Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: a cross-sectional analysis of a large clinical population

Purpose  

Due to inconsistent definitions used in the literature, the prevalence of rapid eye movement (REM)-related sleep-disordered breathing (SDB) has been quite variable and its clinical significance remains unclear. This study aimed to compare the prevalence of and clinical characteristics between various criteria for defining REM-related SDB. We also investigated how frequently CPAP therapy was recommended in patients with REM-related SDB and if they had lower CPAP adherence compared to non-stage-specific SDB.     

Sensitivity pattern of gram negative bacilli to three beta-lactam/beta-lactamase inhibitor combinations using the automated API system

PURPOSE: To evaluate the spectrum of activity of three beta-lactamase inhibitors such as amoxicillin/ clavulanic acid, ticarcillin/ clavulanic acid and piperacillin/ tazobactam in comparison to cephalosporins against gram negative bacilli. METHODS: Gram-negative bacilli isolated from the clinical specimens received in the laboratory were included in the study. Using the API system (bioMiotarieux) during a one-year period, a total of 1,252 Enterobacteriaceae and 385 non-fermenters were evaluated. RESULTS: The percentage resistance of the Enterobacteriaceae isolates was 82.92% to amoxicillin/ clavulanic acid, 58.22% to ticarcillin/clavulanic acid and 22.44% to piperacillin/tazobactam respectively. Pseudomonas aeruginosa showed resistance of 96% to ticarcillin/ clavulanic acid and 61% to piperacillin/ tazobactam and Acinetobacter baumannii showed 49% resistance to ticarcillin/ clavulanic acid and 77% resistance to piperacillin/ tazobactam respectively. The isolates exhibited high resistance to all the generations of cephalosporins and the other groups of antibiotics except carbapenems. CONCLUSIONS: Piperacillin/tazobactam was found to be the most active combination of the three against Enterobacteriaceae and Pseudomonas spp. and ticarcillin/clavulanic acid against Acinetobacter spp. and Stenotrophomonas maltophilia.     

Pharmacokinetics and biochemical efficacy of pirmagrel, a thromboxane synthase inhibitor, in renal allograft recipients.

The effects of a 48-hour 0.5 mg/kg/hr infusion of the thromboxane synthase inhibitor pirmagrel were studied in 10 renal allograft recipients with cyclosporine nephrotoxicity. Plasma concentrations reached a mean steady-state plasma level of 1798 +/- 481 ng/ml. Biphasic, rapid elimination of pirmagrel was observed with a distribution half-life of 6.7 minutes and a terminal half-life of 73 minutes. Plasma clearance and the volume of distribution of the drug were 300 +/- 87 ml/hr/kg and 497 +/- 232 ml/kg, respectively. The pharmacodynamic effects of pirmagrel were marked by a mean 96% suppression of serum thromboxane B2 (TXB2), which coincided with a suppression of urinary excretion of TXB2, 2,3-dinor-TXB2, and 11-dehydro-TXB2 of 85% +/- 8%, 91% +/- 5%, and 89% +/- 9%, respectively. Urinary excretion of all thromboxane metabolites measured at the end of 1 week after termination of infusion was returned to the baseline. In conclusion, pirmagrel caused effective and sustained suppression of all thromboxane derived metabolites in plasma and urine during continuous infusion in kidney transplant patients receiving cyclosporine.     

Pathology of fungal infections of the central nervous system: 17 years' experience from Southern India

Aims:  To describe the pathology of central nervous system (CNS) fungal infections with particular reference to India.
Methods and results:  This was a retrospective study from 1988 to 2004 constituting 130 cases. The diagnosis was based on morphology of biopsy/autopsy material. These included aspergillosis ( n  = 73), zygomycosis ( n  = 40), cryptococcosis ( n  = 2), rhodotorulosis ( n  = 1), candidiasis ( n  = 5), maduramycosis ( n  = 1), pheohyphomycosis ( n  = 3) and mixed infections ( n  = 5). Predisposing risk factors were present in 49 (38%) patients only. The majority of the patients were immunocompetent. The commonest risk factor was diabetes mellitus, the commonest route of infection was from a contiguous site and the commonest pathology was granuloma. Culture positivity was seen in only 31%.
Conclusion:  Environmental factors in tropical countries such as India play a significant role in the pathogenesis of CNS fungal infections.     

