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Paracetamol pack size cuts deaths
A DECISION in the UK in 1998 to restrict the size of paracetamol packs reduced paracetamol-related deaths by 43% in the following 11 years and liver transplant registrations for paracetamol-related hepatotoxicity by 61%, according to research published in the BMJ. Pack sizes were restricted to 32 tablets for those sold in pharmacies and 16 for those sold through other outlets. The researchers used data for poisoning deaths in England and Wales between 1993 and 2009, and liver unit registrations and transplantations between 1995 and 2009. They authors wrote that the effect of the change in pack sizes probably reflected the fact that many people who intentionally overdosed with paracetamol took what was available, especially if the overdose was impulsive. However, they said there were still a considerable number of paracetamol poisoning deaths, averaging 121 a year between 2000 and 2009. “The benefits should therefore not lead to complacency”, they wrote.
Healthy adults use supplements
ADULTS who use dietary supplements are more likely than non-users to be in very good or excellent health, have health insurance, use alcohol moderately, eschew cigarette smoking, and exercise frequently, according to research published in JAMA Internal Medicine. Researchers used data from nearly 12 000 people who completed a dietary supplement questionnaire, which asked about the use of vitamins, minerals, herbal and other supplements over 30 days. They found that 49% of adults reported using a dietary supplement, particularly women. The most common reasons given for taking supplements were to “improve overall health” (45%), to “maintain health” (33%) and for “bone health” (25%). Only 22% of users said they used supplements to “supplement the diet”. Multivitamin and mineral products were the most commonly used supplements. The authors wrote that because of the widespread use of dietary supplements for health promotion and maintenance, “increased clinical research efforts are warranted to address safety and efficacy”.
Fruit and vegies work for CKD
CONSUMING fruits and vegetables works just as effectively as taking oral sodium bicarbonate (NaHCO3) to improve metabolic acidosis and reduce kidney injury in stage 4 chronic kidney disease (CKD), according to research published in the Clinical Journal of the American Society of Nephrology. The comparative study involved 76 patients with stage 4 CKD due to hypertensive nephropathy, who were randomly assigned to 1 year of daily oral NaHCO3 at 1.0 mEq/kg/day or fruits and vegetables dosed to reduce dietary acid by half. Patients in both groups had a higher plasma total carbon dioxide (CO2) levels after 1 year, consistent with improved metabolic acidosis. Urine indices of kidney injury were lower than baseline in both groups and plasma potassium did not increase in either group. The study authors wrote that patients in the study were selected to be at low risk for hyperkalaemia and warned clinicians to exercise caution in prescribing fruits and vegetables in patients with very low estimated glomerular filtration rate (GFR). “Nevertheless, treating metabolic acidosis in individuals with stage 4 CKD due to hypertensive nephropathy with fruits and vegetables or NaHCO3 appears to be an effective kidney-protective adjunct to [blood pressure] control with regimens including [angiotensin-converting enzyme] inhibition”, they wrote.
Congenital abnormalities double in multiples
THE prevalence of babies from multiple births with congenital abnormalities has almost doubled in the past 30 years, increasing from 5.9 cases per 10 000 births in 1984–1987 to 10.7 in 2004–2007, according to research published in BJOG. The research was based on 5.4 million births in 14 European countries, of which 3% were multiple births. It included cases of congenital anomaly from live births, fetal deaths from 20 weeks of gestation and terminations of pregnancy for fetal anomaly. The percentage of babies from multiple births rose from 2.32% to 3.09%, with most of the rise occurring in the late 1980s before numbers plateaued. The researchers found that the risk of congenital anomalies was 27% higher in multiple births than singleton births, and that this excess risk had also increased over time. The authors wrote that the increase might be related to assisted reproductive technology, rather than multiple birth status. “The co-occurrence of multiple birth and congenital anomaly among liveborn infants places particular demands on parents and health services”, the authors concluded.
Seizures common in paediatric ICH
A PROSPECTIVE study of paediatric intracerebral haemorrhage (ICH) has found that nearly half of children experience acute symptomatic seizures at or within 7 days of presentation, putting them at greater risk of epilepsy. The research, published in JAMA Neurology, included 73 children with spontaneous ICH, and found seizures occurred at presentation in 60% of children who suffered a perinatal ICH (n = 20) and in about one-third of those who presented later in childhood (28 days to 18 years old; n = 53). The researchers said the results of the study indicated that acute symptomatic seizures were more common in children (48%) than in adults (7%–31%) with ICH, and more common in children with ICH than in those with arterial ischaemic stroke. Follow-up data showed that remote seizures (those occurring more than 7 days after the ICH) had occurred in about one-third of patients within 2 years, while the risk of epilepsy was 13% at 2 years. “This study provides clinicians with useful information for counseling parents of pediatric patients with ICH who present in the perinatal and childhood periods regarding the risk for remote seizures and epilepsy”, the authors concluded.
Vitamin D deficiency in obesity
NEW research in PLOS Medicine has provided genetic evidence that higher body mass index (BMI) leads to lower vitamin D status and, conversely, shows no evidence for a causal role of vitamin D in obesity. The study of more than 42 000 people in 21 cohorts from North America and Europe demonstrated an association between BMI and lower 25(OH)D concentrations across different age groups and in both men and women. The study used the Mendelian randomisation approach, where causality is inferred from associations between genetic variants that mimic the influence of a modifiable environmental exposure and the outcome of interest, and found that a 10% higher genetically instrumented BMI was associated with 4.2% lower 25(OH)D concentrations. The associations between vitamin D scores and BMI were confirmed in the Genetic Investigation of Anthropometric Traits (GIANT) consortium. The researchers wrote that they had provided evidence for the role of obesity as a causal risk factor for the development of vitamin D deficiency. “Together with the suggested increases in vitamin D requirements in obese individuals, our study highlights the importance of monitoring and treating vitamin D deficiency as a means of alleviating the adverse influences of excess adiposity on health”, they wrote.
Posted 11 February 2013