Infant sleep position: A telephone survey of inner-city parents of color

OBJECTIVE

To assess what positions parents were placing their infants to sleep and their opinion about sleep positioning.

DESIGN

A prospective telephone survey of parents of 2-month-old infants with repeated measures at 4 months that began during the second wave of the Back to Sleep campaign in 1994.

PARTICIPANTS

African-American, Hispanic, Asian, and American Indian parents from inner cities in the north central United States.

RESULTS

Preference for prone positioning existed at both 2 and 4 months (over 40%). Twenty-four percent of parents disagreed with the recommendations of the American Academy of Pediatrics regarding supine or lateral positioning.

CONCLUSIONS

Although prone sleep positioning has decreased over the past 5 years, many inner-city parents of color prefer this over supine. The Back to Sleep campaign appears effective in changing attitudes and medical personnel appear influential in promoting risk reductions associated with sudden infant death syndrome. More efforts are clearly needed to convince parents who disagree with and resist recommendations.sleep, infants, SIDS, African-Americans, Back to Sleep (campaign).

Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database

OBJECTIVES

To investigate patterns of self monitoring of blood glucose concentration in diabetic patients who use insulin and to determine whether frequency of self monitoring is related to glycaemic control.

SETTING

Diabetes database, Tayside, Scotland.

SUBJECTS

Patients resident in Tayside in 1993-5 who were using insulin and were registered on the database and diagnosed with insulin dependent (type 1) or non-insulin dependent (type 2) diabetes before 1993.

MAIN OUTCOME MEASURES

Number of glucose monitoring reagent strips dispensed (reagent strip uptake) derived from records of prescriptions. First recorded haemoglobin A1c concentration in the study period, and reagent strips dispensed in the previous 6 months.

RESULTS

Among 807 patients with type 1 diabetes, 128 (16%) did not redeem any prescriptions for glucose monitoring reagent strips in the 3 year study period. Only 161 (20%) redeemed prescriptions for enough reagent strips to test glucose daily. The corresponding figures for the 790 patients with type 2 diabetes who used insulin were 162 (21%; no strips) and 131 (17%; daily tests). Reagent strip uptake was influenced both by age and by deprivation category. There was a direct relation between uptake and glycaemic control for 258 patients (with recorded haemoglobin A1c concentrations) with type 1 diabetes. In a linear regression model the decrease in haemoglobin A1c concentration for every extra 180 reagent strips dispensed was 0.7%. For the 290 patients with type 2 diabetes who used insulin there was no such relation.

CONCLUSIONS

Self monitoring of blood glucose concentration is associated with improved glycaemic control in patients with type 1 diabetes. Regular self monitoring in patients with type 1 and type 2 diabetes is uncommon.

Elder mistreatment

Elder mistreatment is a widespread problem in our society that is often under-recognized by physicians. As a result of growing public outcry over the past 20 years, all states now have abuse laws that are specific to older adults; most states have mandated reporting by all health care professionals. The term "mistreatment" includes physical abuse and neglect, psychologic abuse, financial exploitation and violation of rights. Poor health, physical or cognitive impairment, alcohol abuse and a history of domestic violence are some of the risk factors for elder mistreatment. Diagnosis of elder mistreatment depends on acquiring a detailed history from the patient and the caregiver. It also involves performing a comprehensive physical examination. Only through awareness, a healthy suspicion and the performing of certain procedures are physicians able to detect elder mistreatment. Once it is suspected, elder mistreatment should be reported to adult protective services.

Corticosteroid requirements in polymyalgia rheumatica

BACKGROUND

Polymyalgia rheumatica (PMR) is a systemic inflammatory disease of unknown cause that affects older individuals. Clinical symptoms respond promptly to corticosteroids, but treatment is often required for several years, frequently resulting in adverse drug effects. Guidelines for the optimal use of corticosteroids that maximize relief of symptoms but minimize adverse effects of the therapy are needed.

OBJECTIVE

To determine whether clinical or laboratory parameters in PMR could be identified that allow for stratifying patients into subsets with differences in corticosteroid requirements.

PATIENTS AND METHODS

We studied 27 patients with PMR treated with a standardized schedule of prednisone. Patients were reevaluated at monthly intervals for pain scores and physician and patient assessments. Plasma interleukin 6 level and the erythrocyte sedimentation rate were measured at each visit. The duration of steroid therapy and the cumulative steroid dose were calculated.

