patients with osteoarthritis (OA). The systematic review, published in Arthritis & Rheumatism, included 40 studies describing primary total arthroplasty of the hip or knee in patients with RA and OA. The researchers found no evidence of differences in rates of revision, 90-day mortality or venous thromboembolism events between the two groups. They said the finding of an increased risk of dislocation following hip replacement in patients with RA was unexpected.

Post pre-eclampsia risk higher with one child
WOMEN with pre-eclampsia who have only one child have a higher risk of cardiovascular death than women who have two or more children, according to research published in the BMJ. The prospective, population-based study included 836 147 Norwegian women with a first birth between 1967 and 2009 who were followed up for cardiovascular mortality through a death registry. About 23 000 women had died by 2009, including 3891 from cardiovascular causes. Associations between pre-eclampsia and cardiovascular death were assessed by hazard ratios. The rate of cardiovascular mortality among women with preterm pre-eclampsia was 9.2% after having only one child, falling to 1.1% for those with two or more children. With term pre-eclampsia, the rates were 2.8% and 1.1%, respectively. The study authors said the association might be due to health problems that discourage or prevent further pregnancies rather than to pre-eclampsia itself. “As a screening criterion for cardiovascular disease risk, pre-eclampsia is a strong predictor primarily among women with only one child — particularly with preterm pre-eclampsia”, they wrote.

Grapefruit dangers on rise
CANADIAN researchers have reported a big jump in the number of medications with the potential to interact with grapefruit and cause serious adverse effects in the past 4 years. In a report published in CMAJ the researchers said the number of drugs affected had increased from 17 to 43 between 2008 and 2012, with potential adverse events including torsade de pointes, rhabdomyolysis, myelotoxicity, respiratory depression, gastrointestinal bleeding and nephrotoxicity. “This increase is a result of the introduction of new chemical entities and formulations”, the authors wrote. Affected drugs had three essential characteristics — an oral route of administration, very low (< 10%) to intermediate (> 30%–70%) intrinsic oral bioavailability, and metabolism by cytochrome P450 3A4 (CYP3A4) enzyme. Older patients were more vulnerable to interactions as they were more likely to eat grapefruit. “Patient vulnerability to this pharmacokinetic interaction varies markedly”, they wrote. “Current data are not available to provide an absolute or even approximate number representing the true incidence of grapefruit–drug interactions in routine practice.”

Posted 3 December 2012

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