Blood pressure targets in chronic kidney disease
Intensive blood pressure lowering is effective for preserving kidney function in chronic kidney disease, but the benefit appears to be limited to patients with proteinuria. This systematic review of 11 randomized trials by Lv and colleagues also found that there was no significant cardiovascular or survival benefit to lower blood pressure targets. Too few trials included patients with diabetes to assess benefit in this disease. See Research, page 949
The guideline on intensive blood pressure lowering in chronic kidney disease is based on trial evidence that is convincing but, all the same, not very robust. In this commentary, Hildebrand and Garg call for better trials that would help to confirm the benefit, allow us to examine other possible ones and tell us more about potential adverse effects. See Commentary, page 941
Sensitivity, specificity and prevalence
The estimated specificity of a diagnostic test was lower in studies with a higher prevalence of disease, but sensitivity and prevalence were not associated overall. This study evaluated 23 meta-analyses, containing 416 individual studies, identified from a prior systematic literature review. When applying evidence from studies of diagnosis, clinicians should preferentially emphasize studies whose prevalence is closest to that of their own clinical context, say the authors. See Research, page E537
Early eating habits and cholesterol
Eating behaviours in preschool-aged children were associated with serum non-HDL cholesterol levels. Parents’ answers to a nutritional questionnaire were compared with blood test results and other measurements from 1076 children aged 3–5 years in this cross-sectional study. These results support arguments for interventions aimed at improving the eating behaviours of young children, suggest the authors. See Research, page E531
Mental disorders in the military
Canadian Forces personnel deployed in support of the mission in Afghanistan were at increased risk of later having a mental disorder such as posttraumatic stress disorder perceived to be related to the deployment. Boulos and Zamorski reviewed the medical records of 2014 personnel and linked them to information from Canadian Forces databases to identify the most common mental disorders and the associated risk factors. Determining long-term outcomes is an important next step, suggest the authors. See Research, page E545
Blood pressure in type 2 diabetes
What should the target blood pressure be for patients with type 2 diabetes and hypertension? 130/80 mm Hg? Or is 140/80 mm Hg safer? Rabi and colleagues review the evidence behind these blood pressure targets. See Review, page 963
Magnet ingestion by a 3-year-old boy
Although rare-earth magnets have made it much easier to post children’s artwork on the refrigerator, their ready availability has led to increased ingestion by children. Ingestion of a single magnet generally does not cause problems, but ingestion of more than 1 magnet can result in gastrointestinal perforation. Rosenfield and colleagues review the management of this increasingly common problem. See Practice, page 972
Concussions
We have heard a lot in the news about the consequences of concussion among amateur and professional athletes alike. Rest is one of the most important aspects of initial management, but the term “rest” now includes rest from cognitive activities. Tator reviews the latest information on concussion and highlights some revised clinical tools for use in the office and on the playing field. See Practice, page 975
Because our understanding of concussion is improving, the management of this common condition is changing, say Purcell and colleagues for the Canadian Concussion Collaborative. We now know that concussions can occur even without loss of consciousness. See Practice, page 981