Infection and intussusception
Intussusception, which occurs when a part of the intestine invaginates within a more distal segment, is a common cause of acute bowel obstruction in infants. Case-control studies have implicated viruses, particularly adenovirus type C, in its causation and an oral vaccine against rotavirus had to be recalled because it increased the risk of intussusception. An ecological analysis from Australia reports that rates of idiopathic intussusception halved during pandemic lockdowns, suggesting that transmissible agents are the trigger in a substantial number of cases (Clin Infect Dis doi:10.1093/cid/ciae084).
Lead poisoning
Lead has no physiological role in the body and even small amounts can be toxic. In the past, exposure to lead from paint and contaminated water was common but most environmental exposures have now been reduced or eliminated. However, lead continues to be widely used in ammunition and an outbreak of lead poisoning among staff at an indoor firing range in the UK draws attention to the dangers of exposure to dust from discharged firearms (Occup Environ Med doi:10.1136/oemed-2023-109218).
Anticoagulation after PCI
Routine post procedural anticoagulation after primary percutaneous coronary intervention is safe but pointless, according to a large trial conducted at 53 centres in China. Each centre selected one of three anticoagulation regimens (enoxaparin, unfractionated heparin, or bivalirudin) and 3000 patients were randomised either to the chosen anticoagulant or to placebo. Judged by end points of death, myocardial infarction, stroke, stent thrombosis, or need for urgent revascularisation, post procedural anticoagulation was of no benefit but there was no difference in the incidence of bleeding between active treatments and placebo (Circulation doi:10.1161/CIRCULATIONAHA.123.067079).
Sweetened drinks and atrial fibrillation
A longitudinal analysis of data from 200 000 participants in the UK Biobank study who were without cardiac arrhythmias at baseline reports that, during 10 years observation, atrial fibrillation occurred in about 5%. The risk was slightly greater—about 20% higher—among people who said they drank two litres or more of artificially sweetened drinks each week and among people who said they drank similar amounts of sugar sweetened beverages. Consumption of pure fruit juice, on the other hand, seemed to be modestly protective (Circ Arrhythm Electrophysiol doi:10.1161/CIRCEP.123.012145).
Differential diagnosis of sepsis
Among nearly 3000 adult patients admitted to four Swedish intensive care units with a suspected diagnosis of sepsis, about a quarter turned out to have something else. The most common revised diagnoses were acute heart failure or respiratory failure. Case fatality was as high in patients with diagnoses mimicking sepsis as it was in cases of confirmed sepsis. Levels of C reactive protein had modest discriminatory power in confirming sepsis, with an area under the receiver operating characteristic curve of 0.7 (Infection doi:10.1007/s15010-023-02158-w).