Deshpande A.,Cleveland Clinic |
Pant C.,University of Oklahoma |
Pasupuleti V.,Cleveland Clinic |
Rolston D.D.K.,Geisinger Medical Center |
And 5 more authors.
Clinical Gastroenterology and Hepatology | Year: 2012
Background & Aims: In the past decade, there has been a growing epidemic of Clostridium difficile infection (CDI). During this time, use of proton pump inhibitors (PPIs) has increased exponentially. We evaluated the association between PPI therapy and the risk of CDI by performing a meta-analysis. Methods: We searched MEDLINE and 4 other databases for subject headings and text words related to CDI and PPI in articles published from 1990 to 2010. All observational studies that investigated the risk of CDI associated with PPI therapy and used CDI as an end point were considered eligible. Two investigators screened articles independently for inclusion criteria, data extraction, and quality assessment; disagreements were resolved based on consensus with a third investigator. Data were combined by means of a random-effects model and odds ratios were calculated. Subgroup and sensitivity analyses were performed based on study design and antibiotic use. Results: Thirty studies (25 case-control and 5 cohort) reported in 29 articles met the inclusion criteria (n = 202,965). PPI therapy increased the risk for CDI (odds ratio, 2.15, 95% confidence interval, 1.81-2.55), but there was significant heterogeneity in results among studies (P < .00001). This association remained after subgroup and sensitivity analyses, although significant heterogeneity persisted among studies. Conclusions: PPI therapy is associated with a 2-fold increase in risk for CDI. Because of the observational nature of the analyzed studies, we were not able to study the causes of this association. Further studies are needed to determine the mechanisms by which PPI therapy might increase risk for CDI. © 2012 AGA Institute.
Kudaravalli J.,Bhaskar Medical College
Indian Journal of Pharmacology | Year: 2011
Objective: To study the effects of N-acetylcysteine (NAC) and atorvastatin on endothelial dysfunction in patients with systemic lupus erythematosus (SLE). Materials and Methods: Thirty-two SLE patients and age, sex-matched 10 healthy control subjects were studied. The patients were between 17 and 65 years of age and positive for diagnostic tests, such as antinuclear antibodies (ANA). Photoplethysmogram (PPG) detects the changes in the amount of light absorbed by hemoglobin, which reflects changes in the blood volume. Pulse wave analysis was performed at rest, 30 s, 90 s after shear stress, and 10 min after 300 μm of salbutamol inhalation. Results: Stiffness index (SI) of patients before the treatment was 8.46±2.78 cm/s and of controls was 6.07±1.4 cm/s (P = 0.002) and that of reflection index (RI) was 73±13 for patients and 65±7 for controls (P = 0.001). The percentage change in RI after salbutamol inhalation for controls and patients were -16±6 and -7±4 (P = 0.001), respectively, indicating the presence of endothelial dysfunction. The percentage decrease in RI after salbutamol inhalation was from -2.36±0.76 to 7.92±1.46 in patients treated with N-acetylcysteine (NAC, P = 0.007). The percentage decrease in RI after salbutamol inhalation was from 6.36±1.21 to -9.92±1.21 in patients treated with atorvastatin (P = 0.05). This indicated the improvement in endothelial function. There was decrease in C-reactive protein (CRP) from 1.03±0.72 mg/dL to 0.52±0.22 mg/dL and that of malondialdehyde (MDA) from 11.20±4.07 nmol/mL to 8.81±2.79 nmol/mL with N-acetylcysteine treatment (P < 0.05). The CRP was decreased from 1.11±0.92 mg/dL to 0.440.16 mg/dL (P = 0.05) and that of MDA was decreased from 9.37±3.29 nmol/mL to 8.51±3.27 nmol/mL after treatment with atorvastatin. It showed improvement in oxidative stress with these treatments. Conclusion: The presence of arterial stiffness indicated endothelial dysfunction. There was reduction in RI and SI with treatment of N-acetylcysteine and atorvastatin suggesting improvement in endothelial dysfunction. There was decrease in CRP (a marker of inflammation) and MDA after treatment with N-acetylcysteine suggesting improvement in endothelial dysfunction. There was reduction in CRP after treatment with atorvastatin, suggesting improvement in endothelial function. Improvement in endothelial dysfunction is associated with decreased incidence of cardiovascular and cerebrovascular accidents.
