Albaramki J, Hodson EM, Craig JC, et al. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane Database Syst Rev. 2012 Jan 18;1:CD007857. (Review) PMID: 22258974
BACKGROUND: The anaemia seen in chronic kidney disease (CKD) may be
exacerbated by iron deficiency. Iron can be provided through different
routes, with advantages and drawbacks of each route. It remains unclear
whether the potential harms and additional costs of intravenous (IV)
compared with oral iron are justified.
OBJECTIVES: To determine the
benefits and harms of IV iron supplementation compared with oral iron
for anaemia in adults and children with CKD. SEARCH
METHODS: In March
2010 we searched the Cochrane Renal Group`s specialised register, the
Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane
Library, MEDLINE and EMBASE without language restriction.
SELECTION
CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs
in which oral and IV routes of iron administration were compared in
adults and children with CKD.
DATA COLLECTION AND ANALYSIS: Two
authors independently assessed study eligibility, risk of bias, and
extracted data. Results were reported as risk ratios (RR) or risk
differences (RD) with 95% confidence intervals (CI) for dichotomous
outcomes and for continuous outcomes the mean difference (MD) was used
or standardised mean difference (SMD) if different scales had been used.
Statistical analyses were performed using the random-effects model.
Subgroup analysis and univariate meta-regression were performed to
investigate between study differences.
MAIN RESULTS: Twenty eight
studies (2098 participants) were included. Risk of bias attributes were
poorly performed and/or reported with low risk of bias reported in 12
(43%) studies for sequence generation, incomplete outcome reporting and
selective outcome reporting and in 6 (16%) studies for allocation
concealment. No study was blinded for participants, investigators and
outcome assessors but all were considered at low risk of bias because
the primary outcome of haemoglobin was a laboratory outcome and unlikely
to be influenced by lack of blinding. Haemoglobin (22 studies, 1862
patients: MD 0.90 g/dL, 95% CI 0.44 to 1.37); ferritin (24 studies, 1751
patients: MD 243.25 mug/L, 95% CI 188.74 to 297.75); and transferrin
saturation (18 studies, 1457 patients: MD 10.20%, 95% CI 5.56 to 14.83)
were significantly increased by IV iron compared with oral iron. There
was a significant reduction in erythropoiesis-stimulating agent (ESA)
dose in patients receiving dialysis who were treated with IV iron (9
studies, 487 patients: SMD -0.76, 95% CI -1.22 to -0.30). There was a
high level of heterogeneity in all analyses. Mortality and
cardiovascular morbidity did not differ significantly, but were reported
in few studies. Gastrointestinal side effects were more common with
oral iron, but hypotensive and allergic reactions were more common with
IV iron.
AUTHORS' CONCLUSIONS: The included studies provide strong
evidence for increased ferritin and transferrin saturation levels,
together with a small increase in haemoglobin, in patients with CKD who
were treated with IV iron compared with oral iron. From a limited body
of evidence, we identified a significant reduction in ESA requirements
in patients treated with IV iron, and found no significant difference in
mortality. Adverse effects were reported in only 50% of included
studies. We therefore suggest that further studies that focus on
patient-centred outcomes are needed to determine if the use of IV iron
is justified on the basis of reductions in ESA dose and cost,
improvements in patient quality of life, and with few serious adverse
effects.
Monday, February 20, 2012
Proton Pump Inhibitors (PPIs) - Drug Safety Communication: Clostridum Difficile-Associated Diarrhea (CDAD) Can be Associated With Stomach Acid Drugs
- AcipHex (rabeprazole sodium)
- Dexilant (dexlansoprazole)
- Nexium (esomeprazole magnesium)
- Omeprazole (omeprazole) Over-the-Counter (OTC)
- Prevacid (lansoprazole) and OTC Prevacid 24hr
- Prilosec (omeprazole) and OTC
- Protonix (pantoprazole sodium)
- Vimovo (esomeprazole magnesium and naproxen)
- Zegerid (omeprazole and Sodium bicarbonate) and OTC
ISSUE: FDA notified the public that the use of stomach acid drugs known as proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile–associated diarrhea (CDAD). A diagnosis of CDAD should be considered for patients taking PPIs who develop diarrhea that does not improve. The FDA is working with manufacturers to include information about the increased risk of CDAD with use of PPIs in the drug labels.
