Fournier's gangrene in patients with type 2 diabetes using second-line antidiabetic medications

Cases of a rare but serious infection called Fournier's gangrene have been reported with sodium-glucose co-transporter-2 inhibitors (SGLT-2i). To evaluate the safety signal in a population of patients with type 2 diabetes, we used administrative claims data from Horizon Blue Cross Blue Shield of New Jersey from 2014 through 2017 to estimate incidence rates of Fournier's gangrene or necrotizing fasciitis of the perineum among patients treated with a second-line antidiabetic drug. We found very low incidence rates of Fournier's gangrene or necrotizing fasciitis. While we found no indication of an increased risk among SGLT-2i users compared with similar patients treated with other second-line antidiabetic medications, the small number of events yielded wide confidence intervals.     

Using Digital Health Technology to Better Generate Evidence and Deliver Evidence-Based Care

As we enter the information age of health care, digital health technologies offer significant opportunities to optimize both clinical care delivery and clinical research. Despite their potential, the use of such information technologies in clinical care and research faces major data quality, privacy, and regulatory concerns. In hopes of addressing both the promise and challenges facing digital health technologies in the transformation of health care, we convened a think tank meeting with academic, industry, and regulatory representatives in December 2016 in Washington, DC. In this paper, we summarize the proceedings of the think tank meeting and aim to delineate a framework for appropriately using digital health technologies in healthcare delivery and research.     

T2R38 taste receptor polymorphisms underlie susceptibility to upper respiratory infection

Innate and adaptive defense mechanisms protect the respiratory system from attack by microbes. Here, we present evidence that the bitter taste receptor T2R38 regulates the mucosal innate defense of the human upper airway. Utilizing immunofluorescent and live cell imaging techniques in polarized primary human sinonasal cells, we demonstrate that T2R38 is expressed in human upper respiratory epithelium and is activated in response to acyl-homoserine lactone quorum-sensing molecules secreted by Pseudomonas aeruginosa and other gram-negative bacteria. Receptor activation regulates calcium-dependent NO production, resulting in stimulation of mucociliary clearance and direct antibacterial effects. Moreover, common polymorphisms of the TAS2R38 gene were linked to significant differences in the ability of upper respiratory cells to clear and kill bacteria. Lastly, TAS2R38 genotype correlated with human sinonasal gram-negative bacterial infection. These data suggest that T2R38 is an upper airway sentinel in innate defense and that genetic variation contributes to individual differences in susceptibility to respiratory infection.     

Immune modulatory oligonucleotides in the prevention and treatment of OVA-induced eustachian tube dysfunction in rats.

BACKGROUND: Otitis media with effusion (OME) is often associated with allergies. Immune modulatory oligonucleotides (IMO) mediate allergic inflammation and may therefore be efficacious in the treatment of airway inflammation. OBJECTIVE: To evaluate the role of an IMO via transtympanic mucosal application in prevention and treatment of ovalbumin-induced OME. DESIGN: Forty brown Norway rats were divided into control and treatment groups. Eustachian tube dysfunction was evaluated by passive opening pressures, passive closing pressures, active clearance of negative pressure, and mucociliary clearance transit time. RESULTS: Rats who underwent IMO treatment required 50% less pressure to open and close the eustachian tube (P < 0.05) and were able to actively clear 50% more negative pressure than the ovalbumin-control rats (P < 0.001). The treatment rats' mucociliary clearance time was half that of the control group (P < 0.001). CONCLUSION: IMO via transtympanic application can prevent and treat allergy-induced eustachian tube dysfunction in rats. IMO may offer substantial promise in the future management of OME.     

A 28-day oral (dietary) toxicity study of sucromalt in Sprague--Dawley rats.

A new sweetener, sucromalt, was produced via enzymatic conversion of sucrose and maltose to a mixture of fructose, leucrose and gluco-oligosaccharides. The present study evaluated the safety of this sweetener when administered as a dietary admix at concentrations of 50, 100 and 200 g/kg to Sprague-Dawley rats for 28 days. There were no treatment-related effects on the general condition and behavior as determined by clinical observations, functional observational battery and locomotor activity assessments. Evaluation of clinical pathology parameters revealed no toxicologically-relevant treatment-related effects on hematology, serum chemistry or urinalysis. Macroscopic and microscopic findings revealed no treatment-related effects on any organ evaluated. A treatment-related increase in mean food consumption was observed resulting in slightly higher body weight gains (2-4%) for both the male and female rats, which was not toxicologically relevant. Results of this study clearly demonstrate that consumption of high concentrations of sucromalt for 28 days is not associated with obvious signs of toxicity.     

Idiopathic non-cirrhotic intrahepatic portal hypertension: common cause of cryptogenic intrahepatic portal hypertension in a Southern Indian tertiary hospital

Background and aim  

Patients with intrahepatic portal hypertension and negative etiological work-up for liver disease are often labeled as having cryptogenic cirrhosis. The aim of this study was to evaluate causes of liver disease in patients with unexplained intrahepatic portal hypertension.     

Adult Separation Anxiety Disorder: A Disorder Comes of Age

This article explores accruing evidence supporting the occurrence of an adult form of separation anxiety disorder (ASAD), a category yet to be recognized by international classification systems. ASAD can have its first onset in adulthood, although in a portion of cases, it represents a persistence or recurrence of the childhood-onset type. Recent large-scale clinic studies have suggested that ASAD is associated with high levels of disability. In addition, the presence of ASAD in individuals with anxiety disorders seems to signal a poor outcome to cognitive-behavioral therapy. The existing evidence suggests possible grounds for removing the childhood-onset requirement for the category of separation anxiety disorder, thereby allowing for first onset in adulthood. There is a pressing need to design and test appropriate treatments for ASAD and to educate clinicians to identify and manage the condition.     

Evaluation of repellent action of neem oil against the filarial vector, Culex quinquefasciatus (Diptera: Culicidae)

Studies were carried out to evaluate the repellent action of neem oil against Culex quinquefasciatus. Application of 2 and 5 per cent neem oil @ 5 ml/person/night gave 50 and 40.9 per cent protection in indoor collections and 17.4 and 5.6 per cent in outdoor collections as compared with that of untreated control respectively. The protection time ranged from 0100 to 0300 hrs and 0100 to 0600 hrs in indoor and outdoor collections respectively. Results of repellent action of Autan, a synthetic mosquito repellent studied concurrently showed a relatively higher protection rate from the bites of Cx. quinquefasciatus.