Regular-dose versus High-dose Omeprazole in Peptic Ulcer Bleeding A Prospective Randomized Double-blind Study

Background: It has been suggested that profound acid inhibition along with endoscopic therapy might prevent rebleeding and reduce mortality in patients with peptic ulcer bleeding. The aim of the study was to test the possible equivalence of a high dose and the regular dose of omeprazole in peptic ulcer bleeding. Methods: We performed a prospective randomized double-blind study involving 142 patients with acute peptic ulcer bleeding (Forrest classification I-II: spurting or oozing bleeding, non-bleeding visible vessel, clot and black base). One-hundred-and-two (71.8%) patients received endoscopic treatment (adrenaline injection and/or heater probe) in pre-entry. Patients were randomly assigned to receive the regular dose of omeprazole intravenously (20 mg once a day for 3 days, i.e. 60 mg/72 h) or a high dose of omeprazole (80 mg bolus + 8 mg/h for 3 days, i.e. 652 mg/72 h). Rebleeding, surgery and death were the outcome measures. Results: Six (8.2%) of the 73 patients receiving the regular dose of omeprazole and 8 (11.6%) of the 69 patients receiving the high dose of omeprazole rebled ( P = 0.002 for equivalence, equivalence limit 0.15). Three (4.1%) of the former patients and 5 (7.2%) of the latter group underwent surgery. Four (5.5%) patients in the regular-dose and 2 (2.9%) in the high-dose group died within 30 days. Conclusion: Under the defined tolerance limits, the regular dose of omeprazole is as successful as a high dose in preventing peptic ulcer rebleeding.     

Reproducibility of DXA in obese women.

Dual-energy X-ray absorptiometry (DXA) measurements were analyzed using two versions of software (Hologic V8.1a and V8.21) to compare the short- and long-term precisions of the measurements. Software V8.21 was designed by the manufacturer to better address magnification effects on estimations of soft tissue lean mass. Twenty weight-stable, obese postmenopausal Caucasian women aged 40-70 yr participated in the study. Total and regional body composition measurements were obtained at baseline and after 3 mo, using a fan beam Hologic QDR 4500A absorptiometer. For the estimation of precision, duplicate scans obtained on the same day for nine women were analyzed using both versions of the software. The correlations between duplicate scans ranged from 0.886 to 0.998 and were similar between software versions. The CVs for fat and lean weights and bone mineral content (BMC) were 1.2%, 1.1%, and 1.7%, respectively, for software V8.21 compared to 1.3%, 1.3%, and 2.1%, respectively, for V8.1a. Systematic differences were found between software versions with higher values for fat and lean weights for software version V8.21. The 3-mo, long-term reproducibility of body composition estimates from DXA was only slightly less than short-term reproducibility for both software versions (coefficient of variation [CV] range from 1.3% for BMC weight to 11.0% for arm fat). Software V8.21 yielded smaller percentage mean differences between scale and DXA-estimated weights (-2.4% and -7.2% at baseline and -2.9% and -7.6% at 3 mo, respectively) and higher fat and lean weights (49.12 and 47.1 kg and 49.6 and 44.6 kg, respectively) than V8.1a. Reproducibility of all variables was comparable between software versions.     

The effect of diabetes mellitus on the association between measures of glycaemic control and ICU mortality: a retrospective cohort study

Introduction

In critical illness, four measures of glycaemic control are associated with ICU mortality: mean glucose concentration, glucose variability, the incidence of hypoglycaemia (≤ 2.2 mmol/l) or low glucose (2.3 to 4.7 mmol/l). Underlying diabetes mellitus (DM) might affect these associations. Our objective was to study whether the association between these measures of glycaemic control and ICU mortality differs between patients without and with DM and to explore the cutoff value for detrimental low glucose in both cohorts.

Methods

This retrospective database cohort study included patients admitted between January 2004 and June 2011 to a 24-bed medical/surgical ICU in a teaching hospital. We analysed glucose and outcome data from 10,320 patients: 8,682 without DM and 1,638 with DM. The cohorts were subdivided into quintiles of mean glucose and quartiles of glucose variability. Multivariable regression models were used to examine the independent association between the four measures of glycaemic control and ICU mortality, and for defining the cutoff value for detrimental low glucose.

Results

Regarding mean glucose, a U-shaped relation was observed in the non-DM cohort with an increased ICU mortality in the lowest and highest glucose quintiles (odds ratio = 1.4 and 1.8, P < 0.001). No clear pattern was found in the DM cohort. Glucose variability was related to ICU mortality only in the non-DM cohort, with highest ICU mortality in the upper variability quartile (odds ratio = 1.7, P < 0.001). Hypoglycaemia was associated with ICU mortality in both cohorts (odds ratio non-DM = 2.5, P < 0.001; odds ratio DM = 4.2, P = 0.001), while low-glucose concentrations up to 4.9 mmol/l were associated with an increased risk of ICU mortality in the non-DM cohort and up to 3.5 mmol/l in the DM cohort.