Serodiagnosis of dengue virus infection in patients presenting to a tertiary care hospital

Dengue is an acute infectious disease of viral etiology. It is probably one of the most important arthropod borne viral disease in terms of human morbidity and mortality. The spectrum of disease ranges from self-limited dengue fever to more severe forms of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Laboratory diagnosis of dengue virus infection mainly depends on detection of virus specific antibodies. The aim of the study was to correlate the serological results with clinical presentation in patients with a diagnosis of dengue. Eleven out of 15 (73.3%) patients with DHF and DSS had secondary antibody response and mortality was 100% in these patients.     

Obstructive Sleep Apnea in Young Lean Men: Impact on insulin sensitivity and secretion

OBJECTIVE

To assess whether the presence of obstructive sleep apnea (OSA) affects glucose metabolism in young, lean individuals who are healthy and free of cardiometabolic disease.

RESEARCH DESIGN AND METHODS

In a prospective design, 52 healthy men (age 18–30 years; BMI 18–25 kg/m²) underwent laboratory polysomnogram followed by a morning oral glucose tolerance test (OGTT). We stratified all subjects according to the presence or absence of ethnicity-based diabetes risk and family history of diabetes. We then used a frequency-matching approach and randomly selected individuals without OSA, yielding a total of 20 control men without OSA and 12 men with OSA. Indices of glucose tolerance, insulin sensitivity, and insulin secretion (early phase and total) were compared between men with OSA and control subjects. The incremental areas under the glucose (incAUC_glu) and insulin (incAUC_ins) curves were calculated using the trapezoidal method from 0 to 120 min during the OGTT.

RESULTS

Men with OSA and control subjects were similar in terms of age, BMI, ethnicity-based diabetes risk, family history of diabetes, and level of exercise. Both groups had normal systolic and diastolic blood pressure and fasting lipid levels. After ingestion of a glucose load, men with OSA had 27% lower insulin sensitivity (estimated by Matsuda index) and 37% higher total insulin secretion (incAUC_ins) than the control subjects, despite comparable glucose levels (incAUC_glu).

CONCLUSIONS

In young, lean, and healthy men who are free of cardiometabolic disease, the presence of OSA is associated with insulin resistance and a compensatory rise in insulin secretion to maintain normal glucose tolerance. Thus, OSA may increase the risk of type 2 diabetes independently of traditional cardiometabolic risk factors.Obstructive sleep apnea (OSA) is a disorder characterized by repetitive episodes of upper-airway obstruction during sleep, which result in intermittent hypoxemia and transient arousals leading to sleep fragmentation and poor sleep quality. Obesity, male sex, and advancing age are the strongest risk factors for OSA (1). Notably, OSA is highly prevalent in overweight and obese individuals (2,3), who represent approximately two-thirds of the U.S. adult population today.Increasing evidence from population-based and clinical studies suggests an association between OSA, insulin resistance, and type 2 diabetes in overweight and obese adults (4–7) even after statistical adjustments for age, adiposity, and other shared risk factors. In the few studies that have included individuals with a BMI <25 kg/m², the presence of OSA was found to be associated with insulin resistance in selected clinical populations of Asian origin (8–10) and with a higher prevalence of prediabetes in a subset of data obtained from the Sleep Heart Health Study, a multicenter cohort of community-dwelling adults in the U.S (11). However, these studies of lean individuals were conducted in middle-aged and older adults who had varying degrees of cardiovascular disease such as hypertension and dyslipidemia, as well as other potential comorbidities. Thus, it is still unclear whether the link between OSA and type 2 diabetes is independent of potential confounding effects of obesity and other cardiometabolic risk factors (12), which prevail both in OSA and in disorders of glucose metabolism.We questioned whether the presence of OSA affects glucose metabolism in individuals who are otherwise healthy and free of cardiometabolic disease. To address this question, we assessed the response to oral glucose tolerance testing (OGTT) in healthy young lean men with and without OSA.