Jaiman S.,Fernandez Hospital |
Nalluri H.B.,Bhaskar Medical College
Congenital Anomalies | Year: 2013
Anomalies of the umbilical venous system are perplexing essentially due to dissection errors and vascular connection delineation failure. Continuation of umbilical vein into the extra-hepatic portal vein is classified as group IV umbilical vein anomaly and involves the vitelline vein or its remnants. Despite this categorization most examiners ascribe fetal extra hepatic abdominal vascular abnormality as an umbilical vein anomaly. Since these anomalies involve vitelline vein, the term "umbilical vein anomaly" is inappropriate and should be referred to as "vitelline vein abnormalities". Vitelline vein abnormalities are exceedingly rare and to the best of our knowledge only three cases have been reported prenatally. We report three cases presenting with intrauterine fetal demise and on perinatal autopsy demonstrating aneurysmally dilated group IV umbilical vein anomaly. Review of the literature, embryological basis and clinical implications of persistent vitelline vein and its varix are discussed. © 2013 Japanese Teratology Society.
Krishnaveni D.V.,Bhaskar Medical College
International Journal of Pharma and Bio Sciences | Year: 2011
This study was undertaken to evaluate the variations in thyroid profile, lipid profile and transaminase levels in overt hypothyroid patients, compared to healthy controls. Thirty hypothyroid patients, both male & female, in the age group of 20 to 50 years (study group) and 30 age & sex matched healthy subjects (control group) were enrolled in the study. We found significant increase in mean levels of total cholesterol, serum triglycerides, LDL-c, AST & TSH and significant decrease in T3 & T4 in study group compared to controls. There was no significant difference in HDL -c values between two groups. The ALT and VLDL-c values were near the upper limits of normal range in study group, while they were near the lower limit in control group, the difference being significant.
Deshpande A.,Cleveland Clinic |
Pasupuleti V.,Cleveland Clinic Lerner Research Institute |
Rolston D.D.K.,Geisinger Medical Center |
Jain A.,Medicine Institute |
And 4 more authors.
Clinical Infectious Diseases | Year: 2011
Background.Current detection methods for Clostridium difficile infection (CDI) can be time-consuming and have variable sensitivities. Real-time polymerase chain reaction (PCR) may allow earlier and more accurate diagnosis of CDI than other currently available diagnostic tests. A meta-analysis was performed to determine the diagnostic accuracy of real-time PCR.Methods.We searched MEDLINE (Pubmed/Ovid) and 4 other online electronic databases (1995-2010) to identify diagnostic accuracy studies that compared PCR with cell culture cytotoxicity neutralization assay (CCCNA) or anaerobic toxigenic culture (TC) of C. difficile. Screening for inclusion, data extraction, and quality assessment were carried out independently by 2 investigators and disagreements resolved. Data were combined by means of a random-effects model, and summary receiver operating characteristic curves and diagnostic odds ratios were calculated.Results.Nineteen studies (7392 samples) met our inclusion criteria. The overall mean sensitivity of PCR was 90% (95% confidence interval [CI]: 88%-91%), specificity 96% (CI: 96%-97%), positive likelihood ratio 26.89 (CI: 20.81-34.74), negative likelihood ratio 0.11 (CI:. 08-.15), diagnostic odds ratio 278.23 (CI: 213.56-362.50), and area under the curve 0.98 (CI:. 98-.99). Test accuracy depended on the prevalence of C. difficile but not on the reference test used. At C. difficile prevalence of <10%, 10%-20% and >20% the positive predictive value and the negative predictive value were 71%, 79%, 93% and 99%, 98% and 96%, respectively.Conclusions.Real-time PCR has a high sensitivity and specificity to confirm CDI. Overall diagnostic accuracy is variable and depends on CDI prevalence. © 2011 The Author.