PURLs: Counseling is a must with this smoking cessation aid

For many smokers, the benefits of quitting will outweigh the risks associated with varenicline.     

Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility-acquired infection

PubMed, EMBASE and conference abstracts were reviewed systematically to determine the clinical and economic burden associated with Clostridium difficile infection (CDI) acquired and treated in European healthcare facilities. Inclusion criteria were: published in the English language between 2000 and 2010, and study population of at least 20 patients with documented CDI acquired/treated in European healthcare facilities. Data collection was completed by three unblinded reviewers using the Cochrane Handbook and PRISMA statement. The primary outcomes were mortality, recurrence, length of hospital stay (LOS) and cost related to CDI. In total, 1138 primary articles and conference abstracts were identified, and this was narrowed to 39 and 30 studies, respectively. Data were available from 14 countries, with 47% of studies from UK institutions. CDI mortality at 30 days ranged from 2% (France) to 42% (UK). Mortality rates more than doubled from 1999 to 2004, and continued to rise until 2007 when reductions were noted in the UK. Recurrent CDI varied from 1% (France) to 36% (Ireland); however, recurrence definitions varied between studies. Median LOS ranged from eight days (Belgium) to 27 days (UK). The incremental cost of CDI was ￡4577 in Ireland and ￡8843 in Germany, after standardization to 2010 prices. Country-specific estimates, weighted by sample size, ranged from 2.8% to 29.8% for 30-day mortality and from 16 to 37 days for LOS. CDI burden in Europe was most commonly described using 30-day mortality, recurrence, LOS and cost data. The continued spread of CDI and resultant healthcare burden underscores the need for judicious use of antibiotics.     

Pancreatic cancer treated with carmustine, fluorouracil, and spironolactone: a randomized study

A prospective randomized trial between two drug regimens in 38 patients with advanced pancreatic carcinoma was performed. The two-drug regimen consisted of carmustine and fluorouracil. The survival rate and response to these two drugs was compared to a three-drug regimen consisting of these same two drugs plus spironolactone. Objective partial responses were rare in both groups, being 3/18 in the two-drug group and 2/20 in the three-drug group. Life table analysis in previously untreated patients from time of treatment shows longer survival for the three-drug group, but this difference was not statistically significant.     

Prevalence of resistance against activated protein C resulting from factor V Leiden is significantly increased in myocardial infarction: investigation of 507 patients with myocardial infarction

Background

A point mutation in the gene encoding coagulation factor V is a cause of resistance against activated protein C. The presence of factor V Leiden is linked to 50% of congenital defects causing venous thrombosis. Its relationship to arterial thrombosis, particularly to myocardial infarction, has not been defined. Therefore, we performed a study on the role of factor V Leiden in patients with myocardial infarction. The study was carried out in Bavarians of German origin, a relatively homogeneous population.

Methods and results

The study group consisted of 507 patients with documented myocardial infarction (77.5% (393/507) men, 22.5% (114/507) women), with a mean age of 56.1 (range 18--86) years. Strict criteria for patient selection and highly sensitive and specific functional tests for factor V Leiden were used. In addition, all patients with pathological test results were genotyped. The prevalence of factor V Leiden in patients with myocardial infarction was 8.7% (44/507), a significant increase in the prevalence of this mutation compared with the control group (3.7%, P = .0025). The odds ratio was 2.46 (95% CI 1.35-4.50).

Conclusions

A significantly increased prevalence of factor V Leiden in patients with documented myocardial infarction was seen. Patients with this mutation appear to have a predisposition for myocardial infarction.     

The pathologic significance of occult blood in feces

Summary ⁵¹Cr studies of feces to determine the presence of occult blood have confirmed that small amounts of⁵¹Cr are present in the stools of normal healthy individuals. A volume representing as much as 3 ml of blood may be present in the stool of a normal person, and this probably is excreted in bile. A loss of⁵¹Cr beyond this “normal” loss represents true blood loss, and this loss we have defined as “positive” occult blood. Twelve patients with proven malignant lesions of the alimentary tract were investigated, and all 12 had “positive” occult blood in the stools passed. Similar studies of 33 patients with benign lesions of the alimentary tract which caused symptoms were made but only 11 of these had “positive” fecal occult blood. It is suggested that this investigation may help in determining whether a lesion in the alimentary tract is likely to be malignant, and it may also be of some value in screening for cancer.     

Serial enzyme-linked immunosorbent assays for antibody to Candida antigens during induction chemotherapy for acute leukemia

Two or more sera were collected from 68 adult patients who received a total of 100 courses of induction chemotherapy for acute leukemia. Sera were tested by ELISAs for antibody to candidal mannan and a major cytoplasmic antigen. Twenty episodes of induction chemotherapy were accompanied by invasive candidiasis of skin, esophagus, or deeper organs. Levels of antibody to mannan rose more than 2.75 times normal activity in nine of these episodes and were already above this level in all sera in two episodes. Levels of antibody to mannan exceeded 2.75 times normal in only two of the remaining episodes in which invasive candidiasis was not observed. An eightfold increase in antibody to mannan occurred at some point in five of the 20 episodes complicated by invasive candidiasis but in only one of the remaining 80 episodes. Antibody to the major cytoplasmic antigen was detected infrequently in sera from episodes complicated by invasive candidiasis. Further studies of precise serial measurements of antibody to mannan therefore appear warranted.     

Triiodothyronine stimulates food intake via the hypothalamic ventromedial nucleus independent of changes in energy expenditure

Increased food intake is characteristic of hyperthyroidism, although this is presumed to compensate for a state of negative energy balance. However, here we show that the thyroid hormone T(3) directly stimulates feeding at the level of the hypothalamus. Peripheral administration of T(3) doubled food intake in ad libitum-fed rats over 2 h and induced expression of the immediate early gene, early growth response-1, in the hypothalamic ventromedial nucleus (VMN), whereas maintaining plasma-free T(3) levels within the normal range. T(3)-induced feeding occurred without altering energy expenditure or locomotion. Injection of T(3) directly into the VMN produced a 4-fold increase in food intake in the first hour. The majority of T(3) in the brain is reported to be produced by tissue-specific conversion of T(4) to T(3) by the enzyme type 2 iodothyronine deiodinase (D2). Hypothalamic D2 mRNA expression showed a diurnal variation, with a peak in the nocturnal feeding phase. Hypothalamic D2 mRNA levels also increased after a 12- and 24-h fast, suggesting that local production of T(3) may play a role in this T(3) feeding circuit. Thus, we propose a novel hypothalamic feeding circuit in which T(3), from the peripheral circulation or produced by local conversion, stimulates food intake via the VMN.