2009 August 29

Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends.

Aug 292009

Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends.

Lancet. 2009 Aug 15;374(9689):565-76

Authors: Sun JC, Davidson MJ, Lamy A, Eikelboom JW

Over 4 million people worldwide have received a prosthetic heart valve, and an estimated 300,000 valves are being implanted every year. Prosthetic heart valves improve quality of life and survival of patients with severe valvular heart disease, but the need for antithrombotic therapy to prevent thrombotic complications in valve recipients poses challenges for clinicians and patients. Here, we review antithrombotic therapies for patients with prosthetic heart valves and management of thromboembolic complications. Advances in antithrombotic therapy and valve technologies are likely to improve the management of patients with prosthetic heart valves in developed countries, but the most important unmet need and potential for benefit from these new therapies is in developing countries where a massive and rapidly increasing burden of valvular heart disease exists.

PMID: 19683642 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Diabetes and acute coronary syndromes.

Best Pract Res Clin Endocrinol Metab Start a Discussion »

Aug 292009

Diabetes and acute coronary syndromes.

Best Pract Res Clin Endocrinol Metab. 2009 Jun;23(3):305-16

Authors: Roffi M, Eberli FR

Diabetic patients with acute coronary syndromes (ACSs) are at a high risk for subsequent cardiovascular events but derive, at the same time, greater benefit from evidence-based therapy than non-diabetic individuals. State-of-the-art anti-thrombotic therapy includes a triple anti-platelet combination - aspirin, clopidogrel and glycoprotein (GP) IIb/IIIa receptor inhibitors - and unfractionated heparin or enoxaparin. For low- or medium-risk individuals, a treatment based on aspirin, clopidogrel and bivalirudin is a valuable alternative. Prasugrel, a new and more potent inhibitor of the platelet P2Y(12) receptor, has to be regarded as the most promising anti-thrombotic agent for diabetic patients with ACS. This agent may replace clopidogrel - and possibly GP IIb/IIIa inhibitors - in the future. In addition to aggressive anti-thrombotic therapy, diabetic patients should undergo systematic early invasive angiography if presenting with non-ST-segment elevation ACS, and immediate percutaneous coronary intervention if presenting with ST-segment elevation myocardial infarction. Indeed, the benefit derived from these strategies appears to be more pronounced in the diabetic population than in non-diabetic individuals. Despite the benefit, multiple surveys have demonstrated that, in the setting of ACS, diabetic patients receive evidence-based therapy less frequently than non-diabetic counterparts.

PMID: 19520305 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Invasive mold infections: recent advances in management approaches.

Leuk Lymphoma Start a Discussion »

Aug 292009

Invasive mold infections: recent advances in management approaches.

Leuk Lymphoma. 2009 May;50(5):703-15

Authors: Chandrasekar P

An increasing number of patients are undergoing transplantation procedures or receiving aggressive immunosuppression and chemotherapy. The growing population of immunocompromised hosts has led to a rise in the prevalence of invasive fungal infections (IFIs) due to yeasts and molds. Recent trends suggest that patients are acquiring infections with non-Candida albicans species, non-Aspergillus fumigatus species and non-Aspergillus molds such as Fusarium species, Scedosporium species and Zygomycetes. There are also a few reports of resistance to standard azole and echinocandin therapy, and some Aspergillus (A. ustus, A. terreus) and Scedosporium species are inherently resistant to polyenes. Early diagnosis and appropriate treatment of mold infections are important to improve outcomes. The use of high-resolution computed tomography scanning and new diagnostic tools such as the galactomannan and beta-glucan tests help early detection of IFIs. With the changing epidemiology of fungal infections and emergence of rare pathogens, and with the availability of a larger number of antifungal drugs, new management strategies are evolving to effectively treat invasive mold infections.

PMID: 19337880 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Clinical efficacy of intravenous ciprofloxacin in patients with biliary tract infection: a randomized controlled trial with carbapenem as comparator.

J Gastroenterol Start a Discussion »

Aug 292009

Clinical efficacy of intravenous ciprofloxacin in patients with biliary tract infection: a randomized controlled trial with carbapenem as comparator.