FDA is also reviewing the risk of CDAD in users of histamine H2 receptor blockers. H2 receptor blockers are used to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and heartburn.
BACKGROUND: Proton pump inhibitors (PPIs) are marketed under various brand and generic drug names as prescription and over-the-counter (OTC) products. They work by reducing the amount of acid in the stomach. Prescription PPIs are used to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus. Over-the-counter PPIs are used to treat frequent heartburn.
Clostridium difficile (C. difficile) is a bacterium that can cause diarrhea that does not improve. Symptoms include watery stool, abdominal pain, and fever, and patients may go on to develop more serious intestinal conditions. The disease can also be spread in hospitals.
RECOMMENDATION: Patients should immediately contact their healthcare professional and seek care if they take PPIs and develop diarrhea that does not improve. Information for Healthcare Professionals:
- A diagnosis of CDAD should be considered for PPI users with diarrhea that does not improve.
- Advise patients to seek immediate care from a healthcare professional if they experience watery stool that does not go away, abdominal pain, and fever while taking PPIs.
- Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated.
- Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
- Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm290838.htm
New antibiotic cefpodoxime for bladder infection has disappointing results.
Health Day
(2/8, Mann) reports, "New antibiotics are needed to help treat bladder
infections, but the drug cefpodoxime, once thought promising, doesn't
appear to be up to the task," according to a study
published Feb. 8 in the Journal of the American Medical
Association. The study "included 300 women aged 18 to 55 with
uncomplicated bladder infections" who "received either 250 milligrams
(mg) of ciprofloxacin orally twice a day for three days or 100 mg of
cefpodoxime proxetil orally twice a day for three days." Dr. Thomas
Hooton, a professor of clinical medicine at the University of Miami
Miller School of Medicine, said, "We do have antibiotics to treat
bladder infections, but due to increasing rates of resistance, we wanted
to see if this other drug [cefpodoxime] was comparable to the gold
standard, but it wasn't."
Court: Social Security Beneficiaries Cannot Reject Right To Medicare Benefits.
The Hill 
(2/8, Pecquet) reports in its "Healthwatch" blog, "Americans who are
eligible for Medicare benefits can't give them up, a federal appeals
court ruled Tuesday. The unusual case was brought by five people who
would prefer not to be on Medicare because their private insurer limits
hospital coverage for customers who are entitled to the government
health program." The plaintiffs, "who include former House Majority
Leader Dick Armey (R-Texas), sued to stop their automatic enrollment
into Medicare," but the court explained in
its decision that the plaintiffs "seek a legal declaration that Medicare
Part A benefits cannot be paid on their behalf" and concluded that the
law "does not provide a mechanism for beneficiaries to opt out."
(2/8, Pecquet) reports in its "Healthwatch" blog, "Americans who are
eligible for Medicare benefits can't give them up, a federal appeals
court ruled Tuesday. The unusual case was brought by five people who
would prefer not to be on Medicare because their private insurer limits
hospital coverage for customers who are entitled to the government
health program." The plaintiffs, "who include former House Majority
Leader Dick Armey (R-Texas), sued to stop their automatic enrollment
into Medicare," but the court explained in
its decision that the plaintiffs "seek a legal declaration that Medicare
Part A benefits cannot be paid on their behalf" and concluded that the
law "does not provide a mechanism for beneficiaries to opt out."
The AP
(2/8) reports, "'We understand plaintiffs' frustration with their
insurance situation and appreciate their desire for better private
insurance coverage,' Judge Brett Kavanaugh wrote in a majority opinion
joined by Douglas Ginsburg, both Republican appointees. But they agreed
with the Obama administration that the law says those over age 65 who
enroll in Social Security are automatically entitled to Medicare Part A,
which covers services including hospital, nursing home care, hospice
and home health care." Meanwhile, attorney Kent
Brown, "who argued the case for the plaintiffs, says they want to keep
their Social Security because they believe they earned it, but none of
them want Medicare Part A," and he vowed to appeal the ruling, calling
it "outrageous" and contending that it was never intended by Congress to
be unable to "decline Medicare Part A and not opt out of Social
Security."
