Randomized clinical trial: Atorvastatin versus placebo in patients with acute exacerbation of mild to moderate ulcerative colitis

Background

Statins are known to possess pleiotropic anti-inflammatory properties which have been evaluated for clinical benefits in a number of disorders. Studies have demonstrated beneficial actions of statins in experimental models of colitis. Clinical evidence in acute exacerbation of ulcerative colitis (UC) is lacking.

Aim

This study aims to assess the efficacy and safety of add-on atorvastatin in mild to moderately severe acute exacerbation of UC.

Methods

Patients with acute exacerbation of UC were randomized to receive either atorvastatin (20 mg) or matching placebo once daily orally for 8 weeks in addition to the standard therapy. Clinical efficacy was assessed by using partial Mayo score (PMS).

Results

Previously diagnosed 64 cases of UC presenting with mild to moderately severe acute exacerbation were randomized to receive either atorvastatin of 20 mg or placebo. Mean PMS increased by 1.5 points and decreased by 0.31 points in atorvastatin and placebo groups, respectively, at 8 weeks compared to the baseline values (p?=?0.04). Eight (25 %) and 13 (40.6 %) patients attained the primary outcome criteria for clinical improvement in the atorvastatin and placebo arms, respectively (p?=?0.18). Fifteen (46.8 %) patients in the atorvastatin group and no patient in the placebo group had ≥2 point increase in PMS after 8 weeks (p?<?0.001).

Conclusion

Atorvastatin therapy in acute exacerbation of UC may not be associated with beneficial effects. Paradoxical increase in disease activity may be seen in some patients. However, these findings need to be substantiated in larger studies.     

NS1619-Induced Vasodilation is Enhanced and Differentially Mediated in Chronically Hypoxic Lungs

Purpose

To identify the effect of the benzimidazalone derivative, NS1619, on modulating pulmonary vascular tone in lungs from rats exposed to normoxia (21 % FiO₂) or chronic hypoxia (10 % FiO₂) for three weeks.

Methods

Isolated perfused lungs were preconstricted (U46619), and dose-dependent vasodilation to NS1619 was assessed. To elucidate the mechanisms responsible, NS1619 vasodilatory responses were assessed following inhibition of large-conductance Ca²⁺-activated (BK_Ca; iberiotoxin and paxilline), L-type Ca²⁺ (nifedipine), K⁺ (tetraethylammonium), Cl^? (niflumic acid), and cation/TRP (lanthanum) channels, as well as nitric oxide synthase (L-NAME).

Results

Compared to normoxia, NS1619-induced vasodilation was significantly greater following hypoxia; however, NO-dependent vasodilation and BK_Ca-mediated vasodilation, in response to NS1619, were similar in the normoxic and hypoxic lungs. In contrast, direct activation of L-type Ca²⁺ and non-BK_Ca K⁺ channel was involved in the NS1619-induced vasodilation only in hypoxic lungs.

Conclusions

NS1619 causes pulmonary vasodilation by affecting multiple complementary pathways, including stimulation of NO production, activation of BK_Ca channels, other TEA-sensitive K⁺ channels, and L-type Ca²⁺ channels, and could be considered as a therapeutic agent in hypoxic PH.     

Barriers to Cure for Children with Cancer in India and Strategies to Improve Outcomes: A Report by the Indian Pediatric Hematology Oncology Group

The survival of children with cancer in India is inferior to that of children in high-income countries. The Indian Pediatric Hematology Oncology Group (IPHOG) held a series of online meetings via www.Cure4kids.org to identify barriers to cure and develop strategies to improve outcomes. Five major hurdles were identified: delayed diagnosis, abandonment, sepsis, lack of co-operative groups, and relapse. Development of regional networks like IPHOG has allowed rapid identification of local causes of treatment failure for children with cancer in India and identification of strategies likely to improve care and outcomes in the participating centers. Next steps will include interventions to raise community awareness of childhood cancer, promote early diagnosis and referral, and reduce abandonment and toxic death at each center. Starting of fellowship programs in pediatric hemato-oncology, short training programs for pediatricians, publishing outcome data, formation of parent and patient support groups, choosing the right and effective treatment protocol, and setting up of bone marrow transplant services are some of the effective steps taken in the last decade, which needs to be supported further.     

Nucleated RBC count as predictor of neurological outcome in perinatal asphyxia

The immediate and short term outcomes of term newborns with perinatal asphyxia were studied in relation to the nucleated red blood cell count at admission. The mean (SD) NRBC/100WBC (white blood cells) was significantly higher in sequelae group than normal [9.8 (98.9) vs. 2.9 (43); P = 0.001].     

The StenTec gauge for measuring static intra-access pressure ratio (P(Ia Ratio) ) of fistulas and grafts

The StenTec? Gauge provides a method to determine the static intra‐access pressure ratio (P_{Ia Ratio}) within a fistula or graft. The StenTec Gauge estimates the peak systolic pressure within the fistula or graft by measurement of the distance that the blood–air interface progresses into the tubing of the fistula needle, after the needle is inserted “dry” into the fistula or graft and before the cap is removed from the tubing. The peak systolic pressure is graphically compared with the systolic arterial blood pressure of the patient, to determine P_{Ia Ratio}. For best accuracy, the StenTec Gauge should be chosen that best matches the internal volume of the fistula needle tubing (2.3–2.6 ml for 12‐inch tubing and 3.6 ml for 16‐inch tubing) and the approximate elevation of the city in which it is used (0–1000, 1000–3000, and 3000–6000 feet above sea level). In this article, we explain the rationale for this method of surveillance, evidence for accuracy of the StenTec Gauge, and the correlation of changes in the P_{Ia Ratio} to the development of stenosis in a fistula or graft.     

