Effects of combined treatment with pravastatin and ursodeoxycholic acid on hepatic cholesterol metabolism

BACKGROUND: Treatment with ursodeoxycholic acid and also, to some degree, statins reduces cholesterol saturation of bile. The present study aimed [1] to study the effects of combined treatment with ursodeoxycholic acid and pravastatin on hepatic cholesterol metabolism and [2] to evaluate if the addition of pravastatin to ursodeoxycholic acid treatment has beneficial effects on the lipid composition of gallbladder bile in gallstone patients. MATERIALS AND METHODS: Nineteen patients with cholesterol gallstones were subjected to combined treatment with ursodeoxycholic acid (500 mg bid) and pravastatin (20 mg bid) for three weeks before cholecystectomy. Eleven patients received ursodeoxycholic acid only and 20 untreated gallstone patients served as controls. Gallbladder bile was collected, and for both the patients receiving combined treatment and the controls a liver biopsy was also obtained peroperatively. RESULTS: The cholesterol saturation of bile averaged 59% in the patients on combined treatment, 60% in the ursodeoxycholic acid-treated patients, and 130% in the untreated controls. In the patients receiving ursodeoxycholic acid, this bile salt constituted approximately 60% of all bile salts. The patients receiving combined treatment had reduced cholesterol synthesis, as reflected by a 45% reduction in serum lathosterol. The activity and the mRNA levels of cholesterol 7 alpha-hydroxylase and the mRNA levels for the low density lipoprotein-receptor were not significantly affected. CONCLUSIONS: Pravastatin does not further reduce the cholesterol saturation of bile in gallstone patients treated with ursodeoxycholic acid, although hepatic cholesterol synthesis is inhibited. The study supports the important concept that de novo synthesized cholesterol is not particularly important for biliary cholesterol secretion in humans.     

Staff Stress and Morale in Community‐Based Settings for People with Intellectual Disabilities and Challenging Behaviour: A Brief Report

Background There are no studies that have compared outcomes for staff in different types of supported accommodation for people with intellectual disabilities and challenging behaviour. This study looked at stress, morale and intended job turnover in staff in two types of community‐based residential supports: non‐congregate settings where the minority of residents have challenging behaviour; and congregate settings where the majority of residents have challenging behaviour. Materials and methods A self‐completion survey questionnaire was used to collect information on the basic characteristics of staff, levels of staff stress, job satisfaction and propensity to leave their employment. Results One hundred and fifty‐seven questionnaires were returned from staff, the majority of whom were on fixed‐term contracts. Congregate settings were not associated with higher levels of stress as might be assumed. Overall, over a quarter of staff reached criterion on the General Health Questionnaire‐12 for experiencing emotional distress, and over a third were likely to actively seek new employment in the next year. The greatest perceived sources of stress were lack of resources and lack of staff support. The lowest level of satisfaction was with the rate of pay. Those in non‐congregate settings reported greater perceived stress because of lack of procedures to deal with challenging behaviour. Conclusions High levels of intended staff turnover may be more due to job insecurity and lack of support than service user challenging behaviour. Employers seeking to reduce turnover should pay attention to basic pay and conditions, as well as staff training in appropriate methods for dealing with challenging behaviour.     

Pneumonia caused by oxacillin-resistant Staphylococcus aureus treated with glycopeptides

OBJECTIVE: To determine whether ventilator-associated pneumonia caused by oxacillin-resistant Staphylococcus aureus (VAP-ORSA) treated with glycopeptides is associated with an increased mortality rate. DESIGN: Retrospective matched cohort study. SETTING: Four intensive care units in teaching hospitals. PATIENTS: Seventy-five patients were matched to 75 controls. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All adult intensive care unit patients with microbiologically documented VAP-ORSA were matched to intubated controls who did not develop VAP-ORSA, based on disease severity (Acute Physiology and Chronic Health Evaluation II score) at admission (+/-3 points), diagnostic category, and length of stay before pneumonia onset. Population characteristics and intensive care unit mortality rates of patients with VAP-ORSA and their controls without pneumonia were compared. Attributable mortality was determined by subtracting the crude mortality rate of controls from the crude mortality rate of VAP-ORSA patients. Thirty-six of the 75 matched VAP-ORSA patients died, representing a crude mortality rate of 48%, whereas 19 of the 75 controls died, a crude mortality rate of 25.3% (p < .01). Excess mortality was estimated to be 22.7% (95% confidence interval, 2.4-42.9%). Median length of intensive care unit stay in the surviving pairs was 33 days (interquartile range, 25-75%: 25-45 days) for VAP-ORSA patients and 21 days (interquartile range, 25-75%: 15-34.75 days) days for controls (p = .054). CONCLUSIONS: Despite appropriate glycopeptide therapy, there is an increased attributable mortality for pneumonia by ORSA, after careful adjustment for disease severity and diagnostic category.     

La pollution atmosphérique comme facteur déterminant de la polyarthrite rhumatoïde

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The reliable measurement of radial pulse: gender differences in pulse profiles

This study was undertaken to determine whether healthy adults exhibited characteristic pulse profiles. Pulse characteristics measured for 83 women and 65 men included presence at the Traditional Chinese Medicine (TCM) locations (Cun, Guan, Chi); and depth (superficial, middle, deep), overall pulse force, relative pulse force, pulse width and pulse rhythm. Most subjects had similar values for many of the characteristics investigated including relative pulse force at the three traditional palpation locations (Cun, Guan and Chi), pulse width and pulse rhythm. There were some significant gender differences. The pulse was present beyond Chi in 90% of males compared with 56% of females. Female pulses tended to be less forceful compared with males. However, with the exception of overall force, there was little support for TCM assumptions of gender differences in pulse such as in left/right balance. There was some support for the use of the TCM palpation locations Cun, Guan and Chi to discriminate between pulses since there was significant differences in manifestations of some pulse characteristics among these locations.