Gatifloxacin produces both hypoglycemia and hyperglycemia: a retrospective study

BACKGROUND: Gatifloxacin, until recently one of the most commonly prescribed antibiotics, has been shown to produce hypoglycemia. METHODS: To further examine the effects of Gatifloxicin (G) on blood glucose (BS), we conducted a retrospective chart review on 264 inpatients, examining for both hypoglycemia and hyperglycemia, comparing G with another quinolone, Ciproflaxin (C), and nonquinolone, Ceftriaxone (R). RESULTS: We found that of 292 patient encounters, 28 hypoglycemia and 48 hyperglycemic events occurred. Patients given G were 5 times as likely to become hypoglycemic as C (P < 0.01) and 9 times as likely as those given R (P < 0.02). Patients given G were 5.6 times more likely to develop hypoglycemia (P < 0.001) than the combined group, R+C. Conversely, patients treated with G were 3.8 times as likely to become hyperglycemic as those give C (P < 0.01) and 9.8 times as those given R (P < 0.01). With C and R combined, those given G were 5.2 times as likely to develop hyperglycemia (P < 0.01). Looking at patient encounters where G was given, we found that having preexisting diabetes mellitus (DM) was positively associated with hypoglycemia (21/144, P < 0.001). Steroid use (P < 0.05) and being in the ICU (P < 0.01) were also positively associated with hyperglycemia (38/144, P < 0.01). CONCLUSIONS: In summary, G was clearly associated with both hypoglycemia and hyperglycemia compared with C and R. The risk of hyperglycemia increased in the presence of DM, steroid use, and "sick enough" to be in the intensive care unit.     

Prevalence and significance of unrecognized renal insufficiency in patients with heart failure.

AIMS: Renal insufficiency (RI) is a strong predictor of adverse outcome in patients with heart failure (HF). We aimed to determine the prevalence of RI being unrecognized and its significance in patients hospitalized with HF. METHODS AND RESULTS: We analysed data from a prospective survey of 4102 hospitalized patients with HF. RI [defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] was present in 2145 (57%) patients but, based on medical records, was unrecognized in 872 [41%, 95% confidence interval (CI) 39-43%] of them. Patients with unrecognized RI were more likely to be women, elderly, and with better functional class, compared with patients with recognized RI. In-hospital and 1 year mortality was significantly higher among patients with recognized and unrecognized RI compared with patients without RI: 6.5 and 7.1 vs. 2.1%, and 38.8 and 30.9 vs. 18.8% (P < 0.001), respectively. After adjustment, recognized and unrecognized RI comparably predicted increased in-hospital mortality: odds ratio (OR) and 95% CI of 2.34 (1.43-3.87), P < 0.001, and 2.30 (1.45-3.72), P < 0.001. After 1 year, recognized RI remained an independent predictor for mortality: OR 1.79 (1.45-2.20), P < 0.001, whereas there was a trend for increased mortality predicted by unrecognized RI: OR 1.22 (0.97-1.53), P = 0.08. CONCLUSION: A high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR.     

Magnetic susceptibility studies of laccase and oxyhemocyanin.

The magnetic susceptibility of Rhus vernicifera laccase has been remeasured over the temperature range 5-260 K. In contrast to our previous results [Solomon, E.I., Dooley, D. M., Wang R.-H., Gray, H.B., Cerdonio, M., Mogno, F. & Romani, G. L. (1975) J. Am. Chem. Soc. 98, 1029-1031] linear chi versus T-1 behavior was observed. The susceptibility of Limulus polyphemus oxyhemocyanin has also been measured in the range 5-260 K. Only weak paramagnetism, attributable to dissolved oxygen and a small amount of paramagnetic impurities, was observed. Analysis of the data establishes a lower limit of 550 cm-1 for J, consistent with our earlier work. The temperature dependence of the susceptibility of laccase is quantitatively accounted for by the presence of two paramagnetic copper ions (types 1 and 2) per enzyme molecule. Curie law behavior at low temperatures rules out significant interaction between the two coppper types, indicating that these redox centers are well separated (several angstroms) and are not connected by bridging ligands. Formulation of the type 3 site as binuclear Cu(II) requires J greater than or equal to 500 cm-1.     

