Episodes of recurrent Clostridium difficile infection (CDI) are difficult to treat for several reasons. Foremost, data are lacking to support any particular treatment strategy. In addition, treatment of recurrent episodes is not always successful, and repeated, prolonged treatment is often necessary. Identification of subgroups at risk for recurrent CDI may aid in diagnosing and treating these patients. Two likely mechanistic factors increasing the risk of recurrent CDI are an inadequate immune response to C. difficile toxins and persistent disruption of the normal colonic flora. Important epidemiologic risk factors include advanced age, continuation of other antibiotics, and prolonged hospital stays. Current guidelines recommend that the first recurrent episode be treated with the same agent (i.e., metronidazole or vancomycin) used for the index episode. However, if the first recurrence is characterized as severe, vancomycin should be used. A reasonable strategy for managing a subsequent episode involves tapering followed by pulsed doses of vancomycin. Other potentially effective strategies for recurrent CDI include vancomycin with adjunctive treatments, such as Saccharomyces boulardii, rifaximin “chaser” therapy after vancomycin, nitazoxanide, fecal transplantation, and intravenous immunoglobulin. New treatment agents that are active against C. difficile, but spare critical components of the normal flora, may decrease the incidence of recurrent CDI.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Tuesday, January 31, 2012
Sunday, January 15, 2012
Best Treatment for Patients with Both Heart Disease and Diabetes? No Clear Answer
For patients with both coronary artery disease and type 2 diabetes, outcomes are similar regardless of whether revascularization or medical therapy is used — and whether insulin sensitization or insulin provision is used — reports an industry-supported study published online in the New England Journal of Medicine.
Researchers randomized some 2400 patients to either prompt revascularization or medical treatment, and to either insulin-sensitization or insulin-provision therapy. At 5 years, all-cause mortality did not differ between the revascularization and medical-therapy groups or between the insulin-sensitization and insulin-provision groups. Similarly, major cardiovascular events did not differ between groups.
Patients were stratified before randomization according to type of revascularization, and patients in the CABG (but not PCI) group had fewer major cardiovascular events with revascularization but a similar mortality rate.
Asked to comment, Journal Watch Cardiology Editor-in-Chief Dr. Harlan Krumholz said that the failure of the study to show clear superiority of revascularization and insulin sensitization "reinforces the need to incorporate the patient's preferences, values, and goals — and costs — into decisions about which strategy to pursue."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Researchers randomized some 2400 patients to either prompt revascularization or medical treatment, and to either insulin-sensitization or insulin-provision therapy. At 5 years, all-cause mortality did not differ between the revascularization and medical-therapy groups or between the insulin-sensitization and insulin-provision groups. Similarly, major cardiovascular events did not differ between groups.
Patients were stratified before randomization according to type of revascularization, and patients in the CABG (but not PCI) group had fewer major cardiovascular events with revascularization but a similar mortality rate.
Asked to comment, Journal Watch Cardiology Editor-in-Chief Dr. Harlan Krumholz said that the failure of the study to show clear superiority of revascularization and insulin sensitization "reinforces the need to incorporate the patient's preferences, values, and goals — and costs — into decisions about which strategy to pursue."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Thursday, December 29, 2011
Cancer Incidence And Mortality Continue To Decline
Cancer incidence and mortality continue to decline, with the most dramatic decreases in lung, prostate, and colorectal cancers among men, and breast and colorectal cancers in women, according to the latest national report card.
"Overall cancer incidence rates for all racial/ethnic groups combined decreased by 0.7% per year during 1999-2006 for both sexes combined, by 1.3% per year during 2000-2006 for men, and by 0.5% per year during 1998-2006 for women," authors from the American Cancer Society, the CDC, the National Cancer Institute, and the North American Association of Central Cancer Registries concluded. The report, was published online in the ACS journal, Cancer.
There has been a decline in cancer death rates since the early 1990s and that trend appears to be durable.The decreases were slightly larger for men, who had declines of 1.5% per year during 1993-2001 and 2.0% per year during 2001-2006 compared with women, whose cancer death rates declined 0.8% per year during 1994-2002 and 1.5% per year during 2002-2006," the authors wrote.
