Heidi Splete

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.

Major findings: TPN-induced hyperglycemia is associated with longer hospital stay, more complications, and higher mortality rates.

Data source: A review of 276 adult medical and surgical patients who received TPN at a single hospital.

Disclosures: Co-author Dr. Guillermo Umpierrez has received research support from the American Diabetes Association and the National Institutes of Health. The other researchers had no financial conflicts to disclose.

Hyperglycemia caused by total parenteral nutrition is significantly associated with increased length of stay, risk of complications, and mortality, according to a study of 276 hospitalized adults.

Furthermore, the best predictors of death and complications in total parenteral nutrition (TPN) patients were blood glucose levels both before and within the first 24 hours of TPN, said Dr. Francisco J. Pasquel of Emory University, Atlanta, and his colleagues.

In this study, the researchers reviewed data from 276 consecutive patients at a single hospital. The average age of the patients was 51 years, and 19% had diabetes before entering the hospital. The patients received TPN for an average of 15 days, and most (65%) were surgical patients (Diabetes Care 2009 Dec. 29 [doi: 10.2337/dc09-1748

After the researchers controlled for age, sex, and diabetes history, mortality was significantly associated with a pre-TPN blood glucose level of 121-150 mg/dL, 151-180 mg/dL, or greater than 180 mg/dL. In addition, blood glucose within 24 hours of TPN was a significant predictor of mortality. Compared with patients who did not die, deceased patients had significantly higher blood glucose within 24 hours of TPN (162 mg/dL vs. 139 mg/dL) and during days 2-10 of TPN (161 mg/dL vs. 142 mg/dL).

Patients with blood glucose greater than 180 mg/dL within 24 hours of TPN were more than three times as likely to develop pneumonia and more than twice as likely to develop acute renal failure, compared with patients with blood glucose levels below 120 mg/dL.

In addition, patients with higher blood glucose levels during TPN treatment spent significantly more time in both the ICU and the hospital compared with patients with lower blood glucose levels.

The results suggest that early intervention against hyperglycemia may improve outcomes for TPN patients.

“Our study indicates that blood glucose values prior to and within 24 hours of TPN are better predictors of hospital mortality and complications than the mean blood glucose during the entire duration of TPN,” the researchers said.

Major findings: TPN-induced hyperglycemia is associated with longer hospital stay, more complications, and higher mortality rates.

Data source: A review of 276 adult medical and surgical patients who received TPN at a single hospital.

Disclosures: Co-author Dr. Guillermo Umpierrez has received research support from the American Diabetes Association and the National Institutes of Health. The other researchers had no financial conflicts to disclose.

Hyperglycemia caused by total parenteral nutrition is significantly associated with increased length of stay, risk of complications, and mortality, according to a study of 276 hospitalized adults.

Furthermore, the best predictors of death and complications in total parenteral nutrition (TPN) patients were blood glucose levels both before and within the first 24 hours of TPN, said Dr. Francisco J. Pasquel of Emory University, Atlanta, and his colleagues.

In this study, the researchers reviewed data from 276 consecutive patients at a single hospital. The average age of the patients was 51 years, and 19% had diabetes before entering the hospital. The patients received TPN for an average of 15 days, and most (65%) were surgical patients (Diabetes Care 2009 Dec. 29 [doi: 10.2337/dc09-1748

After the researchers controlled for age, sex, and diabetes history, mortality was significantly associated with a pre-TPN blood glucose level of 121-150 mg/dL, 151-180 mg/dL, or greater than 180 mg/dL. In addition, blood glucose within 24 hours of TPN was a significant predictor of mortality. Compared with patients who did not die, deceased patients had significantly higher blood glucose within 24 hours of TPN (162 mg/dL vs. 139 mg/dL) and during days 2-10 of TPN (161 mg/dL vs. 142 mg/dL).

Patients with blood glucose greater than 180 mg/dL within 24 hours of TPN were more than three times as likely to develop pneumonia and more than twice as likely to develop acute renal failure, compared with patients with blood glucose levels below 120 mg/dL.

In addition, patients with higher blood glucose levels during TPN treatment spent significantly more time in both the ICU and the hospital compared with patients with lower blood glucose levels.

The results suggest that early intervention against hyperglycemia may improve outcomes for TPN patients.

“Our study indicates that blood glucose values prior to and within 24 hours of TPN are better predictors of hospital mortality and complications than the mean blood glucose during the entire duration of TPN,” the researchers said.

Major findings: TPN-induced hyperglycemia is associated with longer hospital stay, more complications, and higher mortality rates.

Data source: A review of 276 adult medical and surgical patients who received TPN at a single hospital.

Disclosures: Co-author Dr. Guillermo Umpierrez has received research support from the American Diabetes Association and the National Institutes of Health. The other researchers had no financial conflicts to disclose.

Hyperglycemia caused by total parenteral nutrition is significantly associated with increased length of stay, risk of complications, and mortality, according to a study of 276 hospitalized adults.

Furthermore, the best predictors of death and complications in total parenteral nutrition (TPN) patients were blood glucose levels both before and within the first 24 hours of TPN, said Dr. Francisco J. Pasquel of Emory University, Atlanta, and his colleagues.

In this study, the researchers reviewed data from 276 consecutive patients at a single hospital. The average age of the patients was 51 years, and 19% had diabetes before entering the hospital. The patients received TPN for an average of 15 days, and most (65%) were surgical patients (Diabetes Care 2009 Dec. 29 [doi: 10.2337/dc09-1748

After the researchers controlled for age, sex, and diabetes history, mortality was significantly associated with a pre-TPN blood glucose level of 121-150 mg/dL, 151-180 mg/dL, or greater than 180 mg/dL. In addition, blood glucose within 24 hours of TPN was a significant predictor of mortality. Compared with patients who did not die, deceased patients had significantly higher blood glucose within 24 hours of TPN (162 mg/dL vs. 139 mg/dL) and during days 2-10 of TPN (161 mg/dL vs. 142 mg/dL).

