2012 April 12

Pancreas divisum is not a cause of pancreatitis by itself but acts as a partner of genetic mutations.

Apr 122012

Pancreas divisum is not a cause of pancreatitis by itself but acts as a partner of genetic mutations.

Am J Gastroenterol. 2012 Feb;107(2):311-7

Authors: Bertin C, Pelletier AL, Vullierme MP, Bienvenu T, Rebours V, Hentic O, Maire F, Hammel P, Vilgrain V, Ruszniewski P, Lévy P

Abstract
OBJECTIVES: The role of pancreas divisum (PD) as a cause of acute recurrent or chronic pancreatitis (AR/CP) is still a matter of debate.
METHODS: The aims of this study were to evaluate the frequency of PD diagnosed using magnetic resonance cholangiopancreatography (MRCP) in patients with AR/CP of unknown origin (n=40) after careful exclusion of all known causes and to test the hypothesis of an interaction between anatomical (PD) and functional genetic anomalies (SPINK1, PRSS1, or CFTR gene mutations or polymorphisms (n=19, 25, and 30, respectively)) that could result in AR/CP. Patients with alcohol-induced pancreatitis (n=29) and subjects who had MRCP for a nonpancreatic disease (n=45) served as controls.
RESULTS: PD frequency was 7% in subjects without pancreatic disease, 7% in patients with alcohol-induced pancreatitis, and 5, 16, 16, and 47% in those with idiopathic, and PRSS1-, SPINK1-, and CFTR-associated pancreatitis, respectively (P<0.0001). There was no significant difference between idiopathic pancreatitis and the two control groups. The frequency of PD was higher in patients with CFTR gene-associated pancreatitis as compared with those with idiopathic and alcoholic pancreatitis (P<0.0001) and with those with SPINK1 and PRSS1 gene-associated pancreatitis (P<0.02).
CONCLUSIONS: The frequency of PD was not different in patients with idiopathic pancreatitis as compared with controls, demonstrating that PD by itself is not a cause of pancreatitis. PD frequency was higher in patients with genetic pancreatitis, especially in those with CFTR mutations or polymorphisms, suggesting a cumulative effect of these two cofactors.

PMID: 22158025 [PubMed - indexed for MEDLINE]

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Heparin or 0.9% sodium chloride to maintain central venous catheter patency: A randomized trial.

Crit Care Med Start a Discussion »

Apr 122012

Heparin or 0.9% sodium chloride to maintain central venous catheter patency: A randomized trial.

Crit Care Med. 2012 Apr 6;

Authors: Schallom ME, Prentice D, Sona C, Micek ST, Skrupky LP

Abstract
OBJECTIVE:: To compare heparin (3 mL, 10 units/mL) and 0.9% sodium chloride (NaCl, 10 mL) flush solutions with respect to central venous catheter lumen patency. DESIGN:: Single-center, randomized, open label trial. SETTING:: Medical intensive care unit and Surgical/Burn/Trauma intensive care unit at Barnes-Jewish Hospital, St. Louis, MO. PATIENTS:: Three hundred forty-one patients with multilumen central venous catheters. Patients with at least one lumen with a minimum of two flushes were included in the analysis. INTERVENTIONS:: Patients were randomly assigned within 12 hrs of central venous catheter insertion to receive either heparin or 0.9% sodium chloride flush. MEASUREMENTS AND MAIN RESULTS:: The primary outcome was lumen nonpatency. Secondary outcomes included the rates of loss of blood return, inability to infuse or flush through the lumen (flush failure), heparin-induced thrombocytopenia, and catheter-related blood stream infection. Assessment for patency was performed every 8 hrs in lumens without continuous infusions for the duration of catheter placement or discharge from intensive care unit. Three hundred twenty-six central venous catheters were studied yielding 709 lumens for analysis. The nonpatency rate was 3.8% in the heparin group (n = 314) and 6.3% in the 0.9% sodium chloride group (n = 395) (relative risk 1.66, 95% confidence interval 0.86-3.22, p = .136). The Kaplan-Meier analysis for time to first patency loss was not significantly different (log rank = 0.093) between groups. The rates of loss of blood return and flush failure were similar between the heparin and 0.9% sodium chloride groups. Pressureinjectable central venous catheters had significantly greater rates of nonpatency (10.6% vs. 4.3%, p = .001) and loss of blood return (37.0% vs. 18.8%, p<.001) compared to nonpressure-injectable catheters. The frequencies of heparin-induced thrombocytopenia and catheter-related blood stream infection were similar between groups. CONCLUSION:: 0.9% sodium chloride and heparin flushing solutions have similar rates of lumen nonpatency. Given potential safety concerns with the use of heparin, 0.9% sodium chloride may be the preferred flushing solution for short-term use central venous catheter maintenance.