Analysis of dose–volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT

Purpose  

Multimodality therapy for esophageal cancer can cause various kinds of treatment-related sequelae, especially pulmonary toxicities. This prospective study aims to investigate the clinical and dosimetric parameters predicting lung injury in patients undergoing radiation therapy for esophageal cancer.     

Comparison of size 2 i-gel supraglottic airway with LMA-ProSeal™ and LMA-Classic™ in spontaneously breathing children undergoing elective surgery

Background: We compared size 2 i‐gel^® (Intersurgical Inc.), a relatively new supraglottic airway device for use in spontaneously breathing anesthesized children with two different types of laryngeal mask airway‐ProSeal? laryngeal mask airway (PLMA) and Classic? laryngeal mask airway (cLMA) for the ease of insertion, oropharyngeal sealing pressures (OSPs), and air leak. The hemodynamic effects on insertion of device and postoperative adverse effects were also noted. Methods: A randomized prospective study was planned in 120 children aged 2–5 years, weighing 10–20 kg, ASA physical status I–II scheduled for routine elective surgeries of <1‐h duration. They were randomly divided in three groups (i‐gel, PLMA, and cLMA) of 40 each, and a standard protocol for anesthesia was followed. Results: The age, weight, height, and type of surgery were similar in all groups. Success rate for first attempt was 95% for the i‐gel group and 90% for the two laryngeal mask airway groups. Insertion was found to be easy in the majority of cases in all groups, and there was no change in blood pressure, heart rate, or oxygen saturation on insertion. The OSP was 26 ± 2.6, 23 ± 1.2, and 22 ± 2.3 cm H₂O for i‐gel, PLMA, and cLMA, respectively. The difference between the i‐gel and both laryngeal mask airway groups was statistically significant (P < 0.01). There were no clinically important complications in the postoperative period. Conclusion: Pediatric size 2 i‐gel is easy to insert and provides higher OSP compared with same size PLMA and cLMA in spontaneously breathing children undergoing elective surgery. It may be a safe alternative to laryngeal mask airways in day care surgeries.     

Awareness and Management of Chronic Disease, Insurance Status, and Health Professional Shortage Areas in the REasons for Geographic and Racial Differences in Stroke (REGARDS): A Cross-Sectional Study

ABSTRACT: BACKGROUND: Limited financial and geographic access to primary care can adversely influence chronic disease outcomes. We examined variation in awareness, treatment, and control of hypertension, diabetes, and hyperlipidemia according to both geographic and financial access to care. METHODS: We analyzed data on 17,458 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study with either hypertension, hyperlipidemia, or diabetes and living in either complete Health Professional Shortage Area (HPSA) counties or non-HPSA counties in the U.S. All analyses were stratified by insurance status and adjusted for sociodemographics and health behaviors. RESULTS: 2,261 residents lived in HPSA counties and 15,197 in non-HPSA counties. Among the uninsured, HPSA residents had higher awareness of both hypertension (adjusted OR 2.30, 95% CI 1.08, 4.89) and hyperlipidemia (adjusted OR 1.50, 95% CI 1.01, 2.22) compared to non-HPSA residents. Also among the uninsured, HPSA residents with hypertension had lower blood pressure control (adjusted OR 0.45, 95% CI 0.29, 0.71) compared with non-HPSA residents. Similar differences in awareness and control according to HPSA residence were absent among the insured. CONCLUSIONS: Despite similar or higher awareness of some chronic diseases, uninsured HPSA residents may achieve control of hypertension at lower rates compared to uninsured non-HPSA residents. Federal allocations in HPSAs should target improved quality of care as well as increasing the number of available physicians.     

Intersibling variability of retinopathy of prematurity in twins and its risk factors

To study intersibling variability of retinopathy of prematurity (ROP) in twins and determine its risk factors. A retrospective chart review of twin neonates developing ROP at a tertiary center over a 5 year period (January 2004 to December 2008). Twin pairs with intersibling variability of ROP were retrieved based on one of the following criterion: (1) two-stage difference in ROP between siblings, (2) one sibling with treatable ROP and the other with spontaneously regressed ROP, or (3) one sibling with aggressive posterior ROP and the other with staged ROP. Babies with greater severity of ROP were included in group A (case group) and their siblings with less severity in group B (control group).The two groups were compared for birth weight, birth order and putative post-gestational risk factors. Thirty-five twin pairs developed ROP of which 28 pairs (80%) had severe intersibling variability. Twenty-one pairs with complete information about risk factors were analyzed. The birth weight of the case group was 1212.1 ± 248.3 g (mean ± SD) and control group 1172.1 ± 216.5 g (mean ± SD) (p = 0.33). In twelve of the 21 pairs the second born twin had more severe ROP. However, birth order was not a significant predictor (p = 0.664). Various post-gestational risk factors did not differ significantly between the two groups [oxygen administration (p = 1), sepsis (p = 0.625), exchange transfusion (p = 1), blood transfusion (p = 0.325), respiratory distress syndrome (p = 1), anemia (p = 0.125), apnea (0.375), neonatal jaundice (p = 1), patent ductus arteriosus (p = 0.5) and hypoglycemia (p = 1)]. The majority of the twins developing ROP had severe intersibling variability. Birth weight, birth order and post-gestational neonatal risk factor were not predictive of more severe ROP in a twin sibling.