Patients with blood glucose greater than 180 mg/dL within 24 hours of TPN were more than three times as likely to develop pneumonia and more than twice as likely to develop acute renal failure, compared with patients with blood glucose levels below 120 mg/dL.

In addition, patients with higher blood glucose levels during TPN treatment spent significantly more time in both the ICU and the hospital compared with patients with lower blood glucose levels.

The results suggest that early intervention against hyperglycemia may improve outcomes for TPN patients.

“Our study indicates that blood glucose values prior to and within 24 hours of TPN are better predictors of hospital mortality and complications than the mean blood glucose during the entire duration of TPN,” the researchers said.

Major Finding: Oral misoprostol may be an alternative to intravenous oxytocin for controlling postpartum hemorrhage.

Data Source: Efficacy of oral misoprostol as an alternative to intravenous oxytocin was studied in 978 women in four hospitals in one trial, and in another 809 women who had received prophylactic oxytocin during the third stage of labor in five hospitals in a second trial.

Disclosures: Both studies were funded by the Bill and Melinda Gates Foundation. Dr. Winikoff and Ms. Blum said they had no financial conflicts to disclose.

Oral misoprostol may be as effective as intravenous oxytocin for controlling postpartum hemorrhage, based on data from two studies. Both studies involved an off-label use of misoprostol, and each study included more than 800 women.

Oxytocin is the drug of choice for postpartum bleeding, but misoprostol may be more feasible in areas with limited resources, said Dr. Beverly Winikoff of Gynuity Health Projects in New York City and her colleagues.

The first study, conducted by Dr. Winikoff and her colleagues, assessed the effectiveness of oral misoprostol as an alternative to oxytocin at four hospitals: one in Ecuador, one in Egypt, and two in Vietnam. The researchers randomized 488 women to receive four 200-mcg tablets of misoprostol and an intravenous saline placebo, while 490 women received 40 IU of intravenous oxytocin and placebo tablets. The average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61924-3]).

Within 20 minutes of administration, active bleeding was controlled in 440 (90%) of the women in the misoprostol group and 468 (96%) of the women in the oxytocin group. This difference was statistically significant. In addition, significantly more women in the misoprostol group bled at least 300 mL after treatment, compared with the oxytocin group (30% vs. 17%).

Oxytocin stopped active bleeding 2 minutes faster, on average, than did misoprostol, and women in the oxytocin group lost approximately 50 mL less blood than did women in the misoprostol group, the researchers noted. Women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (47% vs. 17%) and fever (44% vs. 6%). No women in this study had hysterectomies and no deaths were reported.

Although the difference in treatments was statistically significant, misoprostol could substitute for oxytocin in certain settings, Dr. Winikoff and her colleagues said. “Since many women in developing countries deliver at home or at low-level facilities, misoprostol provides a potential for immediate treatment of postpartum hemorrhage.”

In a second study conducted by Gynuity Health Projects, lead author Jennifer Blum and her colleagues compared 800 mcg of oral misoprostol to 40 IU of intravenous oxytocin for primary postpartum hemorrhage in women who had received prophylactic oxytocin during the third stage of labor. This study included 407 women in the misoprostol group and 402 women in the oxytocin group. As in the first study, the average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL. The study was conducted at five hospitals: one in Egypt, one in Turkey, one in Burkina Faso, and two in Vietnam (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61923-1]).

Within 20 minutes of administration, active bleeding was controlled in 363 (89%) of the misoprostol group and 360 (90%) of the oxytocin group. Additional blood loss of at least 300 mL occurred in 139 women (34%) in the misoprostol group and 123 women (31%) in the oxytocin group. The differences in bleeding between the two groups were not significant. But women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (37% vs. 15%) and fever (22% vs. 15%). In this study, six women had hysterectomies (four with misoprostol and two with oxytonin), and two of these women died because of uncontrolled postpartum bleeding (both with misoprostol).

Major Finding: Oral misoprostol may be an alternative to intravenous oxytocin for controlling postpartum hemorrhage.

Data Source: Efficacy of oral misoprostol as an alternative to intravenous oxytocin was studied in 978 women in four hospitals in one trial, and in another 809 women who had received prophylactic oxytocin during the third stage of labor in five hospitals in a second trial.

Disclosures: Both studies were funded by the Bill and Melinda Gates Foundation. Dr. Winikoff and Ms. Blum said they had no financial conflicts to disclose.

Oral misoprostol may be as effective as intravenous oxytocin for controlling postpartum hemorrhage, based on data from two studies. Both studies involved an off-label use of misoprostol, and each study included more than 800 women.

Oxytocin is the drug of choice for postpartum bleeding, but misoprostol may be more feasible in areas with limited resources, said Dr. Beverly Winikoff of Gynuity Health Projects in New York City and her colleagues.

The first study, conducted by Dr. Winikoff and her colleagues, assessed the effectiveness of oral misoprostol as an alternative to oxytocin at four hospitals: one in Ecuador, one in Egypt, and two in Vietnam. The researchers randomized 488 women to receive four 200-mcg tablets of misoprostol and an intravenous saline placebo, while 490 women received 40 IU of intravenous oxytocin and placebo tablets. The average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61924-3]).

Within 20 minutes of administration, active bleeding was controlled in 440 (90%) of the women in the misoprostol group and 468 (96%) of the women in the oxytocin group. This difference was statistically significant. In addition, significantly more women in the misoprostol group bled at least 300 mL after treatment, compared with the oxytocin group (30% vs. 17%).

Oxytocin stopped active bleeding 2 minutes faster, on average, than did misoprostol, and women in the oxytocin group lost approximately 50 mL less blood than did women in the misoprostol group, the researchers noted. Women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (47% vs. 17%) and fever (44% vs. 6%). No women in this study had hysterectomies and no deaths were reported.

Although the difference in treatments was statistically significant, misoprostol could substitute for oxytocin in certain settings, Dr. Winikoff and her colleagues said. “Since many women in developing countries deliver at home or at low-level facilities, misoprostol provides a potential for immediate treatment of postpartum hemorrhage.”