PMID: 22488006 [PubMed - as supplied by publisher]

Link to Article at PubMed

Can early cardiac troponin I measurement help to predict recent coronary occlusion in out-of-hospital cardiac arrest survivors?

Crit Care Med Start a Discussion »

Apr 122012

Can early cardiac troponin I measurement help to predict recent coronary occlusion in out-of-hospital cardiac arrest survivors?

Crit Care Med. 2012 Apr 6;

Authors: Dumas F, Manzo-Silberman S, Fichet J, Mami Z, Zuber B, Vivien B, Chenevier-Gobeaux C, Varenne O, Empana JP, Pène F, Spaulding C, Cariou A

Abstract
OBJECTIVES:: Recent guidelines recommend the immediate performance of a coronary angiography when an acute myocardial infarction is suspected as a cause of out-of-hospital cardiac arrest. However, prehospital factors such as postresuscitation electrocardiogram pattern or clinical features are poorly sensitive in this setting. We searched to evaluate if an early measurement of cardiac troponin I can help to detect a recent coronary occlusion in out-of-hospital cardiac arrest. DESIGN:: Retrospective analysis of a prospective electronic registry database. SETTING:: University cardiac arrest center. PATIENTS:: Between January 2003 and December 2008, 422 out-of-hospital cardiac arrest survivors without obvious extra-cardiac cause have been consecutively studied. An immediate coronary angiography has been systematically performed. The primary outcome was the finding of a recent coronary occlusion. INTERVENTION:: First, blood cardiac troponin I levels at admission were analyzed to assess the optimum cutoff for identifying a recent coronary occlusion. Second, a logistic regression was performed to determine early predictive factors of a recent coronary occlusion (including cardiac troponin I) and their respective contribution. MEASUREMENTS AND MAIN RESULTS:: An ST-segment elevation was present in 127 of 422 patients (30%). During coronary angiography, a recent occlusion has been detected in 193 of 422 patients (46%). The optimum cardiac troponin I threshold was determined at 4.66 ng·mL (sensitivity 66.7%, specificity 66.4%). In multivariate analyses, in addition of smoking and epinephrine initial dose, cardiac troponin I (odds ratio 3.58 [2.03-6.32], p < .001) and ST-segment elevation (odds ratio 10.19 [5.39-19.26], p < .001) were independent predictive factors of a recent coronary occlusion. CONCLUSIONS:: In this large cohort of out-of-hospital cardiac arrest patients, isolated early cardiac troponin I measurement is modestly predictive of a recent coronary occlusion. Furthermore, the contribution of this parameter even in association with other factors does not seem helpful to predict recent occlusion. As a result and given the high benefit of percutaneous coronary intervention for such patients, the dosage of cardiac troponin I at admission could not help in the decision of early coronary angiogram.

PMID: 22488008 [PubMed - as supplied by publisher]

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Peramivir Use for Treatment of Hospitalized Patients with Influenza A(H1N1)pdm09 under Emergency Use Authorization, October 2009 – June 2010.

Clin Infect Dis Start a Discussion »

Apr 122012

Peramivir Use for Treatment of Hospitalized Patients with Influenza A(H1N1)pdm09 under Emergency Use Authorization, October 2009 - June 2010.

Clin Infect Dis. 2012 Apr 5;

