Ibuprofen first may be best for kids' fever

NEW YORK (Reuters Health) — The optimal method of reducing fever in children is to start with ibuprofen alone and then consider using paracetamol plus ibuprofen later, results of a new clinical trial suggest.

Ibuprofen is the ingredient in brand-name products like Advil or Motrin, while paracetamol — called acetaminophen in many regions — is found in Tylenol, for example. Both ibuprofen and paracetamol are widely available as generic products.

As reported in the British Medical Journal, Dr. Alastair D. Hay, from the University of Bristol, UK, and colleagues assessed the duration of fever in 146 children, between six months and six years of age, who were randomly assigned to get ibuprofen, paracetamol, or both for a high temperature.

In the first four hours after treatment, the drug combination cut the duration of fever by about 55 minutes compared with paracetamol alone. Ibuprofen alone was comparable to the combined therapy.

Over 24 hours, paracetamol plus ibuprofen reduced the fever duration by 4.4 hours relative to paracetamol alone and by 2.5 hours compared to ibuprofen alone.

Side effects were comparable with each treatment.

The authors of the report conclude: "Doctors, nurses, pharmacists, and parents wanting to use medicines to treat young, unwell children with fever should be advised to use ibuprofen first and to consider the relative benefits and risks of using paracetamol plus ibuprofen over a 24 hour period."

Prostate irradiation raises risk of cancer

NEW YORK (Reuters Health) — Data from the Geneva Cancer Registry show an increased long-term risk of colon cancer in men who have undergone external radiation therapy for prostate cancer.

"The risk of second cancer after irradiation, although probably small, needs nevertheless to be carefully monitored," the study team advises.

Dr. Christine Bouchardy from the University of Geneva, Switzerland and colleagues analysed data on 1,134 men diagnosed with prostate cancer between 1980 and 1998 who survived for at least 5 years after diagnosis. Of these, 264 were treated with external radiation.

During follow-up through the end of 2003, 19 men out of the total group developed colorectal cancer.

The risk of colorectal cancer among the men who did not have radiation therapy was not increased compared to the general population, but it was 3.4-times higher than normal among the men who did have radiation, the team reports in the International Journal of Cancer.

On further analysis, the risk was significantly increased for colon cancer specifically but not for rectal cancer. The risk of colon cancer was mainly elevated in the five- to nine-year period after diagnosis, according to Bouchardy and colleagues.

Genes may link birth weight, diabetes

NEW YORK (Reuters Health) — A large study of Swedish twins indicates that a common genetic cause underlies both low birth weight and the propensity to develop Type 2 diabetes.

While low birth weight is more common among individuals with Type 2 diabetes, poor fetal nutrition and other environmental factors leading to low birth weight do not "cause" diabetes, according Dr. Stefan Johansson and colleagues.

Rather, data from their study suggest that common genes may be responsible for both reduced fetal growth and development of diabetes in adulthood, said Johansson, of the Karolinska Institute in Stockholm.

In the journal Epidemiology, Johansson's group describes their study of 18,230 fraternal and identical twins (592 with Type 2 diabetes), born between 1926 and 1958.

Twins share the same early environment, but identical twins, of course, also share the same genetic makeup, whereas fraternal twins have different sets of genes.

The investigators first examined all twins as independent individuals, Johansson told Reuters Health. Similar to previous research, the current analysis found that low birth weight was more common among adults with Type 2 diabetes.

Johansson's group further analysed the twins as pairs when one had diabetes and the other did not. This showed a continued link between low birth weight and diabetes among fraternal twins but no such link between identical twins who share all their genes.

Explaining what this means, Johansson said: "Within a fraternal twin pair, the lighter twin would face an increased risk of diabetes ... But within an identical twin pair, the lighter and the heavier twin have the same risk of developing diabetes later in life."

Inflammatory bowels linked to depression

NEW YORK (Reuters Health) — Rates of depression, and possibly some types of anxiety disorder, are high among people with inflammatory bowel disease or IBD — conditions such as Crohn's disease and ulcerative colitis — Canadian researchers report.

"There is a relatively high incidence of anxiety and mood disorders in IBD," Dr. Charles N. Bernstein from the University of Manitoba, Winnipeg, told Reuters Health. "This needs to be addressed with all patients as readily as their arthritis or skin rashes need addressing."

Bernstein and colleagues in the Manitoba IBD Cohort Study assessed rates of anxiety and mood disorders in 351 patients with clearly established IBD, compared with 779 similar people surveyed in the same region, and with general populations in the United States and New Zealand.

Compared with the general populations, IBD patients had higher rates of panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and major depression, the researchers report in the American Journal of Gastroenterology.