The role of octreotide versus placebo in the prevention of post-ERCP pancreatitis

BACKGROUND/AIMS: To evaluate the effectiveness of a single administration of intravenous octreotide infusion in preventing post-ERCP pancreatitis and progressing hyperamylasemia. METHODOLOGY: One hundred and twenty (71 female, 59 male) patients who had been diagnosed with pancreaticobiliary pathology were included in this study. 100 microgram (0.1 mg) octreotide diluted in 60 mL normal saline solution administered intravenously 60 minutes prior to the procedure and continued during the procedure and after the procedure. Placebo was given in 87 patients. Patients were assessed clinically and serum amylase level was also measured before the procedure and 3, 12, and 24 hours after the procedure. We define clinical pancreatitis as serum amylase level greater than 4-5 times in conjunction with clinical assessment. RESULTS: Hyperamylasemia was assessed in 14 of 33 (42.4%) administered octreotide patients. Clinical findings of pancreatitis were observed in 5 of these 14 (11.5%) patients. Hyperamylasemia was also assessed in 41 of 87 (47.1%) administered placebo patients. Clinical findings of pancreatitis were observed in 10 of these 41 (11.5) patients. There were no significant differences between the groups, statistically (p > 0.05) (Pearson chi-square test). CONCLUSIONS: The results of this trial indicate that a single administration of intravenous octreotide infusion does not prevent ERCP-induced pancreatitis and effect serum amylase level.     

The Longitudinal Examination of Arthritis Pain (LEAP) study: relationships between weekly fluctuations in patient-rated joint pain and other health outcomes

OBJECTIVE: To examine relationships between weekly fluctuations in self-rated joint pain and other health outcomes among adults with osteoarthritis (OA). METHODS: In this observational study, 287 adults (aged > or = 50 yrs) with hip or knee OA were recruited from 16 medical practices across the United States. Patients were telephoned weekly for 12 weeks to assess pain/stiffness, daily activities/function, productivity, emotional well-being, quality of life, and healthcare utilization. Associations between changes in joint pain levels and other health outcomes were evaluated using a generalized estimating equation model. RESULTS: The mean (SD) pain score at Week 1 was 4.2 (2.1) on the Western Ontario and McMaster Universities OA index (WOMAC) pain subscale (0 = no pain, 10 = extreme pain); during the study, 49% of patients reported a between-week fluctuation of > or = 2 points. A 2-point decrease in WOMAC pain subscale score was associated with a 22% decrease in number of days of limited activity/week (beta = -0.107; 95% confidence interval -0.163, -0.051); a 48% decrease in number of days of missed work/week (beta = -0.217; 95% CI -0.395, -0.039); a 14% decrease in number of nights with pain-related sleep interference/week (beta = -0.068; 95% CI -0.109, -0.027). Patients were 1.6 times more likely to contact a healthcare provider when their pain changed from "acceptable" to "unacceptable." CONCLUSION:Weekly fluctuations in pain levels and other health outcomes were identified among adults with OA. Decreases in patient-reported pain were associated with improvements in daily activities/functioning and decreases in work absenteeism, sleep interference, and healthcare resource use.     

First report of Ancylostoma tubaeforme in Persian Leopard (Panthera pardus saxicolor)

Ancylostoma tubaeforme was originally described as a separate species parasitizing the cat. The adults of A. tubaeforme are 7 to 12 mm long. A. tubaeforme can be differentiated from the adults of A. braziliense and A. ceylanicum by the presence of three teeth. Here we describe the first report of A. tubaeforme in a Persian young female leopard, 2–3 years old, with head and trunk length 120 centimeters, length of tail 98 centimeters and body weight 35 kilograms.     

Update on pythiosis immunobiology and immunotherapy

Pythiosis is an invasive, ulcerative, pyogranulomatous disease caused by Pythium insidiosum, a fungus-like oomycete that has been reported to affect humans, horses, dogs, and other mammals mainly in tropical and subtropical areas of the world. The disease is characterized by an eosinophilic granulomatous and a Th2 immune response which in turn helps to protect the fungus from the host cells. Pythiosis can present clinically in subcutaneous, gastrointestinal, and vascular tissues or in a systemically disseminated form depending on the species and site of infection. Changes in iron metabolism and anemia are commonly observed. The diagnosis is accomplished through clinical and pathological features, laboratory characteristics of cultures, serological and molecular tests. Treatment includes radical surgery, antimicrobial drugs, immunotherapy or a combination of these treatments. Immunotherapy is a practical and non-invasive alternative for treating pythiosis which is believed to promote a switch from a Th2 to Th1 immune response, resulting in a favorableclinical response. This therapy has demonstrated cure rates above 70% and 55% in horses and humans but low cure rates in dogs and cats. Despite the curative properties of this type of immunotherapy, the antibodies that are produced do not prevent host reinfection. Thus, development of effective adjuvants and new diagnostic techniques for early disease diagnosis are of utmost importance. The aim of this review was to promote pythiosis awareness and to provide an update about the immunotherapy and immunobiology of this disease.