Medicine News

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No Difference in Mortality Seen with Factor VIIa in Emergency Department Patients With Warfarin Use and Traumatic Intracranial Hemorrhage
A study out Academic Emergency Medicine compared outcomes in emergency department (ED) patients with preinjury warfarin use and traumatic intracranial hemorrhage (tICH) who did and did not receive recombinant activated factor VIIa (rFVIIa) for international normalized ratio (INR) reversal. Overall in patients with preinjury warfarin and tICH, use of rFVIIa was associated with a decreased time to normal INR. However, no difference in mortality was identified. Use of rFVIIa in patients on warfarin and tICH requires further study to demonstrate important patient-oriented outcomes.

Insurance Coverage Is Associated with Mortality after Gunshot Trauma
An article in this months American College of Surgeons hypothesized that insurance coverage is also associated with mortality after gunshot trauma and found that Despite similar injury severity, uninsured trauma patients were more likely to die after gunshot injury than insured patients. The in-hospital mortality rate was significantly higher for uninsured patients than for insured patients (9% vs 6%, p = 0.02). After controlling for age, gender, race, and injury severity by logistic regression analysis, the odds ratio for death of uninsured patients was 2.2 (95% CI 1.1 to 4.5).

Proton-Pump Inhibitor Use Is Not Associated With Osteoporosis or Accelerated Bone Mineral Density Loss
Recent studies have shown an association between proton-pump inhibitor use (PPI) and hip fracture. The mechanism by which PPI use promotes the development of hip fracture is uncharacterized. A study out of Gastroenterology sought to determine whether PPI use is associated with osteoporosis or accelerated bone mineral density (BMD) loss. PPI use was not associated with having osteoporosis at either the hip (OR, 0.84; 95% CI, 0.55–1.34) or the lumbar spine (OR, 0.79; 95% CI, 0.59–1.06) for PPI use >1500 doses over the previous 5 years. In the longitudinal study no significant decrease was observed in BMD at either site attributable to PPI use.

Orthostatic Syndromes Differ in Syncope Frequency
There are conflicting opinions on whether postural tachycardia syndrome predisposes to syncope. We investigated this relationship by comparing the frequency of syncope in postural tachycardia syndrome and orthostatic hypotension. Of 810 patients referred for postural tachycardia syndrome, 185 met criteria while another 328 patients had orthostatic hypotension. Of the postural tachycardia syndrome patients, 38% had syncope on head-up tilt, compared with only 22% of those with orthostatic hypotension (P<.0001). In the postural tachycardia group, syncope on head-up tilt was associated with a clinical history of syncope in 90%, whereas absence of syncope on head-up tilt was associated with a clinical history of syncope in 30% (P<.0001). In contrast, syncope on head-up tilt did not bear any relationship to clinical history of syncope in the orthostatic hypotension group (41% vs 36%; P=.49). results demonstrate that syncope (both tilt table and clinical) occurs far more commonly in patients who have postural tachycardia syndrome than in patients with orthostatic hypotension. More Information on Postural Tachycardia Syndrome, also from the National Institute of Health

Bacteriophages Can Treat and Prevent Pseudomonas aeruginosa Lung Infections
Antibiotic‐resistant bacteria threaten life worldwide. Although new antibiotics are scarce, the use of bacteriophages, viruses that infect bacteria, is rarely proposed as a means of offsetting this shortage. Doubt also remains widespread about the efficacy of phage therapy despite recent encouraging results. Using a bioluminescent Pseudomonas aeruginosa strain, we monitored and quantified the efficacy of a bacteriophage treatment in mice during acute lung infection. Bacteriophage treatment not only was effective in saving animals from lethal infection, but also was able to prevent lung infection when given 24 h before bacterial infection, thereby extending the potential use of bacteriophages as therapeutic agents to combat bacterial lung infection.

Resolution of ST-segment depression: a new prognostic marker in ST-segment elevation myocardial infarction
An article out of the European Heart Journal evaluatee the prognostic impact of ST depression resolution among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. When compared with patients with both STE-R and STD-R≥50%, patients with both STE-R and STD-R<50% had the worst outcomes [hazard ratios (HR) 90 day death: 2.54; 95% confidence intervals (CI): 1.71–3.77; HR 90 day composite: 2.18; 95% CI: 1.63–2.91]. Overall when ST depression is present in STEMI patients undergoing primary PCI, ST Depression-Resolution <50% provides independent prognostic value that is incremental to ST elevation-Resolution.

Radiation Most Effective Soon After Breast Cancer Surgery
For women who have had breast cancer surgery, the question of whether or not to wait before receiving radiation therapy has been answered by new research that suggests that the longer women wait, the greater the chance of cancer recurrence. The findings, published in the March 3 online edition of BMJ, are based on an analysis of national cancer records for 18,050 American women who were diagnosed with early-stage breast cancer between 1991 and 2002, at age 65 or older.

Radiation After Mastectomy May Be Overused
Many women who undergo mastectomy for early-stage breast cancer may not benefit from radiotherapy, a retrospective study suggested.

Among those who had stage I or II disease with spread to no more than three lymph nodes and who did not undergo radiation therapy, the overall locoregional recurrence rate was just 2.3% at 10 years, according to Ranjna Sharma, MD, of the University of Texas M.D. Anderson Cancer Center in Houston.

Rectally administered misoprostol versus intravenous oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss
A study out of the International Journal of Gynecology compared the efficacy of rectally administered misoprostol with intravenous oxytocin infusion in preventing uterine atony and blood loss during cesarean delivery. A total of 96 and 94 women were analyzed in the misoprostol and oxytocin groups, respectively. Intraoperative and postoperative blood loss was significantly lower in the misoprostol group than in the oxytocin group. Rectal misoprostol appears to be an effective alternative to intravenous oxytocin in preventing blood loss for routine use during cesarean delivery.

Therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction
A meta-analysis out of the British Journal of Surgery assessed the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in adhesive small bowel obstruction (SBO). The appearance of contrast in the colon within 4-24 h after administration had a sensitivity of 96 per cent and specificity of 98 per cent in predicting resolution of SBO. It concluded that water-soluble contrast was effective in predicting the need for surgery in patients with adhesive SBO. In addition, it reduced the need for operation and shortened hospital stay.

Chest Tube Size Doesn't Affect Outcome in Pleural Infection
The optimal choice of chest tube size for the treatment of pleural infection is unknown, with only small cohort studies reported describing the efficacy and adverse events of different tube sizes. An article published in Chest evaluated a total of 405 patients with pleural infection and showed smaller, guide-wire-inserted chest tubes cause substantially less pain than blunt-dissection-inserted larger tubes, without any impairment in clinical outcome in the treatment of pleural infection.

No Significant Difference in the Rate of Death Between Patients with Shock Treated with Dopamine or Norepinephrine
Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other. A multicenter, randomized trial was conducted and assigned 1679 patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P=0.10). However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P<0.001). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock.

Leflunomide: Is a New Oral Agent in Treatment of Acute Pancreatitis?
Nuclear factor-κB (NF-κB) is a potent mediator in several steps of acute pancreatitis. Leflunomide is a novel immunomodulating drug that is also a potent inhibitor of NF-κB activation. The aim of this study was to investigate the effects of leflunomide pretreatment in severe necrotizing pancreatitis. Leflunomide pretreatment significantly ameliorated pancreatic hemorrhage, edema, and neutrophil infiltration and decreased histopathological score compared with the untreated severe necrotizing pancreatitis group. Leflunomide is a beneficial agent in the severe form of acute pancreatitis in rats and should be considered as a potential agent for treatment of acute pancreatitis.

Mortality After Hospitalization for Heart Failure Lower in Blacks Compared to Whites
Heart failure (HF) disproportionately affects black compared to white Americans, and overall mortality from HF is greater among blacks. Paradoxically, mortality rates after a hospitalization for HF are lower in black than in white patients. These racial differences might reflect hospital, physician, and patient factors and could have implications for comparative hospital profiles. A study out of the American Journal of Cardiology identified published studies reporting the posthospitalization mortality for black and white patients with a discharge diagnosis of HF and conducted random-effects meta-analyses with the outcome of all-cause mortality. Overall it found mortality after hospitalization for HF was 32% lower during short-term follow-up and 16% lower during long-term follow-up for black than for white patients. The mortality differences imply unmeasured differences by race in clinical severity of illness at hospital admission and might lead to biased hospital mortality profiles.

Identifying Children at Low Risk for Bacterial Conjunctivitis
A study out of the Archives of Pediatrics and Adolescent Medicine conducted a prospective observational cohort study to identify a population of children at low risk for bacterial conjunctivitis on the basis of history and physical examination findings. Age 6 years or older, presentation in April through November, no or watery discharge, and no glued eye in the morning were the clinical factors found to be independently associated with a negative conjunctival culture. If 3 factors were present, 76.4% (95% confidence interval, 63.6%-85.6%) of patients had a negative culture. If all 4 factors were present, 92.3% (95% confidence interval, 66.1%-98.2%) of patients had a negative culture.

Decreased Hippocampal Volume in Healthy Girls at Risk of Depression
Researchers have documented that the hippocampus is smaller in individuals with depression than in those without. The temporal or causal association of this reduction in hippocampal volume in depression, however, is not known. A study out the Archives of General Psychiatry used magnetic resonance imaging to examine brain structure volume in individuals at high and low familial risk of depression. Compared with individuals at low familial risk of the development of depression, high-risk individuals have reduced hippocampal volume, indicating that neuroanatomic anomalies associated with depression may precede the onset of a depressive episode and influence the development and course of this disorder.

Association Between Cannabis Use and Psychosis
The early use of marijuana increases the risks for schizophrenia, delusions and hallucinations in young adulthood, according to a study published online March 1 in the Archives of General Psychiatry.

