Alcohol consumption patterns and HbA1c,C-peptide and insulin concentrations in men

OBJECTIVE: Observational studies support inverse associations between moderate alcohol consumption and fasting insulin concentrations, but the importance of drinking pattern on the effect of alcohol on insulin sensitivity has not been fully explored. We examined the relations of alcohol consumption patterns-including average daily consumption, frequency of consumption and drinking with meals-to fasting insulin, fasting c-peptide and hemoglobin A1c (HbA1c). METHODS: A cross-sectional study of 462 disease-free men selected from the Health Professionals' Follow-up Study to provide information on a range of drinking patterns. Study participants were 48 to 82 years of age who provided a blood sample and detailed information on diet, life-style and alcohol consumption patterns in 1994. Among the study participants, 267 men provided a fasting blood sample and contributed to the analyses of insulin and c-peptide. RESULTS: Biologic markers were not strongly related to average alcohol consumption. Compared to abstainers, differences in insulin concentrations-all statistically non-significant-were 0.06, 1.25, 1.02, and 0.12 micro U/mL for consumers of <1, 1-1.9, 2-2.9, 3+ drinks per day, respectively. The frequency of alcohol consumption was inversely related to fasting c-peptide and insulin concentrations after controlling for average alcohol consumption and other potential confounding variables. Compared to men who reported consuming alcohol one to three days per week, c-peptide concentrations were 0.08 ng/mL and 0.29 ng/mL lower (p-trend = 0.04) in men who reported consuming alcohol on four to five days per week and six to seven days per week, respectively. Men who consumed alcohol on most days also had lower fasting insulin levels than more irregular drinkers (p-trend = 0.05). CONCLUSIONS: Our results suggest that frequent alcohol consumption is inversely related to fasting c-peptide and insulin concentrations.     

Combining carbohydrate-deficient transferrin and gamma-glutamyltransferase to increase diagnostic accuracy for problem drinking

AIM: To examine methods for combining quantitative results for serum carbohydrate deficient transferrin (CDT), gamma-glutamyltransferase (GGT) and/or aspartate aminotransferase (AST), and refining these by inclusion of patient characteristics. METHODS: Data from 1684 subjects, recruited from the general population, abstainer groups and alcohol treatment centres (participants in the five nations WHO/ISBRA study of biological markers of alcohol use), were used to develop clinical rules for combining results of GGT, AST and CDT. The algorithm derived by Sillanaukee and Olsson was tested, and compared with new algorithms derived by logistic regression and discriminant analysis. Diagnostic accuracy was assessed by area underneath the receiver operator characteristic curve. Effects of adding gender and clinical information to the algorithm were estimated. RESULTS: The predictive ability of combination rules derived from the two studies and by two different statistical techniques was remarkably consistent. For men, combining lnCDT and lnGGT provided the best accuracy for detecting daily consumption of 60 g ethanol or more in the past 30 days. For women, GGT alone provided the best accuracy for that consumption level. Clinical variables added significantly to the diagnostic accuracy of the models for both men and women, and conversely the test results modified the probability of problem drinking as assessed from clinical data alone. A graphic method was produced to help clinicians estimate probabilities for consumption of 60 g or more per day. CONCLUSIONS: Combining biochemical markers enhances detection of problem drinking in men but not in women. Information on clinical variables increases the ability to correctly detect problem drinking.     

A qualitative study to identify community structures for management of severe malaria: a basis for introducing rectal artesunate in the under five years children in Nakonde District of Zambia

Background  

Malaria is a serious illness among children aged 5 years and below in Zambia, which carries with it many adverse effects including anemia and high parasites exposure that lead to infant and childhood mortality. Due to poor accessibility to modern health facilities, malaria is normally managed at home using indigenous and cosmopolitan medicines. In view of problems and implications associated with management of severe malaria at home, rectal artesunate is being proposed as a first aid drug to slow down multiplication of parasites in children before accessing appropriate treatment.     

Lymphocyte depletion of donor bone marrow by counterflow centrifugal elutriation: results of a phase I clinical trial

We report here the results of a phase I clinical trial using counterflow centrifugal elutriation (CCE) for the removal of donor T lymphocytes before allogeneic bone marrow transplantation (BMT). Thirty- eight patients received lymphocyte-depleted allografts from HLA- identical, MLR-nonreactive sibling donors. The patients entered onto the study were either at high risk on the basis of age (median, 39 years) or disease status (acute leukemia in early relapse [ER], chronic myelogenous leukemia [CML] in accelerated phase [AP], or therapy resistant [RES] lymphoma). All patients received a standard lymphocyte dose of 1 x 10(6) morphologic lymphocytes per kilogram ideal body weight (BW) and were maintained on cyclosporine A (CsA) for 170 days after BMT. Prompt engraftment occurred in 37 of 38 patients with a median time to absolute neutrophil count (ANC) greater than 500/microL of 18 days. Although acute graft-v-host disease (GVHD; clinical stage I or greater) was observed in 45%, it was limited to the skin in all but five patients. Survival was related to disease status at the time of BMT. Among patients with acute leukemia in first or second remission, CML in chronic phase (CP) or lymphoma in partial remission (PR), 64% are currently alive, in contrast to 31% of patients with acute leukemia in third remission or early relapse, CML in second CP or AP, or RES lymphoma. Median follow-up for all patients was 351 days (range, 105 to 711 days). We conclude that this procedure is safe and warrants further evaluation in a randomized efficacy trial.     

