Antihypertensive medication and the risk of acute pancreatitis: The European case-control study on drug-induced acute pancreatitis (EDIP)

Objective. Angiotensin-converting enzyme (ACE) inhibitors and diuretics have been associated with acute pancreatitis. We quantified the risk of acute pancreatitis associated with the use of antihypertensive medication in the European study on drug-induced acute pancreatitis (EDIP). Material and methods. The EDIP study is a multicenter population-based European case-control investigation of the association between drug use and acute pancreatitis. Patients between 40 and 85 years of age hospitalized for acute pancreatitis were included in the study between 1 October 1994 and 31 December 1998. For each case, age- and gender-matched community controls were recruited. Detailed information on drug use and potential confounders (e.g. comorbidity, alcohol use) was obtained through a structured interview. Results. In all, 724 patients with acute pancreatitis and 1791 community controls were identified and interviewed. Use of ACE inhibitors in the week prior to the index date was associated with an increased risk of acute pancreatitis (adjusted odds ratio 1.5; 95% CI: 1.1–2.2). The risk of acute pancreatitis associated with ACE inhibitors increased with higher daily doses and was highest in the first 6 months of therapy. Calcium channel blockers increased the risk of acute pancreatitis (adjusted odds ratio 1.5; 95% CI: 1.1–2.1) without an apparent dose- or response relationship. Loop and thiazide diuretic use was not associated with an increased risk of acute pancreatitis. Potassium-sparing diuretics elevated the risk of acute pancreatitis, albeit non-significantly. Conclusion. Use of ACE inhibitors is associated with a modest increase in the risk of acute pancreatitis during the first months of treatment.     

Infants colonized with enterotoxin‐producing staphylococci at 3 months display a decreased frequency of interferon‐γ‐producing CD45RO lymphocytes upon stimulation with staphylococcal enterotoxin A at birth but not at 6 months of age

The aim of the study was to elucidate the relationship between the cytokine response to staphylococcal enterotoxin A (SEA) at birth and subsequent staphylococcal colonization in the first months of life. In a cohort of 45 newborns, cord blood lymphocytes were stimulated with SEA (10 ng/ml) in vitro , re‐stimulated with PMA (phorbol myristate acetate) and ionomycin at day 3 and assessed for CD45RO expression and cytokine generation by flow cytometry. The infants were classified into three groups according to nasal staphylococcal colonization and enterotoxin generation at 3 months: There were 16 infants with either no colonization or non‐enterotoxin‐producing staphylococci, 16 infants with enterotoxins B, C, D and E, and 13 infants colonized with SEA‐producing staphylococci. At birth, the group without subsequent colonization displayed a significantly higher frequency of CD45RO‐positive interferon‐γ‐producing cells (1.7%; range 0.0–9.3%) in comparison to the SEA‐positive group (0.1%; range 0.0–0.4%) and also to the group positive for other enterotoxins (0.50%; range 0.0–2.5%). Comparable but less pronounced results were found for interleukin‐5 but not for interleukins 2 and 4. At 6 months, no differences in cytokine generation were detected between the three groups. The results provide evidence that a non‐specific immunologic immaturity at birth is a risk factor for early bacterial colonization. Furthermore, it is remarkable that this immaturity is similar to that seen in infants destined to be atopic with respect to disequilibrium of interferon‐γ to interleukin‐4 generation. Thus the link between early staphylococcal colonization and subsequent atopy requires further investigation.     

A New Reconstructive Technique for Posterior Vaginal Wall Defects,a Case Report

IntroductionPost‐partum vaginal laxity is a problem encountered by many women. More uncommon is a resulting vaginal defect. In most cases of laxity, a period of extensive physiotherapy can strengthen the pelvic muscles enough for symptoms to be minimized. However, this is not the case once there is a tissue defect.AimTo present a new reconstructive method for patients with posterior vaginal wall defects.MethodsWe present a case of a 38‐year‐old female who, 12 years prior to presentation, had a vaginal delivery. Due to complications during the delivery, she sustained pelvic trauma and developed a posterior vaginal wall defect. She had a sizable soft tissue defect, causing sexual, urinary, and confidence problems. Fat was harvested from the patient's abdomen and injected into the defect after more conservative treatment options were exhausted.ResultsThe defect was corrected successfully using the minimally invasive Coleman fat grafting technique.Discussion/ConclusionThis is to our knowledge the first case in the literature where a posterior vaginal defect has been corrected using Coleman fat grafting, and we believe that this treatment method may be of benefit to more patients. Zetlitz E, Manook M, MacLeod A, and Hamilton S. A new reconstructive technique for posteriorvaginal wall defects, a case report. J Sex Med 2013;10:2579–2581.     

Low-Birthweight Prevention Programs: The Enigma of Failure

Background: Low birthweight is the primary cause of neonatal morbidity and mortality in the United States. The purpose of our study was to identify factors associated with the effectiveness and apparent ineffectiveness of comprehensive, multicomponent, prenatal care programs for preventing low birthweight. Methods: We reviewed obstetric, pediatric, and public health program evaluations, research reports, and commentaries, published in the English language literature, over the last four decades that pertained to the efficacy of prenatal care for preventing low birthweight. Results: The heterogeneous nature of the services delivered and the lack of consistency in the definition of variables made it impossible to use rigorous, quantitative techniques to summarize this evaluation of the literature. Two general limitations of research design that emerged from our reviews were the focus on clusters of commonly associated risk factors, which has blurred the causal pathways linking specific risk factors to low birthweight, and the failure to examine process variables. These two methodologic problems have led investigators to erroneous conclusions that overstate the significance of negative intervention outcomes. The success and failure of low-birthweight prevention programs has rarely been examined in relation to evidence that the intervention actually modified the targeted risk factors. Conclusions: Few rigorous evaluations of well-designed programs have been conducted. Without an improvement in intervention designs and evaluation studies, recommendations to support or curtail the funding of comprehensive, multicomponent prenatal care services are inappropriate. Rigorously obtained evidence of the costs and benefits of approaches to the prevention of low birthweight are sorely needed.     

Magnesium-to-Calcium Ratio and Mortality from COVID-19

Obesity, type 2 diabetes, arterial hypertension, decrease in immune response, cytokine storm, endothelial dysfunction, and arrhythmias, which are frequent in COVID-19 patients, are associated with hypomagnesemia. Given that cellular influx and efflux of magnesium and calcium involve the same transporters, we aimed to evaluate the association of serum magnesium-to-calcium ratio with mortality from severe COVID-19. The clinical and laboratory data of 1064 patients, aged 60.3 ± 15.7 years, and hospitalized by COVID-19 from March 2020 to July 2021 were analyzed. The data of 554 (52%) patients discharged per death were compared with the data of 510 (48%) patients discharged per recovery. The ROC curve showed that the best cut-off point of the magnesium-to-calcium ratio for identifying individuals at high risk of mortality from COVID-19 was 0.20. The sensitivity and specificity were 83% and 24%. The adjusted multivariate regression model showed that the odds ratio between the magnesium-to-calcium ratio ≤0.20 and discharge per death from COVID-19 was 6.93 (_95%CI 1.6–29.1) in the whole population, 4.93 (_95%CI 1.4–19.1, p = 0.003) in men, and 3.93 (_95%CI 1.6–9.3) in women. In conclusion, our results show that a magnesium-to-calcium ratio ≤0.20 is strongly associated with mortality in patients with severe COVID-19.