An Algorithm for Tuberculosis Screening and Diagnosis in People with HIV
Tuberculosis screening is recommended for people with human immunodeficiency virus (HIV) infection to facilitate early diagnosis and safe initiation of antiretroviral therapy and isoniazid preventive therapy. No internationally accepted, evidence-based guideline addresses the optimal means of conducting such screening, although screening for chronic cough is common. A study in the New England Journal of Medicine consecutively enrolled people with HIV infection from eight outpatient clinics. The presence of cough of any duration, fever of any duration, or night sweats lasting 3 or more weeks in the preceding 4 weeks was 93% sensitive and 36% specific for tuberculosis.In persons with HIV infection, screening for tuberculosis should include asking questions about a combination of symptoms rather than only about chronic cough. It is likely that antiretroviral therapy and isoniazid preventive therapy can be started safely in people whose screening for all three symptoms is negative, whereas diagnosis in most others will require mycobacterial culture.

Stents, surgery both prevent strokes: study
For many years, surgery has been the preferred way to clear away dangerous fatty deposits in neck arteries that can cause strokes. But newer, less invasive approaches using angioplasty and stents have been approved for use in higher-risk patients, stirring debate over which approach is best.It showed that both approaches were safe and effective overall at preventing stroke, but they did find some differences between the two approaches.They found that patients who had had surgery had lower rates of subsequent strokes, while those who had gotten a stent were less likely to have a heart attack after the procedure.

Myopic Eyes Less Likely to Have Diabetic Retinopathy
Eyes with myopia may be less likely to develop diabetic retinopathy (DR). The relationship between refractive error, ocular biometry, and DR therefore was investigated in the Journal of Ophthalmology that showed Myopic refraction and longer Axial Length are associated with a lower risk of DR, particularly vision-threatening retinopathy, without any evidence of a threshold.

Assessment of the Effects of Desmopressin on Impaired Platelet Function Using Multiple Electrode Whole-Blood Aggregometry in Patients After Cardiac Surgery
Blood loss after cardiac surgery can be caused by acquired platelet dysfunction after cardiopulmonary bypass. Monitoring of platelet function is clinically important for the identification of patients experiencing such platelet dysfunction. 1-Deamino-8-d-arginine vasopressin (desmopressin acetate, DDAVP) has been shown to augment platelet function and to reduce blood loss in patients with platelet dysfunction. In this study, we examined the feasibility of whole blood multiple electrode aggregometry (MEA) for the detection of cardiopulmonary bypass–induced platelet dysfunction and investigated its ability to monitor DDAVP treatment. This study showed that Impaired platelet function after cardiac surgery can be assessed at the bedside using MEA. The effect of DDAVP on impaired platelet function can also be detected as significant improvement in platelet aggregation to all activators. This device might be helpful for the identification of patients who may benefit from DDAVP therapy.

Serum testosterone is associated with aggressive prostate cancer in older men: results from the Baltimore Longitudinal Study of Aging
An Article in the British Journal of Urology evaluated the relationship between testosterone levels and the development of high-risk prostate cancer, by prospectively examining serum androgen concentrations in a well-studied cohort, as the role of testosterone in prostate cancer progression is debated. The study comprised 781 men in the Baltimore Longitudinal Study of Aging who had sex steroid measurements before a diagnosis of prostate cancer, or at their last visit for those without cancer. The likelihood of high-risk prostate cancer doubled per unit (0.1) increase in the free testosterone index (FTI) for patients aged >65 years and concluded that higher levels of serum free testosterone are associated with an increased risk of aggressive prostate cancer among older men. These data highlight the importance of prospective trials to insure the safety of testosterone-replacement therapy.

Lower Dose Alteplase Shows Similar Clinical Outcomes in Middle Cerebral Artery Occlusion than Higher Dose
A study out the Journal Stroke evaluated the efficacy of 0.6 mg/kg intravenous alteplase on vascular and clinical outcomes in patients with middle cerebral artery occlusion in a postmarketing Phase IV trial of prospective cohort study design. Recanalization was noted in 51.7% on 6-hour MR angiography and 69.0% on 24-hour MR angiography. A favorable clinical outcome was achieved in 46.6% concluding the rates of recanalization and favorable outcome are comparable to that previously reported with the 0.9-mg/kg dose.

Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy
A study published in JAMA tested the hypothesis of noninferiority between lactate clearance and central venous oxygen saturation (ScvO2) as goals of early sepsis resuscitation. randomly assigned patients to 1 of 2 resuscitation protocols. The ScvO2 group was resuscitated to normalize central venous pressure, mean arterial pressure, and ScvO2 of at least 70%; and the lactate clearance group was resuscitated to normalize central venous pressure, mean arterial pressure, and lactate clearance of at least 10%. The study protocol was continued until all goals were achieved or for up to 6 hours.Thirty-four patients (23%) in the ScvO2 group died while in the hospital (95% confidence interval [CI], 17%-30%) compared with 25 (17%; 95% CI, 11%-24%) in the lactate clearance group. This observed difference between mortality rates did not reach the predefined –10% threshold concluding additional management to normalize lactate clearance compared with management to normalize ScvO2 did not result in significantly different in-hospital mortality.

Hormone replacement tied to lung cancer risk

Cardiology Groups Stand by Embattled Diabetes Drug

End Tidal CO2 Monitoring Predicts Hypoxia by 60 Seconds During Emergency Department Procedural Sedation and Analgesia With Propofol
An article from the Annals of Emergency Medicine sought to determine whether the use of capnography is associated with a decreased incidence of hypoxic events than standard monitoring alone during emergency department (ED) sedation with propofol. One hundred thirty-two subjects were evaluated and included in the final analysis. We observed hypoxia in 17 of 68 (25%) subjects with capnography and 27 of 64 (42%) with blinded capnography. Capnography identified all cases of hypoxia before onset (sensitivity 100%; specificity 64%), with the median time from capnographic evidence of respiratory depression to hypoxia 60 seconds concluding the addition of capnography to standard monitoring reduced hypoxia and provided advance warning for all hypoxic events.

No Benefit Seen with Early Invasive Versus Selective Invasive Management in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome
A study out of the Journal of the American College of Cardiology present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial. 1,200 patients were randomly assigned to an early invasive or selective invasive strategy. The outcomes were the composite of death or myocardial infarction (MI) and its individual components. Risk stratification was performed with the FRISC (Fast Revascularization in InStability in Coronary artery disease) risk score. At 5-year follow-up, revascularization rates were 81% in the early invasive and 60% in the selective invasive group. Cumulative death or MI rates were 22.3% and 18.1%, respectively. In patients presenting with NSTE-ACS and elevated troponin T, we could not demonstrate a long-term benefit of an early invasive strategy in reducing death or MI. (Invasive versus Conservative Treatment in Unstable coronary Syndromes [ICTUS].

Risk Factors for Treatment Failure in Patients Receiving Vancomycin for Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Pneumonia
The rate of vancomycin failure in patients with hospital-acquired pneumonia (HAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) has exceeded 40% in several studies. This observation was attributed initially to the lack of weight-based dosing and targeting of lower trough concentrations. However, a subsequent study demonstrated no additional benefit in patients who achieved trough vancomycin concentrations >15mg/L compared with patients with concentrations between 5 and 15mg/L. A study out of Surgical Infections sought to identify contributors to vancomycin failure in patients with MRSA HAP and found data suggest that patients who have recent exposure to vancomycin are at high risk for vancomycin failure and may benefit from an appropriate alternative when a diagnosis of MRSA HAP is made.

The Status of the Fourth Ventricle and Ambient Cisterns Predict Outcome in Moderate and Severe Traumatic Brain Injury
Computed tomography (CT) of the head has become the diagnostic tool of choice, particularly for moderate and severe traumatic brain injury (TBI). Various CT characteristics are associated with outcome, and may therefore be used as outcome predictors. One of the most prominent predictors appears to be the status of the basal cisterns. This study describes the prognostic value of the appearance of individual cisterns and ventricles in relation to that of the basal cisterns. Its results showed that the absence (complete obliteration), but also compression of the ambient cisterns and/or the fourth ventricle were strongly related to unfavorable outcome and death and emerged as the only significant outcome predictors after multivariate analysis.

'Diabetic effect' in dolphins offers new hope for type 2 diabetes cure
Dolphins are the only animals apart from humans to develop a natural form of type 2 diabetes, according to new research. The discovery offers important insights into a disease that is linked to one in 20 deaths. American scientists have discovered that bottlenosed dolphins show a form of insulin resistance very similar to that seen in human diabetes. Unlike patients with the condition, the marine mammals can turn this state on and off when appropriate, so it is not normally harmful.

FDA reports says Avandia can hurt heart: report
Confidential U.S. government reports recommend that GlaxoSmithKline Plc's diabetes drug Avandia be pulled from the market because it can hurt the heart, The New York Times reported on Friday.The newspaper said the findings, which it said it obtained, reported that if all diabetics now taking Avandia were given Takeda's Actos drug instead, about 500 heart attacks and 300 cases of heart failure would be averted each month because Avandia, also known as rosiglitazone, can be harmful to the heart.

Initial Prostate Specific Antigen 1.5 ng/ml or Greater in Men 50 Years Old or Younger Predicts Higher Prostate Cancer Risk
Screening with PSA has been widely used to detect PCa for 2 decades but it continues to be controversial. The results of 2 large randomized, controlled trials were recently released but due to conflicting results the usefulness of PSA screening for decreasing PCa mortality remains hotly debated. A study out of the Journal of Urology showed a median prostate specific antigen in black and white men was 0.7 ng/ml at age 50 years or less. The prostate cancer rate was not significantly different in the groups with prostate specific antigen less than 0.6 and 0.7 to 1.4 ng/ml in black or white men. Black and white men with initial prostate specific antigen in the 1.5 to 2.4 ng/ml range had a 9.3 and 6.7-fold increase in the age adjusted prostate cancer RR, respectively. At up to 9 years of followup initial prostate specific antigen 1.5 ng/ml or greater was associated with gradually increased detection at followup in black and white men.

