Diarrhea is a common complication for hospitalized patients, but a specific causative pathogen is not usually identified. Here, Marshall highlights a randomized, placebo-controlled trial by Beausoleil et al on 89 hospitalized patients who were to take more than or equal to three days of systemic antibiotics with lactobacilli-fermented milk intervention. Results show that fermented milk with Lactobacillus acidophilus and L. casei prevented antibiotic-associated diarrhea in hospitalized patients.
Menzies presents a study by Aissa et al discussing if an effective screening model be validated for detecting tuberculosis (TB) in persons who have come into contact with others with TB. Results show that a model was sensitive but not specific for screening for tuberculosis infections in contacts of persons with tuberculosis.
Mayes discusses the study conducted by Bell et al that determined the risk for death by drowning in persons with epilepsy. The review found that although the absolute risk for drowning in persons with epilepsy is less than half the risk for sudden unexplained death in epilepsy, it is still higher than the risk for drowning in the general population. By necessity, the meta-analysis combines data from somewhat disparate cohorts, and the risks for drowning in individual cohorts vary dramatically. Mayes notes that combined data for similar cohorts may be more meaningful in a given clinical context than the overall result.
Moore determines the risk for death in HIV-infected persons compared with the general population considering the introduction of highly active antiretroviral therapy based on the study of Bhaskaran and colleagues. Results show that persons infected with HIV had higher mortality than did the general population, but mortality and excess mortality have greatly decreased in the past 10 years. By 2004 to 2006, HIV seroconversion from sexual exposure was not associated with increased mortality in the first 5 years. The study by Bhaskaran et al could not do more than minimally examine causes of death. Because HIV-infected individuals now survive longer, comorbid conditions not previously associated with HIV/AIDS are being seen with increasing frequency, including cardiovascular diseases and non-AIDS cancer.
Schattner determines the 10-year absolute risk for cardiovascular (CV) events for patients with rheumatoid arthritis (RA) based on the study of Kremers et al. She states that the study by Kremers and colleagues is to be commended for its long follow-up, large subgroups, and strong composite endpoint. However, it lacks clinical information on the patients with RA, although past research tells that long disease duration, more extraarticular manifestations, rheumatoid-factor positivity, continuously raised erythrocyte sedimentation rate, and lack of treatment with methotrexate or anti-tumor necrosis factor agents are all additional risk factors for adverse CV outcomes. Results show that in patients with rheumatoid arthritis, absolute 10-year risk for cardiovascular events was 10% to 56%; risk for those with 5 traditional cardiovascular risk factors was 14% to 90%.
Alcorn presents a randomized controlled trial by Lawrence et al that examines whether rifaximin is effective and safe for treatment of hepatic encephalopathy. Results show that in patients with hepatic encephalopathy, rifaximin is as effective as other antibiotics and may be more effective than nonabsorbable disaccharides.
Del Mar presents a randomized placebo-controlled trial by Lambertz et al that analyzes whether premedication with acetaminophen, ibuprofen, or 4% lidocaine gel decreases discomfort in women who expect a high degree of discomfort from screening mammography. Results show that 4% lidocaine gel applied to the skin of the breasts and chest wall about 1 hour before screening mammography reduced discomfort in women who expected a high degree of discomfort. Oral medications did not reduce discomfort.
Good comments on the study by Stone et al comparing the effectiveness of anticoagulation with bivalirudin (BVD) and heparin (HP) plus a glycoprotein (GP) IIb/IIIa inhibitor in patients with ST-segment elevation myocardial infarction having primary percutaneous coronary intervention. He contends that in the REPLACE 2 trial, BVD was shown to be equivalent to HP plus GP inhibitors in low- to moderate-risk patients having PCI. The investigators declared noninferiority, but the Food and Drug Administration disagreed. In the ACUITY trial, the effect of BVD in high-risk patients with the acute coronary syndrome was even more controversial because of the complex study design involving multiple randomizations and a short duration of therapy. In the HORIZONS-AMI trial, when analyzed alone, BVD was actually superior to HP and a GP inhibitor for net adverse clinical events and bleeding.
Ganda examines a study by Gaede et al determining the effect of a multifactorial intervention on mortality in type 2 diabetes. Results show that intensive therapy reduced mortality and morbidity in patients with type 2 diabetes and microalbuminuria at 5.5 years following a 7.8-year randomized trial. The Steno-2 study also supports that an early targeted approach to pathogenetic risk factors may have lasting benefits even if improvements in risk-factor levels are not maintained.