(2/8) reports, "'We understand plaintiffs' frustration with their
insurance situation and appreciate their desire for better private
insurance coverage,' Judge Brett Kavanaugh wrote in a majority opinion
joined by Douglas Ginsburg, both Republican appointees. But they agreed
with the Obama administration that the law says those over age 65 who
enroll in Social Security are automatically entitled to Medicare Part A,
which covers services including hospital, nursing home care, hospice
and home health care." Meanwhile, attorney Kent
Brown, "who argued the case for the plaintiffs, says they want to keep
their Social Security because they believe they earned it, but none of
them want Medicare Part A," and he vowed to appeal the ruling, calling
it "outrageous" and contending that it was never intended by Congress to
be unable to "decline Medicare Part A and not opt out of Social
Security."
Guidelines Recommend Compression Stockings For Travelers At High Risk Of DVT.
The Wall Street Journal (2/8, McCartney, Subscription Publication) reports that the American College of Chest Physicians has released new guidelines
recommending that travelers at an increased risk for developing deep
vein thrombosis (DVT) use compression stockings when on long flights.
(2/8, McCartney, Subscription Publication) reports that the American College of Chest Physicians has released new guidelines
recommending that travelers at an increased risk for developing deep
vein thrombosis (DVT) use compression stockings when on long flights.
The AP
(2/8, Tanner) reports that "the guidelines were released online
Tuesday in the group's journal, Chest. They're based on a review of
recent research and other medical evidence on deep vein thrombosis,
blood clots that form deep in leg veins." The AP adds, "There's no
proof that flying economy-class increases your chances of dangerous
blood clots, according to" the "new guidelines."
(2/8, Tanner) reports that "the guidelines were released online
Tuesday in the group's journal, Chest. They're based on a review of
recent research and other medical evidence on deep vein thrombosis,
blood clots that form deep in leg veins." The AP adds, "There's no
proof that flying economy-class increases your chances of dangerous
blood clots, according to" the "new guidelines."
MedPage Today
(2/8, Fiore) reports, meanwhile, that "clinicians should not recommend
that all travelers use aspirin for prevention of deep vein thrombosis
during long plane trips, according to" the "new recommendation."
(2/8, Fiore) reports, meanwhile, that "clinicians should not recommend
that all travelers use aspirin for prevention of deep vein thrombosis
during long plane trips, according to" the "new recommendation."
CDC Survey Finds Bread Is Top Source Of Sodium In US Diet.
ABC World News (2/7, story 7, 0:35, Sawyer) reported that "the
Center for Diseases Control said nine out of ten adults eat too much
salt. And the number one source of their salt is a surprise -- bread
and rolls."
The CBS Evening News (2/7, story 9, 0:20, Pelley) reported, "The
Centers for Disease Control said today that salty snacks like potato
chips are not our biggest source of sodium."
NBC Nightly News (2/7, story 8, 2:25, Williams) reported that CDC
Director Thomas Frieden, MD, said, "We're eating more food made by
others, in restaurants or prepared food from grocery stores. And when
other people make food for us, they put a lot more salt in it." NBC's
Costello added, "More fruits, veggies and home cooking are the solution,
says the CDC."
The AP
(2/8, Stobbe) reports, "Bread and rolls are the No. 1 source of salt
in the American diet, accounting for more than twice as much sodium as
salty junk food like potato chips. That surprising finding comes in a
government report released Tuesday that includes a list of the top 10
sources of sodium." CDC officials "are encouraging consumers to read
labels and, for example, buy brands of bread that have lower sodium."
CDC Director Frieden noted, "Potato chips, pretzels, and popcorn --
which we think of as the saltiest foods in our diet
-- are only No. 10."
(2/8, Stobbe) reports, "Bread and rolls are the No. 1 source of salt
in the American diet, accounting for more than twice as much sodium as
salty junk food like potato chips. That surprising finding comes in a
government report released Tuesday that includes a list of the top 10
sources of sodium." CDC officials "are encouraging consumers to read
labels and, for example, buy brands of bread that have lower sodium."
CDC Director Frieden noted, "Potato chips, pretzels, and popcorn --
which we think of as the saltiest foods in our diet
-- are only No. 10."