Sympathetic Nonadrenergic Transmission Contributes to Autonomic Dysreflexia in Spinal Cord–Injured Individuals
Autonomic dysreflexia is a hypertensive episode in spinal cord–injured individuals induced by exaggerated sympathetic activity and thought to be -adrenergic mediated. -Adrenoceptor antagonists have been a rational first choice; nevertheless, calcium channel blockers are primarily used in autonomic dysreflexia management. However, -adrenoceptor blockade may leave a residual vasoconstrictor response to sympathetic nonadrenergic transmission unaffected. The aim was to assess the -adrenergic contribution and, in addition, the role of supraspinal control to leg vasoconstriction during exaggerated sympathetic activity provoked by autonomic dysreflexia in spinal cord–injured individuals and by a cold pressure test in control individuals. These results indicate that the leg vascular resistance increase during autonomic dysreflexia in spinal cord–injured individuals is not entirely -adrenergic mediated and is partly explained by nonadrenergic transmission, which may, in healthy subjects, be suppressed by supraspinal control.

Increased tissue damage and lesion volumes in African Americans with multiple sclerosis
African American (AA) patients with multiple sclerosis (MS) have more rapid disease progression and poorer responses to disease-modifying therapies than white American (WA) patients with MS. A study out of the Journal of Neurology investigated brain MRI characteristics in AA compared to WA in a cohort of consecutive patients with MS. The study showed that African American patients showed increased tissue damage, as measured by magnetization transfer ratio, and presented higher lesion volumes compared to white Americans. The greater tissue damage and faster lesion volume accumulation may explain the rapid clinical progression in African American patients.

Contrast-enhanced ultrasound is helpful in the differentiation of malignant and benign breast lesions
A study out of the European Journal of Radiology evaluate the significance of contrast-enhanced ultrasound (CEUS) examination in differential diagnosis of malignant and benign breast lesions. Following SonoVue administration different perfusion phases could be identified. In the early phase, CEUS identified 91.1% of malignant tumors characterized by a claw-shaped enhancement, while 83.9% of benign tumors had a homogeneous enhancement, with a statistically significant difference between the two enhancement patterns. Moreover, contrast medium persistence in the late phase was helpful in the identification of benign and malignant tumors contrast medium was present in 88.9% of malignant tumors, while in only 9.7% of the benign tumors. The study showed that various parametric imaging color maps for peak intensity and time to peak were mostly suggestive of malignancy, while quite uniform peak intensity and time to peak of color maps were the characteristic of benign tumors. The study also found that malignant lesions presented with a higher maximum intensity signal than benign ones on the time–intensity curves.

Routine testing in patients with asymptomatic elevated blood pressure in the ED
There are no clear recommendations for the diagnostic evaluation of patients who present to the emergency department (ED) with asymptomatic elevated blood pressure. In patients presenting with asymptomatic elevated blood pressure in the ED, we measured the prevalence of abnormalities on a basic metabolic profile (BMP) that led to hospital admission as well as the prevalence of diminished renal function. One hundred sixty-seven patients with asymptomatic elevated BP were studied and Twelve patients were admitted due to abnormal results on the BMP. Twenty-seven patients met the secondary outcome measure of diminished renal function. In a homogenous African American population presenting to the ED with asymptomatic elevated BP, there is a relatively high prevalence of abnormalities on the BMP that led to hospital admission. We suggest routine testing of a serum creatinine should be strongly considered in a largely African American patient population with asymptomatic elevated BP in the ED.

Optimization of initial energy for cardioversion of atrial tachyarrhythmias with biphasic shocks
Optimization of initial energy for cardioversion of atrial tachyarrhythmias with biphasic shocks. Recommendations for optimal first-shock energies with biphasic waveforms are conflicting. We evaluated prospectively the relation between type and duration of atrial tachyarrhythmias and the probability of successful cardioversion with a specific biphasic shock waveform to develop recommendations for the initial energy setting aiming at the lowest total cumulative energy with 2 or less consecutive shocks. Cardioversion was successful in 448 patients (cumulative efficacy, 99 %). In patients with AFL/AT, the lowest total cumulative energy was attained with an initial energy setting of 50 J. In patients with AF, lowest values were achieved with an initial energy of 100 J for arrhythmia durations of 2 days or less and an initial energy of 150 J for arrhythmia durations of more than 2 days. We recommend an initial energy setting of 50 J in patients with AFL/AT, of 100 J in patients with AF 2 days or less, and of 150 J with AF more than 2 days.

ST-segment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction
ST-segment depression in lead aVR in acute inferior wall ST-segment elevation myocardial infarction (STEMI) has recently been suggested as a predictor of left circumflex (LCx) artery involvement. The purpose of this study is to evaluate the clinical significance of aVR depression during inferior wall STEMI. The sensitivity and specificity of aVR depression as a predictor of LCx infarction were 53% and 86%, respectively. In patients with right coronary artery infarction, aVR depression was associated with increased cardiac enzymes and the involvement of a large posterolateral branch, which may explain the larger infarction. ST-segment depression in lead aVR in inferior wall STEMI predicts LCx infarction or larger RCA infarction involving a large posterolateral branch.

Accelerated, hypofractionated radiation therapy successfully treats breast cancer
An intense 3-week course of radiation therapy is just as effective as the standard 5-week regimen for women with early-stage breast cancer, Canadian research shows. “For women with breast cancer who are similar to the patients in this trial, an abbreviated course of radiation therapy should be more convenient and less costly than standard treatment,” remark Timothy Whelan (Juravinski Cancer Centre, Hamilton, Ontario) and co-authors in the New England Journal of Medicine.

Aspirin cuts death risk after breast cancer: U.S. study
"This is the first study to find that aspirin can significantly reduce the risk of cancer spread and death for women who have been treated for early stage breast cancer, " said Dr. Michelle Holmes of Harvard Medical School, who led the study published in the Journal of Clinical Oncology.

Bilateral TKA associated with poor peri-operative outcome
Unilateral total knee arthroplasty (TKA) appears to be associated with better peri-operative morbidity and mortality than bilateral procedures, say researchers. They also found that staging bilateral TKA procedures during the same hospitalization offers no mortality benefit and may even increase morbidity compared with carrying out bilateral TKA on the same day.

Quarter of stroke patients die within a year: U.S. study
The risks were higher for African-Americans compared to whites and increased with age and the number of other ailments stroke patients had, the researchers wrote in the journal Neurology.Dr Wuwei Feng of the Medical University of South Carolina in Charleston and colleagues studied records of 10,399 hospital patients in the state who had a stroke in 2002. The average age of the patients was 69.

57 Million Americans Sickened by H1N1 Flu: CDC
With the H1N1 swine flu pandemic apparently winding down, federal health officials said Friday that about 57 million Americans have suffered through the illness since last April, and the total could range as high as 84 million. In addition, the U.S. Centers for Disease Control and Prevention (CDC) estimates that as many as 378,000 people were hospitalized due to H1N1 flu and up to 17,160 Americans may have died from the virus.

Evaluation and Treatment of Severe Asymptomatic Hypertension
Approximately one third of adults in the United States have some degree of hypertension,1–3 and up to 5 percent of patients presenting to the emergency department have severely elevated blood pressure.4 In one study, about one fourth of patients presenting with diastolic blood pressure of 110 mm Hg or greater were unaware of their hypertension, including 28 percent of those with severe asymptomatic hypertension and 8 percent of those with a hypertensive emergency..

Two Agents, One Syringe Provides Effective Anesthetic
A single syringe of remifentanil and propofol can deliver safe, effective IV anesthesia to patients undergoing ambulatory orthopedic surgery, a recent study has found. The researchers, from the University of Utah, say their results may be hard for some clinicians to accept, given what they have been told to believe about total IV anesthesia (TIVA).

Plasma B-type natriuretic peptide reduction predicts long-term response to levosimendan therapy in acutely decompensated chronic heart failure
A study in the International Journal of Cardiology sought to identify predictors of long-term response to levosimendan therapy among patients' baseline features and treatment-induced changes in acutely decompensated chronic heart failure (ADHF Compared to standard therapy, levosimendan induced a significant improvement in NYHA class (F=37.529, p<0.001), B-type natriuretic peptide (BNP, F=22.917, p<0.001), left ventricular ejection fraction (F=23.561, p<0.001), transmitral E deceleration time. In the levosimendan group, treatment-induced percent BNP change was the best predictor of events (OR=0.970, 95% CI=0.954–0.986, p<0.001). A cut-off for BNP change of 58% predicted events with 87% sensitivity and 83% specificity. Event-free survival was longer in patients with a BNP reduction ≥58% (median, 135 versus 43 days, p=0.0001). JAMA: Levosimendan vs Dobutamine for Patients With Acute Decompensated Heart Failure

Omeprazole and clopidogrel: Should clinicians be worried?
The US Food and Drug Administration has issued a warning that omeprazole (Prilosec) reduces the antiplatelet activity of clopidogrel (Plavix) by about 50%. However, the warning is based largely on ex vivo data. Preliminary results from a randomized clinical trial revealed no effect on cardiovascular outcomes when omeprazole was given with clopidogrel. We recommend that physicians continue to prescribe a proton pump inhibitor for patients receiving dual antiplatelet therapy who are at risk of gastrointestinal bleeding or have an indication for use of a proton pump inhibitor.

Brain Dopamine Receptor Density Correlates With Social Status
People have typically viewed the benefits that accrue with social status primarily from the perspective of external rewards. A new paper in the February 1st issue of Biological Psychiatry, published by Elsevier suggests that there are internal rewards as well.