RESULTS

Based on the initial response to therapy and the duration of disease, the 27 patients could be subdivided into 3 distinct groups. Eight with low erythrocyte sedimentation rates responded rapidly and required corticosteroids for less than 1 year with rare disease flares on tapering of prednisone. Twelve others responded well initially but did not tolerate reduction to lower doses and had remitting disease of more than 1 year. Seven patients had only a partial response to the initial steroid regimen. After 4 weeks of therapy, the erythrocyte sedimentation rates improved, but levels of interleukin 6 remained elevated. Pretreatment pain scores were also higher in these partial responder patients (P = .05).

CONCLUSIONS

Polymyalgia rheumatica is a heterogeneous disease with variations in the treatment duration and dose of corticosteroids required for suppression of symptoms. Pretreatment erythrocyte sedimentation rate and nonresponsiveness of interleukin 6 to steroid therapy are helpful in dividing patients into subsets with different treatment requirements.

Identification of (-)-cis-6-acetyl-4S-(3-chloro-4-fluoro-benzoylamino)- 3,4-dihydro-2,2-dimethyl-2H-benzo[b]pyran-3S-ol as a potential antimigraine agent

Optimisation of novel cis- and trans-4-(substituted-amido)benzopyran-3-ol derivatives has led to the identification of SB-220453 20 with an in vivo pre-clinical CNS profile predictive of potential antimigraine activity.

Congestive heart failure in the community: trends in incidence and survival in a 10-year period

OBJECTIVE

To compare the incidence of congestive heart failure and the survival in patients with congestive heart failure in Rochester, Minn, in 1981 with that observed in 1991.

METHODS

Population-based, descriptive epidemiological study with ecological and individual level comparisons over time. Olmsted County, Minnesota, where the Rochester Epidemiology Project provides passive surveillance of the population for health outcomes. All 248 patients fulfilled the Framingham criteria, 107 patients presenting with the new onset of congestive heart failure in 1981 and 141 patients in 1991. The community inpatient and outpatient medical records of all incident cases were reviewed to evaluate the presenting characteristics of patients at diagnosis.

RESULTS

The incidence of congestive heart failure after adjustment for age and sex to the US population was not significantly different in the 1991 cohort compared with that in 1981 (3.0 per 1000 person-years; 95% confidence interval, 2.5-3.5 vs 2.8 per 1000 person-years; 95% confidence interval, 2.2-3.3; P = .55). The survival of patients with new diagnosis of congestive heart failure was similar in the 2 cohorts (P = .53). Survival adjusted for age, sex, and New York Heart Association functional class was not significantly different in patients with congestive heart failure in 1981 and 1991 (relative risk, 0.907; P = .55).

CONCLUSIONS

These data suggest that recent advances in management of cardiovascular disease, as used in the community, had not yet impacted incidence or survival of patients with congestive heart failure in the community during the 10-year study period. This highlights the need to continue efforts to ensure that advances in diagnosis and therapy are incorporated into the care of patients with congestive heart failure in the community.

Record-linkage for pharmacovigilance in Scotland

Record-linkage is the linkage of patient-specific information that is stored separately. Recent advances in computerization have meant that record-linkage techniques in medical research are increasingly being used and refined. In particular, they have made a significant contribution to pharmacovigilance, which involves linking drug exposure to outcomes data. In this article, the contribution of record-linkage in Scotland to medical research is described. The two organizations that utilize record-linkage techniques are the Medicines Monitoring Unit (MEMO) of the University of Dundee and the Information and Statistics Division (ISD) of the NHS in Scotland. Pharmacovigilance is MEMO's main concern (using data from the Tayside region of Scotland), while ISD link health care datasets for Scotland for general health care research. The experience of the two groups is now being combined to carry out drug safety studies in the entire population of Scotland.

Use of echocardiography in the management of congestive heart failure in the community

OBJECTIVES

We evaluated the use and the impact of echocardiography in patients receiving an initial diagnosis of congestive heart failure in Olmsted County, Minnesota, in 1991.

BACKGROUND

The American College of Cardiology/American Heart Association clinical practice guidelines recommend echocardiography in all patients with suspected congestive heart failure. No data are available on use and impact of echocardiography in management of congestive heart failure in a community.

METHODS

The medical records linkage system of the Rochester Epidemiology Project was used to identify all 216 patients who satisfied the Framingham criteria for congestive heart failure. Of these, 137 (63%) underwent echocardiography within 3 weeks before or after the episode of congestive heart failure (Echo group), and the other 79 patients constitute the No-Echo group.

