Peter Smerdely

Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals.

Abstract

TOPICAL IODINE-CONTAINING ANTISEPTICS AND NEONATAL HYPOTHYROIDISM IN VERY-LOW-BIRTHWEIGHT INFANTS

The thyroid function of very-low-birthweight (VLBW; below 1500 g) infants admitted to neonatal intensive-care units was studied at two hospitals; one routinely used topical iodinated antiseptic agents and the other used chlorhexidine-containing antiseptics. Serial monitoring of urinary iodine excretion and serum thyrotropin and thyroxine levels was undertaken from birth for the first 4 weeks of life. Urinary iodine excretion rose dramatically in the 54 iodine-exposed infants and was up to fifty times greater than in the 29 non-exposed infants. Within 14 days, 25% (9 of 36) of the infants exposed to iodine had serum thyrotropin levels above 20 mIU/l, compared with none of the control group. The mean serum thyroxine level in these 9 infants (44.1 nmol/l) was significantly lower than that in exposed infants with normal thyrotropin levels (83.1 nmol/l) and in the non-exposed control group (83.0 nmol/l); thyroxine levels fell before serum thyrotropin rose. These disturbances in thyroid function correlated positively with urinary iodine excretion and hence iodine absorption. Thyroid function had returned to normal by the time of discharge from hospital. It is concluded that iodine absorption, from topical iodine-containing antiseptics, may cause hypothyroidism during a critical period of neurological development in the newborn infant. The routine use of iodine antisepsis in VLBW infants should be avoided because of this effect.

A comparison of community-based resistance exercise and flexibility exercise for seniors

Progressive resistance training has positive effects on the health of elderly people, however exercise programs for seniors frequently focus on other forms of exercise. This study is a randomised trial with a blinded assessor comparing a community based progressive resistance training program (n = 20) with a flexibility program (n = 20), both one hour twice weekly for 10 weeks. Outcomes were strength, gait, balance and quality of life. Progressive resistance training had a greater effect than flexibility training on right sided quadriceps strength (mean difference between groups = 7.7%; 95% CI 3.6-11.8%, p < 0.003 MANOVA), left sided quadriceps strength (mean difference = 9.9%; 95% CI 5.6-14.2%, p < 0.003 MANOVA), left sided biceps strength (mean difference = 15.2%; 95% CI 11.7-19.2%, p < 0.003 MANOVA), functional reach (mean difference = 11.7%; 95% CI 7.1-16.3%, p < 0.003 MANOVA) and step test (mean difference = 8.6%; 95% CI 3.8-13.4%, p < 0.003 MANOVA). Neither group had improvements in SF36 quality of life measures. Results suggest progressive resistance training produces greater strength, gait and balance improvements in elderly people than a flexibility exercise program.

Relationship between serum parathyroid hormone levels in the elderly and 24 h ambulatory blood pressures

Background An association between serum parathyroid hormone (PTH) levels in normotensive elderly subjects and blood pressure values had been reported. Objective To examine the relationship between PTH levels and other biochemical markers of calcium metabolism in elderly subjects and 24 h ambulatory blood pressures. Methods We performed 24 h ambulatory blood pressure recordings for 123 independent elderly subjects aged 63–88 years using a SpaceLabs 90207 recorder. Mean night-time blood pressures were calculated from the average of readings during sleep; mean daytime blood pressures were calculated from the remaining recordings. Demographic data and details concerning the alcohol consumption and medication usage of the subjects were recorded. Serum PTH, 25-hydroxy-vitamin D, albumin, renin, aldosterone, noradrenaline, creatinine and calcium levels were measured. Results Fifty-five patients were being administered antihypertensive therapy. Serum PTH levels correlated to the nocturnal systolic blood pressure (SBP; β = 0.29, P = 0.002), nocturnal diastolic blood pressure (DBP), daytime SBP and mean 24 h SBP on univariate and multivariate analysis. Aldosterone levels were related to nocturnal SBP in univariate analysis (β = 0.21, P = 0.02) but the relationship was weakened when PTH levels were included in the analysis (β = 0.16, P = 0.09). Nocturnal, daytime and mean 24 h blood pressures were not significantly related to serum calcium, 25-hydroxy- vitamin D, age, body mass index and alcohol consumption. Sex was a significant predictor of the DBP, men having higher levels than did women (daytime DBP β = 0.29, P = 0.001). Conclusions Serum PTH levels are related strongly to the blood pressure, particularly the nocturnal blood pressure in the elderly. It is not known whether PTH levels are a consequence or a cause of the elevation in blood pressure.

