Comparative efficacy of preprandial or postprandial Humalog Mix75/25 versus glyburide in patients 60 to 80 years of age with type 2 diabetes mellitus

BACKGROUND: Humalog Mix75/25 (Mix75/25) is a novel premixed insulin containing 75% neutral protamine lispro (an intermediate-acting insulin) and 25% insulin lispro. OBJECTIVE: The purpose of this study was to compare glycemic control and hypoglycemia rates with Mix75/25 versus glyburide, and with preprandial versus postprandial Mix75/25, in patients aged 60 to 80 years with type 2 diabetes mellitus and persistent hyperglycemia on sulfonylurea therapy. METHODS: In this open-label, 16-week, parallel-group study, patients were randomized to 1 of 2 treatments: glyburide 15 mg/d (or up to the maximum daily dose) or Mix75/25. The Mix75/25 group was randomly subdivided into preprandial (immediately before breakfast and dinner) and postprandial (within 15 minutes after the start of breakfast and dinner) injection subgroups. The primary outcomes were glycemic control and rate of hypoglycemia. RESULTS: A total of 143 patients were randomized; 127 completed the study. The change in glycosylated hemoglobin (HbA(1c)) from baseline to end point was significantly greater with Mix75/25 than with glyburide (mean +/- SEM, -1.14% +/- 0.18% vs -0.36% +/- 0.15%, P = 0.001). HbA(1c) changes with preprandial and postprandial Mix75/25 were not significantly different (-1.20% +/- 0.26% vs -1.08% +/- 0.26%, P = 0.748). Fasting blood glucose (BG), 2-hour postprandial BG, and mean daily BG reductions were greater with Mix75/25 than with glyburide (P < 0.001); preprandial and postprandial Mix75/25 administration did not differ significantly with respect to any of these BG variables. The hypoglycemia rate increased with Mix75/25 by 0.17 +/- 0.02 episodes per patient per 30 days, but there was no change with glyburide (P = 0.077). Body weight increased by 1.02 +/- 0.35 kg with Mix75/25 and decreased by 0.85 +/- 0.18 kg with glyburide (P < 0.001). CONCLUSIONS: Compared with glyburide, Mix75/25 significantly improved glycemic control in older patients with type 2 diabetes mellitus, could be administered after meals without compromising glycemic control, and was well tolerated.     

Bilateral congenital absence of the internal carotid artery

Bilateral congenital absence of the internal carotid artery was incidentally found in an 11-year-old boy. Magnetic resonance imaging showed a normal-appearing brain that was entirely supplied by the vertebrobasilar system, and CT confirmed the absence of the bony carotid canals. Although most reported patients with agenesis of both internal carotid arteries presented with cerebrovascular lesions, this case demonstrates that this rare malformation may be asymptomatic.     

Elevated serum values of procollagen Ⅲ peptide （PⅢP）in patients with ulcerative colitis who will develop pseudopolyps

AIM: To assess the impact of procollagen Ⅲ peptide as a marker of collagenesis in the development of pseudopolyps in patients with ulcerative colitis.METHODS: Development of pseudopolyps was monitored in 25 patients with ulcerative colitis classified according to Powell-Tuck index as mild (n=12) or moderate (n=13) form of disease. Patients with a mild form of disease were treated with oral mesalazine medication (2-4 g/day) and local mesalazine preparation (suppository). Patients with a moderate form of disease received oral mesalazine medication (2-4 g/day), local mesalazine preparation(suppository) and local methylprednisolone at an initial dose of 60 rag/day, followed by dose tapering. How many significant variables (previously determined by analysis of variance) were elevated in the groups with and without pseudopolyp developement was observed. ROC analysis for calculation of new index was made.RESULTS: Serum values of procollagen Ⅲ peptide (PⅢP), C-reactive protein (CRP) and C4 complement component (C4)were statistically significantly lower in the group of patients flee from pseudopolyp development bhan bhose who developed one or more pseudopolyps (0.45&#177;0.12 vs 1.42&#177;0.70,P&lt;0.0027; 7.6&#177;4.7 vs 17.8&#177;9.17, P&lt;0.035, and 0.46&#177;0.11 vs 0.34&#177;0.16, P&lt;0.068, respectively) at endoscopic conrtrols with patohistologically samples during 13 months. There were no statistically significant differences in the values of C3, ceruloplasmin and IgM between the two groups (P&gt;0.05).Discrimination function analysis yielded highest standardized cannon coefficients for PⅢP (0.876), CRP (0.104), C3 (-0.534) and C4 (0.184) (P&lt;0.036). The elevation in two of three laboratory variables (PⅢP, CRP and C4) reached sensitivity of 93 % and specificity of 90 % in the development of pseudopolyps.CONCLUSION: It is proposed that an increase in two of the three laboratory parameters (PⅢP, CRP and C4) could improve the accuracy of prediction of the development of pseudopolyps. When using PⅢP, CRP and C4 on decision making, the positive predictive value and accuracy were 90 % and 92 %, respectively.     

Magnetization transfer, HASTE, and FLAIR imaging

Continuous technologic developments and research have increased the clinical applications of MT, HASTE, and FLAIR imaging in neuroradiology. HASTE has become the MR imaging sequence of choice for fetal neuroimaging. Other promising uses, such as for diffusion-weighted imaging, have not been fully exploited. FLAIR has been firmly established as one of the cornerstones of brain imaging; however, post-contrast FLAIR images have not offered a clear advantage over standard T1-weighted images as suggested by early studies. FLAIR imaging with echoplanar acquisition is not considered advantageous, because the decreased imaging times are obtained at the expense of lower sensitivity. For a number of applications, diffusion-weighted imaging has surpassed FLAIR. Nevertheless, FLAIR images may be more sensitive for the detection of acute brain infarction. Recently described methods for the elimination of CSF flow artifacts may lead to improved quality and reliability of FLAIR images for subarachnoid space disease. MT preparation is now routinely incorporated in time-of-flight MR angiography and gradient-echo T2*-weighted spine imaging sequences and provides increased sensitivity for postcontrast MR imaging. These applications may not be advantageous in all clinical settings. MTR analysis offers valuable information for an increasing number of pathologic processes but has not yet gained wide clinical acceptance owing to sophisticated postprocessing and significant intercenter variations. Different modifications of these techniques are being evaluated, and further developments are expected.     

Prevalence of HIV, hepatitis B, C and G virus infections among injecting drug users on methadone maintenance treatment in Maribor

The prevalence of human immunodeficiency virus (HIV) infection and hepatitis B, C, and G virus infections was determined in a selected group of 40 intravenous drug addicts on methadone maintenance treatment. No drug addict was infected with HIV. Seven drug addicts (17.5%) had serologic markers of hepatitis B infection but only one among them (2.5%) exhibited signs of active infection. 16 drug addicts (40%) had serologic markers of hepatitis C infection and 13 (32.5%) of them had an active infection with positive viral tests. 22 addicts (55%) had signs of hepatitis G infection, 9 (22.5%) of them had signs of active infection and 13 (32.5%) had signs of past infection. Addicts infected with the hepatitis B and C viruses were older and had also been taking drugs longer than those who were not infected with these two viruses. The proportion of those susceptible to infection with hepatitis B (70%) is high, reflecting a low prevalence of this disease and at the same time revealing the failure of preventive measures and the unacceptably low vaccination rate.