RESULTS

The No-Echo group patients were older (p=0.022), were more likely to be female (p=0.072), had milder symptoms (p=0.001) and were less often hospitalized at diagnosis (p=0.001). Fewer patients in the No-Echo group were treated with angiotensin-converting enzyme inhibitors (p=0.001). Advanced age (> or = 80 years), lower New York Heart Association functional class, absence of a fourth heart sound on examination, absence of cardiomegaly or signs of congestive heart failure on chest radiography and absence of known valve disease were independently related to the decision not to obtain an echocardiogram. Survival after adjustment for age, functional class and gender was lower in the No-Echo group than the Echo group (risk ratio=0.607, p=0.017).

CONCLUSIONS

The underuse of echocardiography appears to be associated with poorer survival and underuse of angiotensin-converting enzyme inhibitor therapy.

Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991

BACKGROUND

Data are limited regarding the classification and prognosis of patients with congestive heart failure (CHF) in the community.

METHODS AND RESULTS

Using the resources of the Rochester Epidemiology Project, we evaluated all patients receiving a first diagnosis of CHF in Olmsted County, Minnesota, in 1991 (n=216). Among these patients, 88% were >/=65 years and 49% were >/=80 years of age. The prognosis of patients with a new diagnosis of CHF was poor; survival was 86+/-2% at 3 months, 76+/-3% at 1 year, and 35+/-3% at 5 years. Of the 216 patients, 137 (63%) had an assessment of ejection fraction. In these patients, systolic function was preserved (ejection fraction >/=50%) in 59 (43%) and reduced (ejection fraction <50%) in 78 (57%). Survival adjusted for age, sex, NYHA class, and coronary artery disease was not significantly different between patients with preserved and those with reduced systolic function (relative risk, 0.80; P=0.369). ACE inhibitors were used in only 44% of the total population with CHF.

CONCLUSIONS

The present study reports the clinical characteristics and natural history of CHF as it presents in the community in the vasodilator era. CHF is a disease of the "very elderly," frequently occurs in the setting of normal ejection fraction, and has a poor prognosis, regardless of the level of systolic function. Diagnostic and therapeutic methods are underused in the community.

Kilohertz Cr:forsterite regenerative amplifier

We report on a tunable regenerative amplifier that is operational in the near-infrared spectral region from 1230 to 1280 nm based on the vibronic laser material Cr:forsterite. Utilizing the technique of chirped-pulse amplification, we generated pulses as short as 150 fs at 1255 nm at a repetition rate of 1 kHz. Pulse amplification of more than 5 x 10(5) times was observed, with recorded output pulse energies of 34 muJ . Implementation of a second-harmonic generator yielded 110-fs-duration pulses of 7-muJ energy at 625 nm.

Aspirin, nonsteroidal anti-inflammatory drugs, and epistaxis. A regional record linkage case control study

To assess the relationship between nonsteroidal anti-inflammatory drugs (NSAIDs) and spontaneous epistaxis in adults over 50 years old, a case control study was carried out by using a record linkage database for the population of Tayside, Scotland, which included 319,465 people. The study group consisted of 326 patients who were hospitalized with epistaxis between May 1989 and December 1992, but who had not previously been hospitalized with this diagnosis. Six community controls and 4 hospital controls, matched for age and sex to each case, were used. Previous exposure to prescribed aspirin and other NSAIDs was investigated. There was a significant association between aspirin exposure and epistaxis when either community or hospital controls were used (p < .001). Patients who had aspirin prescriptions had a relative risk of hospital admission for epistaxis of between 2.17 and 2.75, depending on the control group used. No association between non-aspirin NSAIDs and epistaxis was evident with either control group.

Polymyalgia rheumatica and giant cell arteritis

Giant cell (temporal) arteritis and polymyalgia rheumatica are related conditions that primarily affect older persons. They are among the most common chronic inflammatory disorders in this age group. In recent years, several new insights have been gained about the clinical features of these illnesses as well as their underlying pathophysiology. In addition, a great deal of study is underway to find better ways of detecting, monitoring, and treating them. This article provides a general review of these conditions, including their diagnosis and treatment.

Two-dimensional near-infrared transillumination imaging of biomedical media with a chromium-doped forsterite laser

Transillumination images of objects hidden in normal and cancerous human breast tissues and bovine, porcine, and gallinaceous (chicken) tissues as well as model-random-scattering media were recorded with 1250-nm light from a chromium-doped forsterite laser. A Fourier space gate and a polarization gate were used to sort out image-bearing photons and discriminate against multiply scattered image-blurring photons. Better contrast, higher spatial resolution, and deeper penetration of samples were achieved for imaging with 1250-nm light than those obtained at shorter wavelengths, such as 1064 nm from a neodymium-doped yttrium aluminum garnet (YAG) laser. Better contrast and higher resolution were also obtained when the object was imaged through normal human breast tissue than through cancerous breast tissue. Images with marked distinction between fatty and fibrous human breast tissues were obtained when the Cr:forsterite laser was tuned to 1225 nm, a wavelength that resonates with an optical absorption band of breast fat tissues. Imaging with linearly polarized light revealed that the image quality depends significantly on the orientation of the polarization of the incident light with respect to the fibers in the bovine tissue.