A model for amyloid fibril formation in immunoglobulin light chains based on comparison of amyloidogenic and benign proteins and specific antibody binding.

In an attempt to understand the mechanism of amyloid fibril formation in light chain amyloidosis, the properties of amyloidogenic (SMA) and benign (LEN) immunoglobulin light chain variable domains (VL) were compared. The conformations of LEN and SMA were measured using secondary and tertiary structural probes over the pH range from 2 and 8. At all pH values, LEN was more stable than SMA. The CD spectra of LEN at pH 2 were comparable to those of SMA at pH 7.5, indicating that the low pH conformation of LEN closely resembles that of SMA at physiological pH. At low pH, a relatively unfolded intermediate conformation is populated for SMA and rapidly leads to amyloid fibrils. The lack of such an intermediate with LEN, is attributed to sequence differences and accounts for the lack of LEN fibrils in the absence of agitation. A kappa IV-specific monoclonal antibody that recognizes the N-terminal of SMA caused unraveling of the fibrils to the protofilaments and was observed to bind to one end of SMA protofilaments by atomic force microscopy. The antibody result indicates that each protofilament is asymmetric with different ends. A model for the formation of fibrils by SMA is proposed.     

Regenerative medicine as applied to general surgery

The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues, or organs to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues, and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate.     

Does Bone Wax Induce a Chronic Inflammatory Articular Reaction?

Background  

Bone wax is used to control femoral neck bleeding during open femoroacetabular impingement (FAI) surgery. Despite its widespread use, only a few case reports and small case series describe side effects after extraarticular use. It is unclear whether intraarticular use of bone wax leads to such complications. However, during revision FAI surgery, we have observed various degrees of articular inflammatory reactions.     

Femoral Bone Is Preserved Using Cemented Polished Stems in Young Patients

Background  

Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery.     

Imaging periprosthetic osteolysis around total knee arthroplasties using a human cadaver model

We examined the sensitivity and accuracy of measuring osteolysis around total knee arthroplasty (TKA) on radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) in a cadaver model. Fifty-four simulated osteolytic defects ranging from 0.7 to 14 cm(3) were created in 6 cadaver knees implanted with either a cemented or an uncemented TKA. Three blinded investigators assessed the presence, location, and volume of defects on radiographs and CT and MRI scans with metal reduction protocols. Both CT and MRI had significantly higher sensitivities and specificities than did plain radiographs (P < .005). Overall, there was no difference in the accuracy of defect volume measurements between CT and MRI (P = .574). This study demonstrates the limitations of radiographs and the high sensitivity and specificity of both CT and MRI in assessing osteolysis around TKA.     

Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study

Objective

This report describes the first prospective cohort study comparing transvaginal cholecystectomies (TVC) with single incision laparoscopic cholecystectomies (SILC) and four-port laparoscopic cholecystectomies (4PLC).

Methods

Between May 2009 and August 2010, 14 patients underwent a TVC. These patients were compared with patients who underwent SILC (22 patients) or 4PLC (11 patients) in a concurrent, randomized, controlled trial. Demographic data, operative time, numerical pain scales, complications, and return to work were recorded.

Results

Mean age (TVC: 33.5?±?3.0?year; SILC: 38.4?±?3.3?year; 4PLC: 35.5?±?4.1?year; p?=?0.58) and mean BMI (TVC: 28.8?±?1.5?kg/m²; SILC: 31.8?±?1?kg/m²; 4PLC: 31.4?±?2.2?kg/m²; p?=?0.35) were not statistically significant. However, mean operative time (TVC: 67?±?3.9?min; SILC: 48.9?±?2.6?min; 4PLC: 42.3?±?3.9?min; p?p?=?0.02) with equilibration of pain scores by days 14 and 30. Return to work (TVC: 6.4?±?1.5?days; SILC: 13.1?±?1.3?days; 4PLC: 14.1?±?1.4?days; p?Conclusions Transvaginal cholecystectomy is a safe and well-tolerated procedure with statistically significantly less pain at 1 and 3?days after surgery, with a faster return to work but longer operative times compared with single incision and four-port laparoscopic cholecystectomy.