In a second study conducted by Gynuity Health Projects, lead author Jennifer Blum and her colleagues compared 800 mcg of oral misoprostol to 40 IU of intravenous oxytocin for primary postpartum hemorrhage in women who had received prophylactic oxytocin during the third stage of labor. This study included 407 women in the misoprostol group and 402 women in the oxytocin group. As in the first study, the average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL. The study was conducted at five hospitals: one in Egypt, one in Turkey, one in Burkina Faso, and two in Vietnam (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61923-1]).

Within 20 minutes of administration, active bleeding was controlled in 363 (89%) of the misoprostol group and 360 (90%) of the oxytocin group. Additional blood loss of at least 300 mL occurred in 139 women (34%) in the misoprostol group and 123 women (31%) in the oxytocin group. The differences in bleeding between the two groups were not significant. But women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (37% vs. 15%) and fever (22% vs. 15%). In this study, six women had hysterectomies (four with misoprostol and two with oxytonin), and two of these women died because of uncontrolled postpartum bleeding (both with misoprostol).

Major Finding: Oral misoprostol may be an alternative to intravenous oxytocin for controlling postpartum hemorrhage.

Data Source: Efficacy of oral misoprostol as an alternative to intravenous oxytocin was studied in 978 women in four hospitals in one trial, and in another 809 women who had received prophylactic oxytocin during the third stage of labor in five hospitals in a second trial.

Disclosures: Both studies were funded by the Bill and Melinda Gates Foundation. Dr. Winikoff and Ms. Blum said they had no financial conflicts to disclose.

Oral misoprostol may be as effective as intravenous oxytocin for controlling postpartum hemorrhage, based on data from two studies. Both studies involved an off-label use of misoprostol, and each study included more than 800 women.

Oxytocin is the drug of choice for postpartum bleeding, but misoprostol may be more feasible in areas with limited resources, said Dr. Beverly Winikoff of Gynuity Health Projects in New York City and her colleagues.

The first study, conducted by Dr. Winikoff and her colleagues, assessed the effectiveness of oral misoprostol as an alternative to oxytocin at four hospitals: one in Ecuador, one in Egypt, and two in Vietnam. The researchers randomized 488 women to receive four 200-mcg tablets of misoprostol and an intravenous saline placebo, while 490 women received 40 IU of intravenous oxytocin and placebo tablets. The average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61924-3]).

Within 20 minutes of administration, active bleeding was controlled in 440 (90%) of the women in the misoprostol group and 468 (96%) of the women in the oxytocin group. This difference was statistically significant. In addition, significantly more women in the misoprostol group bled at least 300 mL after treatment, compared with the oxytocin group (30% vs. 17%).

Oxytocin stopped active bleeding 2 minutes faster, on average, than did misoprostol, and women in the oxytocin group lost approximately 50 mL less blood than did women in the misoprostol group, the researchers noted. Women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (47% vs. 17%) and fever (44% vs. 6%). No women in this study had hysterectomies and no deaths were reported.

Although the difference in treatments was statistically significant, misoprostol could substitute for oxytocin in certain settings, Dr. Winikoff and her colleagues said. “Since many women in developing countries deliver at home or at low-level facilities, misoprostol provides a potential for immediate treatment of postpartum hemorrhage.”

In a second study conducted by Gynuity Health Projects, lead author Jennifer Blum and her colleagues compared 800 mcg of oral misoprostol to 40 IU of intravenous oxytocin for primary postpartum hemorrhage in women who had received prophylactic oxytocin during the third stage of labor. This study included 407 women in the misoprostol group and 402 women in the oxytocin group. As in the first study, the average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL. The study was conducted at five hospitals: one in Egypt, one in Turkey, one in Burkina Faso, and two in Vietnam (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61923-1]).

Within 20 minutes of administration, active bleeding was controlled in 363 (89%) of the misoprostol group and 360 (90%) of the oxytocin group. Additional blood loss of at least 300 mL occurred in 139 women (34%) in the misoprostol group and 123 women (31%) in the oxytocin group. The differences in bleeding between the two groups were not significant. But women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (37% vs. 15%) and fever (22% vs. 15%). In this study, six women had hysterectomies (four with misoprostol and two with oxytonin), and two of these women died because of uncontrolled postpartum bleeding (both with misoprostol).

Three Chilean patients had confirmed reinfection with the 2009 pandemic influenza A (H1N1) virus after successful treatment with oseltamivir, according to a letter published in the January 2010 issue of Emerging Infectious Diseases.

“Reinfection is rarely seen in nonpandemic influenza A,” said Dr. Carlos M. Perez of Pontificia Universidad Catolica de Chile (Santiago) and colleagues.

The first patient was a healthy 14-year-old girl who had a fever, sore throat, and nasal congestion when H1N1 infection was confirmed by polymerase chain reaction (PCR) testing. She was treated with oseltamivir, and her symptoms resolved after 2 days.

“Twenty days later, fever, muscle aches, and vomiting developed in the patient,” the researchers said. The patient was treated with amantadine, and she recovered. Subsequent PCR testing confirmed reinfection with pandemic influenza (EID 2010;16:156-7).

The second patient was a 62-year-old woman who developed a high fever, cough, and nasal congestion while she was hospitalized prior to surgery. PCR testing and viral culture confirmed infection with the pandemic H1N1 virus. She received oseltamivir starting 5 days after the onset of symptoms, and the symptoms resolved within the next 5 days.

Two weeks later, while she was still hospitalized, the patient again developed fever, bronchial obstruction, and productive cough; PCR testing again was positive for pandemic H1N1. “The patient was again treated with oseltamivir, and PCR results were negative for influenza after 48 hours of antiviral treatment,” the researchers said.

The third patient was a previously healthy 38-year-old man hospitalized for mitral and aortic valve replacement following acute endocarditis caused by Staphylococcus aureus. The patient developed a sore throat, nasal congestion, cough, and a low-grade fever 11 days after surgery, while he was still hospitalized.

