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25 July 2018  |  Volume 5  |  Issue 15

Each bi-weekly issue of Current UpDate highlights a few of the recent, important additions to our "What's New" and "Practice Changing UpDates" topics.

This issue features “What’s New” entries related to:
  • Pregnancy-related hypertensive disorders and risk for cardiovascular disease
  • Updated guidelines from the International Workshop Group on chronic lymphocytic leukemia
  • Long-term risk of respiratory and allergic illnesses following tonsillectomy and adenoidectomy in childhood

To see "What's New" in your specialty (and 25 others, including drug therapy), or to read "Practice Changing UpDates" across all specialties, click here.

 
Pregnancy-related hypertensive disorders and risk for cardiovascular disease
 
Previous studies have established an association between pregnancy-related hypertensive disorders and future mortality from cardiovascular disease. A cohort study of long-term outcomes, comparing women with pregnancy-related hypertensive disorders in their first birth with normotensive women, found an association between pregnancy-related hypertension and increased risks for chronic hypertension, type 2 diabetes, and hypercholesterolemia, even after correction for multiple prepregnancy confounders [1]. The increased relative risk was highest in the first five years after delivery but persisted for decades. These findings add to the body of evidence supporting assessment of a history of pregnancy-related hypertension during post-pregnancy clinical care, with appropriate monitoring for other risk factors for cardiovascular disease and risk reduction interventions, when indicated.
1. Stuart JJ,Tanz LJ,Missmer SA, et al. Hypertensive Disorders of Pregnancy and Maternal Cardiovascular Disease Risk Factor Development: An Observational Cohort Study. Ann Intern Med 2018.

 

 
 
 
 
 
 
Updated guidelines from the International Workshop Group on chronic lymphocytic leukemia
 
The International Workshop Group on chronic lymphocytic leukemia (CLL) has updated guidelines addressing diagnosis, indications for treatment, response assessment, and supportive management of CLL [2]. Patients with one or more cytopenias due to bone marrow infiltration with typical CLL cells are now diagnosed with CLL regardless of the absolute lymphocyte count in the peripheral blood or the presence of lymphadenopathy. Indications for treatment now include symptomatic or functional extranodal involvement (table 1). Response criteria have been modified such that tumor mobilization and lymphocytosis during treatment with certain drugs (eg, ibrutinib, idelalisib) are no longer classified as progressive disease (table 2). These and other revisions have been incorporated into our content.
2.Hallek M,Cheson BD,Catovsky D, et al.iwCLL guidelines for diagnosis, indications for treatment, response assessment,andsupportivemanagementofCLL. Blood 2018; 131:2745.

 

 
 
 
 
Long-term risk of respiratory and allergic illnesses following tonsillectomy and adenoidectomy in childhood
 
It is unclear if children undergoing tonsillectomy and/or adenoidectomy are at increased risk of developing respiratory or allergic illnesses later in life. In the largest study addressing this question to date, which involved >1 million children followed for 10 to 30 years, rates of respiratory and allergic illnesses (eg, asthma, eczema, upper respiratory illness, pneumonia) were higher among children who underwent tonsillectomy and/or adenoidectomy than those who did not undergo surgery [3]. Whether the surgery itself increased the risk for these conditions remains uncertain. The observed association may be explained by underlying factor(s) that predispose both to conditions commonly treated with tonsillectomy and adenoidectomy (eg, obstructive sleep apnea, recurrent otitis media) and other respiratory and allergic illnesses.
3.Byars SG,Stearns SC,Boomsma JJ. Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood.JAMAOtolaryngolHeadNeckSurg 2018; 144:594.

 

 
 
 
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