Conclusion

Mean glucose and high glucose variability are related to ICU mortality in the non-DM cohort but not in the DM cohort. Hypoglycaemia (≤ 2.2 mmol/l) was associated with ICU mortality in both. The cutoff value for detrimental low glucose is higher in the non-DM cohort (4.9 mmol/l) than in the DM cohort (3.5 mmol/l). While hypoglycaemia (≤ 2.2 mmol/l) should be avoided in both groups, DM patients seem to tolerate a wider glucose range than non-DM patients.     

Nutritional Practices of Coaches in the Big Ten

Many coaches in Big Ten schools still burden their athletes with a protein-rich precompetition meal. This survey indicates that coaches need—and want—more and better information about nutrition.     

Exercise frequency and calcium intake predict 4-year bone changes in postmenopausal women

The aim of this study was to examine the association of exercise frequency and calcium intake (CI) with change in regional and total bone mineral density (BMD) in a group of postmenopausal women completing 4 years of progressive strength training. One hundred sixty-seven calcium-supplemented (800 mg/day) sedentary women (56.1±4.5 years) randomized to a progressive strength training exercise program or to control were followed for 4 years. Fifty-four percent of the women were using hormone therapy (HT) at baseline. At 1 year, controls were permitted to begin the exercise program (crossovers). The final sample included 23 controls, 55 crossovers, and 89 randomized exercisers. Exercisers were instructed to complete two sets of six to eight repetitions of exercises at 70–80% of one repetition maximum, three times weekly. BMD was measured at baseline and thereafter annually using dual-energy X-ray absorptiometry. Four-year percentage exercise frequency (ExFreq) averaged 26.8%±20.1% for crossovers (including the first year at 0%), and 50.4%±26.7% for exercisers. Four-year total CI averaged 1,635±367 mg/day and supplemental calcium intake, 711±174 mg/day. In adjusted multiple linear regression models, ExFreq was positively and significantly related to changes in femur trochanter (FT) and neck (FN), lumbar spine (LS), and total body (TB) BMD. Among HT users, FT BMD increased 1.5%, and FN and LS BMD, 1.2% ( p <0.01) for each standard deviation (SD) of percentage ExFreq (29.5% or 0.9 days/week). HT non-users gained 1.9% and 2.3% BMD at FT and FN, respectively, ( p <0.05) for every SD of CI. The significant, positive, association between BMD change and ExFreq supports the long-term usefulness of strength training exercise for the prevention of osteoporosis in postmenopausal women, especially HT users. The positive relationship of CI to change in BMD among postmenopausal women not using HT has clinical implications in light of recent evidence of an increased health risk associated with HT.     

Association of IL-5 cytokine production and in vivo IgE levels in infants and parents

BACKGROUND: Total IgE in human subjects tracks strongly from birth onward through unknown mechanisms. Regulation of IgE might occur in relation to adaptive immune cytokine production. In vitro studies have assessed the role of individual cytokines in regulating IgE production in human subjects. OBJECTIVE: We sought to investigate the association between IgE levels in vivo and the capacity of the individuals to produce adaptive immune cytokines. METHODS: Blood samples from participants in the Tucson Infant Immune Study (children at birth and at 3 and 12 months of age, fathers, and mothers before and after delivery) were assessed for percentage of eosinophils and plasma total IgE levels. IFN-gamma, IL-4, IL-5, IL-13, and IL-10 levels were measured in supernatants of mitogen-stimulated PBMCs and examined cross-sectionally for relation to cytokine production by using simple regression, multiple regression with cytokines only and with other known predictors of IgE levels, and longitudinally by means of random effects modeling. RESULTS: After adjusting for eosinophils and other predictors, IL-5 production (but not that of other cytokines) was associated directly with total IgE levels in children at 3 months (P = .009) and 12 months (P = .011) of age but not at birth. The IL-5/IgE association was present also in fathers (P = .040) and in mothers, both during pregnancy (P < .001) and after delivery (P = .030). CONCLUSIONS: This study indicates that mitogen-stimulated IL-5 production is associated with in vivo total IgE levels, independent of the production of other cytokines and circulating eosinophils. CLINICAL IMPLICATIONS: Understanding the regulation of IgE in vivo might help elucidate the development of allergic responses in individuals.