Medicine Digest was at least as effective as current WHO differs from PH in adults and separate
policy for severe pneumonia. Soofi S et al. Effectiveness of community case man- agement of severe pneumonia with oral amoxicillin in children aged 2–59 months in Matiari district, rural Pakistan: a cluster-randomised controlled trial. Lancet 2012; 379: 729–37; Black RE, El Arifeen S. Community-based treatment of severe childhood pneumonia. Ibid: 692–4 (comment).
Pulmonary hypertension in children
The overall population prevalence of pulmonary hypertension (PH) in West- ern countries is around 25–50 per mil- lion. It is probably much less prevalent in children than in adults and there may be considerable differences between the adult and paediatric disease. A global registry at 31 centres in 19 countries has provided data about paediatric pulmo- nary hypertension (PPH). PH is classified into five groups, the most common of which is pulmonary arterial hyperten- sion (PAH), which can be idiopathic (IPAH), heritable (HPAH), or associated with conditions such as congenital heart disease (APAH). The study included 362 children
(59% girls) aged 3 months to 18 years (median 7 years) at the time of diagnosis. All had confirmed pulmonary hyperten- sion (mean pulmonary artery pressure at least 25mmHg, pulmonary capillary wedge pressure at least 12mmHg, pul- monary capillary wedge pressure at least 12mmHg, and pulmonary vascular re- sistance index at least 3WU/m-2). Most (317 patients, 88%) were classified as PAH, among whom 182 had idiopathic or familial PAH and 135 had PAH as- sociated with other disorders (115 with congenital heart disease). Of the remain- ing 45 cases, 42 had lung disease or hy- poxaemia and three had chronic throm- boembolic pulmonary hypertension or ‘miscellaneous causes’. Most (93%) of the children with congenital heart disease had a systemic-to-pulmonary shunt. Eighty-six (24%) of the total co- hort had an additional disorder, trisomy 21 in 42 cases. Twenty-one patients had lived at high altitude (>2000 metres) for >6 months, 47 had been born preterm, and eight had had persistent pulmonary hypertension of the newborn. Exertional dyspnoea was the presenting symptom in 65% of the cohort. Syncope occurred in 20%, 31% of patients with idiopathic or familial PAH and 18% of those with repaired congenital heart disease. Right heart function was often preserved, 64% of patients being in functional class I or II. Paediatric pulmonary hypertension
58 Africa Health
paediatric data are needed. Berger RF et al. Clinical features of paediatric pul- monary hypertension: a registry study. Lancet 2012; 379: 537–46; a registry study. Lancet 2012; 379: 537–46; Mallory GB. Pulmonary hypertension in early life. Ibid: 500–1 (comment).
Moderate or late preterm birth and health outcomes
The UK Millennium cohort study is na- tionally representative prospective co- hort study including 18818 infants born in 2000–2002 and still living in the UK at the age of 9 months. Health outcomes in relation to gestational age at birth were assessed at ages 3 and 5 years and included growth, hospital admissions, longstanding illness, wheezing, use of prescribed drugs, and parental rating of children’s health. In general, there was an inverse relationship between ges- tational age at birth and frequency of adverse health outcomes. The greatest number of such outcomes was among children born at moderate or late preterm (32–36 weeks) or at early term (37–38 weeks). Birth at 32–36 weeks accounted for 5.7% of children with three or more hospital admissions at ages 9 months to 5 years. Birth before 32 weeks account- ed for 3.8% of such children and birth at 37–38 weeks for 7.2%. For a limiting longstanding illness the corresponding population attributable fractions were 5.4% for birth at 32–36 weeks, 2.7% for birth before 32 weeks, and 5.4% for birth at 37–38 weeks. Modestly preterm birth and early term birth contribute more to the burden of adverse health outcomes than does very
preterm birth. Bryle EM et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based co- hort study. BMJ 2012; 344 (March 17): 17 (e896).
of recurrent laryngeal nerve palsy and hypoparathyroidism were 2.08% and 2.69% respectively. The rate of recur- rent laryngeal nerve palsy fell during the first 4 years of surgical practice but rose considerably after 20 or more years of experience. The rate of postoperative hypoparathyroidism fell little in the early years of practice but rose considerably after 20 or more years. The optimal age of surgeons appeared to be 35–50 years. Older surgeons may have poorer re- sults. These results need to be confirmed
and possible reasons explored. Duclos A et al. Influence of experience on perfor- mance of individual surgeons in thyroid surgery: pro- spective cross sectional multicentre study. BMJ 2012; 344 (11 Feb): 19 (d8041).
Oncology
Algorithm for ovarian cancer risk in general practice patients
Researchers in Nottingham, England have produced a new algorithm to esti- mate risk of ovarian cancer among wom- en presenting in general practice. A total of 375 practices (1158723
Surgery Surgeons: too young and too old?
A study at five large centres in France (Lille, Lyon, Marseille, Paris, and Poitiers) has suggested that increased complica- tion rates may occur with both younger, less experienced, surgeons and surgeons in the later years of their careers. The study included all 3679 thyroid-
ectomies performed in the five centres between April 2008 and December 2009. Of these operations, 3574 (97%) were performed by 28 surgeons over the course of 1 year. Overall, the rates
women) contributed to the derivation cohort and 189 practices (608862 wom- en) to the validation cohort. The women were aged 30–84 with no previous diag- nosis of ovarian cancer. The risk factors examined were age, family history of ovarian cancer, previous other cancers, BMI, smoking, alcohol, deprivation, loss of appetite, loss of weight, abdominal pain, abdominal distension, rectal bleed- ing, postmenopausal bleeding, urinary frequency, diarrhoea, constipation, tired- ness, and anaemia. During 2.03million person-years of follow-up, 976 women developed a first ovarian cancer. A fam- ily history of ovarian cancer increased the risk 9.8-fold. Other significant risk factors were anaemia (x 2.3), abdominal pain (x 7), abdominal distension (x 23), rectal bleeding (x 2), postmenopausal bleeding (x 7), loss of appetite (x 5), and weight loss (x 2). Of all ovarian cancers occurring with 2 years of assessment, 63% were in women with a predicted risk in the highest 10%. The algorithm could be used, after independent validation in an external cohort, to facilitate early diagnosis and referral. A calculator is available at www.
qcancer.org/ovary. Further research is needed into the cost-effectiveness of the algorithm and its effect on clinical out- comes.
July 2012
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76