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Memphis, TN, United States

Mikhail N.,View Medical
Current Drug Safety | Year: 2011

Dipeptidyl peptidase 4 (DPP-4) inhibitors are a new class of drugs introduced in 2006 for treatment of type 2 diabetes. In clinical trials lasting up to 2 years, these agents are well tolerated. Incidence of hypoglycemia associated with the use of DPP-4 inhibitors is similar to placebo, but is markedly increased when used in conjunction with sulfonylureas (SUs). DPP-4 inhibitors have neutral effect on body weight but their combination with a thiazolidinedione (TZD) results in slight weight gain averaging 0.5 to 1.3 kg compared with placebo. Other adverse effects recorded more commonly with DPP-4 inhibitors versus placebo are mild, and include nasopharyngitis, headache, and possibly urinary tract infections (UTIs). In the postmarketing period, new adverse effects are reported such as angioedema, increased rates of infection, and skin toxicity. Pancreatitis is inconsistently reported in relationship to sitagliptin, and one analysis links this agent to elevated risk of pancreatic cancer. Pancreatitis is also a rare adverse effect observed in linagliptin clinical studies. There is no evidence that DPP-4 inhibitors increase cardiovascular events or death. Overall, although short-term safety of DPP-4 inhibitors is reassuring, their safety needs to be established by long-term clinical trials and close surveillance during the postmarketing period. © 2011 Bentham Science Publishers. Source

Singer A.J.,State University of New York at Stony Brook | Talan D.A.,View Medical | Talan D.A.,University of California at Los Angeles
New England Journal of Medicine | Year: 2014

Abscesses are a common form of skin and soft-tissue infection and are increasing in incidence. Although the diagnosis of an abscess can be straightforward, ultrasonography may be helpful in cases in which the abscess is deep, complex, or obscured by extensive cellulitis. A standard approach to incision and drainage remains the mainstay of abscess management, whereas routine packing may be unnecessary. The use of smaller incisions with loop drains and the use of primary closure may be considered in appropriate cases. Adjunctive antibiotic treatment and wound cultures should be limited to patients with severe cases, immunocompromised patients, and those in whom initial therapy is failing. Because of the relatively high failure rates even with optimal treatment, patient education and follow-up are recommended. Copyright © 2014 Massachusetts Medical Society. Source

The idea of a Global Health Section within the American Academy of Neurology (AAN) came from a group of neurologists with active work in sub-Saharan Africa, who believed that the AAN could provide a greater leadership role in supporting the advancement of quality neurologic training, research, and patient care in low and middle-income countries (LMICs). Initially a Special Interest Group, the Global Health Section was approved for full section status in September 2011 and endorsed by the AAN Board of Directors in October 2011. The Global Health Section currently consists of over 200 members. In a 2-part series, we present a summary of the Global Health Section strategic plan and vision for future activities. Source

Yu P.P.,View Medical
Cancer Journal | Year: 2011

Health information technology will transform health care delivery over the coming years. The central element of this will be the electronic health record, maintained by health professionals and linked to other health care providers, patients, and research and population health databases. Support of oncology functionality will necessitate special attention to how electronic health records are constructed, cancer-related data represented within, and clinical decision support tools designed to best support the objectives of quality care and cost-effectiveness. Standardization of functions and software will permit data exchange, leading to enhanced interoperability of systems. The present efforts at establishing oncology-related standards for electronic health records are reviewed. Copyright © 2011 by Lippincott Williams & Wilkins. Source

Studies designed to evaluate the short-term effects of incretin-related drugs in subjects with cardiac disease are still preliminary. In patients with heart failure, two of five studies showed that glucagon-like peptide-1 (GLP-1) infusion was associated with an absolute increase in left ventricular ejection fraction (LVEF) by 6-10 %, whereas no significant benefit was observed in the remaining three studies. In patients with coronary artery disease, single infusion of the GLP-1 receptor analog, exenatide, did not increase LVEF, but this drug may decrease infarct size in patients with myocardial infarction presenting with short duration of ischemic symptoms. Single dose of GLP-1 and the dipeptidyl-peptidase-IV (DPP-IV) inhibitor, sitagliptin, may improve left ventricular function, predominantly in ischemic segments, and attenuate post-ischemic stunning. Nausea, vomiting and hypoglycemia were the most common adverse effects associated with GLP-1 and exenatide administration. Increased heart rate was also observed with exenatide in patients with heart failure. Large randomized trials including diabetic patients with preexisting heart failure and myocardial infarction showed that chronic therapy with the DPP-IV inhibitors saxagliptin and alogliptin did not reduce cardiovascular events or mortality. Moreover, saxagliptin use was associated with significant increase in frequency of heart failure requiring hospitalization, hypoglycemia and angioedema. Overall, short-term preliminary data suggest potential cardioprotective effects of exenatide and sitagliptin in patients with heart failure and myocardial infarction. Meanwhile, long-term randomized trials suggest no benefit of alogliptin, and increased harm associated with the use of saxagliptin. © 2014 Springer Science+Business Media. Source

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