Surfactant phosphatidylcholine composition during dexamethasone treatment in chronic lung disease

OBJECTIVES--To determine whether dexamethasone 'matures' the phosphatidylcholine (PC) composition of broncheoalveolar fluid in infants at high risk of neonatal chronic lung disease (CLD), either by increasing the proportion of dipalmitoylphosphatidylcholine (DPPC), expressed as a percentage of total PC (%DPPC), or by increasing the ratio of DPPC to palmitoyloleoylphosphatidylcholine (DPPC:POPC ratio). DESIGN--Double blind, placebo controlled. SETTING AND PATIENTS--Sixteen infants < 32 weeks' gestation, < 1250 g birth weight who were dependent on mechanical ventilation and requiring a fractional inspired oxygen of > 0.30 at 12 days of chronological age. INTERVENTION--Randomisation to receive a two week reducing course of dexamethasone base at an initial dose of 0.2 mg/kg three times a day, or equivalent volumes of normal saline, starting at 14 days. Eight infants were randomised into each group. Broncheoalveolar lavage was performed serially throughout the study period or until extubation. PC composition of the fluid was analysed by high performance liquid chromatography. OUTCOME MEASURES--The %DPPC and the DPPC:POPC ratios were calculated for individual infants for days -1 and 0 combined, days 1 and 3 combined, and days 5 and 7 combined. Analysis of covariance was used to analyse the results. RESULTS--The DPPC:POPC ratio was significantly less in the treated group than the placebo group on days 1 and 3, and not greater as the hypothesis stated. Three out of five infants treated with dexamethasone and for whom data were available showed a substantial rise in DPPC:POPC ratio on days 5/7, compared with the placebo group, but overall these changes were not statistically significant. CONCLUSIONS--The data do not support the hypothesis that dexamethasone's action in producing a clinical improvement within the first 72 hours of treatment for neonatal CLD is by the 'maturation' of pulmonary surfactant PC.     

PIC10 The Influence of Case Mix Bias on Costs of Hospitalisation for Lower Respiratory Tract Infection

OBJECTIVE: To compare costs of hospitalisation for lower respiratory tract infection (LRTI) in patients who received antibiotics before admission versus those who did not and in patients with and without underlying chronic obstructive airways disease (COAD).
METHODS: All hospitalisations were analysed in a population of 350,000 resident in Tayside during 1993–94. Three groups of patients were identified by primary discharge diagnosis in 1993–94 and previous admissions from 1980 to 1992: (1) acute exacerbation of COAD, (2) LRTI plus a secondary diagnosis of COAD or previous admission with COAD, and (3) LRTI but no secondary COAD or previous admission with COAD. Setting-specific costs were applied (e.g., general medicine, intensive care, geriatrics). Dispensed antibiotic prescribing in the 28 days before admission was identified from all community pharmacies. Non-parametric statistical tests were used.
RESULTS: Patients with COAD were more likely to have received antibiotics before admission: COAD (n = 893) 49%; COAD+LRTI (n = 316) 43%; LRTI only (n = 822) 33%. Odds ratio for COAD vs LRTI only 1.90 (95% CI 1.56 to 2.31); COAD+LRTI vs LRTI only 1.50 (95% CI 1.15 to 1.96). Patients who received antibiotics before admission had lower hospital costs than patients who did not. Median total costs per admission: COAD £1050 vs £1164 (p = 0.5); COAD+LRTI £1067 vs £1354 (p = 0.5); LRTI only £1220 vs £1500; (p = 0.009). Adjusted for community antibiotic prescribing, the hospital costs of patients with LRTI were significantly higher than those of patients with COAD (p = 0.001) but not those of patients with COAD+LRTI (p = 0.096).
CONCLUSION: Economic models of the potential impact of different community antibiotics on hospital LRTI costs will be subject to case mix bias unless they adjust for community antibiotic use and co-morbidity with COAD.     

Peritoneal reaction resulting from iodinated contrast material: comparative study

A consensus does not exist as to the optimal contrast agent for hysterosalpingography. This study was undertaken to evaluate the early and delayed inflammatory responses of the peritoneal surfaces to various types of iodinated contrast media. Guinea pigs received intraperitoneal injections of lactated Ringer solution, iothalamate meglumine, diatrizoate sodium, ioxilan, or ethiodized oil. The inflammatory response of the peritoneal surfaces was assessed at 1,7, and 30 days. Five animals were studied at each time point for each agent. No animals that received Ringer lactate or iothalamate meglumine had inflammation at any time. Ioxilan produced inflammation in two of five animals at 7 days and no inflammation at 1 or 30 days. Ethiodized oil produced no inflammation at 1 day; however, three animals had inflammation at 7 days, and all five had inflammation at 30 days. The 30-day group showed striking inflammatory response with granulomatous features. The authors recommend the continued use of meglumine-based water-soluble ionic contrast material for hysterosalpingography.