Idarucizumab for dabigatran reversalDabigatran is an oral thrombin inhibitor which has been shown to be an effective anticoagulant and, unlike warfarin, does not need frequent blood tests to make it effective and safe. However, until now there has been no way to rapidly reverse its effects.Idarucizumab, a monoclonal antibody fragment, binds dabigatran with an affinity that is 350 times as high as that observed with thrombin. This report concerns a prospective study which evaluates its effectiveness in the clinical setting. 90 patients being treated with dabigatran were involved. 51 of them has serious bleeding and 39 required an urgent surgical procedure.Apparently, 5g of intravenous idarucizumab completely reversed the anticoagulant effect of dabigatran within minutes. There were no toxic or rebound hypercoagulable effects.N Eng J Med 2015;373:511-20Birth weight and later life adherence to unhealthy lifestyles predicting type 2 diabetesBoth unhealthy lifestyles and early development have been implicated in the rapid rise of type 2 diabetes, but very few studies have explored potential interaction between prenatal and postnatal factors.This prospective cohort study reviews this matter by evaluating data obtained from approximately 150,000 male and female health professionals in the US. The subjects did not have diabetes, cardiovascular disease or cancer at baseline and were followed for 20-30 years. The researchers defined unhealthy lifestyle on the basis of body mass index, smoking, physical activity, alcohol consumption and the alternate healthy eating index.The conclusions reached were that both low birth weight and unhealthy lifestyle are associated with a significantly higher risk of type 2 diabetes and the joint effects of low birth rate and unhealthy lifestyle score are greater than the addition of risks associated with each individual factor, indicating significant interaction on an additive scale.BMJ 2015;351:h3673Induction of labour vs expectant management for large-for-date fetusesMacrosomic fetuses are at increased risk of shoulder dystocia. This randomised trial aimed to compare induction of labour with expectant management for large-for-date fetuses for prevention of shoulder dystocia and other neonatal and maternal morbidity associated with macrosomia.Nineteen tertiary-care centres in France, Switzerland and Belgium were involved. Women with singleton fetuses whose estimated weight exceeded the 95th percentile, were randomly assigned to receive induction of labour within 3 days between 37+0 weeks and 38+6 weeks of gestation, or expectant management. There were 407 women in the induction group and 411 in the expectant management group.The conclusions reached were that induction of labour for suspected large-for-date fetuses is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management. Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal delivery. These benefits should be balanced with the effects pf early-term induction of labour.Lancet 2015;385:2600-05

Idarucizumab for dabigatran reversalDabigatran is an oral thrombin inhibitor which has been shown to be an effective anticoagulant and, unlike warfarin, does not need frequent blood tests to make it effective and safe. However, until now there has been no way to rapidly reverse its effects.Idarucizumab, a monoclonal antibody fragment, binds dabigatran with an affinity that is 350 times as high as that observed with thrombin. This report concerns a prospective study which evaluates its effectiveness in the clinical setting. 90 patients being treated with dabigatran were involved. 51 of them has serious bleeding and 39 required an urgent surgical procedure.Apparently, 5g of intravenous idarucizumab completely reversed the anticoagulant effect of dabigatran within minutes. There were no toxic or rebound hypercoagulable effects.N Eng J Med 2015;373:511-20Birth weight and later life adherence to unhealthy lifestyles predicting type 2 diabetesBoth unhealthy lifestyles and early development have been implicated in the rapid rise of type 2 diabetes, but very few studies have explored potential interaction between prenatal and postnatal factors.This prospective cohort study reviews this matter by evaluating data obtained from approximately 150,000 male and female health professionals in the US. The subjects did not have diabetes, cardiovascular disease or cancer at baseline and were followed for 20-30 years. The researchers defined unhealthy lifestyle on the basis of body mass index, smoking, physical activity, alcohol consumption and the alternate healthy eating index.The conclusions reached were that both low birth weight and unhealthy lifestyle are associated with a significantly higher risk of type 2 diabetes and the joint effects of low birth rate and unhealthy lifestyle score are greater than the addition of risks associated with each individual factor, indicating significant interaction on an additive scale.BMJ 2015;351:h3673Induction of labour vs expectant management for large-for-date fetusesMacrosomic fetuses are at increased risk of shoulder dystocia. This randomised trial aimed to compare induction of labour with expectant management for large-for-date fetuses for prevention of shoulder dystocia and other neonatal and maternal morbidity associated with macrosomia.Nineteen tertiary-care centres in France, Switzerland and Belgium were involved. Women with singleton fetuses whose estimated weight exceeded the 95th percentile, were randomly assigned to receive induction of labour within 3 days between 37+0 weeks and 38+6 weeks of gestation, or expectant management. There were 407 women in the induction group and 411 in the expectant management group.The conclusions reached were that induction of labour for suspected large-for-date fetuses is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management. Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal delivery. These benefits should be balanced with the effects pf early-term induction of labour.Lancet 2015;385:2600-05