"Most sodium in the US diet comes from bread, lunch meat, pizza, chicken, soup, and burgers, the CDC found," according to the National Journal
(2/8, Fox, Subscription Publication). In a statement, CDC Director
Frieden said, "We're encouraged that some food manufacturers are already
taking steps to reduce sodium," noting that manufacturers such as Kraft
and Leprino Foods are "actively working on providing customers and
consumers with healthier options."
(2/8, Fox, Subscription Publication). In a statement, CDC Director
Frieden said, "We're encouraged that some food manufacturers are already
taking steps to reduce sodium," noting that manufacturers such as Kraft
and Leprino Foods are "actively working on providing customers and
consumers with healthier options."
The NPR
(2/8, Barclay) "The Salt" blog reports, "According to the CDC, the
average American consumes about 3,300 milligrams of sodium per day, not
including any salt that may be added during a meal. ... The US Dietary
Guidelines recommend no more than 2,300 mg a day, except if you're over
51 years or African American or have high blood pressure, diabetes or
chronic kidney disease."
(2/8, Barclay) "The Salt" blog reports, "According to the CDC, the
average American consumes about 3,300 milligrams of sodium per day, not
including any salt that may be added during a meal. ... The US Dietary
Guidelines recommend no more than 2,300 mg a day, except if you're over
51 years or African American or have high blood pressure, diabetes or
chronic kidney disease."
The Atlanta Journal-Constitution
(2/8, Jeffries) lists the "10 types of foods are responsible for more
than 40 percent of people's sodium intake," according to the CDC list.
The foods are "breads and rolls; luncheon meat, such as deli ham or
turkey; pizza; poultry; soups; cheeseburgers and other sandwiches;
cheese; pasta dishes; meat dishes such as meat loaf; and snack foods
such as potato chips, pretzels and popcorn." The Journal-Constitution
points out that "breads and rolls aren't
saltier than many of the other foods on the CDC list, but people tend to
eat a lot of them," which makes them the cop source of salt in the
diet.
(2/8, Jeffries) lists the "10 types of foods are responsible for more
than 40 percent of people's sodium intake," according to the CDC list.
The foods are "breads and rolls; luncheon meat, such as deli ham or
turkey; pizza; poultry; soups; cheeseburgers and other sandwiches;
cheese; pasta dishes; meat dishes such as meat loaf; and snack foods
such as potato chips, pretzels and popcorn." The Journal-Constitution
points out that "breads and rolls aren't
saltier than many of the other foods on the CDC list, but people tend to
eat a lot of them," which makes them the cop source of salt in the
diet.
CQ
(2/8, Subscription Publication) quotes a statement by CDC Director
Frieden, who said, "Too much sodium raises blood pressure, which is a
major risk factor for heart disease and stroke." He added, "These
diseases kill more than 800,000 Americans each year and contribute an
estimated $273 billion in health care costs."
(2/8, Subscription Publication) quotes a statement by CDC Director
Frieden, who said, "Too much sodium raises blood pressure, which is a
major risk factor for heart disease and stroke." He added, "These
diseases kill more than 800,000 Americans each year and contribute an
estimated $273 billion in health care costs."
MedPage Today
(2/8, Fiore) notes, "The data come from the 'What We Eat in America'
portion of the National Health and Nutrition Examination Survey (NHANES)
2007-2008. NHANES is a survey that relies on self-reported data, a fact
that may introduce bias and also raises questions about the
generalizability of its findings." The study is published in the CDC's Morbidity and Mortality Weekly Report. The Los Angeles Times (2/8, Muskal) "Nation Now" blog also covers the story.
(2/8, Fiore) notes, "The data come from the 'What We Eat in America'
portion of the National Health and Nutrition Examination Survey (NHANES)
2007-2008. NHANES is a survey that relies on self-reported data, a fact
that may introduce bias and also raises questions about the
generalizability of its findings." The study is published in the CDC's Morbidity and Mortality Weekly Report. The Los Angeles Times (2/8, Muskal) "Nation Now" blog also covers the story.
Soda Linked to Lung Disease
Direct Medpage Link
5 comment(s)
More bad news for soda lovers: in addition to obesity and heart disease, the sugary drinks may be tied to asthma and chronic obstructive pulmonary disease (COPD), Australian researchers found.