Osteopathic care may ease late-pregnancy back pain
NEW YORK (Reuters Health) - Gentle manipulation from an osteopathic doctor may relieve late-pregnancy back pain that frequently hinders bending, lifting, or walking, findings from a small study hint. The study, in the American Journal of Obstetrics and Gynecology, included 144 otherwise healthy pregnant women, about 24 years old on average, with moderate levels of back pain and related movement difficulties during late pregnancy.

Long-Term Prognosis of Patients Diagnosed With Brugada Syndrome
Brugada syndrome is characterized by ST-segment elevation in the right precordial leads and an increased risk of sudden cardiac death (SCD). Fundamental questions remain on the best strategy for assessing the real disease-associated arrhythmic risk, especially in asymptomatic patients. In the largest series of Brugada syndrome patients thus far 1029 patients were recruited in 11 tertiary centers in 4 European countries. The cardiac event rate per year was 7.7% in patients with aborted SCD, 1.9% in patients with syncope, and 0.5% in asymptomatic patients showing event rates in asymptomatic patients were low. Inducibility of ventricular tachyarrhythmia and family history of SCD were not predictors of cardiac events.

Enoxaparin Anticoagulation Monitoring in the Catheterization Laboratory Using a New Bedside Test
A study out of the Journal of the American College of Cardiology evaluated the ability of the bedside test Hemochron Jr. Hemonox (International Technidyne Corporation, Edison, New Jersey) to identify patients with insufficient anti-Xa activity level in the catheterization laboratory in 296 unselected patients undergoing catheterization and/or PC. When using Hemonox CT to discriminate patients with anti-Xa level <0.5 IU/ml a 94.9% sensitivity and a 73.3% specificity to detect patients with inadequate anti-Xa level. Hemonox CT appears to be a fast and reliable bedside test for detecting patients insufficiently anticoagulated and needing adjustment of anticoagulation therapy with enoxaparin before PCI.

Hyponatremia associated with in-hospital mortality and heightened resource consumption
A study out the Archives of Internal Medicine evaluated whether hospital-associated hyponatremia has an independent effect on all-cause mortality, hospital length of stay (LOS), and patient disposition. This cohort study included all adult hospitalizations at an academic medical center occurring between 2000-2007 for which an admission serum sodium concentration ([Na+]) was available. Community-acquired hyponatremia occurred in 37.9% of hospitalizations and was associated with adjusted odds ratios (ORs) of 1.52 for in-hospital mortality and 1.12 for discharge to a short- or long-term care facility and a 14% adjusted increase in LOS. Hospital-acquired hyponatremia developed in 38.2% of hospitalizations longer than 1 day in which initial serum [Na+] was 138 to 142 mEq/L. Hospital-acquired hyponatremia was associated with adjusted ORs of 1.66 for in-hospital mortality and 1.64 (95% CI, 1.55-1.74) for discharge to a facility and a 64% adjusted increase in LOS. The strength of these associations tended to increase with hyponatremia severity.

Age of mother affects child's autism risk: study
Being an older mother significantly increases the risk of having a child with autism, but being an older father only increases the risk when the mother is under the age of 30, U.S. researchers said on Monday. But being an older father -- 40 or older -- only contributes significantly to autism risk when the mother is under 30.

African-American Women Have a Higher Risk for Developing Peripartum Cardiomyopathy
A study out of the Journal of the American College of Cardiology assessed whether African-American women are at increased risk of having peripartum cardiomyopathy. Peripartum cardiomyopathy is a heart disease of unknown cause that affects young women, often with devastating consequences. The frequency of peripartum cardiomyopathy varies markedly between African and non-African regions. A case-control study was performed and showed African-American women had a 15.7-fold higher relative risk of peripartum cardiomyopathy than non–African Americans. Other significant univariate risk factors were hypertension and having had >2 previous pregnancies. African-American ethnicity remained a significant risk factor for peripartum cardiomyopathy when other risk factors were considered in multivariable and stratified analyses. Although the frequency of peripartum cardiomyopathy (185 of 100,000 deliveries) at this center was higher than in previous U.S. reports, it was comparable to the frequency in countries with more women of African descent (100 to 980 of 100,000). Analysis of other U.S. studies confirmed that the frequency of peripartum cardiomyopathy was significantly higher among African-American women.

ICU Catheter Infections Can Be Virtually Eliminated
Catheter-related infections aren't inevitable in the ICU, according to a quality initiative that maintained rates at nearly zero for three years in Michigan hospitals. The maintenance phase, after initial implementation of low-tech measures such as handwashing and removal of unneeded catheters, saw no rebound in catheter-related infections, Peter J. Pronovost, MD, PhD, of Johns Hopkins, and colleagues reported online in BMJ.

Oseltamivir Treatment Shortens Duration of Clinical Illness but not Viral Shedding in Household Transmission of Influenza Virus
Large clinical trials have demonstrated the therapeutic efficacy of oseltamivir against influenza. We assessed the indirect effectiveness of oseltamivir in reducing secondary household transmission in an incident cohort of influenza index patients and their household members.Index patients who took oseltamivir within 24 h of symptom onset halved the time to symptom alleviation. Oseltamivir treatment was not associated with statistically significant reduction in the duration of viral shedding. Household contacts of index patients who had taken oseltamivir within 24 h of onset had a nonstatistically significant lower risk of developing laboratory‐confirmed infection.

Study fails to link saturated fat, heart disease
The saturated fat found mainly in meat and dairy products has a bad reputation, but a new analysis of published studies finds no clear link between people's intake of saturated fat and their risk of developing heart disease.

Déjà vu? Experts debate new data on diuretic/CCB combo and MI risk
Low-risk hypertensive patients taking a combination of diuretics and calcium-channel blockers (CCBs) had a higher risk of MI than users of other common two-drug BP-lowering regimens in a new case-control study published online January 25, 2010 in BMJ. Lead author Dr Inbal Boger-Megiddo (University of Washington, Seattle) told heartwire she cannot determine "whether the findings indicate a positive effect of one group of drugs or a negative effect of another." But the new study "raises a good clinical question that we should address in further trials," she says. "We should definitely look into secondary hypertension and the fact that all drug groups, while being comparable in terms of their BP-lowering effects, are not necessarily comparable in terms of cardiovascular outcomes."

Single Ultrasound for DVT May Suffice
For patients with suspected deep vein thrombosis, the risk of symptomatic venous thromboembolism after a single, negative whole-leg compression ultrasound examination is low, a meta-analysis showed. Pooled results from seven studies showed the risk to be just 0.57% (95% CI 0.25% to 0.89%) through three months of follow-up in patients who were not given anticoagulants, Scott Stevens, MD, of Intermountain Medical Center in Murray, Utah, and colleagues reported in the Feb. 3 issue of the Journal of the American Medical Association.

Long-Chain -3 Fatty Acids for Indicated Prevention of Psychotic Disorders
The use of antipsychotic medication for the prevention of psychotic disorders is controversial. Long-chain (omega-3) polyunsaturated fatty acids (PUFAs) may be beneficial in a range of psychiatric conditions, including schizophrenia. A Randomized, double-blind, placebo-controlled trial from the Archives of Psychiatry found that Long-chain -3 PUFAs reduce the risk of progression to psychotic disorder and may offer a safe and efficacious strategy for indicated prevention in young people with subthreshold psychotic states.

Efficacy of Ceftriaxone or Meropenem as Initial Therapies in Whipple's Disease
Whipple's disease is a chronic infection caused by the actinomycete Tropheryma whipplei. An article from the Journal of Gastroenterology presented a randomized controlled trial of the efficacy of antimicrobials that are able to cross the blood-brain barrier and to which T whipplei is susceptible. Patients from central Europe with previously untreated Whipple's disease (n = 40) were assigned randomly to groups given daily infusions of either ceftriaxone (1 × 2 g, 20 patients) or meropenem (3 × 1 g, 20 patients) for 14 days, followed by oral trimethoprim–sulfamethoxazole for 12 months. The primary outcome measured was maintenance of remission for 3 year. All achieved clinical and laboratory remission. Remission was maintained in all patients during the time of observation, except for 2 who died from unrelated causes.

Vaccine-Autism Study Is Retracted
A major British medical journal on Tuesday retracted a flawed study linking the measles, mumps and rubella vaccine to autism and bowel disease. The retraction by The Lancet comes a day after a competing medical journal, BMJ, issued an embargoed commentary calling for The Lancet to formally retract the study. The commentary was to have been published on Wednesday.

Hypocoaguability predicts 30-day ICU survival
Intensive care unit (ICU) patients with hypocoaguability on admission have an increased short-term risk for death, demonstrate the results of a thromboelastography (TEG) study. In addition, patients with hypocoaguability required more ventilator treatment, a higher rate of renal replacement therapy, and more blood products than patients with normal TEG results on admission to the ICU, the Danish team reports in the journal Blood Coagulation and Fibrinolysis.

NIH policy urges CT makers to track radiation dose
The National Institutes of Health plans to require that all makers of CT and other radiation-producing scanners used at NIH clinics have software that tracks a patient's radiation dose and logs it into an electronic medical record.The new policy arises from patient concerns about studies suggesting that repeated exposure to radiation from diagnostic tests may raise their risk of cancer, said Dr. David Bluemke, director of radiology and imaging sciences at the NIH Clinical Center. The policy was announced on Monday in the Journal of the American College of Radiology.

Nasogastric Aspiration and Lavage in Emergency Department Patients with Hematochezia or Melena Without Hematemesis
The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This evidence-based emergency medicine review evaluates the following question: does nasogastric aspiration and lavage in patients with melena or hematochezia and no hematemesis differentiate an upper from lower source of gastrointestinal (GI) bleeding? A literature review out of the Journal of Academic Emergency Medicine was done showing that nasogastric aspiration, with or without lavage, has a low sensitivity and poor negative likelihood ratio, which limits its utility in ruling out an upper GI source of bleeding in patients with melena or hematochezia without hematemesis.