PCR testing confirmed pandemic H1N1 infection, and the patient was treated with oseltamivir. His respiratory symptoms resolved after 5 days. “He was discharged from the hospital, but readmitted 18 days later with nasal congestion, cough, and high fever,” the researchers said. Repeat testing again was positive for pandemic flu; he was successfully retreated with oseltamivir.

H1N1 reinfection in these patients could be due to the high rate of infection in the community at the time, as well as the immunocompromised status of the second and third patients, the researchers noted. The occurrence of two reinfections in hospitalized patients raises the possibility of nosocomial transmission, they added, but more information is needed.

Disclosures: None was reported.

Three Chilean patients had confirmed reinfection with the 2009 pandemic influenza A (H1N1) virus after successful treatment with oseltamivir, according to a letter published in the January 2010 issue of Emerging Infectious Diseases.

“Reinfection is rarely seen in nonpandemic influenza A,” said Dr. Carlos M. Perez of Pontificia Universidad Catolica de Chile (Santiago) and colleagues.

The first patient was a healthy 14-year-old girl who had a fever, sore throat, and nasal congestion when H1N1 infection was confirmed by polymerase chain reaction (PCR) testing. She was treated with oseltamivir, and her symptoms resolved after 2 days.

“Twenty days later, fever, muscle aches, and vomiting developed in the patient,” the researchers said. The patient was treated with amantadine, and she recovered. Subsequent PCR testing confirmed reinfection with pandemic influenza (EID 2010;16:156-7).

The second patient was a 62-year-old woman who developed a high fever, cough, and nasal congestion while she was hospitalized prior to surgery. PCR testing and viral culture confirmed infection with the pandemic H1N1 virus. She received oseltamivir starting 5 days after the onset of symptoms, and the symptoms resolved within the next 5 days.

Two weeks later, while she was still hospitalized, the patient again developed fever, bronchial obstruction, and productive cough; PCR testing again was positive for pandemic H1N1. “The patient was again treated with oseltamivir, and PCR results were negative for influenza after 48 hours of antiviral treatment,” the researchers said.

The third patient was a previously healthy 38-year-old man hospitalized for mitral and aortic valve replacement following acute endocarditis caused by Staphylococcus aureus. The patient developed a sore throat, nasal congestion, cough, and a low-grade fever 11 days after surgery, while he was still hospitalized.

PCR testing confirmed pandemic H1N1 infection, and the patient was treated with oseltamivir. His respiratory symptoms resolved after 5 days. “He was discharged from the hospital, but readmitted 18 days later with nasal congestion, cough, and high fever,” the researchers said. Repeat testing again was positive for pandemic flu; he was successfully retreated with oseltamivir.

H1N1 reinfection in these patients could be due to the high rate of infection in the community at the time, as well as the immunocompromised status of the second and third patients, the researchers noted. The occurrence of two reinfections in hospitalized patients raises the possibility of nosocomial transmission, they added, but more information is needed.

Disclosures: None was reported.

Three Chilean patients had confirmed reinfection with the 2009 pandemic influenza A (H1N1) virus after successful treatment with oseltamivir, according to a letter published in the January 2010 issue of Emerging Infectious Diseases.

“Reinfection is rarely seen in nonpandemic influenza A,” said Dr. Carlos M. Perez of Pontificia Universidad Catolica de Chile (Santiago) and colleagues.

The first patient was a healthy 14-year-old girl who had a fever, sore throat, and nasal congestion when H1N1 infection was confirmed by polymerase chain reaction (PCR) testing. She was treated with oseltamivir, and her symptoms resolved after 2 days.

“Twenty days later, fever, muscle aches, and vomiting developed in the patient,” the researchers said. The patient was treated with amantadine, and she recovered. Subsequent PCR testing confirmed reinfection with pandemic influenza (EID 2010;16:156-7).

The second patient was a 62-year-old woman who developed a high fever, cough, and nasal congestion while she was hospitalized prior to surgery. PCR testing and viral culture confirmed infection with the pandemic H1N1 virus. She received oseltamivir starting 5 days after the onset of symptoms, and the symptoms resolved within the next 5 days.

Two weeks later, while she was still hospitalized, the patient again developed fever, bronchial obstruction, and productive cough; PCR testing again was positive for pandemic H1N1. “The patient was again treated with oseltamivir, and PCR results were negative for influenza after 48 hours of antiviral treatment,” the researchers said.

The third patient was a previously healthy 38-year-old man hospitalized for mitral and aortic valve replacement following acute endocarditis caused by Staphylococcus aureus. The patient developed a sore throat, nasal congestion, cough, and a low-grade fever 11 days after surgery, while he was still hospitalized.

PCR testing confirmed pandemic H1N1 infection, and the patient was treated with oseltamivir. His respiratory symptoms resolved after 5 days. “He was discharged from the hospital, but readmitted 18 days later with nasal congestion, cough, and high fever,” the researchers said. Repeat testing again was positive for pandemic flu; he was successfully retreated with oseltamivir.

H1N1 reinfection in these patients could be due to the high rate of infection in the community at the time, as well as the immunocompromised status of the second and third patients, the researchers noted. The occurrence of two reinfections in hospitalized patients raises the possibility of nosocomial transmission, they added, but more information is needed.

Disclosures: None was reported.

Main Finding: One dose of adjuvant vaccine may protect young children against 2009 H1N1 influenza.

Data Source: A randomized trial of three dosing regimens of H1N1 vaccines, including 194 children aged 3-8 years.

Disclosures: The study was sponsored by Novartis, which manufactured the vaccines used. Study coauthor Dr. Kelly Lindert is an employee of Novartis Vaccines and Diagnostics in Cambridge, Mass.

A single dose of a 7.5-mcg adjuvant vaccine met immunogenicity criteria for protection against the 2009 H1N1 influenza in children aged 3-8 years, based on preliminary data from 390 children in one study.