But the news was not all good. As men saw decreased rates of prostate, lung, oral, stomach, brain, and colorectal cancers, there was a concurrent increase in the cancers of the kidney, renal, liver, and esophagus -- as well as increases in leukemia, myeloma, and melanoma of the skin.
For women the story was similar -- decreased rates of breast, colorectal, ovarian, cervical, uterine corpus, and oral cancers, but an uptick in lung, thyroid, pancreas, bladder, and kidney cancers, as well as increases in non-Hodgkin lymphoma, melanoma, and leukemia.
Colorectal cancer [CRC] is a focus of this year's report, not a surprising choice because the news here is good: "CRC death rates have declined since 1984 in both men and women, with an accelerated rate of decline since 2002 (for men) and 2001 (for women)."
And a "microsimulation model" suggests that death rates from colorectal cancer could be reduced by 36% over the next decade if "1995-2000 trends for risk factor prevalence, screening, and treatment continue."But the authors point out that increased obesity among younger Americans could derail this trend.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
"Overall cancer incidence rates for all racial/ethnic groups combined decreased by 0.7% per year during 1999-2006 for both sexes combined, by 1.3% per year during 2000-2006 for men, and by 0.5% per year during 1998-2006 for women," authors from the American Cancer Society, the CDC, the National Cancer Institute, and the North American Association of Central Cancer Registries concluded. The report, was published online in the ACS journal, Cancer.
There has been a decline in cancer death rates since the early 1990s and that trend appears to be durable.The decreases were slightly larger for men, who had declines of 1.5% per year during 1993-2001 and 2.0% per year during 2001-2006 compared with women, whose cancer death rates declined 0.8% per year during 1994-2002 and 1.5% per year during 2002-2006," the authors wrote.
But the news was not all good. As men saw decreased rates of prostate, lung, oral, stomach, brain, and colorectal cancers, there was a concurrent increase in the cancers of the kidney, renal, liver, and esophagus -- as well as increases in leukemia, myeloma, and melanoma of the skin.
For women the story was similar -- decreased rates of breast, colorectal, ovarian, cervical, uterine corpus, and oral cancers, but an uptick in lung, thyroid, pancreas, bladder, and kidney cancers, as well as increases in non-Hodgkin lymphoma, melanoma, and leukemia.
Colorectal cancer [CRC] is a focus of this year's report, not a surprising choice because the news here is good: "CRC death rates have declined since 1984 in both men and women, with an accelerated rate of decline since 2002 (for men) and 2001 (for women)."
And a "microsimulation model" suggests that death rates from colorectal cancer could be reduced by 36% over the next decade if "1995-2000 trends for risk factor prevalence, screening, and treatment continue."But the authors point out that increased obesity among younger Americans could derail this trend.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Thursday, December 15, 2011
Americans living longer than ever
Americans living longer than ever. And every year that gets tacked on to the average life expectancy costs an extra trillion dollars in expenditures by Social Security and Medicare.
Americans are living a record 77 years and 11 months on average...according to two studies that led researchers to suggest raising the retirement age." The first study, from the CDC's National Center for Health Statistics, found that in the "US in 2007, the latest year for which figures are available," the "0.76 percent death rate is the lowest ever," driven by "a decline in deaths from heart disease and other ailments." Meanwhile, a second study published Dec. 14 in the health journal Milbank Quarterly, found that "every year that gets tacked on to the average life expectancy costs an extra trillion dollars in expenditures by Social Security and Medicare."
Overall, the 2007 data "show continued improvements in life expectancy for all Americans, although women are faring better than men, and whites fare better than other racial groups" by a "race differential" of about "4.6 years." But, even amid this progress, vast geographical discrepancies remain -- with people in southern states still facing higher death rates than those living in other parts of the country." And, "even though Americans can expect to live longer than their parents, life expectancy in the" US "is still lower than in many other industrialized countries, including Canada and Japan. Even so, the "dramatic improvements in the health of Americans over the last 20 years" will "have unforeseen effects on the country. The Social Security and Medicare "programs weren't designed to support people for that long."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Americans are living a record 77 years and 11 months on average...according to two studies that led researchers to suggest raising the retirement age." The first study, from the CDC's National Center for Health Statistics, found that in the "US in 2007, the latest year for which figures are available," the "0.76 percent death rate is the lowest ever," driven by "a decline in deaths from heart disease and other ailments." Meanwhile, a second study published Dec. 14 in the health journal Milbank Quarterly, found that "every year that gets tacked on to the average life expectancy costs an extra trillion dollars in expenditures by Social Security and Medicare."