Anticholinergics and Ketamine Sedation in Children: Atropine Bests Glycopyrrolate
Adjunctive anticholinergics are commonly administered during emergency department (ED) ketamine sedation in children under the presumption that drying oral secretions should decrease the likelihood of airway and respiratory adverse events. Pharmacologic considerations suggest that glycopyrrolate might exhibit a superior adverse effect profile to atropine. A study out the Journal of Academic Emergency Medicine contrasted the adverse events noted with use of each of these anticholinergics in a large multicenter observational database of ketamine sedations. This secondary analysis unexpectedly found that the coadministered anticholinergic atropine exhibited a superior adverse event profile to glycopyrrolate during ketamine sedation.

Primary and booster immunization with a diphtheria, tetanus, acellular pertussis, hepatitis B (DTPa–HBV) and Haemophilus influenzae type b (Hib) vaccine administered separately or together is safe and immunogenic
A study out of the International Journal of Infectious Disease was conducted to evaluate the safety and immunogenicity of DTPa–HBV and Hib vaccines given mixed or separately to 360 healthy infants at 2, 4, and 6 months of age. One month after primary vaccination, 98% had seroprotective antibody levels against HBV and 94–97% against Hib (anti-PRP≥0.15μg/ml). One month after primary vaccination, 98% had seroprotective antibody levels against HBV and 94–97% against Hib (anti-PRP≥0.15μg/ml). After DTPa–HBV/Hib booster vaccination, 96–100% of subjects had seroprotective antibody concentrations against Hib, hepatitis B, tetanus, and diphtheria and high vaccine response rates against pertussis toxoid, filamentous hemagglutinin, and pertactin.

Tamoxifen after adjuvant chemotherapy in premenopausal women with early breast cancer shows to be effective
In the early 1990s, the role of adjuvant tamoxifen in premenopausal women with early breast cancer (EBC) was not established. Similarly, optimum timing relative to adjuvant chemotherapy and efficacy of tamoxifen in hormone receptor-negative tumors were unclear. A study out of the Annals of Oncology was done where premenopausal women with EBC, any hormone receptor status, after surgery received standard adjuvant chemotherapy [doxorubicin (adriamycin)/cyclophosphamide, cyclophosphamide/methotrexate/5-fluorouracil, or cyclophosphamide/epirubicin/5-fluorouracil] followed by randomization to tamoxifen or placebo for 5 years. Median follow-up for 672 women was 9.7 years. Multivariate analysis showed improved Disease Free Survival [78.2% versus 71.3% at 5 years; hazard ratio (HR) 0.77; P = 0.056] and a trend for improved Overall Survival (86.6% versus 82.1% at 5 years; HR 0.78; P = 0.12). There was no evidence of greater benefit for the receptor-positive subgroup.

Safety of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Receiving Antiplatelet Therapy at Stroke Onset
Antiplatelets (APs) may increase the risk of symptomatic intracerebral hemorrhage (ICH) following intravenous thrombolysis after ischemic stroke. We assessed the safety of thrombolysis under APs in 11 865 patients compliant with the European license criteria and recorded between 2002 and 2007 in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register (SITS-ISTR). National Institutes of Health Stroke Scale

Teen pregnancy, abortion rates rise
The teen pregnancy rate in the USA rose 3% in 2006, the first increase in more than a decade, according to data out today. The data also show higher rates of births and abortions among girls 15-19. The numbers, calculated by the Guttmacher Institute, a non-profit group that studies reproductive and sexual health, show a clear reversal from the downward trend that began in the 1990s.

New Drug Slows Advanced Kidney Cancer
Treating advanced kidney cancer patients with the drug pazopanib (Votrient) slowed their disease progression by 54 percent, a new study has found.The phase 3 study included 233 patients with previously untreated kidney cancer (also known as renal cell carcinoma) that was locally advanced or had spread, and 202 patients with renal cell carcinoma who had previously been treated with cytokine therapy (interferon or interleukin). The patients were randomly assigned to take pazopanib tablets (290 patients) or a placebo drug (145 patients).

Biomarker Guideline Reduced Antibiotic Use
A biomarker-guided strategy for antibiotics in intensive care units reduced drug use without increasing mortality, French researchers said. In a randomized, open-label study, the biomarker procalcitonin allowed physicians to reduce the quantity of antibiotics they prescribed, according to Michel Wolff, MD, of Hôpital Bichat-Claude-Bernard in Paris, and colleagues.

Red Yeast Rice Comparable to Pravastatin for Statin-intolerant Patients
Red-yeast-rice extract is as well tolerated as pravastatin in patients who previously developed a statin-associated myalgia and withdrew from therapy, research shows [1]. Withdrawals from the red-yeast-rice and pravastatin treatment arms were low; and both groups achieved comparable reductions in LDL-cholesterol levels, report researchers.

Treatment with Monoclonal Antibodies against Clostridium difficile Toxins
New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection. A study out of the New England Journal showed that among the 200 patients who were enrolled (101 in the antibody group and 99 in the placebo group), the rate of recurrence of C. difficile infection was lower among patients treated with monoclonal antibodies (7% vs. 25%). The addition of monoclonal antibodies against C. difficile toxins to antibiotic agents significantly reduced the recurrence of C. difficile infection.

Blood Test Detects Colorectal Cancer
A novel blood test that measures CD24 protein levels may detect early colorectal cancer and precancerous adenomas, researchers found. The investigational assay had 78.4%% sensitivity and 86.8% specificity for distinguishing patients with colorectal adenoma or cancer from healthy controls in a study led by Sarah Kraus, PhD, of Tel Aviv Souraski Medical Center in Israel.

Adding Fish Oil to IV May Speed Sepsis Recovery
Adding fish oil to intravenous solutions proved beneficial for intensive care patients with the potentially lethal blood infection known as sepsis, a new study finds. The study, published Jan. 19 in the journal Critical Care, compared 13 patients who received fish oil in the normal IV nutrient solution given to patients with sepsis, and 10 patients who received traditional solutions. The patients who received the fish oil had lower levels of inflammatory chemicals in their blood, achieved better lung function, and had a shorter hospital stay.

Insulin pumps may be better than shots
Pumps that deliver insulin to the body as needed may be more effective than insulin injections for helping people with type 1 diabetes keep their blood sugar under control, according to a new review of 23 studies comparing the two approaches.

Red blood cell distribution width and 1-year mortality in acute heart failure
Red blood cell distribution width (RDW) predicts mortality in chronic heart failure (HF) and stable coronary artery disease. The prognostic value of RDW in more acute settings such as acute HF, and its relative prognostic value compared with more established measures such as N-terminal pro-brain natriuretic peptide (NT-proBNP), remains unknown. In a cohort of 205 patients with acute HF, independent predictors of RDW were identified using linear regression analysis and showed red blood cell distribution width is frequently elevated among patients with acute HF and does not appear to be associated with nutritional status, transfusion history, or inflammation. Red blood cell distribution width independently predicts 1-year mortality in acute HF. The value of RDW appears additive to other established prognostic variables such as NT-proBNP.

Antiplatelet pre-treatment increases the risk of intracranial haemorrhage in acute ischaemic stroke after intravenous thrombolysis
Pre-treatment with antiplatelet agents (AP) is present amongst 30% of acute stroke patients. Previous studies have shown conflicting results on the effect of these drugs regarding haemorrhagic transformation after thrombolytic therapy. This retrospective study of consecutive prospectively registered patients with acute ischaemic stroke treated with iv tPA in the last 5 years. Parietal Hemorrhage was observed prior in 54.5% of patients with prior Anti-Platlet (AP) therapy vs 26.9% of patients not on any therapy, concluding pre-treatment with AP is associated with an increased risk of PH after intravenous thrombolysis in patients with acute ischaemic stroke.

Restenosis Halved by Drug Eluting Stents in Diabetic Patients
Patients with diabetes mellitus have more extensive coronary artery disease, more disease progression, and restenosis. The use of drug-eluting stents (DES) in these patients is widespread, despite uncertain long-term safety and efficacy. All consecutive patients with diabetes mellitus in Sweden who underwent percutaneous coronary intervention were entered into the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) during 2003–06 with complete follow-up for 1–4 years and the results showed that myocardial infarction was significantly less common with DES in patients who received only one stent with a restenosis rate was 50% lower in DES-treated patients. DES was associated with reduced restenosis rates in all subgroups of diabetic patients with the greatest benefit in stent diameters <3 mm or stent length >20 mm. The number of lesions treated with DES to prevent one restenosis ranged from 11 to 47 in various subgroups.

Eye test that spots Alzheimer's 20 years before symptoms
It exploits the fact that the light-sensitive cells in the retina at the back of the eye are a direct extension of the brain. Using eye drops which highlight diseased cells, the UCL researchers showed for the first time in a living eye that the amount of damage to cells in the retina directly corresponds with brain cell death. They have also pinpointed the pattern of retinal cell death characteristic of Alzheimer's. So far their diagnosis has been right every time.

Shots Relieve Children's Hay Fever, Cut Expenses
Allergy vaccinations reduce total health-care costs in children with hay fever by one-third and drug prescription costs by 16 percent, according to a 10-year U.S. study. Researchers compared the medical claims for 2,770 children with hay fever (allergic rhinitis) who received allergy vaccinations with the claims of 11,000 children with allergic rhinitis who didn't receive allergen immunotherapy.

Using antibiotics, doubling surgical gloves among ways to prevent periprosthetic infection
While the greatest risk for periprosthetic infection after hip and knee replacement procedures occur within the first few months after surgery, the risk of infection persists throughout the lifetime of the patient and the implant, according to an orthopedist from the Mayo Clinic College of Medicine, Rochester in Minnesota. “The one thing we can do most effectively to prevent periprosthetic infection is to give antibiotics,” Robert T. Trousdale, MD, said during his presentation at Orthopedics Today Hawaii 2010, here. He suggested that surgeons administer antibiotics to their patients within an hour before the skin incision.