“The use of adjuvant may provide a rapid immune response at a lower hemagglutinin dose than that required in vaccine without adjuvant,” said Dr. Adriano Arguedas of the Instituto de Atención Pediátrica in San José, Costa Rica, and associates.

They conducted a randomized trial of three dosing regimens of H1N1 vaccines in individuals aged 3-64 years, including 194 children aged 3-8 years and 196 children aged 9-17 years.

The children were randomized to receive one 7.5-mcg hemagglutinin dose with adjuvant, one 15-mcg hemagglutinin dose without adjuvant, or two 15-mcg hemagglutinin doses without adjuvant (N. Engl. J. Med. 2009 Dec. 30 [doi: 10.1056/NEJMc0909988

At 22 days after vaccination, hemagglutinin-inhibition (HI) titers had increased in both age groups for all three vaccine regimens.

After a single dose of each vaccine, children aged 9-17 years met the Food and Drug Administration's Center for Biologics Evaluation and Research (CBER) criteria for immunogenicity, but “in children 3-8 years of age, only the 7.5-mcg dose of 2009 H1N1 vaccine with adjuvant met both the immunogenicity criteria after one dose,” Dr. Arguedas and colleagues wrote.

Neither one nor two 15-mcg doses of unadjuvanted vaccine met the immunogenicity criteria in this younger age group.

According to the CBER criteria, immunogenicity is reached when the lower bound of the two-sided 95% confidence interval was at least 40% in individuals who showed seroconversion on HI assays, and when the lower bound of the two-sided 95% confidence interval was at least 70% in individuals with an HI antibody titer of at least 1:40.

No serious adverse events related to the vaccine were reported in any of the age groups.

The study is ongoing, but the results suggest that use of an adjuvant vaccine could accelerate the process of vaccinating young children (a high-risk group) against H1N1 influenza, the researchers said.

Main Finding: One dose of adjuvant vaccine may protect young children against 2009 H1N1 influenza.

Data Source: A randomized trial of three dosing regimens of H1N1 vaccines, including 194 children aged 3-8 years.

Disclosures: The study was sponsored by Novartis, which manufactured the vaccines used. Study coauthor Dr. Kelly Lindert is an employee of Novartis Vaccines and Diagnostics in Cambridge, Mass.

A single dose of a 7.5-mcg adjuvant vaccine met immunogenicity criteria for protection against the 2009 H1N1 influenza in children aged 3-8 years, based on preliminary data from 390 children in one study.

“The use of adjuvant may provide a rapid immune response at a lower hemagglutinin dose than that required in vaccine without adjuvant,” said Dr. Adriano Arguedas of the Instituto de Atención Pediátrica in San José, Costa Rica, and associates.

They conducted a randomized trial of three dosing regimens of H1N1 vaccines in individuals aged 3-64 years, including 194 children aged 3-8 years and 196 children aged 9-17 years.

The children were randomized to receive one 7.5-mcg hemagglutinin dose with adjuvant, one 15-mcg hemagglutinin dose without adjuvant, or two 15-mcg hemagglutinin doses without adjuvant (N. Engl. J. Med. 2009 Dec. 30 [doi: 10.1056/NEJMc0909988

At 22 days after vaccination, hemagglutinin-inhibition (HI) titers had increased in both age groups for all three vaccine regimens.

After a single dose of each vaccine, children aged 9-17 years met the Food and Drug Administration's Center for Biologics Evaluation and Research (CBER) criteria for immunogenicity, but “in children 3-8 years of age, only the 7.5-mcg dose of 2009 H1N1 vaccine with adjuvant met both the immunogenicity criteria after one dose,” Dr. Arguedas and colleagues wrote.

Neither one nor two 15-mcg doses of unadjuvanted vaccine met the immunogenicity criteria in this younger age group.

According to the CBER criteria, immunogenicity is reached when the lower bound of the two-sided 95% confidence interval was at least 40% in individuals who showed seroconversion on HI assays, and when the lower bound of the two-sided 95% confidence interval was at least 70% in individuals with an HI antibody titer of at least 1:40.

No serious adverse events related to the vaccine were reported in any of the age groups.

The study is ongoing, but the results suggest that use of an adjuvant vaccine could accelerate the process of vaccinating young children (a high-risk group) against H1N1 influenza, the researchers said.

Main Finding: One dose of adjuvant vaccine may protect young children against 2009 H1N1 influenza.

Data Source: A randomized trial of three dosing regimens of H1N1 vaccines, including 194 children aged 3-8 years.

Disclosures: The study was sponsored by Novartis, which manufactured the vaccines used. Study coauthor Dr. Kelly Lindert is an employee of Novartis Vaccines and Diagnostics in Cambridge, Mass.

A single dose of a 7.5-mcg adjuvant vaccine met immunogenicity criteria for protection against the 2009 H1N1 influenza in children aged 3-8 years, based on preliminary data from 390 children in one study.

“The use of adjuvant may provide a rapid immune response at a lower hemagglutinin dose than that required in vaccine without adjuvant,” said Dr. Adriano Arguedas of the Instituto de Atención Pediátrica in San José, Costa Rica, and associates.

They conducted a randomized trial of three dosing regimens of H1N1 vaccines in individuals aged 3-64 years, including 194 children aged 3-8 years and 196 children aged 9-17 years.

The children were randomized to receive one 7.5-mcg hemagglutinin dose with adjuvant, one 15-mcg hemagglutinin dose without adjuvant, or two 15-mcg hemagglutinin doses without adjuvant (N. Engl. J. Med. 2009 Dec. 30 [doi: 10.1056/NEJMc0909988

At 22 days after vaccination, hemagglutinin-inhibition (HI) titers had increased in both age groups for all three vaccine regimens.

After a single dose of each vaccine, children aged 9-17 years met the Food and Drug Administration's Center for Biologics Evaluation and Research (CBER) criteria for immunogenicity, but “in children 3-8 years of age, only the 7.5-mcg dose of 2009 H1N1 vaccine with adjuvant met both the immunogenicity criteria after one dose,” Dr. Arguedas and colleagues wrote.