Overall, the 2007 data "show continued improvements in life expectancy for all Americans, although women are faring better than men, and whites fare better than other racial groups" by a "race differential" of about "4.6 years." But, even amid this progress, vast geographical discrepancies remain -- with people in southern states still facing higher death rates than those living in other parts of the country." And, "even though Americans can expect to live longer than their parents, life expectancy in the" US "is still lower than in many other industrialized countries, including Canada and Japan. Even so, the "dramatic improvements in the health of Americans over the last 20 years" will "have unforeseen effects on the country. The Social Security and Medicare "programs weren't designed to support people for that long."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Wednesday, November 30, 2011
Maternal Use of Sertaline, Citalopram Linked to Septal Heart Defects in Offspring
Women who use the antidepressants sertraline (Zoloft) or citalopram (Celexa) early in pregnancy face increased risk for septal heart defects in their offspring, BMJ reports online.
Researchers examined data on more than 490,000 infants born in Denmark between 1996 and 2003. They found that women who filled prescriptions for sertraline and citalopram (but not other SSRIs) during their first trimester were significantly more likely to have children with septal heart defects (but not other malformations) than those who didn't use SSRIs (odds ratios: 3.2 and 2.5, respectively).
The authors and an editorialist (both with ties to SSRI manufacturers) note that the absolute risks for septal heart defects were low: 0.9% in children exposed to at least one SSRI and 2.1% in those exposed to more than one.
The editorialist concludes: "Clinicians and patients need to balance the small risks associated with SSRIs against those associated with undertreatment or no treatment."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Researchers examined data on more than 490,000 infants born in Denmark between 1996 and 2003. They found that women who filled prescriptions for sertraline and citalopram (but not other SSRIs) during their first trimester were significantly more likely to have children with septal heart defects (but not other malformations) than those who didn't use SSRIs (odds ratios: 3.2 and 2.5, respectively).
The authors and an editorialist (both with ties to SSRI manufacturers) note that the absolute risks for septal heart defects were low: 0.9% in children exposed to at least one SSRI and 2.1% in those exposed to more than one.
The editorialist concludes: "Clinicians and patients need to balance the small risks associated with SSRIs against those associated with undertreatment or no treatment."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Tuesday, November 15, 2011
Patient Balance Problems
Millions of people may suffer from inner-ear disorders that affect their balance but not be aware that they have a problem, a new study has found.Writing in The Archives of Internal Medicine, researchers noted the connection between balance problems and falls, especially among the elderly. The findings of the study, they said, suggest that doctors should make balance tests a routine part of checkups. This is especially true in nursing and assisted-living homes, they said.
“The big deal here really is falls,” the lead author, Dr. Yuri Agrawal of Johns Hopkins, said in an e-mail message, adding that a serious fall can be the beginning of the end for an older patient.The researchers drew on data from a federal study in which more than 5,000 people age 40 and over were surveyed about their history of falls and balance problems. They were then given examinations to determine how well they could maintain their balance in a variety of situations, including with their eyes closed.
More than a third of the subjects, the researchers found, had the balance disorder known as vestibular dysfunction — a figure that would translate to 69 million Americans.They also found that 32 percent of the volunteers who did not report problems with dizziness showed evidence of balance problems. Though they did not experience symptoms, they were still at higher risk for falls, the study said.
For doctors, Dr. Agrawal said, detecting balance problems in a patient is not very complicated. And treatment is available, including exercises that help people compensate for inner-ear problems that lead to poor balance.The cost of the treatment, they said, would most likely be less than medical costs associated with falls.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
“The big deal here really is falls,” the lead author, Dr. Yuri Agrawal of Johns Hopkins, said in an e-mail message, adding that a serious fall can be the beginning of the end for an older patient.The researchers drew on data from a federal study in which more than 5,000 people age 40 and over were surveyed about their history of falls and balance problems. They were then given examinations to determine how well they could maintain their balance in a variety of situations, including with their eyes closed.