Emphysema Drug Is Safe, FDA Finds
Inhaled tiotropium bromide (Spiriva HandiHaler) for COPD does not pose a special risk for cardiovascular events, the FDA found after reviewing data from a large placebo-controlled trial. The announcement came nearly two years after the agency said it would investigate the product's safety, after pooled data from earlier trials suggested a 33% increase in stroke risk. (See FDA Cites Excess Strokes with COPD Medicine) Tiotropium is a long-acting anticholinergic drug that acts as a bronchodilator. It is approved for COPD treatment.

Bipolar diagnosis jumps in young children: study
BOSTON (Reuters) - The number of children aged 2 to 5 who have been diagnosed with bipolar disorder and prescribed powerful antipsychotic drugs has doubled over the past decade, according to research released on Friday.The research suggests that while it is still rare to prescribe powerful psychiatric drugs to 2-year-olds, the practice is becoming more frequent.

Strong Independent Correlation of Proteinuria With Cerebral Microbleeds in Patients With Stroke and Transient Ischemic Attack
To assess the association of proteinuria with the frequency and number of cerebral microbleeds (CMB), a harbinger of future hemorrhagic stroke, a cross sectional analysis was conducted.Of 236 patients, 72 (31%) had CMB present on gradient-echo imaging and 89 (38%) had evidence of proteinuria. In multivariable analyses with presence of CMB as the outcome, higher urinary protein, being female, history of atrial fibrillation , elevated serum homocysteine, and small-vessel disease subtype were all significantly associated with presence of CMB.

Ustekinumab Bests Etanercept for Moderate-to-Severe Psoriasis
Biologic agents offer a range of new therapeutic options for patients with psoriasis; however, the relative benefit–risk profiles of such therapies are not well known. An article published in the New England Journal of Medicine compared two biologic agents, ustekinumab (an interleukin-12 and interleukin-23 blocker) and etanercept (an inhibitor of tumor necrosis factor), for the treatment of psoriasis. There was at least 75% improvement in the PASI at week 12 in 67.5% of patients who received 45 mg of ustekinumab and 73.8% of patients who received 90 mg, as compared with 56.8% of those who received etanercept. Among patients who did not have a response to etanercept, 48.9% had at least 75% improvement in the PASI within 12 weeks after crossover to ustekinumab.

A score to predict early risk of recurrence after ischemic stroke
There is currently no instrument to stratify patients presenting with ischemic stroke according to early risk of recurrent stroke. We sought to develop a comprehensive prognostic score to predict 90-day risk of recurrent stroke. The 90-day risk of recurrent stroke was calculated by summing up the number of independent predictors weighted by their corresponding β-coefficients. The resultant score was called recurrence risk estimator at 90 days or RRE-90 score ( Link Here ). The RRE-90 score demonstrated adequate calibration and good discrimination, which was maintained when applied to a separate cohort of 433 patients. The model's performance was also maintained for predicting early (14-day) risk of recurrence.

Why Light Hurts During Migraines
Researchers believe they know why light exacerbates the already debilitating pain of migraines, even in some blind people. A report published online Jan. 10 in Nature Neuroscience reveals how visual and pain pathways in the brain converge to produce this phenomenon.

Cancer linked to Alzheimer disease but not vascular dementia
To investigate whether cancer is associated with Alzheimer disease (AD) and vascular dementia (VaD). A Cox proportional hazards models were used to test associations between prevalent dementia and risk of future cancer hospitalization, and associations between prevalent cancer and risk of subsequent dementia. It showed that in white older adults, prevalent Alzheimer disease (AD) was longitudinally associated with a reduced risk of cancer, and a history of cancer was associated with a reduced risk of AD. Together with other work showing associations between cancer and Parkinson disease, these findings suggest the possibility that cancer is linked to neurodegeneration.

Study suggests use of anitbiotic lavage in peritonitis increases survival
Morbidity and mortality associated with bacterial peritonitis remain a challenge for contemporary surgery. Despite great surgical improvements, death rates have not improved. A secondary debate concerns the volume and nature of peritoneal lavage or washout - what volume, what carrier and what, if any, antibiotic or antiseptic? In an experimental peritonitis setting a mortality rate of 48·9 per cent was found for saline lavage compared with 16·4 per cent for antibiotic lavage.

Scientists find new leukemia gene risk factors
LONDON (Reuters) - Researchers have found four new genetic variants that increase the risk of contracting one of the major forms of leukemia, confirming that risk factors for the fatal blood cancer can be inherited. The findings mean scientists now know of 10 genetic variants associated with chronic lymphocytic leukemia (CLL), scientists at Europe's Institute of Cancer Research who conducted the study said. The four new genetic factors are all common in European populations and each factor contributes to an increase in the risk of the disease.

FDA Reviewers Oppose CHF Indication for Beta-Blocker
In a harshly-worded document prepared for a meeting of FDA advisers, reviewers said there was no convincing evidence to support the use of the beta-blocker nebivolol (Bystolic) for treatment of heart failure in patients ages 70 and older.

Ultrasound-enhanced thrombolysis warrants further study
High-frequency ultrasound-enhanced thrombolysis is a promising new approach for patients with acute ischemic stroke, a literature review and meta-analysis suggests.

Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug Classes
The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti‐HIV drugs in the Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) study. A meta analysis showed that over 178,835 person‐years, 580 patients developed MI. Recent exposure to abacavir or didanosine was associated with an increased risk of MI. No association was found between MI risk and cumulative exposure to nevirapine, efavirenz, nelfinavir, or saquinavir. Cumulative exposure to indinavir and lopinavir‐ritonavir was associated with an increased risk of MI. Of the drugs considered, only indinavir, lopinavir‐ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI.

Pomegranate Compounds May Prevent Breast Cancer Growth
US researchers found that pomegranates contain six natural compounds that may prevent the growth of hormone-dependent breast cancer by blocking the enzyme aromatase, which changes androgen to estrogen. However, experts caution this does not mean people should expect the same results from eating pomegranates, because this was an "in vitro" (test tube) study and results on the lab bench don't always translate to animals and humans.

Cocaine changes how genes work in brain
Prolonged exposure to cocaine can cause permanent changes in the way genes are switched on and off in the brain, a finding that may lead to more effective treatments for many kinds of addiction, U.S. researchers said on Thursday.

Chlorhexidine–Alcohol versus Povidone–Iodine for Surgical-Site Antisepsis
A new study from the New England Journal of Medicine hypothesized that preoperative skin cleansing with chlorhexidine–alcohol is more protective against infection than is povidone–iodine. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections. The overall rate of surgical-site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group. Chlorhexidine–alcohol was significantly more protective than povidone–iodine against both superficial incisional infections and deep incisional infections.

Early Beta Blockers within 8 Hours Doesn't Improve Outcomes in ACS
Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). This was a systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. Intervention included intravenous or oral beta-blockers administered within 8 hours of presentation. The comparator included standard medical therapy with or without placebo versus early beta-blocker administration.This systematic review failed to demonstrate a convincing in-hospital mortality benefit for using beta-blockers early in the course of patients with an acute or suspected MI.

Continuation of Low-Dose Aspirin Therapy in Peptic Ulcer Bleeding
It is uncertain whether aspirin therapy should be continued after endoscopic hemostatic therapy in patients who develop peptic ulcer bleeding while receiving low-dose aspirin. In a parallel randomized, placebo-controlled noninferiority trial, in which both patients and clinicians were blinded to treatment assignment. It was shown that among low-dose aspirin recipients who had peptic ulcer bleeding, continuous aspirin therapy may increase the risk for recurrent bleeding but potentially reduces mortality rates. Larger trials are needed to confirm these findings.

Treatment of Aspirin-Resistant Patients With Omega-3 Fatty Acids Versus Aspirin Dose Escalation
Omega-3 fatty acids decrease the availability of platelet arachidonic acid (AA) and indirectly thromboxane A2 formation. A study out of the Journal of the American College of Cardiology was conducted to evaluate whether addition of omega-3 fatty acids or increase in aspirin dose improves response to low-dose aspirin among patients who are aspirin resistant. It was shown that plasma levels of thromboxane B2 were also reduced in both groups (56.8% reduction in the omega-3 fatty acids group, and 39.6% decrease in the aspirin group). Twelve patients (80%) who received omega-3 fatty acids and 11 patients (73%) who received aspirin 325 mg were no longer aspirin resistant after treatment.

Rosuvastatin in the Prevention of Stroke Among Men and Women With Elevated Levels of C-Reactive Protein
Prior primary prevention trials of statin therapy that used cholesterol criteria for enrollment have not reported significant decreases in stroke risk. We evaluated whether statin therapy might reduce stroke rates among individuals with low levels of cholesterol but elevated levels of high-sensitivity C-reactive protein.In Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), 17 802 apparently healthy men and women with low-density lipoprotein cholesterol levels <130 mg/dL and high-sensitivity C-reactive protein levels 2.0 mg/L were randomly allocated to rosuvastatin 20 mg daily or placebo and then followed up for the occurrence of a first stroke. After a median follow-up of 1.9 years (maximum, 5.0 years), rosuvastatin resulted in a 48% reduction in the hazard of fatal and nonfatal stroke as compared with placebo.

Decreased Frontal Serotonin2A Receptor Binding in Antipsychotic-Naive Patients With First-Episode Schizophrenia
Postmortem investigations and the receptor affinity profile of atypical antipsychotics have implicated the participation of serotonin2A receptors in the pathophysiology of schizophrenia. To assess in vivo brain serotonin2A binding potentials in a large sample of antipsychotic-naive schizophrenic patients and matched healthy controls. It was shown schizophrenic patients had significantly lower serotonin2A binding in the frontal cortex than did control subjects suggesting that frontal cortical serotonin2A receptors are involved in the pathophysiology of schizophrenia.

