Does FVIII-activity increase with age in patients with haemophilia A and carriers of haemophilia A?

The retrospective cohort study surveys the influence of age, co-morbidity and laboratory values on FVIII-activity (FVIII:C) in patients with haemophilia A with (mild n = 48, moderate n = 10, severe n = 7 and carriers n = 23). Median observation was 19 years for patients with haemophilia A and 9,5 years for carriers. Results: FVIII:C levels collected from patients with mild haemophilia A displayed a significant median increase of 6.5% with proceeding age (p = 0.0013). Patients with moderate haemophilia A (and carriers of haemophilia A) showed a non significant median increase of 1.05% (carriers 8%). Eight patients showed FVIII:C levels at last blood withdrawal that indicated a change of severity from moderate to mild haemophilia A. A significant correlation was found between FVIII:C and VWF:RCo (p = 0.0203) and AFP (p < 0.0005). The correlation between FVIII:C and triglycerides and LDH was significant negative (p < 0.0005). No significant correlation could be found for FVIII:C and co-morbidity, fibrinogen, cholesterol and VWF:Ag.     

Are there sex differences in energy expenditure and enjoyment in older adults playing active video games?

The aim of this study was to compare sex differences in energy expenditure and enjoyment in older adults during Active Video Game activities and sedentary behavior (watching television). In a within-subjects design, n = 32 older adults were included (15 men and 17 women). Energy expenditure was measured during each activity using indirect calorimetry. Energy expenditure was expressed in J.kg⁻¹.min⁻¹ and Metabolic Equivalents. Enjoyment was measured after each activity with the Physical Activity Enjoyment Scale. Energy expenditure was greater in Active Video Game activities compared to sedentary behavior in both men and women, but no differences were observed between sexes. The women reported greater enjoyment in Active Video Game activities compared to the men, and women reported greater enjoyment in Active Video Game activities compared to watching television, whereas the men did not report differences in enjoyment between Active Video Game vs. television watching. In conclusion, despite no difference in Energy expenditure, older women enjoy more than men playing Active Video Game, maybe they can be targeted for this intervention. (Clinical Trials Registration - NCT04352543).     

Are there fakes and frauds in your nebulizer?

As patient advocates and educators, Allergy and Asthma Network Mothers of Asthmatics is concerned with the safety and quality of respiratory medications in our country. As such, we've formed CHASM, the Consumer Health Alliance for Safe Medications. This is the first in a series of articles looking at this topic.     

Are there sex differences in emotional and biological responses in spousal caregivers of patients with Alzheimer's disease?

The purpose of this study was to compare emotional and biological responses of men and women who are spousal caregivers of patients with Alzheimer's disease (AD). Quality-of-life measurements, bioinstrumentation data, and immunophenotype assessments were obtained from female and male spousal caregivers of patients with AD. Spousal caregivers (women, n = 45 with average age 69.7; men, n = 16 with average age 71.4 years) completed questionnaires that assessed psychosocial variables. Blood was drawn and lymphocyte subsets (including natural killer [NK] cell number) were determined using flow cytometry. The degree of relaxation was determined measuring muscle tension (EMG) in the frontalis and trapezius muscles, skin conductance, skin temperature, and heart rate. Male spousal caregivers, as compared to female spousal caregivers, had significantly lower levels of stress, depression, caregiver burden (subjective), anxiety, anger-hostility, and somatic symptoms and higher levels of mental health, sense of coherence, NK cell number, and social and physical functioning. There were no statistically significant differences between the 2 groups in social support, coping resources, or T, T suppressor, or activated T cells. Women had more T helper cells and fewer NK cells than men. Men had fewer manifestations of a physiological stress response, as indicated by bioinstrumentation parameters. Unique sex-specific issues need to be considered when strategies are implemented to assist the increasing number of caregivers as our society ages.     

Tolerance for depression: are there cultural and gender differences?

This study examined tolerance for depression among Jewish and Protestant men and women in the United Kingdom. A measure of tolerance for depression was developed, which examined willingness to admit to and seek help for depression. More specifically, the items in the measure (developed from extended interviews) covered empathy towards sufferers, potential virtues of the illness, hopes for treatment, seeing the illness as 'normal', and telling other people about it. Existing evidence suggested that tolerance for depression might be greater amongst Jews compared with Protestants, and women compared with men. Also, Jewish men were expected to be more tolerant than Protestant men, whereas Protestant and Jewish women were not expected to differ from each other. It was found that tolerance for depression was greater amongst Jews than Protestants, and this is consistent with the elevated levels of depression amongst Jewish men as compared with Protestant men. However, findings relating to gender were mixed and were not always consistent with our expectations. The findings suggest that there may be some cultural variations in willingness to admit to and seek help for depression, and this may be worth examining in other cultural-religious groups. Individual variations in tolerance for depression may be clinically significant.     

Interaction between statins and clopidogrel: is there anything clinically relevant?

Since their introduction several years ago, the 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase inhibitors-the statins-have been widely used for hyperlipidemia and for the primary/secondary prevention of cardiovascular diseases. They have been shown to be safe as well as efficacious in a number of different clinical trials; however, studies have suggested that they can interact with other co-administered therapies. More recently, the thienopyridines have been successfully integrated with the conventional medical treatment of coronary disease as they showed effectiveness in reducing platelet activity both in stable and unstable settings. They also improve the outcome of patients treated with percutaneous coronary intervention. The potential interaction of statins and thienopyridines is a matter of concern. Despite some preclinical data suggesting an interaction between statins metabolized by the liver cytochrome P3A4-such as atorvastatin, lovastatin and simvastatin-and clopidogrel, there is no compelling clinical evidence to stop their co-administration.     