Neither one nor two 15-mcg doses of unadjuvanted vaccine met the immunogenicity criteria in this younger age group.

According to the CBER criteria, immunogenicity is reached when the lower bound of the two-sided 95% confidence interval was at least 40% in individuals who showed seroconversion on HI assays, and when the lower bound of the two-sided 95% confidence interval was at least 70% in individuals with an HI antibody titer of at least 1:40.

No serious adverse events related to the vaccine were reported in any of the age groups.

The study is ongoing, but the results suggest that use of an adjuvant vaccine could accelerate the process of vaccinating young children (a high-risk group) against H1N1 influenza, the researchers said.

Data from 19 studies support the safety of thimerosal, which is used as a preservative in multidose vials of the pandemic 2009 H1N1 influenza vaccine, according to an updated fact sheet on the Centers for Disease Control and Prevention's Web site.

As with the seasonal flu vaccine, the H1N1 vaccine is produced in single-dose units, which do not contain thimerosal, and in multidose vials, which do contain a small amount of thimerosal to prevent contamination and bacterial growth.

The nasal spray version of the H1N1 vaccine, which contains a live-attenuated influenza vaccine (LAIV), does not contain thimerosal, but also is not approved for many populations at high risk for pandemic flu, such as children aged 6–23 months, pregnant women, or adults with certain other health conditions.

Recent recalls of some single-dose thimerosal-free H1N1 vaccines mean that individuals in H1N1 vaccine priority groups may have trouble finding a thimerosal-free vaccine. However, “it is safe for pregnant women and children to receive a flu vaccine that contains thimerosal,” the agency stressed.

The CDC acknowledged that misconceptions persist about a connection between the thimerosal in some vaccines and the occurrence of autism in children.

“Most research done in the United States, and around the world, shows no link between the thimerosal in vaccines and autism,” according to the CDC. “In fact, sadly, autism rates have actually gone up since thimerosal was taken out of childhood vaccines in 2001, providing further evidence that thimerosal-containing vaccines are not related to autism.”

For the latest information on the H1N1 flu, visit cdc.gov/h1n1flu

Data from 19 studies support the safety of thimerosal, which is used as a preservative in multidose vials of the pandemic 2009 H1N1 influenza vaccine, according to an updated fact sheet on the Centers for Disease Control and Prevention's Web site.

As with the seasonal flu vaccine, the H1N1 vaccine is produced in single-dose units, which do not contain thimerosal, and in multidose vials, which do contain a small amount of thimerosal to prevent contamination and bacterial growth.

The nasal spray version of the H1N1 vaccine, which contains a live-attenuated influenza vaccine (LAIV), does not contain thimerosal, but also is not approved for many populations at high risk for pandemic flu, such as children aged 6–23 months, pregnant women, or adults with certain other health conditions.

Recent recalls of some single-dose thimerosal-free H1N1 vaccines mean that individuals in H1N1 vaccine priority groups may have trouble finding a thimerosal-free vaccine. However, “it is safe for pregnant women and children to receive a flu vaccine that contains thimerosal,” the agency stressed.

The CDC acknowledged that misconceptions persist about a connection between the thimerosal in some vaccines and the occurrence of autism in children.

“Most research done in the United States, and around the world, shows no link between the thimerosal in vaccines and autism,” according to the CDC. “In fact, sadly, autism rates have actually gone up since thimerosal was taken out of childhood vaccines in 2001, providing further evidence that thimerosal-containing vaccines are not related to autism.”

For the latest information on the H1N1 flu, visit cdc.gov/h1n1flu

Data from 19 studies support the safety of thimerosal, which is used as a preservative in multidose vials of the pandemic 2009 H1N1 influenza vaccine, according to an updated fact sheet on the Centers for Disease Control and Prevention's Web site.

As with the seasonal flu vaccine, the H1N1 vaccine is produced in single-dose units, which do not contain thimerosal, and in multidose vials, which do contain a small amount of thimerosal to prevent contamination and bacterial growth.

The nasal spray version of the H1N1 vaccine, which contains a live-attenuated influenza vaccine (LAIV), does not contain thimerosal, but also is not approved for many populations at high risk for pandemic flu, such as children aged 6–23 months, pregnant women, or adults with certain other health conditions.

Recent recalls of some single-dose thimerosal-free H1N1 vaccines mean that individuals in H1N1 vaccine priority groups may have trouble finding a thimerosal-free vaccine. However, “it is safe for pregnant women and children to receive a flu vaccine that contains thimerosal,” the agency stressed.

The CDC acknowledged that misconceptions persist about a connection between the thimerosal in some vaccines and the occurrence of autism in children.

“Most research done in the United States, and around the world, shows no link between the thimerosal in vaccines and autism,” according to the CDC. “In fact, sadly, autism rates have actually gone up since thimerosal was taken out of childhood vaccines in 2001, providing further evidence that thimerosal-containing vaccines are not related to autism.”

For the latest information on the H1N1 flu, visit cdc.gov/h1n1flu

Several office-based pediatric measures, including body mass index and systolic and diastolic blood pressure, were significant predictors of type 2 diabetes in adulthood, based on data from a pair of follow-up studies including nearly 2,000 school-aged children.

The ability to identify children who are on the path to adult type 2 diabetes may give physicians an opportunity to intervene with diet and exercise recommendations, said John A. Morrison, Ph.D., of Cincinnati Children's Hospital Medical Center.

Dr. Morrison and his colleagues reviewed data from two prospective studies. The National Growth and Health Study (NGHS) included 1,067 girls with a mean age of 10 years who were reassessed at a mean age of 19 years. The NGHS measured body mass index (BMI); systolic and diastolic blood pressure; waist circumference; HDL cholesterol, fasting insulin, glucose, and lipid profiles; and parental diabetes.