Idiopathic Intracranial Hypertension Is Associated with Lower Body Adiposity
The disease commonly occurs in women who are overweight. The role of obesity in this disorder is unclear. In some instances, obesity and idiopathic intracranial hypertension may be familial.To characterize the obesity phenotype(s) in 44 patients with idiopathic intracranial hypertension (IIH).This study showed that In IIH, fat tends to preferentially accumulate in the lower body relative to other obese women of the same range. Whereas most complications of obesity, such as hypertension, diabetes, dyslipidemia, and the metabolic syndrome, are linked to upper body adiposity, IIH may represent a unique condition potentially induced by nonvisceral fat-related mechanisms.

Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals
Orthostatic blood pressure (BP) control involves complex compensatory mechanisms allowing the human body to stand upright.As the postural homeostasis is principally mediated by autonomic nervous system, its impairment may lead to BP fall after standing. Orthostatic hypotension (OH) has been linked to increased mortality and incidence of cardiovascular disease in various risk groups, but determinants and consequences of OH in the general population are poorly studied.This study showed that Orthostatic hypotension can be detected in 6% of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes. Presence of OH increases mortality and Cardiovascular risk, independently of traditional risk factors. Although both impaired systolic and diastolic responses predict adverse events, the diastolic impairment shows stronger association with coronary disease.

Drug-Resistant E. Coli Called Significant Threat
First-line use of carbapenem antibiotics for urinary tract infections may become necessary if the spread of drug-resistant E. coli continues, a prominent infectious disease expert warned. An E. coli strain expressing a beta-lactamase enzyme known as CTX-M-15 has suddenly emerged in community-acquired infections worldwide, apparently originating in the Indian subcontinent and spread by travelers, according to Johann Pitout, MMed, of the University of Calgary in Canada.

Procedure Boosts Outcomes in Patients with Ventricular Tachycardia Before Defibrillator Implantation
Heart patients with a dangerous rapid heartbeat called ventricular tachycardia often get implantable cardiac defibrillators to help control the condition, and a new study suggests that they will have fewer recurrences of the abnormality if they undergo a procedure called catheter ablation before they receive the device.

Women have poorer results with arthroscopic revision rotator cuff surgery than men
The largest study investigating arthroscopic revision repair of rotator cuff tears shows that the procedure can significantly improve pain relief and shoulder function, although women had poorer results than men who had the procedure.

Gadolinium Contrast — An Update on Imaging’s Understanding and Prevention of NSF
Researchers are still investigating the suspected connection between gadolinium-based MRI contrast agents and nephrogenic systemic fibrosis (NSF) that made headlines a few years back. But as those studies (and numerous lawsuits) surrounding the suspected link play out, the imaging community has enacted screening protocols that have seemingly eliminated new NSF cases.

Statins don't curb colorectal cancer risk
Taking a cholesterol-lowering statin will lower your cholesterol but it won't cut your risk of developing colorectal cancer, according to study of more than 400,000 Canadians.

New Guidelines Urge A1C Test for Diabetes Diagnosis
In its latest set of clinical guidelines, the American Diabetes Association is promoting a more prominent role for the hemoglobin A1C blood test in the diagnosis of type 2 diabetes and prediabetes. Long used in the management of diabetes, the A1C blood test measures average blood sugar levels for the previous two to three months. The new guidelines call for the diagnosis of type 2 diabetes at A1C levels above 6.5 percent, and prediabetes if the A1C levels are between 5.7 and 6.4 percent.

Predicting Death in Necrotizing Soft Tissue Infections: A Clinical Score
Necrotizing soft tissue infections (NSTIs) are associated with a high mortality rate; however, there is no uniform way to categorize the severity of this disease early in its course. The goal of this study was to develop a clinical score based on data available at the time of initial assessment to aid in stratifying patients according to their risk of death. Six admission parameters independently predicted death: Age>50 years, heart rate>110 beats/min, temperature <36°C, white blood cell count>40,000/mcL, serum creatinine concentration>1.5mg/dL, and hematocrit>50%. The accuracy of this model was 86.8%; the area under the receiver-operating characteristic curve was 0.81, and the Hosmer-Lemeshow statistic was 11.8.

Flomax Helps Pass Kidney Stones
A total of 100 patients with stones sized 10 mm or smaller, located in the distal part of the ureter were included. Patients were randomly assigned to 2 equal groups. Group 1 received 0.4 mg tamsulosin once daily and group 2 received placebo. The investigators and the patients were masked to the type of treatment. Patients were followed-up until passage of the stone, or for a maximum of 4 weeks. Apart from 4 patients in the placebo group who were lost to follow-up, all patients complied with the prescribed medications and continued the study. Stone expulsion occurred in 41 of 50 patients (82%) in group 1 and in 28 of 46 patients (61%) in group 2 (P = .02). The chance of stone expulsion was 3 times higher in the tamsulosin group. Urology

Non Contrast CT Scan Still Shows Diagnostic Ability in Suspected Appendicitis
The diagnostic test characteristics of noncontrast computed tomography (CT) for appendicitis in the adult emergency department (ED) population was evaluated througha conducted search of MEDLINE, EMBASE, the Cochrane Library, and the bibliographies of previous systematic reviews. The search yielded 1,258 publications; 7 studies met the inclusion criteria and provided a sample of 1,060 patients. The included studies were of high methodological quality with respect to appropriate patient spectrum and reference standard. Our pooled estimates for sensitivity and specificity were 92.7% and 96.1%, respectively. Overall the diagnostic accuracy of noncontrast CT for the diagnosis of acute appendicitis in the adult population to be adequate for clinical decisionmaking in the ED setting.

Inadvertent isotretinoin exposure during the first 2 weeks post conception does not necessarily termination of pregnancy
Apart from thalidomide, retinoids like isotretinoin are the strongest teratogens in humans known today. The overall risk of birth defects is estimated as up to 30% after exposure during embryogenesis. In spite of well established pregnancy prevention programs, pregnancies still occur during isotretinoin therapy. A total of 108 pregnancies exposed to systemic isotretinoin (median dosage 20 mg/day) during the contraindicated period were registered. 76% (69/91) of the pregnancies with known outcome were electively terminated—mainly for fear of medication risk. None of the infants showed symptoms of retinoid embryopathy and one showed evidence of a VSD. Inadvertent isotretinoin exposure during the first 2 weeks post conception does not necessarily require discussion of termination of pregnancy, as the risk of major birth defects appears to be much lower than it becomes beyond this period.

Bypass Anemia Drugs in Chronic Kidney Disease, Expert Says
Anemia in most chronic kidney disease patients should be managed with iron supplements or blood transfusions, if anything, rather than erythrocyte-stimulating agents, a leading nephrologist has recommended. The only good case for long-term use of erythropoietin drugs in this population is in those who are transplant candidates or have severe anemia with a hemoglobin under 9 g/dl that cannot be managed with transfusions, Ajay K. Singh, of Harvard and Brigham and Women's Hospital in Boston, concluded.

Statins Decrease the Occurrence of Venous Thromboembolism in Patients with Cancer
Recent data suggest a reduction in the occurrence of venous thromboembolism in select groups of patients who use statins. The objective of this study is to evaluate the impact of statin use on the occurrence of venous thromboembolism in patients with solid organ tumor. The occurrence of venous thromboembolism was 18% (N=132), and 26% (N=194) were receiving statins. Among patients receiving statins, 8% (N=16) developed a venous thromboembolism compared with 21% (N=116) in the control group (odds ratio 0.33; 95% confidence interval, 0.19-0.57). American Journal of Medicine Abstract

Contraceptive Depo-Provera May Weaken Bones
In a study of women who received the "birth control shot" -- also known as depot medroxyprogesterone acetate (Depo-Provera), nearly half lost at least 5 percent of their bone mineral density in the hip and lower spine within two years.

C-reactive protein no cause of heart trouble: study
High levels of a compound called C-reactive protein may be a sign of a future risk for heart attacks, stroke and cancer, though it does not seem to be a cause, researchers said on Tuesday.

Surgical Therapy For Type B Aortic DIssections Doesn't Best Medical Therapy
Circulation

Melanoma in Blacks and White Hispanics Found in Later Stages Than Whites Non-Hispanics
Archives of Dermatology

Natural Heart Drugs May Combat Colon Cancer
A family of naturally derived heart drugs called cardiac glycosides shows promise in fighting colon cancer, new research has found.

Not All Drugs Are the Same After All
There is a gnawing concern among some doctors and researchers that certain prescription generic drugs may not work as well as their brand-name counterparts. The problem is not pervasive, but it’s something consumers should be aware of — especially now that more insurers insist that patients take generic medications when they are available.

Functional and Cognitive Outcome is Preservable in Prolonged Refractory Status Epilepticus
Archives of Neurology Abstract
To determine the functional and cognitive outcomes of patients with prolonged refractory status epilepticus (PRSE) lasting 7 or more days despite the use of anesthetic agents for seizure suppression. Of 14 patients Forty-three percent of patients (6 of 14) died during hospitalization for PRSE, and 57% (8 of 14) had died by the last follow-up. Despite the high mortality rate, survival with meaningful functional and cognitive recovery is possible after PRSE. Prolonged duration of status epilepticus alone should not be considered a reason to discontinue treatment.

Plasmapheresis and Heparin Reexposure as a Management Strategy for Cardiac Surgical Patients with Heparin-Induced Thrombocytopenia
Anesthesia & Analgesia

High-dose vitamin C may boost women's cataract risk
Among nearly 24,600 adult women followed for more than 8 years, those who reported regular or occasional vitamin C supplementation of about 1000 milligrams per serving were about 25 percent more likely than those who did not take supplements to have age-related cataracts removed. Women who took extra vitamin C for 10 years or longer; or in combination with being 65 years and older, or taking hormone replacement or corticosteroid medications had even greater risk, researchers found.

