Day: 03/08/2013

Novel Strategy for Preventing CDI.

Posted by

0


 

Antigermination therapy prevented disease in mice challenged with massive inocula of C. difficile spores.

Spore germination is necessary for the development of symptomatic Clostridium difficile infection (CDI). Recent investigations have yielded novel nonantibiotic agents that inhibit spore germination mediated by taurocholate, a bile salt. To determine whether CamSA — a taurocholate analog that inhibits germination in vitro — might prevent CDIs, researchers conducted experiments using a mouse model.

Mice received an antibiotic “cocktail” in their drinking water for 3 days, and then a single dose of intraperitoneally administered clindamycin on day 4. The animals, in groups of five, each received 0 mg/kg, 5 mg/kg, 25 mg/kg, or 50 mg/kg of CamSA by oral gavage, followed on day 5 by gavage challenge with a massive dose of C. difficile spores and additional doses of CamSA 1 and 24 hours thereafter. The mice were then monitored for clinical evidence of CDI, and disease signs were scored. Some animals in each group were sacrificed and underwent postmortem examination of the gastrointestinal tract.

All animals that received 0 mg/kg of CamSA developed severe CDI within 48 hours of spore inoculation. In contrast, those that received 50 mg/kg showed no clinical or histopathologic evidence of CDI. Animals that received either 5 mg/kg or 25 mg/kg had a delayed onset of CDI and a reduction in disease severity. The excretion of cells and spores in feces also correlated with CamSA dose: Vegetative cells predominated in animals in the untreated (0-mg/kg) and 5-mg/kg groups, whereas spores predominated in those in the 25-mg/kg and 50-mg/kg groups.

Although CamSA (3 doses at 50 mg/kg) was protective in mice challenged with spores, it was ineffective in preventing CDI in animals challenged with vegetative cells.

Comment: These findings in a murine model deserve special attention. The novel, nonantibiotic strategy studied could be a “game changer” as we consider potential approaches for CDI management. As the authors note, patients determined to be at risk for CDI could receive CamSA before initiating antibiotics, then additional doses as needed until the intestinal microbiota has recovered.

Source: Journal Watch Infectious Diseases

 

Can We Build a Better SYNTAX Score?

Posted by

0


 

Adding clinical factors to the anatomical SYNTAX model improved prediction of 4-year mortality with surgery versus stenting for complex coronary artery disease.

The SYNTAX score provides an anatomically based measure of coronary artery disease to help physicians and patients choose an appropriate revascularization strategy. However, other patient characteristics are often important factors in clinical decisions.

To improve the SYNTAX scoring system, investigators used SYNTAX trial data to identify six clinical factors — age, creatinine clearance, left ventricular ejection fraction [LVEF], peripheral vascular disease, female sex, and chronic obstructive pulmonary disease [COPD]) — that independently predicted 4-year mortality or showed an interaction effect between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for long-term mortality (notably, diabetes did not meet either of these criteria and was excluded from the model). These variables were combined with two anatomic measures: SYNTAX score and presence of left main disease.

Compared with the original SYNTAX model, the SYNTAX score II predicted similar 4-year mortality with CABG and PCI at lower scores with some clinical factors (female sex, lower LVEF) and at higher scores with others (older age, COPD, left main disease). The new model discriminated well between CABG and PCI, both in the SYNTAX population and in a validation cohort of 2900 participants in an international registry.

Comment: The inclusion of clinical variables improves the SYNTAX score by allowing clinicians to identify lower-risk patients in high categories of anatomic risk, and vice versa. Although externally validated, the new score requires further validation in randomized studies. In the meantime, clinicians should consider taking this common-sense approach to making revascularization decisions.

Source: Journal Watch Cardiology

Online Queries Find Adverse Interaction Between Paroxetine and Pravastatin.

Posted by

0


 

Researchers claim that a known interaction between pravastatin and paroxetine causing hyperglycemia in some patients could have been detected — before the FDA‘s systems caught it — by examining online queries.

The New York Times reports that a study in the Journal of the American Medical Informatics Association, which was not available online at deadline, identifies the interaction through analysis of some 6 million Internet users‘ online queries to search engines such as Google and Microsoft in 2010. The analysis found that people who searched for both drugs were more likely also to search for terms related to hyperglycemia.

