Type 2 diabetes treatment and outcomes worldwide: A short review of the DISCOVER study programme

The global burden of type 2 diabetes (T2D) is increasing, indicating an urgent need for improved disease prevention and management strategies. Contemporary, global, real-world data, collected in a consistent way, on the characteristics, treatment and outcomes of people with T2D are lacking, particularly in low- and middle-income countries where disease burden is increasing most rapidly. The DISCOVER study programme ( ClinicalTrials.gov identifiers: NCT02322762 and NCT02226822) is a global, prospective, 3-year programme of observational research, which has been designed to fill this knowledge gap. DISCOVER is being conducted in 38 countries across six continents, including several lower-middle- and upper-middle-income countries where patients have rarely or never been studied previously. In total, 15 992 people with T2D who had initiated a second-line glucose-lowering therapy have been recruited. Data being collected include information on demographics, clinical and treatment characteristics, socio-economic status, clinical outcomes and patient-reported outcomes. Findings from DISCOVER will provide unique insights into current patterns of T2D care worldwide, which should contribute to informing clinical guidelines and health policy, and may help to improve patient care.     

Long-term results of the multidisciplinary surgical treatment of non-small-cell bronchial carcinoma in the superior sulcus (Pancoast tumour): a retrospective study

OBJECTIVE: To establish the long-term results of a combination of radiotherapy or chemoradiotherapy and surgery for the treatment of patients with a Pancoast tumour in the Erasmus MC-Daniel den Hoed, Rotterdam, the Netherlands, with special attention for the prognostic factors. DESIGN: Retrospective. METHODS: During the period from 1 January 1991 to 31 December 2004, 36 patients underwent surgical treatment combined with radiotherapy or chemoradiotherapy for a non-small-cell bronchial carcinoma with invasion of the superior sulcus. The study was terminated on 31 January 2006. The data were analysed according to the intention-to-treat principle, with overall survival and disease-free survival as the outcome variables. Cox regression analysis revealed differences between the subgroups on the basis of which prognostic factors could be studied. RESULTS: 36 patients with a non-small-cell bronchial carcinoma invading the superior sulcus (Pancoast tumour) underwent multidisciplinary treatment consisting of pre-operative radiotherapy (since 2002 concomitant chemoradiotherapy), superior-sulcus resection and (partial) lung resection with intra-operative brachytherapy. 2 patients died postoperatively. In 80% of the patients there was a positive histological effect of the preoperative treatment. The median follow-up was 26 months. The 2-year overall and disease-free survival was 45 and 31%, respectively, and at 5 years this was 28 and 19%. These results were comparable with those for stage IIB lung cancer without invasion. Favourable prognostic factors were: at least 75% necrosis of the tumour after pre-treatment, lack of positive mediastinal lymph nodes, and younger age.     

Tibial osteomyelitis due toAspergillus flavus in a heart transplant patient

Summary Aspergillus flavus was identified as the causative organism of a case of osteomyelitis involving the proximal epiphysis of the left tibia in a heart transplant patient. History revealed a previous pretibial wound due to a fall in the street as the consequence of a sudden cardiac arrest. Surgical debridement combined with fungostatic treatment including amphotericin B and itraconazole was followed by clinical improvement, although the fungus could still be recovered by culture on subsequent samples.

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Osteomyelitis der Tibia durch Aspergillus flavus bei einem Herztransplantatempfänger

Zusammenfassung Bei einem Herztransplantatempfänger trat eine Osteomyelitis der linken Tibiaepiphyse auf, als deren kausaler ErregerAspergillus flavus identifiziert wurde. Der Patient war bei einem plötzlichen Herzstillstand gefallen und hatte sich eine Wunde im prätibitalen Bereich zugezogen. Nach chirurgischem Debridement und fungostatischer Behandlung mit Amphotericin B und Itraconazol kam es zu einer klinischen Besserung, doch blieben die Pilzkulturen weiterhin positiv.

     

First report of chronic meningitis caused byTrichosporon beigelii

Trichosporon beigelii (Trichosporon cutaneum) was identified as the causative agent of chronic meningitis in a 15-year-old boy with acute lymphocytic leukaemia. After a neutropenic episode following cytostatic treatment and itraconazole therapy as prophylaxis, cerebrospinal fluid (CSF) samples yielded growth ofTrichosporon beigelii. Treatment with amphotericin B, flucytosine and high doses of fluconazole was followed by clinical improvement, although CSF pleocytosis remained. The cross-reactivity betweenCryptococcus neoformans andTrichosporon beigelii in a cryptococcal antigen latex test was used as a means of diagnosis in CSF and serum samples.     

Three cases of destructive native valve endocarditis caused by Staphylococcus lugdunensis

Described here are three cases of acute native valve endocarditis due to the coagulase-negative pathogen Staphylococcus lugdunensis with serious complications. Two of the three patients died despite optimal antibiotic therapy and cardiovascular surgery. These cases demonstrate the aggressive nature of S. lugdunensis and emphasize the importance of identifying coagulase-negative staphylococci to the species level and not considering the isolation of S. lugdunensis from normally sterile body fluids as contamination. On the contrary, when this organism is found in patients with endocarditis, early surgery should be considered. The possibility that this organism could be misidentified as S. aureus because of autocoagulation and that commercial identification systems may misidentify it as S. haemolyticus, S. hominis or S. warneri should also be remembered.     

Safety of As-Needed Budesonide-Formoterol in Mild Asthma: Data from the Two Phase III SYGMA Studies

Drug Safety - Budesonide-formoterol taken as needed is an emerging treatment for mild asthma. We used data from the SYGMA studies to assess the safety of As-needed budesonide-formoterol compared...     

Subacute endocarditis due to Erysipelothrix rhusiopathiae

Erysipelothrix rhusiopathiae is a rare cause of endocarditis. Most cases were observed in people working with animals. We report a case in a 45-year old man without any exposure to animals. He was admitted to our hospital because of dyspnoea. Blood cultures were drawn following fever on day 8 of hospitalisation. Erysipelothrix rhusiopathiae was cultured and echocardiography showed a vegetation on the mitral valve. Appropriate antibiotic therapy and surgical treatment led to a good outcome of the infection.