Effect of a nutritional supplement used for diabetic foot ulcers on microalbuminuria

We evaluated if a nutritional supplement containing arginine, glutamine, β-hydroxy-β-methyl butyrate commonly used to improve the healing of diabetic foot ulcers had any effect on the kidney function in the diabetic patients. We hypothesized that the action on the skin may be nonspecific and that the supplement might also act on other structural elements of the kidney. We compared the evolution of the blood creatinine and of the overnight albumin excretion in 16 diabetic subjects with mild to moderate nephropathy 6 months prior to and during the 6 months of treatment. The creatinine level remained stable during the treatment, while microalbuminuria decreased to nearly 50% of the initial value (p < 0.000).     

A chemical biology screen identifies glucocorticoids that regulate c-maf expression by increasing its proteasomal degradation through up-regulation of ubiquitin

The oncogene c-maf is frequently overexpressed in multiple myeloma cell lines and patient samples and contributes to increased cellular proliferation in part by inducing cyclin D2 expression. To identify regulators of c-maf, we developed a chemical screen in NIH3T3 cells stably overexpressing c-maf and the cyclin D2 promoter driving luciferase. From a screen of 2400 off-patent drugs and chemicals, we identified glucocorticoids as c-maf-dependent inhibitors of cyclin D2 transactivation. In multiple myeloma cell lines, glucocorticoids reduced levels of c-maf protein without influencing corresponding mRNA levels. Subsequent studies demonstrated that glucocorticoids increased ubiquitination-dependent degradation of c-maf and up-regulated ubiquitin C mRNA. Moreover, ectopic expression of ubiquitin C recapitulated the effects of glucocorticoids, demonstrating regulation of c-maf protein through the abundance of the ubiquitin substrate. Thus, using a chemical biology approach, we identified a novel mechanism of action of glucocorticoids and a novel mechanism by which levels of c-maf protein are regulated by the abundance of the ubiquitin substrate.     

Effects of specific medical nutrition on retinal fundus changes in diabetes

Diabetic retinopathy is a frequent complication of longstanding diabetes mellitus. While using a specialized medical nutrition therapy plus a blend of arginine, glutamine and β-hydroxy-β-metilbutyrate proven to be effective to normalize the body composition in diabetics and improve the rate of healing of the foot ulcers (DFU), we observed a marked improvement in some markers of retinopathy progression.     

Toward a theory of “hypnotic” behavior: Replication and extension of experiments by barber and co-workers (1962–65) and Hilgard and Tart (1966)

Responses to test suggestions (e.g., hallucination and amnesia) were assessed under the following treatments: motivational instructions alone; hypnotic procedure with motivational instructions; and imagination-control. Comparisons were made across independent groups, each tested under one treatment, and also within the same Ss tested twice under various combinations of the treatments. Although Ss were suggestible under the imagination-control treatment, both the motivational instructions alone and the hypnotic procedure given together with the motivational instructions raised suggestibility above the control level. The hypnotic-motivational treatment tended to produce an increment in suggestibility which went slightly beyond that attributable to the motivational instructions. The latter increment is interpreted as due to the slightly greater effectiveness of the hypnotic procedure in defining the situation as one in which unusual manifestations, such as hallucination and amnesia, are within Ss' capabilities and definitely expected by E.     

Quantification of intracardiac shunts by gold-195m, a new radionuclide with a short half life

Gold-195m, a radionuclide with a short half life (30.5 s) was used to quantify left to right intracardiac shunts. The results of this method were compared with those obtained with technetium-99m, a method that was validated against oximetry. In five patients the pulmonary to systemic flow ratio (greater than 3:1) obtained by both radionuclides indicated that the level of shunting was too high to be measured accurately. In one patient fragmentation of the bolus meant that no satisfactory gamma fit could be obtained. In the remaining 16 patients there was no significant difference between two successive 195mAu studies. The agreement between 99mTc results and 195mAu results was excellent. Oxygen administration, straight leg raising exercise, and the use of oblique projections did not affect the values of the pulmonary to systemic flow ratio. The technique of quantification of intracardiac shunts by 195mAu gives reproducible and accurate results and the low radiation dose means that it is suitable for use in children with suspected left to right shunts.     

Electronic Inventory Systems and Barcode Technology: Impact on Pharmacy Technical Accuracy and Error Liability

Purpose:

To measure the effects associated with sequential implementation of electronic medication storage and inventory systems and product verification devices on pharmacy technical accuracy and rates of potential medication dispensing errors in an academic medical center.

Methods:

During four 28-day periods of observation, pharmacists recorded all technical errors identified at the final visual check of pharmaceuticals prior to dispensing. Technical filling errors involving deviations from order-specific selection of product, dosage form, strength, or quantity were documented when dispensing medications using (a) a conventional unit dose (UD) drug distribution system, (b) an electronic storage and inventory system utilizing automated dispensing cabinets (ADCs) within the pharmacy, (c) ADCs combined with barcode (BC) verification, and (d) ADCs and BC verification utilized with changes in product labeling and individualized personnel training in systems application.

Results:

Using a conventional UD system, the overall incidence of technical error was 0.157% (24/15,271). Following implementation of ADCs, the comparative overall incidence of technical error was 0.135% (10/7,379; P = .841). Following implementation of BC scanning, the comparative overall incidence of technical error was 0.137% (27/19,708; P = .729). Subsequent changes in product labeling and intensified staff training in the use of BC systems was associated with a decrease in the rate of technical error to 0.050% (13/26,200; P = .002).

Conclusions:

Pharmacy ADCs and BC systems provide complementary effects that improve technical accuracy and reduce the incidence of potential medication dispensing errors if this technology is used with comprehensive personnel training.     

A systematic review and meta-analysis of thiazide-induced hyponatraemia: time to reconsider electrolyte monitoring regimens after thiazide initiation?

AIMS

Hyponatraemia is one of the major adverse effects of thiazide and thiazide-like diuretics and the leading cause of drug-induced hyponatraemia requiring hospital admission. We sought to review and analyze all published cases of this important condition.

METHODS

Ovid Medline, Embase, Web of Science and PubMed electronic databases were searched to identify all relevant articles published before October 2013. A proportions meta-analysis was undertaken.

RESULTS

One hundred and two articles were identified of which 49 were single patient case reports. Meta-analysis showed that mean age was 75 (95% CI 73, 77) years, 79% were women (95% CI 74, 82) and mean body mass index was 25 (95% CI 20, 30) kg m⁻². Presentation with thiazide-induced hyponatraemia occurred a mean of 19 (95% CI 8, 30) days after starting treatment, with mean trough serum sodium concentration of 116 (95% CI 113, 120) mm and serum potassium of 3.3 (95% CI 3.0, 3.5) mm. Mean urinary sodium concentration was 64 mm (95% CI 47, 81). The most frequently reported drugs were hydrochlorothiazide, indapamide and bendroflumethiazide.

CONCLUSIONS

Patients with thiazide-induced hyponatraemia were characterized by advanced age, female gender, inappropriate saliuresis and mild hypokalaemia. Low BMI was not found to be a significant risk factor, despite previous suggestions. The time from thiazide initiation to presentation with hyponatraemia suggests that the recommended practice of performing a single investigation of serum biochemistry 7–14 days after thiazide initiation may be insufficient or suboptimal. Further larger and more systematic studies of thiazide-induced hyponatraemia are required.