30 Jan 09
Posted in General at 0:28 by Laci
By I Gustavsena, JG Bramnessb, S Skurtveitb, A Engelandb, I Neutele and J Mørlanda
Sleep Medicine 2008;9:818-822
Despite the high prescription rate of benzodiazepine-like hypnotics (z-hypnotics), there is limited information on the road traffic accident risk associated with the use of these drugs. We wanted to investigate whether filling a prescription for zopiclone or zolpidem was associated with increased risk of road traffic accidents at a national population level. Nitrazepam and flunitrazepam were used as comparator drugs.
Method
All Norwegians 18–69 years (3.1 million) were followed-up from January 2004 until the end of September 2006. Information on prescriptions, road traffic accidents and emigration/death was obtained from three Norwegian population-based registries. The first week after the hypnotics had been dispensed was considered to be the exposure period. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of accidents in the exposed person-time to the incidence of accidents in the unexposed person-time.
Results
During exposure, 129 accidents were registered for zopiclone, 21 for zolpidem, 27 for nitrazepam and 18 for flunitrazepam. The SIRs were (SIR for all ages and both sexes combined; 95% CI): z-hypnotics (zopiclone + zolpidem) 2.3; 2.0–2.7, nitrazepam 2.7; 1.8–3.9 and flunitrazepam 4.0; 2.4–6.4. The highest SIRs were found among the youngest users for all hypnotics.
Conclusions
This study found that users of hypnotics had a clearly increased risk of road traffic accidents. The SIR for flunitrazepam was particularly high.
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22 Jan 09
Posted in BNP, Venous thromboembolism at 0:26 by Laci
By R Cavallazzi, A Nair, T Vasu and P E Marik
Intensive Care Med 2008:34;2147-2156
Patients with pulmonary embolism (PE) have a high risk of death, and it is important to recognize factors associated with higher mortality. Recently, several biomarkers have been studied for risk stratification in patients with PE.
Objectives
Evaluate the available evidence on (a) the accuracy of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for the diagnosis of right ventricular dysfunction and (b) their value as a prognostic factor of all-cause in-hospital or short-term mortality in patients with PE.
Data sources
MEDLINE, Embase, and citation review of relevant primary and review articles.
Selection criteria We selected studies evaluating the accuracy of BNP or NT-proBNP for the diagnosis of right ventricular dysfunction. We also selected studies that reported data on BNP or NT-proBNP as a predictor of short-term mortality in patients with PE.
Results
Sixteen studies met our inclusion criteria. The pooled diagnostic odds ratio for the diagnosis of right ventricular dysfunction in pulmonary embolism was 39.45 (95% CI; 15.54ñ100.12) and 24.73 (95% CI 2.02ñ302.37) for BNP and NT-proBNP, respectively. The pooled odds ratio for all-cause in-hospital or short-term mortality was 6 (95% CI 1.31±27.43; p: 0.021) and 16.12 (95% CI 3.1±83.68; p: 0.001) for BNP (cutoff: 100 pg/ml) and NT-proBNP (cutoff: 600 ng/L), respectively.
Conclusion
The results of this meta-analysis indicate that BNP and NT-proBNP are associated with the diagnosis of right ventricular dysfunction (RVD) in patients with an acute PE and are significant predictors of all-cause in-hospital or short-term mortality in these patients.
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21 Jan 09
Posted in Infection at 0:11 by Laci
By T Watanabea, S Watanabea, K Shinyab, J Hyun Kima, M Hattaa and Y Kawaokaa
PNAS 2008; (online before print)
The 1918 influenza pandemic was the most devastating outbreak of infectious disease in human history, accounting for about 50 million deaths worldwide. In addition to a significant number of cases of secondary bacterial pneumonia, this highly pathogenic strain of influenza A virus caused fatal primary viral pneumonia. To identify the viral gene(s) chiefly responsible for the high virulence of the 1918 virus, we generated a series of reassortants between the 1918 virus and a contemporary human H1N1 virus (A/Kawasaki/173/2001; K173) using reverse genetics. We then assessed their virulence properties in ferrets, a model closely resembling humans in terms of sensitivity to influenza virus infection and pattern of spread after intranasal inoculation. Substitution of single genes from the 1918 virus in the genetic background of K173 virus did not markedly alter the pattern of infection. That is, the reassortants grew well in nasal turbinates, but only sporadically (if at all) in the trachea and lungs. One exception was the 1918PB1/K173 reassortant, which replicated efficiently in lung tissues as well as the upper respiratory tract. A reassortant virus expressing the 1918 viral RNA polymerase complex (PA, PB1, and PB2) and nucleoprotein showed virulence properties in the upper and lower respiratory tracts of ferrets that closely resembled those of wild-type 1918 virus. Our findings strongly implicate the viral RNA polymerase complex as a major determinant of the pathogenicity of the 1918 pandemic virus. This new insight may aid in identifying virulence factors in future pandemic viruses that could be targeted with antiviral compounds.
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20 Jan 09
Posted in General at 10:00 by Laci
By J Eisenach, A Borgeat, Z Bosnjak, T Brennan, J Kersten, E Kochs, J Lerman, D Warner, J Wiener-Kronish
Anesthesiology 2008;109:962-972
Welcome to the 2008 year in review, highlighting articles that the Editorial Board believes exemplify the mission of Anesthesiology, to advance the science and practice of perioperative, critical care, and pain medicine through the promotion of seminal discovery. Our goals are to remind you of articles that may change your clinical practice today, to help you better understand the scientific basis of current practice, and to provide glimpses into the future. We recognize how busy you are and hope these brief synopses guide you to new and relevant information.
The full-text on-line articles are a click away at our newly redesigned Web site-www.anesthesiology.org -described more fully in an editorial in this issue.1 In addition to the synopses chronicled in this review, the Anesthesiology Web site now offers new functionality, such as most viewed or most in the press, that will also help you to determine the most relevant and important content for your practice and research. Two thousand eight is the first full calendar year during which content is regularly highlighted through the American Society of Anesthesiologists Press Release office, and the press release program has met with remarkable success. Throughout the year, several news releases were picked up by more than 1,000 news outlets, including nearly all the major news media entities. As Editors, we are very excited about the public interest in research and other content published in the Journal because press interest stresses the critically important medical advances in our specialty and offers well-deserved recognition to the outstanding authors who publish with us.
This year saw the reorganization of our Table of Contents into the three major medical branches of our specialty: perioperative, critical care, and pain medicine. Although we could have organized these synopses into these three areas, we chose to provide a more clinically focused approach. As such, the first six articles address preoperative assessment; the next eight articles address intraoperative care, and the final four articles address postoperative and critical care.
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