Useful bunch of motley learning points from the 15th April BMJ:
A double-blind trial reported in NEJM has looked at the effects of treating borderline thyroid results (raised TSH with normal T4) in the elderly. It didn’t show any benefit in terms of symptoms.
Blood pressure control can go too far. A new paper has reanalysed the results from two previous trials into an antihypertensive in >55s with a history of various arteriopathies (stroke, TIA, coronary artery disease, peripheral artery disease) or of DM with organ damage. The analysis showed that mean achieved systolic BPs <120mmHg were associated with increased risk of cardiovascular outcomes other than MI and CVA, and mean achieved diastolic BPs <70mmHg were at increased risk of cardiovascular outcomes including MI and also heart failure. Could possibly be a reverse causality effect, but still… treat BPs with some caution. More isn’t always better.
Short-term oral corticosteroids aren’t harmless. This paper in the BMJ reported on a dataset study looking at use of oral corticosteroids for less than 30 days. In patients having such a course, the short-term incidence of sepsis, VTE, and fracture increased 2 – 5-fold above background levels after initiation of the steroids.
And another study in the same issue came up with an ingenious response to one of life’s practical problems – getting a urine sample from a baby. The trick is to soak a gauze swab in cold fluid and gently use it to stimulate the suprapubic area while someone else hovers with a sterile container. In almost a third of cases, this was successful in obtaining a urine sample within five minutes. (Oddly, I’d just been reading Dick Francis’s novel ‘Straight’, in which a stableboy is trying unsuccessfully to get a urine sample from a racehorse for drug testing, so I immediately wondered whether the same technique would be worth trying in those cases?)