J Gastroenterol. 2009;44(7):781-92

Authors: Tazuma S, Igarashi Y, Tsuyuguchi T, Ohara H, Inui K, Ohya T,

BACKGROUND: We conducted a randomized controlled trial (RCT) to evaluate the clinical efficacy of an intravenous fluoroquinolone, ciprofloxacin (CIP), in patients with biliary tract infection requiring biliary drainage using imipenem/cilastatin (IPM/CS) as a control. METHODS: After the initial collection of bile, patients were randomly assigned to receive CIP at 300 mg twice daily by intravenous drip infusion or IPM/CS at 500 mg twice daily by intravenous drip infusion with the envelope method. RESULTS: The characteristics of the 104 patients evaluated for efficacy were well balanced. The clinical response rates were 100.0% (50/50 patients) in the CIP group and 94.4% (51/54) in the IPM/CS group. The difference in clinical response rate between groups (CIP, IPM/CS) was 5.56% (90% confidence interval: -0.26%, 13.95%), and the non-inferiority of CIP to IPM/CS was confirmed. Adverse events for which causal relationships with the study drugs could not be ruled out developed in 5.4% (3/56) of patients in the CIP group and 5.2% (3/58) of patients in the IPM/CS group, and none of them were serious. CONCLUSIONS: The clinical efficacy of CIP in treating biliary tract infection requiring drainage was comparable to that of IPM/CS. These findings suggest that CIP is useful as a new therapeutic option for biliary tract infection.

PMID: 19466504 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Prevalence of mid-gastrointestinal bleeding in patients with acute overt gastrointestinal bleeding: multi-center experience with 1,044 consecutive patients.

J Gastroenterol Start a Discussion »

Aug 292009

Prevalence of mid-gastrointestinal bleeding in patients with acute overt gastrointestinal bleeding: multi-center experience with 1,044 consecutive patients.

J Gastroenterol. 2009;44(6):550-5

Authors: Okazaki H, Fujiwara Y, Sugimori S, Nagami Y, Kameda N, Machida H, Yamagami H, Tanigawa T, Shiba M, Watanabe K, Tominaga K, Watanabe T, Oshitani N, Arakawa T

BACKGROUND: Video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) enable the detection of small intestinal lesions. AIM: To examine causes of acute overt gastrointestinal (GI) bleeding and the prevalence of mid-GI bleeding, defined as small intestinal bleeding from the ampulla of Vater to the terminal ileum, in a multi-center experience in Japan in the VCE/DBE era. METHODS: Data were collected retrospectively from consecutive patients with acute overt GI bleeding in ten participating hospitals. All patients were examined by esophagogastroduodenoscopy and/or colonoscopy. When the source of bleeding was not identified after these procedures, patients suspected to have mid-GI bleeding were referred to our hospital and VCE/DBE was performed to determine the source of bleeding. RESULTS: Of the 1044 patients with acute overt GI bleeding, 524 (50.2%) patients were diagnosed with upper GI bleeding, 442 (42.3%) with lower GI bleeding, and 13 (1.2%) with mid-GI bleeding. Gastric ulcer was the most common cause of bleeding (20.4%). Among cases of mid-GI bleeding, ulcers were found in 4 (30.8%) patients, erosions in 3 (23.1%), angiodysplasia in 3 (23.1%), submucosal tumor in 2 (15.4%), and hemangioma in one (7.7%). Seven lesions were located in the jejunum, 5 in the ileum, and one in both the jejunum and ileum. Analysis of age-related cause showed that the prevalence of mid-GI bleeding among younger patients under 40 years of age was higher (5%) than in other age groups (1-2%). CONCLUSION: mid-GI bleeding is rare among Japanese patients with acute overt GI bleeding.

PMID: 19360374 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

What’s growing on your stethoscope? (And what you can do about it).

J Fam Pract Start a Discussion »

Aug 292009

What's growing on your stethoscope? (And what you can do about it).

J Fam Pract. 2009 Aug;58(8):404-9

Authors: Schroeder A, Schroeder MA, D'Amico F

BACKGROUND: Studies have shown that rubbing alcohol pads on stethoscope diaphragms can reduce bacterial colonization, but alcohol pads are used infrequently used and not always available. METHODS: We conducted a prospective, single-blinded study to investigate whether simultaneously scrubbing hands and stethoscope head with alcohol-based hand foam would significantly reduce bacterial counts on the stethoscope. Using their own stethoscope, participants imprinted the stethoscope head onto a chocolate agar plate, then used alcohol-based hand foam to cleanse their hands while simultaneously rubbing the stethoscope head. Once the stethoscope heads were dry, the participants imprinted their stethoscope heads onto a second plate. After 48 hours' incubation, we determined the bacterial counts for the prewash and post-wash plates, and compared the 2. RESULTS: We analyzed a total of 184 cultures (from 92 stethoscopes). Both the mean (28 prewash vs 3 post-wash, P=.001) and median (11 prewash vs 1 post-wash, P=.001) colony counts were significantly greater before being cleansed. Three methicillin-resistant Staphylococcus aureus (MRSA) colonies were identified in the prewash period; all were destroyed by the foam. The estimated number of hand washes needed to prevent 1 MRSA colony is 31 (95% confidence interval [CI], 18-89). CONCLUSION: Simultaneously using hand foam to clean hands and stethoscope heads reduces bacterial counts on stethoscopes. Further research is needed to determine whether this intervention can reduce morbidity and mortality associated with bacterial infection.

PMID: 19679019 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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