People who consumed at least a half a liter of soft drinks a day were more than twice as likely to develop either lung condition compared with those who didn't partake at all (OR 2.33, 95% CI 1.51 to 3.60), Zumin Shi, MD, of the University of Adelaide in Australia, and colleagues reported in Respirology.
The cross-sectional study, however, couldn't prove causality, and researchers not involved in the study suspect an overall unhealthy diet effect might be at play.
"High soda intake is a good marker for poor overall diet, and poor overall attention to health," David Katz, MD, director of the Prevention Research Center at Yale University in New Haven, Conn., said in an email to MedPage Today. "It likely suggests greater exposure to everything from tobacco smoke to air pollution."
Sugar-sweetened beverages have long been linked to a host of poor health outcomes, including stroke and heart disease, but no study has yet assessed potential ties to asthma or COPD, the researchers said.
There are many potential explanations for the increased burden of asthma in Western countries -- less exposure to indoor allergens, improved hygiene, and use of antibiotics (the "hygiene hypothesis"), as well as poor diet and increased obesity -- but fewer noted risk factors for COPD.
Smoking, of course, is a major one, but up to 50% of airway obstruction can't be explained away by cigarette use, they wrote, thus the need to identify novel risk factors.
The group looked at data from the South Australian Monitoring and Surveillance System on 16,907 adults, mean age 46.7, who responded to phone interviews from March 2008 to June 2010.
The prevalence of asthma and COPD, based on self-reported doctor diagnosis, was 12.5% and 4.4%, respectively.
Though the vast majority (72%) said they didn't drink any soda at all, 11.4% reported taking down more than a half a liter of soft drinks every day. In addition to carbonated brand-name soft drinks, lemonade, flavored mineral water, and sports drinks were consumed.
Shi and colleagues found that folks who drank this level of soda had a higher prevalence of asthma and COPD than those who didn't drink any (14.7% versus 11.9% and 6% versus 4.2%, respectively).
In multivariate analyses adjusting for sociodemographic factors, intake of fruit and vegetables, and other life style factors, drinking half a liter of soda a day was associated with an odds ratio of 1.26 for asthma (95% CI 1.01 to 1.58) and an OR of 1.79 for COPD (95% CI 1.32 to 2.43) compared with never drinking soda.
The researchers also saw combined effects for drinking soda and smoking. Consuming more than half a liter a day and being a current smoker carried a 6.6-fold greater risk of COPD and a 1.5-fold higher risk of asthma than not smoking and drinking soda, they reported.
"The combined effect of soft drink consumption and smoking on asthma/COPD emphasizes the importance of lifestyle factor clustering in the etiology of asthma/COPD," they wrote. "Promoting a healthy lifestyle should be encouraged as one means of preventing asthma/COPD."
The mechanisms behind the relationships, however, are unclear. Both asthma and COPD are associated with inflammation, and it could be that foods promoting oxidative stress and inflammation could affect the pathogenesis of these diseases, they wrote.
Drinking soda has also been tied to a higher risk of obesity, which in turn leads to a greater likelihood of developing both lung diseases, they said.
And studies have shown that chemicals such as phthalates from plastic bottles, as well as allergies to preservatives such as nitrites and sulphites, may be linked to asthma.
In addition to not being able to prove causality, the study was limited by its reliance on self-reported data.
Still, Shi and colleagues concluded that "regardless of whether there is a cause-and-effect relationship, the public health implications of consumption of large volumes of soft drink are substantial."
5 comment(s)
More bad news for soda lovers: in addition to obesity and heart disease, the sugary drinks may be tied to asthma and chronic obstructive pulmonary disease (COPD), Australian researchers found.
People who consumed at least a half a liter of soft drinks a day were more than twice as likely to develop either lung condition compared with those who didn't partake at all (OR 2.33, 95% CI 1.51 to 3.60), Zumin Shi, MD, of the University of Adelaide in Australia, and colleagues reported in Respirology.
The cross-sectional study, however, couldn't prove causality, and researchers not involved in the study suspect an overall unhealthy diet effect might be at play.
