Nov 9, 2018

Adult swim

The story

Whoever says good things come to those who wait never wheeled a crashing patient to the ICU. Here’s how paternal age impacts infant birth outcomes.

The background

Despite what your parents say, it's not just you: people are waiting longer to have kids as part of a 40-year-long trend in developed countries. Mature moms are linked to preterm birth, fetal loss, and congenital anomalies, but (surprise, surprise) there's been far less scrutiny of grayed-out baby-daddys. The germ cell changes implicated in many maternal processes affect sperm too, and almost 10% of fathers are now over age 40. Are there consequences?

The study

Using the National Vital Statistics System, researchers examined 40 million live births between 2007 - 2016 and found that infants born to fathers over age 45 had 14% higher odds of premature birth and low birth weight compared to younger fathers. The authors estimate that as many as 13% of preterm births in the last decade may be due to advanced paternal age. Critics point out that effect sizes were low – infants were on average delivered 0.12 weeks earlier and were 20 g lighter than their peers – and older fathers are more likely to have chronic illness and use harmful substances.

The takeaway

There are many caveats here, but it's nice to see a 2-sided story. While we wait for more data, many believe that more men should participate in preconception healthcare.

Say it on rounds

When basic emotion is stamped out by fatigue

We get that high-sensitivity is not your residency thing, but there are practical matters at play. An observational study of patients with stable coronary artery disease found that low levels of high-sensitivity troponin (< 2.5 pg/mL) had negative predictive values > 90% for ruling out inducible myocardial ischemia as measured by traditional stress tests in derivation (n=590) and validation (n=120) cohorts. At 3-year follow-up, zero patients with low troponin levels in the derivation group had coronary events, compared to 7% of patients with high levels.

When your attending is maximally invasive

Maybe she's onto something? While minimally invasive surgery leads to shorter recovery times, a randomized trial comparing minimally invasive (laparoscopic or robot-assisted) hysterectomy vs. open abdominal hysterectomy in 630 women with early stage cervical cancer found a higher rate of disease-free and overall survival (99% vs. 94%) in the open surgery group at 3-year follow-up. Many cancer centers have reverted to open abdominal hysterectomies following publication of these results.

When pet therapy goes global

A proof-of-concept study in Gambia found that dogs could correctly identify the scent of malaria in the socks of infected schoolchildren. After training, dogs correctly identified (see video) 70% of infected socks and ruled out 90% of uninfected socks. The study was designed to test if dog detection was feasible, though the authors envision that the dogs could one day be used to identify malaria in large crowds.
Am Soc Trop Med

Brush up

Hypertrophic cardiomyopathy

Up to 1 in 200 people have hypertrophic cardiomyopathy (HCM), which on a population level adds up. The most common genetic disorder of the heart is famous for causing sudden death in young athletes. Diagnosis is based on the identification of a hypertrophied, nondilated left ventricle on TTE or cardiac MRI in the absence of another causative disease. Despite increased recent attention, the disorder remains underrecognized, and many patients present with late heart failure symptoms like exertional dyspnea and fatigue.

What's the evidence

For implantable cardioverter-defibrillator (ICD) placement in HCM? Ventricular arrhythmias are a common cause of sudden cardiac death in HCM patients, and those at major risk (see diagram) should be considered for primary prevention ICD placement. A 2018 analysis of 500 high-risk patients with ICDs found that 19% of patients received appropriate shocks for VT or VF over mean follow-up of 6.5 years. Device-related morbidity was much lower than that seen in ischemic heart disease settings.

What your research friends are talking about

After a bruising election season, 7 scientists were elected to Congress, including a pediatrician, a registered nurse, a nuclear engineer, and a biochemist. Read about them here.
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