The second study, the Princeton Follow-Up Study (PFS), included 822 boys and girls 6–18 years (mean age, 12 years) who were reassessed at a mean age of 39 years. The PFS measured BMI, systolic and diastolic blood pressure, parental diabetes, triglycerides, HDL cholesterol, and fasting glucose.

The final analysis included data from 80% of the girls in the NGHS and 53% of the children in the PFS (Arch. Pediatr. Adolesc. Med. 2010;164:53–60).

After cases of diabetes were excluded at study entry, the incidence of diabetes at age 39 years in the PFS was 5%. The incidence was higher in black women than white women (10% vs. 4%) and higher in black men than white men (5% vs. 3%). In the NGHS, diabetes incidence after 9 years was 1.2% in black women and 0.2% in white women.

In the PFS, childhood systolic blood pressure, BMI in the top fifth percentile, and black race were significant predictors of type 2 diabetes at 39 years of age. Conversely, if childhood BMI, systolic blood pressure, and diastolic blood pressure all fell below the 75th percentile, the chance of type 2 diabetes at 39 years of age was 2% if the parents had diabetes and 1% if they did not.

In the PFS, “simple office and laboratory measurements and knowledge of parental diabetes usefully predicted” the development of type 2 diabetes 22–30 years later, the researchers wrote.

In the NGHS, childhood systolic blood pressure in the top fifth percentile and parental diabetes were significant predictors of type 2 diabetes at age 19 years. If childhood BMI, systolic blood pressure, and diastolic blood pressure all fell below the 75th percentile, the chance of type 2 diabetes at 19 years of age was 0.2% whether the parents had diabetes or not, and 0.3% if childhood insulin also was below the 75th percentile.

Disclosures: The researchers had no financial conflicts to disclose. The study was supported in part by grants from the National Institutes of Health, the American Heart Association, the Taft Research Fund, and the Lipoprotein Research Fund of the Jewish Hospital of Cincinnati.

The ability to identify children on the path to type 2 diabetes may provide an opportunity to intervene.

Source DR. MORRISON

Several office-based pediatric measures, including body mass index and systolic and diastolic blood pressure, were significant predictors of type 2 diabetes in adulthood, based on data from a pair of follow-up studies including nearly 2,000 school-aged children.

The ability to identify children who are on the path to adult type 2 diabetes may give physicians an opportunity to intervene with diet and exercise recommendations, said John A. Morrison, Ph.D., of Cincinnati Children's Hospital Medical Center.

Dr. Morrison and his colleagues reviewed data from two prospective studies. The National Growth and Health Study (NGHS) included 1,067 girls with a mean age of 10 years who were reassessed at a mean age of 19 years. The NGHS measured body mass index (BMI); systolic and diastolic blood pressure; waist circumference; HDL cholesterol, fasting insulin, glucose, and lipid profiles; and parental diabetes.

The second study, the Princeton Follow-Up Study (PFS), included 822 boys and girls 6–18 years (mean age, 12 years) who were reassessed at a mean age of 39 years. The PFS measured BMI, systolic and diastolic blood pressure, parental diabetes, triglycerides, HDL cholesterol, and fasting glucose.

The final analysis included data from 80% of the girls in the NGHS and 53% of the children in the PFS (Arch. Pediatr. Adolesc. Med. 2010;164:53–60).

After cases of diabetes were excluded at study entry, the incidence of diabetes at age 39 years in the PFS was 5%. The incidence was higher in black women than white women (10% vs. 4%) and higher in black men than white men (5% vs. 3%). In the NGHS, diabetes incidence after 9 years was 1.2% in black women and 0.2% in white women.

In the PFS, childhood systolic blood pressure, BMI in the top fifth percentile, and black race were significant predictors of type 2 diabetes at 39 years of age. Conversely, if childhood BMI, systolic blood pressure, and diastolic blood pressure all fell below the 75th percentile, the chance of type 2 diabetes at 39 years of age was 2% if the parents had diabetes and 1% if they did not.

In the PFS, “simple office and laboratory measurements and knowledge of parental diabetes usefully predicted” the development of type 2 diabetes 22–30 years later, the researchers wrote.

In the NGHS, childhood systolic blood pressure in the top fifth percentile and parental diabetes were significant predictors of type 2 diabetes at age 19 years. If childhood BMI, systolic blood pressure, and diastolic blood pressure all fell below the 75th percentile, the chance of type 2 diabetes at 19 years of age was 0.2% whether the parents had diabetes or not, and 0.3% if childhood insulin also was below the 75th percentile.

Disclosures: The researchers had no financial conflicts to disclose. The study was supported in part by grants from the National Institutes of Health, the American Heart Association, the Taft Research Fund, and the Lipoprotein Research Fund of the Jewish Hospital of Cincinnati.

The ability to identify children on the path to type 2 diabetes may provide an opportunity to intervene.

Source DR. MORRISON

Several office-based pediatric measures, including body mass index and systolic and diastolic blood pressure, were significant predictors of type 2 diabetes in adulthood, based on data from a pair of follow-up studies including nearly 2,000 school-aged children.

The ability to identify children who are on the path to adult type 2 diabetes may give physicians an opportunity to intervene with diet and exercise recommendations, said John A. Morrison, Ph.D., of Cincinnati Children's Hospital Medical Center.

Dr. Morrison and his colleagues reviewed data from two prospective studies. The National Growth and Health Study (NGHS) included 1,067 girls with a mean age of 10 years who were reassessed at a mean age of 19 years. The NGHS measured body mass index (BMI); systolic and diastolic blood pressure; waist circumference; HDL cholesterol, fasting insulin, glucose, and lipid profiles; and parental diabetes.

The second study, the Princeton Follow-Up Study (PFS), included 822 boys and girls 6–18 years (mean age, 12 years) who were reassessed at a mean age of 39 years. The PFS measured BMI, systolic and diastolic blood pressure, parental diabetes, triglycerides, HDL cholesterol, and fasting glucose.