"High soda intake is a good marker for poor overall diet, and poor overall attention to health," David Katz, MD, director of the Prevention Research Center at Yale University in New Haven, Conn., said in an email to MedPage Today. "It likely suggests greater exposure to everything from tobacco smoke to air pollution."
Sugar-sweetened beverages have long been linked to a host of poor health outcomes, including stroke and heart disease, but no study has yet assessed potential ties to asthma or COPD, the researchers said.
There are many potential explanations for the increased burden of asthma in Western countries -- less exposure to indoor allergens, improved hygiene, and use of antibiotics (the "hygiene hypothesis"), as well as poor diet and increased obesity -- but fewer noted risk factors for COPD.
Smoking, of course, is a major one, but up to 50% of airway obstruction can't be explained away by cigarette use, they wrote, thus the need to identify novel risk factors.
The group looked at data from the South Australian Monitoring and Surveillance System on 16,907 adults, mean age 46.7, who responded to phone interviews from March 2008 to June 2010.
The prevalence of asthma and COPD, based on self-reported doctor diagnosis, was 12.5% and 4.4%, respectively.
Though the vast majority (72%) said they didn't drink any soda at all, 11.4% reported taking down more than a half a liter of soft drinks every day. In addition to carbonated brand-name soft drinks, lemonade, flavored mineral water, and sports drinks were consumed.
Shi and colleagues found that folks who drank this level of soda had a higher prevalence of asthma and COPD than those who didn't drink any (14.7% versus 11.9% and 6% versus 4.2%, respectively).
In multivariate analyses adjusting for sociodemographic factors, intake of fruit and vegetables, and other life style factors, drinking half a liter of soda a day was associated with an odds ratio of 1.26 for asthma (95% CI 1.01 to 1.58) and an OR of 1.79 for COPD (95% CI 1.32 to 2.43) compared with never drinking soda.
The researchers also saw combined effects for drinking soda and smoking. Consuming more than half a liter a day and being a current smoker carried a 6.6-fold greater risk of COPD and a 1.5-fold higher risk of asthma than not smoking and drinking soda, they reported.
"The combined effect of soft drink consumption and smoking on asthma/COPD emphasizes the importance of lifestyle factor clustering in the etiology of asthma/COPD," they wrote. "Promoting a healthy lifestyle should be encouraged as one means of preventing asthma/COPD."
The mechanisms behind the relationships, however, are unclear. Both asthma and COPD are associated with inflammation, and it could be that foods promoting oxidative stress and inflammation could affect the pathogenesis of these diseases, they wrote.
Drinking soda has also been tied to a higher risk of obesity, which in turn leads to a greater likelihood of developing both lung diseases, they said.
And studies have shown that chemicals such as phthalates from plastic bottles, as well as allergies to preservatives such as nitrites and sulphites, may be linked to asthma.
In addition to not being able to prove causality, the study was limited by its reliance on self-reported data.
Still, Shi and colleagues concluded that "regardless of whether there is a cause-and-effect relationship, the public health implications of consumption of large volumes of soft drink are substantial."
The researchers reported no conflicts of interest.
Primary source: Respirology
Source reference:
Shi Z, et al "Association between soft drink consumption and asthma and chronic obstructive pulmonary disease among adults in Australia" Respirol 2012; 17: 363-369.
Source reference:
Shi Z, et al "Association between soft drink consumption and asthma and chronic obstructive pulmonary disease among adults in Australia" Respirol 2012; 17: 363-369.
Guideline: Metformin Preferred To Best Control HbA1c In Type 2 Diabetes.
MedPage Today
(2/7, Fiore) reports, "Metformin should be the first drug of choice in
oral therapy for type 2 diabetics who don't respond to diet and
lifestyle changes, according to a new guideline
" published Feb. 7 in the Annals of Internal Medicine. "A second agent
can be added if metformin monotherapy fails to control hyperglycemia,
but there's insufficient evidence to recommend one secondary agent over
another," the guideline from the American College of Physicians (ACP)
explains.
(2/7, Fiore) reports, "Metformin should be the first drug of choice in
oral therapy for type 2 diabetics who don't respond to diet and
lifestyle changes, according to a new guideline
" published Feb. 7 in the Annals of Internal Medicine. "A second agent
can be added if metformin monotherapy fails to control hyperglycemia,
but there's insufficient evidence to recommend one secondary agent over
another," the guideline from the American College of Physicians (ACP)
explains.