Harris-Benedict equation for critically ill patients: Are there differences with indirect calorimetry?

Purpose

The aim of this study was to compare the measured energy expenditure (EE) and the estimated basal EE (BEE) in critically ill patients.

Materials and Methods

Seventeen patients from an intensive care unit were randomly evaluated. Indirect calorimetry was performed to calculate patient's EE, and BEE was estimated by the Harris-Benedict formula. The metabolic state (EE/BEE × 100) was determined according to the following criteria: hypermetabolism, more than 130%; normal metabolism, between 90% and 130%; and hypometabolism, less than 90%. To determine the limits of agreement between EE and BEE, we performed a Bland-Altman analysis.

Results

The average EE of patients was 6339 ± 1119 kJ/d. Two patients were hypermetabolic (11.8%), 4 were hypometabolic (23.5%), and 11 normometabolic (64.7%). Bland-Altman analysis showed a mean of −126 ± 2135 kJ/d for EE and BEE. Only one patient was outside the limits of agreement between the 2 methods (indirect calorimetry and Harris-Benedict).

Conclusions

The calculation of energy needs can be done with the equation of Harris-Benedict associated with lower values of correction factors (approximately 10%) to avoid overfeeding, with constant monitoring of anthropometric and biochemical parameters to assess the nutritional changing and adjust the infusion of energy.     

Are certain multicenter randomized clinical trial structures misleading clinical and policy decisions?

Multicenter studies involving randomized clinical trials (RCTs) may have different structures. We discuss four general types. The first two, an "ideal" multicenter RCT and decentralized multicenter collaborative RCTs, we feel are, in different circumstances, highly recommended approaches. The other two, the multicenter RCT that ignores site differences and centralized multicenter collaborative RCTs, we argue, are not only not cost-effective but may also produce misleading results, thus impeding scientific progress and possibly putting patients at unnecessary risk.     

Do sex differences exist in opioid analgesia? A systematic review and meta-analysis of human experimental and clinical studies

Although a contribution of sex in opioid efficacy has garnered much attention, the confirmation and direction of any such difference remain elusive. We performed a systematic review of the available literature on sex differences in μ and mixed μ/κ opioid effect on acute and experimental pain. Fifty unique studies (including three unpublished studies) were included in the analyses. Across the 25 clinical studies on μ-opioids there was no significant sex-analgesia association. Restricting the analysis to patient-controlled analgesia (PCA) studies (irrespective of the opioid) yielded greater analgesia in women (n = 15, effect size 0.22, 95% c.i. 0.02-0.42, P = 0.028). Further restricting the analysis to PCA morphine studies yielded an even greater effect in women (n = 11, effect size = 0.36, 95% c.i. 0.17-0.56, P = 0.003). Meta-regression indicated that the longer the duration of PCA, the difference in effect between the sexes further increased. Across experimental pain studies on μ-opioids women had greater antinociception from opioids (n = 11, effect size = 0.35; 95% c.i. 0.01-0.69, P = 0.047), which was predominantly due to 6 morphine studies. Female patients had greater μ/κ opioid analgesia (n = 7, effect size 0.84; 95% c.i. 0.25-1.43, P = 0.005), but no sex-analgesia association was present in experimental studies (n = 7). Sex differences exist in morphine-induced analgesia in both experimental pain studies and clinical PCA studies, with greater morphine efficacy in women. The data on non-morphine μ and mixed μ/κ-opioids are less convincing and require further study.     

Are there any real differences between enteral feed formulations used in the critically ill?

PURPOSE OF REVIEW: We know that adequate nutritional support is essential in the treatment of critically ill patients, because it can, if applied appropriately, improve the clinical outcome. Increasing evidence seems to suggest that malnutrition itself is a predictor of poor outcome in intensive care, and significant underfeeding during intensive care stay increases the risk of bloodstream infections. The purpose of this review is to highlight recent advances in enteral nutrition in the critically ill adult patient. RECENT FINDINGS: Recent studies suggest that tight glycaemic control is associated with improved outcome. Enteral feeding should be encouraged, using simple feeding protocols, and started early if safe to do so. Gastric residual volumes do not correlate with the risk of aspiration, and therefore should be used with caution in feeding protocols. Conflicting evidence exists for supplementation with antioxidant and immunonutrition in the critically ill. Glutamine and fish oil/borage oil should be considered for burns patients and patients with adult respiratory distress syndrome, respectively. SUMMARY: This review offers information regarding the latest developments in nutritional support via the enteral route. Further research is needed to clarify the role of enteral supplements such as antioxidants and 'immune modulating substances'.     

Are platelet volume indices of clinical use? A multidisciplinary review

Abstract

Platelet size correlates with platelet activity and can be assessed by platelet volume indices (PVI). The PVI, mean platelet volume (MPV), is universally available with routine blood counts by automated hemograms and therefore is an attractive index to study in clinical scenarios. PVI are useful in assessing the etiology of thrombocytopenia. In addition, a normal platelet distribution width in the setting of thrombocytosis is highly suggestive of a reactive etiology. Higher MPV is also associated with the presence of cardiovascular risk factors, chest pain due to acute coronary syndrome, and adverse outcome after acute coronary syndrome. Results from studies evaluating MPV in patients with peripheral artery disease, unprovoked deep vein thrombosis, and pulmonary embolism further advocate a potential role for MPV in identifying patients at high risk of thrombosis.

Nevertheless, most of these data come from retrospective studies some of which have small study populations and confounding factors influencing platelet volume. Moreover, the cut-off values derived from these retrospective studies have not been validated prospectively. Despite the potential for clinical utility evident from these studies, the above-mentioned flaws together with technical problems in measuring MPV currently limit its clinical usefulness. Our review provides a perspective on PVI's potential clinical use.