Earlier this year, Google compiled flu-related search data as a way to track the intensity of seasonal flu geographically.

Source: New York Times

 

Longer Surveillance Intervals Might Be Safe in Men with Small Abdominal Aortic Aneurysms.

Posted by

0


 

Results are not as clear for women, but risk of rupture appears to be higher with smaller diameters.

Professional organizations recommend a wide range of surveillance intervals when an abdominal aortic aneurysm (AAA) is found, but most are in the range of 12 to 24 months for AAA diameters of 3.0 to 4.5 cm. To evaluate optimal surveillance intervals, researchers conducted a meta-analysis of 18 studies in which 15,500 patients (90% men) with known AAAs were assessed with serial ultrasounds or computed tomography until their AAAs reached diameters of 5.5 cm or ruptured.

Growth rate increased with AAA diameter: In men, the mean annual growth rate of a 3.0-cm AAA was 1.3 mm, compared with 3.6 mm for a 5.0-cm AAA. Estimated times for AAAs to reach 5.5 cm or to rupture generally were longer than recommended screening intervals. For example, it would take about 8 years for 10% of 3-cm AAAs to expand beyond 5.5 cm or for 1% of them to rupture. In contrast, it would take only about 1 year for 10% of 5-cm AAAs to expand beyond 5.5 cm or for 1% of them to rupture.

Comment: Because of the heterogeneity and lack of a firm scientific foundation for the current expert recommendations, these data probably are appropriate to guide longer surveillance intervals in men — perhaps 3 years for AAA diameters of 3.0 to 3.9 cm and 2 years for diameters of 4.0 to 4.4 cm, as recommended by the authors. In women and men with similar AAA diameters, growth and rupture rates were faster in women, but the numbers were too small to provide data for a recommendation.

Source: Journal Watch General Medicine

Novel Coronavirus Seen Spreading Person-to-Person.

Posted by

0


 

A novel coronavirus first identified among visitors to the Arabian Peninsula last autumn shows the ability to spread from person to person, according to MMWR.

The article details a cluster of three cases in a U.K. family, only one of whom — the index patient — had traveled internationally. One of the three died while the other two recovered.

The CDC considers the cluster “the first clear evidence” of person-to-person transmission and has updated guidance on its website to reflect the possibility of this mode of infection.

To date, 14 people have been infected, and 8 of these patients have died.

Source: MMWR

Outbreak of Shigellosis Showed Decreased Susceptibility to Azithromycin.

Posted by

0


 

An outbreak of shigellosis that occurred in Los Angeles last year is the first known transmission in the U.S. of Shigella sonnei with resistance to azithromycin, according to MMWR.

Of 43 cases of shigellosis associated with a private bridge club, 14 were confirmed by culture. Four isolates had elevated azithromycin minimum inhibitory concentrations (MICs) of >16 μg/mL and a plasmid-encoded macrolide resistance gene.

The authors write: “Guidelines for azithromycin susceptibility testing and criteria for interpretation of MICs for Shigella species have not been published. Clinicians are urged to report azithromycin treatment failure among shigellosis patients to public health authorities and to retain Shigella isolates from such cases for further analysis.”

Source: MMWR

Posted by

0


bhardwazbhardwaz

Therapeutic Hunger: Necessary for good health

I want to coin this term “Therapeutic Hunger” (TH), to differentiate it from the hunger that is associated with problem issues like famine, poverty and eating disorders.

“Therapeutic Hunger” (TH) is the residual hunger that is still left when we don’t eat stomach full.  When we finish meals, and have eaten just the right quantity of food, that we don’t feel full and have left some space in stomach to properly digest the food . This sweet hunger is very therapeutic, as it helps optimise digestion, proper absorption of nutrients, and enough space for elimination of waste.

TH is a signal for body organs to digest food more efficiently. Our body parts have evolved to work in such a way, so as to conserve energy. They will not perform any unnecessary work. So when there is plenty of food supply, they don’t need to extract nutrients most…

View original post 435 more words