However, even though "metformin is more effective with fewer side
effects" and costs less, "the ACP is recommending that metformin only be
prescribed after someone has tried to change his or her lifestyle," HealthDay
(2/7, Gordon) reports. HealthDay adds, "There are currently 11
different classes of medications approved by the US Food and Drug
Administration for the treatment of type 2 diabetes, according to the
guidelines."
(2/7, Gordon) reports. HealthDay adds, "There are currently 11
different classes of medications approved by the US Food and Drug
Administration for the treatment of type 2 diabetes, according to the
guidelines."
Reminder that one MUST HAVE Reasonably intact renal function to get metformin
Everolimus May Shrink Rare Type Of Benign Kidney Tumor.
MedPage Today
(2/7, Phend) reports, "The cancer drug everolimus (Afinitor) appears
to shrink a rare type of benign kidney tumor often seen with tuberous
sclerosis," according to research presented at the Genitourinary Cancers
Symposium. Investigators found that "daily oral treatment shrank 42%
of angiomyolipomas to at least half their original volume, whereas no
placebo-treated patients saw any tumor regression (P<0.0001)." The
researchers also found that "the toxicity was low, without any excess in
infections, in the randomized
EXIST-2 trial."
(2/7, Phend) reports, "The cancer drug everolimus (Afinitor) appears
to shrink a rare type of benign kidney tumor often seen with tuberous
sclerosis," according to research presented at the Genitourinary Cancers
Symposium. Investigators found that "daily oral treatment shrank 42%
of angiomyolipomas to at least half their original volume, whereas no
placebo-treated patients saw any tumor regression (P<0.0001)." The
researchers also found that "the toxicity was low, without any excess in
infections, in the randomized
EXIST-2 trial."
Caloric restriction may not improve outcomes in some ventilator-dependent patients.
MedPage Today
(2/6, Bankhead) reports, "Caloric restriction failed to improve
outcomes in ventilator-dependent patients with acute lung injury,
results of an NIH-sponsored, multicenter trial
showed." The trial showed that "60-day mortality and infection
rates...did
not differ between treatment groups, according to data reported
simultaneously at the Society of Critical Care Medicine meeting...and
online in" the Journal of the American Medical Association. An
accompanying editorial
argued, however, that "this study was not designed or powered as an
equivalence study and does not provide definitive data to inform
clinicians about how much nutritional support is enough, how early it
should be
started, or even if there should be 'no nutrition provision' in the
initial phase of critical illness."
Most patients with Guillain-Barre syndrome may be vaccinated safely.
Reuters (2/4, Grens) reported a study
in Clinical Infectious Diseases suggesting that most patients
diagnosed with Guillain-Barré syndrome can safely receive vaccines and
may not suffer flare-ups after vaccination. Previously, the Centers for
Disease Control and
Prevention had warned against giving flu shots to patients who developed
Guillain-Barré within six weeks of a flu vaccination. In the study,
550 patients received about 1,000 vaccines, and none experienced a flare
up to two months after being vaccinated. In addition, two patients who
had developed Guillain-Barré within six weeks of a flu vaccination
received a flu shot and did not experience a flare.
Eating Purple Potatoes May Lower BP Without Weight Gain.
WebMD
(2/4, Nierenberg) reported, "When overweight people included two
servings of purple potatoes a day in their diet for a month, they not
only reduced their blood pressure, they also didn't gain weight in the
process," according to a study published online in the Journal of
Agricultural and Food Chemistry. The study of 18 middle-aged overweight
adults revealed that "compared to those who went spud-free, purple
potato eaters had on average drop of slightly more than 4% in diastolic
pressure (the bottom number in a reading) and a drop of
more than 3% in systolic pressure (the top number)." What's more, even
though "potato eaters took in more calories compared to adults given no
potatoes, their weight didn't change."