More than a third of the subjects, the researchers found, had the balance disorder known as vestibular dysfunction — a figure that would translate to 69 million Americans.They also found that 32 percent of the volunteers who did not report problems with dizziness showed evidence of balance problems. Though they did not experience symptoms, they were still at higher risk for falls, the study said.
For doctors, Dr. Agrawal said, detecting balance problems in a patient is not very complicated. And treatment is available, including exercises that help people compensate for inner-ear problems that lead to poor balance.The cost of the treatment, they said, would most likely be less than medical costs associated with falls.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Sunday, October 30, 2011
Banned Herbal Ingredient Linked to Urinary Tract Cancer
Natural does not equal safe, and any herb strong enough to have a potential benefit is strong enough to have potential to cause harm."
Exposure to aristolochic acid, found in some Chinese herbal products such as Mu Tong and Fangchi, significantly increased the risk for urinary tract cancer, according to a retrospective study.Researchers in Taiwan found prescription of more than 60 grams of Mu Tong and consumption of more than 150 mg aristolochic acid were independently associated with an increased risk for urinary tract cancer.
• Mu Tong, 61 to 100 g: OR 1.6, 95% CI 1.3 to 2.1
• Mu Tong, >200 g: OR 2.1, 95% CI 1.3 to 3.4
• Aristolochic acid, 151 to 250 mg: OR 1.4, 95% CI 1.1 to 1.8
• Aristolochic acid, >500 mg: OR 2.0, 95% CI 1.4 to 2.9
Used in Chinese herbal preparations taken for weight loss or urinary tract infections, aristolochic acid has been banned in several countries, including in Taiwan and in the U.S.The latest study found a linear, dose-dependent relationship between the amount of aristolochic acid consumed and an increased risk for urinary tract cancer (P<0.001). This was independent of arsenic exposure through drinking water, which has also been associated with bladder and urinary tract cancers.Among the more than 4,000 patients analyzed, 57% had bladder cancer and 43% had upper urinary tract cancer.
The International Agency for Research on Cancer has classified herbal remedies containing high concentrations of aristolochic acid as carcinogenic. Traces of aristolochic acid may still be found in adulterated remedies currently on the market.
Wang, et al "Population-based case-control study of chinese herbal products containing aristolochic acid and urinary tract cancer risk" J Nat Can Inst 2009; DOI:10.1093/jnci/djp467.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Exposure to aristolochic acid, found in some Chinese herbal products such as Mu Tong and Fangchi, significantly increased the risk for urinary tract cancer, according to a retrospective study.Researchers in Taiwan found prescription of more than 60 grams of Mu Tong and consumption of more than 150 mg aristolochic acid were independently associated with an increased risk for urinary tract cancer.
• Mu Tong, 61 to 100 g: OR 1.6, 95% CI 1.3 to 2.1
• Mu Tong, >200 g: OR 2.1, 95% CI 1.3 to 3.4
• Aristolochic acid, 151 to 250 mg: OR 1.4, 95% CI 1.1 to 1.8
• Aristolochic acid, >500 mg: OR 2.0, 95% CI 1.4 to 2.9
Used in Chinese herbal preparations taken for weight loss or urinary tract infections, aristolochic acid has been banned in several countries, including in Taiwan and in the U.S.The latest study found a linear, dose-dependent relationship between the amount of aristolochic acid consumed and an increased risk for urinary tract cancer (P<0.001). This was independent of arsenic exposure through drinking water, which has also been associated with bladder and urinary tract cancers.Among the more than 4,000 patients analyzed, 57% had bladder cancer and 43% had upper urinary tract cancer.
The International Agency for Research on Cancer has classified herbal remedies containing high concentrations of aristolochic acid as carcinogenic. Traces of aristolochic acid may still be found in adulterated remedies currently on the market.
Wang, et al "Population-based case-control study of chinese herbal products containing aristolochic acid and urinary tract cancer risk" J Nat Can Inst 2009; DOI:10.1093/jnci/djp467.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
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