Authors: Yu Y, Garg S, Yu PA, Kim HJ, Patel A, Merlin T, Redd S, Uyeki TM

Abstract
BackgroundIn response to the influenza A(H1N1)pdm09 [pH1N1] pandemic, peramivir, an investigational intravenous neuraminidase inhibitor, was made available for treatment of hospitalized patients with pH1N1 in the U.S. under Emergency Use Authorization (EUA). The Centers for Disease Control and Prevention (CDC) implemented a program to manage peramivir distribution to requesting clinicians under EUA. We describe results of CDC's peramivir program and three related surveys.MethodsWe analyzed data on peramivir requests made by clinicians to CDC through an electronic request system. Three surveys were administered to enhance clinician compliance with adverse event reporting, to conduct product accountability, and to collect data on peramivir-treated patients. Descriptive analyses were performed and two-source capture-recapture analysis, based upon the three surveys, was used to estimate the number of patients who received peramivir through the EUA.ResultsDuring October 23, 2009 to June 23, 2010, CDC received 1,371 clinician requests for peramivir and delivered 2,129 five-day adult treatment course equivalents of peramivir to 563 hospitals. Based on survey responses, at least 1,274 patients (median age 43 years, range 0-92 years, 49% male) received one or more doses of peramivir (median duration 6 days). Capture-recapture analysis yielded estimates for the potential total number of peramivir recipients ranging from 1,185 (95% CI: 1,076-1,293) to 1,490 (95% CI: 1,321-1,659).ConclusionsApproximately 1,274 hospitalized patients received peramivir through EUA program during the pH1N1 pandemic. Further analyses are needed to assess the clinical effectiveness of peramivir treatment of hospitalized patients with pH1N1.

PMID: 22491506 [PubMed - as supplied by publisher]

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Meta-analysis: vasoactive medications for the management of acute variceal bleeds.

Aliment Pharmacol Ther Start a Discussion »

Apr 122012

Meta-analysis: vasoactive medications for the management of acute variceal bleeds.

Aliment Pharmacol Ther. 2012 Apr 8;

Authors: Wells M, Chande N, Adams P, Beaton M, Levstik M, Boyce E, Mrkobrada M

Abstract
BACKGROUND: Vasoactive medications such as vasopressin, somatostatin and their analogues (terlipressin, vapreotide and octreotide) are commonly used for the treatment of acute variceal bleeding. However, the risks and benefits of these interventions are not well understood. AIM: To undertake a meta-analysis of the efficacy of vasoactive medications in patients having acute variceal bleeds. METHODS: Randomised controlled trials (RCTs) of vasopressin, somatostatin and their analogues, administered to patients with acute variceal bleeds were identified based on systematic searches of nine electronic databases and multiple sources of grey literature. RESULTS: The search identified 3011 citations, and 30 trials with a total of 3111 patients met eligibility criteria. The use of vasoactive agents was associated with a significantly lower risk of 7-day mortality (RR 0.74; 95% CI 0.57-0.95; P = 0.02; I(2) = 0%; moderate quality of evidence), and a significant improvement in haemostasis (RR 1.21, 95% CI 1.13-1.30; P < 0.001; I(2) = 28%; very low quality of evidence), lower transfusion requirements (pooled mean difference -0.70 units of blood transfused, 95% CI -1.01 to -0.38; P < 0.001; I(2) = 82%; moderate quality of evidence), and a shorter duration of hospitalisation (pooled mean difference -0.71 days; 95% CI -1.23 to -0.19; P = 0.007; I(2) = 0%; low quality of evidence). Studies comparing different vasoactive agents did not show a difference in efficacy, although the quality of evidence was very low. CONCLUSIONS: The use of vasoactive agents was associated with a significantly lower risk of acute all-cause mortality and transfusion requirements, and improved control of bleeding and shorter hospital stay. Studies comparing different vasoactive medications failed to demonstrate a difference in efficacy.

PMID: 22486630 [PubMed - as supplied by publisher]

Link to Article at PubMed

Lewd, crude, and rude behavior: the impact of manners and etiquette in the general hospital.

Psychosomatics Start a Discussion »

Apr 122012

Lewd, crude, and rude behavior: the impact of manners and etiquette in the general hospital.

Psychosomatics. 2012 Jan;53(1):13-20

Authors: Silverman BC, Stern TW, Gross AF, Rosenstein DL, Stern TA

Abstract
BACKGROUND: Lewd, crude, and rude behaviors of patients and staff members have the potential to complicate care; unfortunately, the medical literature on manners and etiquette is sparse.
OBJECTIVE: We sought to understand the impact of lewd, crude, and rude behaviors in the general hospital and to provide a context in which to educate clinicians about the management of troublesome behaviors of patients and staff members.
METHOD: We reviewed the history of etiquette in the general hospital, and discuss the ethical ramifications and clinical management of inappropriate behaviors.
RESULTS: Lewd, crude, and rude language and behaviors are often heard and seen in the general hospital; such behaviors can be understood in a biopsychosocial context.
CONCLUSIONS: Teaching trainees about manners and etiquette can help them identify and manage offensive behaviors and can facilitate the provision of effective and ethical care.

PMID: 22221717 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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