FYI: normal kidney function
(2/4, Nierenberg) reported, "When overweight people included two
servings of purple potatoes a day in their diet for a month, they not
only reduced their blood pressure, they also didn't gain weight in the
process," according to a study published online in the Journal of
Agricultural and Food Chemistry. The study of 18 middle-aged overweight
adults revealed that "compared to those who went spud-free, purple
potato eaters had on average drop of slightly more than 4% in diastolic
pressure (the bottom number in a reading) and a drop of
more than 3% in systolic pressure (the top number)." What's more, even
though "potato eaters took in more calories compared to adults given no
potatoes, their weight didn't change."FYI: normal kidney function
Lack of Sunlight, Vitamin D Tied to Stroke Risk
Lack of Sunlight, Vitamin D Tied to Stroke Risk 
NEW ORLEANS -- Too much sunlight is bad for the skin, but not enough may be a risk factor for stroke, according to a study presented here at the American Stroke Association’s International Stroke Conference.full story
NEW ORLEANS -- Too much sunlight is bad for the skin, but not enough may be a risk factor for stroke, according to a study presented here at the American Stroke Association’s International Stroke Conference.full story
Sunday, February 19, 2012
H. Pylori Infection Associated With Increased Risk For Type 2 Diabetes.
Reuters (2/3, Grens) reports that according to a study
published online Jan. 25 in the journal Diabetes Care, individuals who
have infections caused by Helicobacter pylori (H. pylori), the same
bacteria that causes ulcers, may face double the risk of developing type
2 diabetes over time, compared to people who are not infected with H.
pylori. Researchers arrived at this conclusion after following some 800
people over the course of 10 years. At study start, none of the
participants had type 2 diabetes.
(2/3, Grens) reports that according to a study
published online Jan. 25 in the journal Diabetes Care, individuals who
have infections caused by Helicobacter pylori (H. pylori), the same
bacteria that causes ulcers, may face double the risk of developing type
2 diabetes over time, compared to people who are not infected with H.
pylori. Researchers arrived at this conclusion after following some 800
people over the course of 10 years. At study start, none of the
participants had type 2 diabetes.
Oral Antibiotics May Be Effective For Treating Acute Pyelonephritis In Children.
Reuters
(2/3, Boggs) reports when treating children with acute pyelonephritis,
oral antibiotics seem to be just as effective as sequential IV/oral
antibiotics, according to a study
published online Jan. 30 in Pediatrics. The researchers randomly
assigned 171 children with a first case of acute pyelonephritis to one
of two treatment groups. The first group of children took an oral
antibiotic called cefixime for 10 days. The second group, the
sequential treatment group, received
IV ceftriaxone for four days and subsequently took oral cefixime for six
days. The study found that rates for renal scarring in the
intent-to-treat analysis and per-protocol analysis were comparable for
both groups.
(2/3, Boggs) reports when treating children with acute pyelonephritis,
oral antibiotics seem to be just as effective as sequential IV/oral
antibiotics, according to a study
published online Jan. 30 in Pediatrics. The researchers randomly
assigned 171 children with a first case of acute pyelonephritis to one
of two treatment groups. The first group of children took an oral
antibiotic called cefixime for 10 days. The second group, the
sequential treatment group, received
IV ceftriaxone for four days and subsequently took oral cefixime for six
days. The study found that rates for renal scarring in the
intent-to-treat analysis and per-protocol analysis were comparable for
both groups.
Methotrexate May Be Safely Resumed After Renal Injury In Kids With Cancer.
Reuters (2/3) reports that according to a study
published online Jan. 17 in the journal Cancer, glucarpidase rescue is
associated with complete renal recovery following high-dose therapy
with methotrexate in children with cancer who develop acute kidney
injury. In their study of 20 children who received glucarpidase within a
96-hour timeframe following development of acute renal injury and then
recovered, researchers then challenged 13 of the kids about one month
later with either a full or lowered dose of methotrexate. Notably, 11
of those 13 youngsters were able to complete their course of
methotrexate.
(2/3) reports that according to a study
published online Jan. 17 in the journal Cancer, glucarpidase rescue is
associated with complete renal recovery following high-dose therapy
with methotrexate in children with cancer who develop acute kidney
injury. In their study of 20 children who received glucarpidase within a
96-hour timeframe following development of acute renal injury and then
recovered, researchers then challenged 13 of the kids about one month
later with either a full or lowered dose of methotrexate. Notably, 11
of those 13 youngsters were able to complete their course of
methotrexate.
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