2009 June 25

Proton pump inhibitors as a treatment method for type II diabetes.

Jun 252009

Proton pump inhibitors as a treatment method for type II diabetes.

Med Hypotheses. 2009 Jul;73(1):29-32

Authors: Mefford IN, Wade EU

Recent reports have hypothesized a role for exogenously administered gastrin in regulating beta cell function or activity. We surmised that a class of agents, proton pump inhibitors (omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole), known to increase serum gastrin levels could have such an effect, and that data might be available in our database which could address such an effect. We examined our electronic database to obtain glycohemoglobin (HgbA1c) levels measured in the past two years from all type II diabetics and extracted from those diabetics who were concurrently taking a proton pump inhibitor. A comparison of these groups showed an average HgbA1c of 7.6% for type II diabetics not taking a proton pump inhibitor (n=282) and an average HgbA1c of 7.0% for type II diabetics concurrently taking a proton pump inhibitor (n=65), T=-3.61, p=0.002. These data support the hypothesis that proton pump inhibitors can be used to treat type II diabetes.

PMID: 19304401 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Relationship of carbapenem restriction in 22 university teaching hospitals to carbapenem use and carbapenem-resistant Pseudomonas aeruginosa.

Antimicrob Agents Chemother Start a Discussion »

Jun 252009

Relationship of carbapenem restriction in 22 university teaching hospitals to carbapenem use and carbapenem-resistant Pseudomonas aeruginosa.

Antimicrob Agents Chemother. 2009 May;53(5):1983-6

Authors: Pakyz AL, Oinonen M, Polk RE

Many hospital antimicrobial stewardship programs restrict the availability of selected drugs by requiring prior approval. Carbapenems may be among the restricted drugs, but it is unclear if hospitals that restrict availability actually use fewer carbapenems than hospitals that do not restrict use. Nor is it clear if restriction is related to resistance. We evaluated the relationship between carbapenem restriction and the volume of carbapenem use and both the incidence rate and proportion of carbapenem-resistant Pseudomonas aeruginosa isolates from 2002 through 2006 in a retrospective, longitudinal, multicenter analysis among a consortium of academic health centers. Carbapenem use was measured from billing records as days of therapy per 1,000 patient days. Hospital antibiograms were used to determine both the incidence rate and proportion of carbapenem-resistant P. aeruginosa isolates. A survey inquired about restriction policies for antibiotics, including carbapenems. General linear mixed models were used to examine study outcomes. Among 22 hospitals with sufficient data for analysis, overall carbapenem use increased significantly over the 5 years of study (P < 0.0001), although overall carbapenem resistance in P. aeruginosa did not change. Hospitals that restricted carbapenems (n = 8; 36%) used significantly fewer carbapenems (P = 0.04) and reported lower incidence rates of carbapenem-resistant P. aeruginosa (P = 0.01) for all study years. Fluoroquinolone use was a potential confounder of these relationships, but hospitals that restricted carbapenems actually used fewer fluoroquinolones than those that did not. Restriction of carbapenems is associated with both lower use and lower incidence rates of carbapenem resistance in P. aeruginosa.

PMID: 19273670 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Antibiotic prophylaxis for spontaneous bacterial peritonitis in cirrhotic patients with ascites, without gastro-intestinal bleeding.

Cochrane Database Syst Rev Start a Discussion »

Jun 252009

Antibiotic prophylaxis for spontaneous bacterial peritonitis in cirrhotic patients with ascites, without gastro-intestinal bleeding.

Cochrane Database Syst Rev. 2009;(2):CD004791

Authors: Cohen MJ, Sahar T, Benenson S, Elinav E, Brezis M, Soares-Weiser K

BACKGROUND: Spontaneous bacterial peritonitis is frequent among cirrhotic patients, associated with significant morbidity and mortality. Selective intestinal decontamination employing antibiotics is a proposed prophylactic measure. While data regarding this modality among cirrhotic patients with gastrointestinal bleeding exist, there is insufficient data synthesis regarding cirrhotic patients with ascites and no gastrointestinal bleeding. OBJECTIVES: To assess whether antibiotic prophylaxis decreases spontaneous bacterial peritonitis and mortality among cirrhotic patients with ascites and no gastrointestinal bleeding. SEARCH STRATEGY: We identified relevant randomised trials by searching trial registries of The Cochrane Hepato-Biliary Group and The Cochrane Collaboration, medical literature search engines, and reviewing all literature we found on the topic until February 2009. SELECTION CRITERIA: We searched for randomised clinical trials assessing prophylactic treatment among adult cirrhotic patients with ascites and no gastrointestinal bleeding, comparing antibiotic therapy with no intervention, placebo, or with another antibiotic regimen. DATA COLLECTION AND ANALYSIS: Three independent authors searched for and collected the trials and extracted relevant data. Four other independent authors validated the findings and assessed them. The studies were assessed for design, patient and intervention characteristics, and quality. A meta-analysis was performed to estimate measures of association between antibiotic prophylaxis and spontaneous bacterial peritonitis or mortality. MAIN RESULTS: Nine trials were included in the review. Seven trials, comparing antibiotics to placebo or no treatment, were meta-analysed. Systematic bias in design or publication is suggested by trial results. The randomisation results suggest that the probability that true randomisation took place in all trials is very small and the report of most trials regarding design was poor. The proportion of participants with spontaneous bacterial peritonitis varied between the trials from 15% to 50%. The calculated relative risks (95% confidence interval) of spontaneous bacterial peritonitis and mortality among patients treated with antibiotics compared with no treatment/placebo were 0.20 (0.11 to 0.37) and 0.61 (0.43 to 0.87). There were very few reports of adverse events. AUTHORS' CONCLUSIONS: The pooled estimates suggest that antibiotic prophylaxis might be prudent among cirrhotic patients with ascites and no gastrointestinal bleeding. However, poor trial methodology and report coupled with findings suggesting systematic bias in publication and design reflect the fragility of these findings. Potential hazard to society and the patients themselves from resistant pathogens should be considered when promoting long-lasting antibiotic prophylaxis. It seems that recommending antibiotic prophylaxis is still far from being a substantiated prevention strategy. Trials of better design, well reported, and of longer follow-up are greatly needed.

