Possible link between bisphosphonates and atypical fractures
Is there a link between bisphosphonates and atypical femur fractures? 

The answer is unclear, but endocrinologists from the University of Sydney are encouraging clinicians to be alert to a fracture pattern they say might be linked to long-term use of the antiresorptive agents.

Two case series and three retrospective studies have identified a fracture pattern involving a transverse or oblique fracture line in an area of cortical thickening with a medial unicortical break.

Writing in an MJA editorial, Professor of Endocrinology Markus Seibel and clinical associate lecturer Christian Girgis, from the University of Sydney, said the fractures tended to occur in the subtrochanteric or mid-shaft area of the femur, normally considered the strongest part.

They encouraged doctors to be alert for reports of thigh or groin pain from this patient group because it could be a precursor to long bone fractures.

Despite the concerns, they acknowledge the evidence backing bisphosphonates as highly effective treatment for the prevention of osteoporotic fractures.

Med J Aust 2010; 193:196-198.


New lead as to why H1N1 was so infectious in humans
As the World Health Organization officially declared the global H1N1 pandemic over last week (1), new evidence about how the H1N1 virus spread with such stealth in humans was also revealed.

In a paper published in PLoS Pathogen , Japanese researchers reported that the H1N1 virus had been a mystery to researchers because for the avian virus to replicate in mammals it needed to have two amino acids – lysine and asparagine – at specific sites on a vital protein, and H1N1 viruses do not encode these amino acids.

However, the latest study found lysine was located in an unexpected position on the protein, increasing its adaptability and agility in taking command of the human cell for efficient viral replication.

The finding, from a rat model, offers another marker for predicting the potential for future pandemics, the authors said.

First identified in Mexico in April 2009, the H1N1 pandemic was responsible for around 18,000 deaths globally.

PLoS Pathog 2010; 6: e1001034. doi: 10.1371/journal.ppat.1001034.


Formula for estimating child’s weight using arm circumference
Chinese researchers have developed a formula for rapidly determining a child’s weight in trauma settings, based on arm circumference.


The prospective observational study compared the reliability of age, height, foot-length or mid-arm circumference for determining weight in healthy children aged from 1 to 11 years.

“Mid-arm circumference had the strongest relationship with weight, and this relationship grew stronger with age,” the authors from the Chinese University in Hong Kong and the faculty of Medicine at Melbourne University wrote in the journal Resuscitation.
The formula, derived from the study, was found to be at least as reliable as the Broselow method (which uses height) and better than age-based rules used for school children.
However the arm circumference formula was not reliable when used for pre-school children, the authors said.

The formula:  weight [kg] = (mid-arm circumference [cm] – 10) x 3

Resuscitation 2010;  doi:10.1016/j.resuscitation.2010.05.015

Asbestos still a health threat
Despite high-profile compensation cases drawing attention to the health risks associated with asbestos, millions of tonnes of chrysotile (white asbestos) continue to be produced overseas, putting people in poorer nations at risk.

Locally, education of tradespeople about where asbestos might be found in building material is crucial to avoid exposure, given residual asbestos-containing materials are found in pre-1980 building materials.

A group of leading public health, cancer, occupational health and respiratory experts are calling for international action to ban the mining and manufacturing of asbestos and raise public awareness of the risk associated with the product.

“Asbestos will be with us for decades, so targeted and contextually appropriate education programs for at-risk populations are required,” the authors wrote in the latest MJA.

Med J Aust 2010; 193: 198-199.

Posted 16 August, 2010

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