The effects of dietary supplementation with isoflavones from red clover on cognitive function in postmenopausal women

Objective To examine the effects of dietary isoflavone supplementation with an extract from red clover on cognitive function in postmenopausal women. Design Thirty postmenopausal women aged greater than 60 years received either two tablets of an extract of aglycone isoflavones from red clover (each containing formononetin 25 mg, biochanin 2.5 mg and less than 1 mg of daidzein and genistein) for 6 months in a randomized, controlled clinical trial. Cognitive function tests were performed at baseline and at the end of isoflavone or placebo therapy. Results Isoflavone supplementation was associated with an apparent improvement in block design (a test of visual-spatial intelligence) compared to placebo (isoflavone + 12%, placebo −3%; p = 0.03), no improvement in verbal memory compared to an improvement on placebo (isoflavone +1%, placebo +29%; p = 0.023) and a deterioration in digit recall compared to placebo (isoflavone −6%, placebo +12%; p = 0.029). However, these findings were not statistically significant when corrections were made for potential chance findings due to multiple comparisons. Conclusion Isoflavone supplementation does not appear to have major short-term effects on cognitive function in postmenopausal women. However, further clinical trials are required to determine whether small effects or long-term effects on cognitive function occur during isoflavone supplementation.

Validating the 4A's test in screening for delirium in a culturally diverse geriatric inpatient population

To measure the diagnostic accuracy of the 4As test in screening for delirium in geriatric inpatients from culturally diverse backgrounds.

Protocol of the randomised placebo controlled pilot trial of the management of acute sciatica (SCIATICA): a feasibility study

Introduction Acute sciatica (symptom duration less than 4 weeks), a major cause of pain and disability, is a common presentation to medical practices and hospital emergency departments. Selective CT fluoroscopy transforaminal epidural steroid injection is often used with the hope of reducing pain and improving function. Recently, there has been interest in using systemic corticosteroids in acute sciatica. However, there is limited evidence to inform management of selective CT fluoroscopy transforaminal epidural steroid in subacute and chronic sciatica and there is no evidence in acute sciatica, even though the practice is widespread. There is also limited evidence for the use of systemic corticosteroids in acute sciatica. Furthermore, the management of selective CT fluoroscopy transforaminal epidural steroid versus systemic steroids has never been directly studied. Methods and analysis SCIATICA is a pilot/feasibility study of patients with acute sciatica designed to evaluate the feasibility of undertaking a blinded four-arm randomised controlled intervention study of (1) selective CT fluoroscopy transforaminal epidural steroid (arm 1), (2) selective CT fluoroscopy transforaminal epidural saline (arm 2), (3) 15 days tapering dose of oral steroids (arm 3) and (4) a sham epidural and oral placebo control (arm 4). This feasibility study is designed to evaluate head-to-head, route versus pharmacology of interventions. The primary outcome measure is the Oswestry Disability Index (ODI) at 3 weeks. Secondary outcome is the ODI at 48 weeks. Other outcomes include numerical rating scale for leg pain, Pain DETECT Questionnaire, quality of life, medication use, rescue procedures or surgery, and adverse events. Results of outcomes from this randomised controlled trial will be used to determine the feasibility, sample size and power calculations for a large multicentre study. Ethics and dissemination The study has been approved by South Eastern Sydney Local Health District Human Research Ethics Committee (HREC/15/331/POHW/586). Trial registration number NCT03240783; Pre-results.