PMID: 19370611 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Myopathic complications of medical disease.

Semin Neurol Start a Discussion »

Jun 252009

Myopathic complications of medical disease.

Semin Neurol. 2009 Apr;29(2):163-80

Authors: Soni M, Amato AA

Disorders of muscle may be primary or acquired secondary to an underlying medical condition. Clinical presentations range from asymptomatic elevations in creatine kinase to fatal rhabdomyolysis. Recognition of the underlying precipitant is imperative to effectively institute treatment for a potentially reversible process. The focus of this article is to review complications of systemic illness that result in signs and symptoms of muscle dysfunction. Myopathic complications of endocrinopathy, metabolic abnormalities, medications, critical illness, organ transplantation, infection, autoimmune conditions, malignancy, and toxin exposure are discussed, with an emphasis on the clinical features, electromyography, and muscle biopsy findings.

PMID: 19370496 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Association between blood glucose levels and development of candidemia in hospitalized patients.

Endocr Pract Start a Discussion »

Jun 252009

Association between blood glucose levels and development of candidemia in hospitalized patients.

Endocr Pract. 2009 Mar-Apr;15(2):111-5

Authors: Shoham S, Han G, Granek T, Walsh T, Magee MF

OBJECTIVE: To examine the relationship between blood glucose levels in hospitalized patients and the risk of occurrence of candidemia. METHODS: We undertook a retrospective review of medical records and hospital computerized database information to compare blood glucose levels in 48 patients with nosocomial candidemia and 144 contemporaneous matched control subjects without candidemia at a tertiary teaching hospital. RESULTS: The proportions of days (for patients with candidemia versus control subjects without candidemia) with blood glucose levels >or=100 mg/dL (293 of 325 [90%] versus 849 of 1,007 [84%]; P = .009), >or=140 mg/dL (184 of 325 [57%] versus 507 of 1,007 [50%]; P = .049), and >or=200 mg/dL (80 of 325 [25%] versus 163 of 1,007 [16%]; P = .001) were significantly higher during the 7 days preceding the diagnosis of candidemia than during a 7-day period of hospitalization of control subjects. Blood glucose levels exceeding 200 mg/dL for 4 or more days of the week preceding the diagnosis of candidemia were significantly associated with its development (P = .04; odds ratio, 2.44; and 95% confidence interval, 1.01 to 5.94). CONCLUSION: Inpatient hyperglycemia is an important--and potentially modifiable-risk factor for development of nosocomial candidemia. These findings have implications for innovative infection control strategies that focus on glycemic control.

PMID: 19289320 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Hyponatremia in hepatic encephalopathy: an accomplice or innocent bystander?

Am J Gastroenterol Start a Discussion »

Jun 252009

Hyponatremia in hepatic encephalopathy: an accomplice or innocent bystander?

Am J Gastroenterol. 2009 Jun;104(6):1390-1

Authors: Yun BC, Kim WR

Hyponatremia, a common complication inpatients with advanced liver disease and impaired free water clearance, has been shown to be an important predictor of short-term mortality. Hepatic encephalopathy, also a late complication of end-stage liver disease, has been associated with low-grade cerebral edema as a result of swelling of astrocytes. Guevara et al. hypothesized that hyponatremia and the resultant depletion of organic osmolytes (e.g.,myo-inositol) from brain cells contribute to brain edema, playing an important role in the pathogenesis of hepatic encephalopathy. Using a multivariable analysis, they demonstrated that hyponatremia increased the risk of hepatic encephalopathy more than eightfold, after adjustment for serum bilirubin and creatinine concentrations and previous history of encephalopathy. Their magnetic resonance spectroscopy data correlated low brain concentrations of myoinositol with hepatic encephalopathy. As both hyponatremia and encephalopathy occur in patients with advanced liver disease, it has been difficult to implicate hyponatremia independently in the pathogenesis of hepatic encephalopathy. Guevara's data do suggest that hyponatremia is more likely an accomplice than an innocent bystander.

PMID: 19455127 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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