The final analysis included data from 80% of the girls in the NGHS and 53% of the children in the PFS (Arch. Pediatr. Adolesc. Med. 2010;164:53–60).

After cases of diabetes were excluded at study entry, the incidence of diabetes at age 39 years in the PFS was 5%. The incidence was higher in black women than white women (10% vs. 4%) and higher in black men than white men (5% vs. 3%). In the NGHS, diabetes incidence after 9 years was 1.2% in black women and 0.2% in white women.

In the PFS, childhood systolic blood pressure, BMI in the top fifth percentile, and black race were significant predictors of type 2 diabetes at 39 years of age. Conversely, if childhood BMI, systolic blood pressure, and diastolic blood pressure all fell below the 75th percentile, the chance of type 2 diabetes at 39 years of age was 2% if the parents had diabetes and 1% if they did not.

In the PFS, “simple office and laboratory measurements and knowledge of parental diabetes usefully predicted” the development of type 2 diabetes 22–30 years later, the researchers wrote.

In the NGHS, childhood systolic blood pressure in the top fifth percentile and parental diabetes were significant predictors of type 2 diabetes at age 19 years. If childhood BMI, systolic blood pressure, and diastolic blood pressure all fell below the 75th percentile, the chance of type 2 diabetes at 19 years of age was 0.2% whether the parents had diabetes or not, and 0.3% if childhood insulin also was below the 75th percentile.

Disclosures: The researchers had no financial conflicts to disclose. The study was supported in part by grants from the National Institutes of Health, the American Heart Association, the Taft Research Fund, and the Lipoprotein Research Fund of the Jewish Hospital of Cincinnati.

The ability to identify children on the path to type 2 diabetes may provide an opportunity to intervene.

Source DR. MORRISON

More than half of the adults hospitalized in the early days of the 2009 influenza A (H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a recent review.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with confirmed H1N1 influenza admitted to any hospital in New York City. The study population included 19 patients aged 0–4 years, 39 patients aged 5–17 years, 32 patients aged 18–49 years, 8 patients aged 50–64 years, and 1 patient aged 65 or older. The patients with H1N1 influenza were disproportionately younger compared with the general population (MMWR 2010;58:1436–40).

A total of 95 (96%) patients had fevers at admission, and 89 (90%) complained of cough. Also, 37 children (younger than 18 years) and 36 adults (aged 18 years and older) had at least one underlying medical condition known to increase the risk of flu complications, and 7 children and 10 adults had more than one such condition. Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Four of the five obese children and 11 of the 12 obese adults had underlying medical conditions, including asthma and Down syndrome. Three of the four patients who died were obese; their underlying medical conditions included asthma and Down syndrome.

Of the 76 patients treated with oseltamivir, 36 (47%) were treated within 2 days of symptom onset, but the median time to treatment from the onset of illness was 3 days. Hospital stays were shorter for patients who started antiviral therapy within 2 days.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

The findings confirm that patients at high risk should be encouraged to get vaccinated, the researchers said.

More than half of the adults hospitalized in the early days of the 2009 influenza A (H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a recent review.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with confirmed H1N1 influenza admitted to any hospital in New York City. The study population included 19 patients aged 0–4 years, 39 patients aged 5–17 years, 32 patients aged 18–49 years, 8 patients aged 50–64 years, and 1 patient aged 65 or older. The patients with H1N1 influenza were disproportionately younger compared with the general population (MMWR 2010;58:1436–40).

A total of 95 (96%) patients had fevers at admission, and 89 (90%) complained of cough. Also, 37 children (younger than 18 years) and 36 adults (aged 18 years and older) had at least one underlying medical condition known to increase the risk of flu complications, and 7 children and 10 adults had more than one such condition. Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Four of the five obese children and 11 of the 12 obese adults had underlying medical conditions, including asthma and Down syndrome. Three of the four patients who died were obese; their underlying medical conditions included asthma and Down syndrome.

Of the 76 patients treated with oseltamivir, 36 (47%) were treated within 2 days of symptom onset, but the median time to treatment from the onset of illness was 3 days. Hospital stays were shorter for patients who started antiviral therapy within 2 days.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

The findings confirm that patients at high risk should be encouraged to get vaccinated, the researchers said.

More than half of the adults hospitalized in the early days of the 2009 influenza A (H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a recent review.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with confirmed H1N1 influenza admitted to any hospital in New York City. The study population included 19 patients aged 0–4 years, 39 patients aged 5–17 years, 32 patients aged 18–49 years, 8 patients aged 50–64 years, and 1 patient aged 65 or older. The patients with H1N1 influenza were disproportionately younger compared with the general population (MMWR 2010;58:1436–40).

A total of 95 (96%) patients had fevers at admission, and 89 (90%) complained of cough. Also, 37 children (younger than 18 years) and 36 adults (aged 18 years and older) had at least one underlying medical condition known to increase the risk of flu complications, and 7 children and 10 adults had more than one such condition. Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Four of the five obese children and 11 of the 12 obese adults had underlying medical conditions, including asthma and Down syndrome. Three of the four patients who died were obese; their underlying medical conditions included asthma and Down syndrome.

Of the 76 patients treated with oseltamivir, 36 (47%) were treated within 2 days of symptom onset, but the median time to treatment from the onset of illness was 3 days. Hospital stays were shorter for patients who started antiviral therapy within 2 days.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

The findings confirm that patients at high risk should be encouraged to get vaccinated, the researchers said.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric band surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' BMIs ranged from 36 to 72 kg/m

Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

Disclosures: Dr. Teixeira has served as an advisoer to Allergan, which manufactures an adjustable gastric banding system.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric band surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' BMIs ranged from 36 to 72 kg/m

Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

Disclosures: Dr. Teixeira has served as an advisoer to Allergan, which manufactures an adjustable gastric banding system.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric band surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' BMIs ranged from 36 to 72 kg/m

Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

Disclosures: Dr. Teixeira has served as an advisoer to Allergan, which manufactures an adjustable gastric banding system.