COPD Often Undiagnosed in Two Thirds of Patients
The Clinical Respiratory Journal
A study on Norwegian adult showed three hundred-three persons (9%) were classified as having COPD, and the undiagnosed fraction was 66%. Spirometry was performed before and after inhalation of 400 µg of salbutamol. COPD was defined as post-bronchodilator forced expiratory volume in 1 s (FEV1) / forced vital capacity (FVC) < 0.7 whereas diagnosed COPD was defined as having received treatment for obstructive lung disease the last year.

Hospital Re-Admission High For Dialysis Patients Treated In Long-Term Care Hospitals
A new study by University of Cincinnati (UC) nephrologists shows that most dialysis patients admitted to long-term care hospitals face readmission to acute care facilities, and those with acute kidney failure don't often recover full kidney function. This study is being published in the advanced online edition of the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation.

Most Stem Cells Used in Research Come From Whites
Human embryonic stem cell lines currently used for research come mostly from white donors, a new report finds. That could mean that non-whites will benefit less from any medical breakthroughs that emerge from that research down the line, experts say.

Radiation Dose Associated With Common Computed Tomography Examinations Varies Greatly By Institution
Archives of Internal Medicine Abstract
Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past 2 decades. Even though CT is associated with substantially higher radiation exposure than conventional radiography, typical doses are not known. Radiation doses varied significantly between the different types of CT studies. The overall median effective doses ranged from 2 millisieverts (mSv) for a routine head CT scan to 31 mSv for a multiphase abdomen and pelvis CT scan. Within each type of CT study, effective dose varied significantly within and across institutions, with a mean 13-fold variation between the highest and lowest dose for each study type.

Plasma Leptin Levels Associated with Decreased Incident of Alzheimer Disease and Increased MRI Measures of Brain Aging
JAMA Abstract
The adipokine leptin facilitates long-term potentiation and synaptic plasticity in the hippocampus, promotes β-amyloid clearance, and improves memory function in animal models of aging and Alzheimer disease (AD). Higher leptin levels were associated with a lower risk of incident dementia and AD in multivariable models. This corresponds to an absolute AD risk over a 12-year follow-up of 25% for persons in the lowest quartile (first quartile) vs 6% for persons in the fourth quartile of sex-specific leptin levels.

Tamoxifen following chemotherapy improves breast cancer outcome
Addition of chemotherapy to standard tamoxifen treatment for postmenopausal women with node-positive breast cancer significantly improves disease-free survival, and this benefit is maximized when the tamoxifen follows chemotherapy, US researchers report in The Lancet.

Fat in diet won't affect weight gain over time
The percentage of calories that a person got from fat, as opposed to protein or carbohydrates, had nothing to do with how much weight they gained in the coming years, the research team found. The kinds of fat they ate didn't matter either, Dr. Nita Forouhi of the Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK and her colleagues found. The findings, Forouhi noted in an email to Reuters Health, show that "it is more important to aim for a healthy lifestyle including a balanced healthy diet and regular physical activity, than to focus on fat intake alone as a factor for weight gain."

ilotinib Bests Imatinib for Initial CML Treatment
Nilotinib (Tasigna) was significantly more effective as first-line treatment for chronic myeloid leukemia (CML) than imatinib (Gleevec), the current standard of care, researchers said here. Major molecular responses were seen in about 44% of patients receiving nilotinib compared with 22% of imatinib-treated patients after one year (P<0.0001), reported Giuseppe Saglio, MD, of the University of Turin in Italy.

Higher Mortality Seen In Patients Admitted to the ICU During Morning Rounds
Chest
No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome. Although hospital length of stay was no different, the predicted hospital mortality rate of the round time group was higher (17.4% vs 12.3% predicted, respectively; p < 0.001). The hospital length of stay was similar between the two groups. The round-time group had a higher hospital mortality rate (16.2% vs 8.8%, respectively; p < 0.001). Most of the round-time ICU admissions and deaths occurred in the medical ICU and overall round-time admission was an independent risk factor for hospital death

Risk of preterm delivery and other adverse perinatal outcomes in relation to maternal use of psychotropic medications during pregnancy
American Journal of Obstetrics and Gynecology Abstract
The purpose of this study was to determine the association of maternal psychotropic medication use during pregnancy with preterm delivery and other adverse perinatal outcomes. Maternal use of benzodiazepine during pregnancy was associated with an increased risk of preterm delivery and with increased risks of low birthweight, low Apgar score, neonatal intensive care unit admissions, and respiratory distress syndrome. Selective serotonin receptor inhibitors were associated with preterm deliveries only among women who started treatment after the first trimester. Benzodiazepine was associated highly with preterm delivery and other adverse perinatal outcomes. Well-conducted cohort studies are warranted to draw conclusions about risks and benefits of psychotropic medication use during pregnancy.

Red Cell Transfusions Hike Non-Hodkins Lymphoma Risk
Patients receiving red blood cell transfusions are at increased risk of developing non-Hodgkin's lymphoma (NHL), said a researcher here. Pooled data from 16 studies conducted since 1993 showed a relative risk of 1.43 (95% CI 1.12 to 1.84) for NHL among patients with a history of red blood cell transfusions, compared with those reporting never having received such treatments, said Samir Dalia, MD, of Brown University Medical School in Providence, R.I. He reported the findings here at the American Society of Hematology's annual meeting.

Mortality Lower With Aspirin After Therapy for Ulcer
Patients who have experienced peptic ulcer bleeding on low-dose aspirin and who undergo endoscopic hemostatic therapy for their ulcers have increased risk for recurrent bleeding if they resume taking aspirin, but have lowered risk of death, according to a study published online Nov. 30 in the Annals of Internal Medicine.

Antithrombotic Medication Use Not Improving Among Ischaemic Stroke Survivors
Approximately 20% of ischaemic stroke survivors are not taking their antithrombotic medications, according to a study originally designed to determine whether the use of these medications increased among stroke survivors over a 7-year period. The study also found that individuals who were younger, female, or Hispanic were less likely to be taking antithrombotic agents. The findings appear in the January 2010 issue of the American Journal of Preventive Medicine.

Impact of Implantable Cardioverter-Defibrillator, Amiodarone, and Placebo on the Mode of Death in Stable Patients With Heart Failure
Circulation
The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) demonstrated that implantable cardioverter-defibrillator (ICD) therapy reduces all-cause mortality in patients with New York Heart Association class II/III heart failure and a left ventricular ejection fraction 35% on optimal medical therapy. Whether ICD therapy reduced sudden death caused by ventricular tachyarrhythmias without affecting heart failure deaths in this population is unknown. SCD-HeFT randomized 2521 subjects to placebo, amiodarone, or shock-only, single-lead ICD therapy. Overall ICD therapy reduced cardiac mortality and sudden death presumed to be ventricular tachyarrhythmic in SCD-HeFT and had no effect on heart failure mortality. Amiodarone had no effect on all-cause mortality or its cause-specific components.

Hepatitis C drug fights virus in new way
A drug that targets hepatitis C in an entirely new way was highly effective at suppressing the virus in chimpanzees and kept working for several weeks after the treatment stopped, U.S. researchers said on Thursday. The hope is that the drug -- made by Danish company Santaris Pharma AS under the experimental name SPC3649 -- could replace more toxic drugs as part of a cocktail to fight hepatitis C, said Robert Lanford of the Southwest Foundation for Biomedical Research in San Antonio, Texas.

Oral direct thrombin inhibitor AZD0837 for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation
European Heart Journal
Oral anticoagulation with vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF) is effective but has significant limitations. AZD0837, a new oral anticoagulant, is a prodrug converted to a selective and reversible direct thrombin inhibitor (AR-H067637). We report from a Phase II randomized, dose-guiding study (NCT00684307 [ClinicalTrials.gov] ) to assess safety, tolerability, pharmacokinetics, and pharmacodynamics of extended-release AZD0837 in patients with AF. It was shown AZD0837 was generally well tolerated at all doses tested. AZD0837 treatment at an exposure corresponding to the 300 mg od dose in this study provides similar suppression of thrombogenesis at a potentially lower bleeding risk compared with dose-adjusted VKA. Free Full Text

Survival After Bilateral Versus Single-Lung Transplantation for Idiopathic Pulmonary Fibrosis
Annals of Internal Medicine
Patients with end-stage idiopathic pulmonary fibrosis (IPF) are increasingly having bilateral rather than single-lung transplantation. This study included 3327 patients with IPF who had single (2146 patients [64.5%]) or bilateral (1181 patients [35.5%]) lung transplantation between 1987 and 2009. Overall survival did not differ between patients who had single and bilateral lung transplantation. Single-lung transplantation confers short-term survival benefit but long-term harm, whereas bilateral transplantation confers short-term harm but long-term survival benefit.

Increased Mortality in Bulimia Nervosa and Other Eating Disorders
American Journal of Psychiatry
Anorexia nervosa has been consistently associated with increased mortality, but whether this is true for other types of eating disorders is unclear. The goal of this study was to determine whether anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified are associated with increased all-cause mortality or suicide. Crude mortality rates were 4.0% for anorexia nervosa, 3.9% for bulimia nervosa, and 5.2% for eating disorder not otherwise specified. All-cause standardized mortality ratios were significantly elevated for bulimia nervosa and eating disorder not otherwise specified; suicide standardized mortality ratios were elevated for bulimia nervosa and eating disorder not otherwise specified.

Heart Rate Predicts Outcomes in an Implantable Cardioverter-Defibrillator Population
Circulation
Elevated heart rate (HR) is associated with adverse cardiovascular events and total mortality in the general population and in individuals with heart disease. Our hypothesis was that mean HR predicts total mortality and heart failure hospitalization in patients undergoing implantable cardioverter-defibrillator (ICD) implantation. This study showed that in patients with a mean HR <75 bpm, 5.8% died or were hospitalized for heart failure, whereas 20.9% with a mean HR >90 bpm achieved the same end point, a 3.6-fold difference.