Drug exposure risk windows and unexposed comparator groups for cohort studies in pharmacoepidemiology

AIM

To determine the appropriate size of risk windows in both exposed and unexposed sub-cohorts.

METHOD

Data was taken from a previous study of upper gastrointestinal haemorrhage and perforation. The length of each prescription for NSAIDs was estimated. The risk was calculated for the duration of a prescription plus increments of -30, -25,..., +115, +120 (i.e. 31 increments). Ten unexposed groups were re-sampled for each increment (stratified for age and sex), using the same lengths of risk window as the exposed group. Mean risks and rate-ratios were calculated (per thousand person-years).

RESULTS

The NSAID risk rose from 3.52 at -30 days to a peak of 5.82 at -15 days, and then decreased gradually to 2.83 at +120 days. Unexposed risk was variable for the negative increments, and decreased gradually from 2.16 at +0 days to 1.54 at +120 days. The rate-ratio rose from 1.55 at -30 days to a peak of 2.85 at -5 days, and then decreased to 1.85 at +120 days.

CONCLUSION

Risk windows should be the same as (or slightly less than) the calculated length of a prescription. Lengthy windows should not be used for unexposed comparator groups (the exposed windows may be randomly allocated).

The radiodensity of medications seen on x-ray films

OBJECTIVE

To analyze the radiodensity of commonly used medications and determine their ability to be seen on plan x-ray films.

MATERIAL AND METHODS

Under conditions intended to simulate a patient undergoing radiography of the abdomen (including the use of a patient-equivalent phantom), 50 prescription and nonprescription drugs were tested. Their radiodensities were quantified, and their visibility on plain x-ray films was noted. The study drugs were then ranked in order of decreasing radiodensity. In addition, we report an illustrative case of ingested pills in the stomach that mimicked gallstones, a phenomenon we termed "pseudogallstones".

RESULTS

In a 71-year-old woman with upper abdominal pain and nausea, a presumptive diagnosis of gallstones based on x-ray findings was subsequently found to be retained iron tablets. This case prompted our assessment of the radiodensity of medications frequently prescribed for elderly patients. Although all 50 medications studied were visible on plain x-ray films, a 13-fold difference was found in their relative radiodensities. Of the medications studied, potassium chloride was the most radiodense, and prednisone was the least radiodense. As a group, minerals were the most radiodense of all medications studied.

CONCLUSION

Numerous commonly prescribed medications in their undissolved, undigested state are visible on plain x-ray films, as are mineral supplements, which have high radiodensities. At times, the appearance of these medications and supplements may be confused with organic pathologic conditions.

Relation of colonic transit to functional bowel disease in older people: a population-based study

OBJECTIVE

The pathophysiology underlying chronic constipation in older people is poorly understood. Our objective was to determine if functional bowel disease (particularly constipation) in this population is associated with risk factors (age, immobility, low dietary fiber intake, and medication use) or directly with slow colonic transit.

METHODS

A previously validated questionnaire was administered to a random sample of older residents (age range 65-104 years, n = 1609) of Olmsted County, MN. A random subset who met standard diagnostic criteria for functional constipation (n = 52) or irritable bowel syndrome (IBS) (n = 55) and a group without gastrointestinal symptoms (n = 93) were selected for further study. Each subject underwent structured interview and physical examination. Total caloric and fiber intake were assessed by dietitian interview, a food frequency questionnaire, and a food diary. Physical activity was assessed using a previously validated instrument. Medication use was determined by self-report, physician interview, and review of medical records. Total and segmental colonic transit was assessed radiographically using radioopaque markers.

RESULTS

Total colonic transit times were prolonged in subjects with functional constipation (median 50.4 hours) but not in subjects with IBS (median 34.2 hours) or in healthy controls (median 28.8 hours); however, only rectosigmoid transit was delayed significantly. Age, gender, physical activity, and dietary fiber intake were not associated with total transit times, nor could they discriminate among the three patient groups. Laxative use was associated with prolonged total transit times independent of patient group.

CONCLUSIONS

Older subjects can be classified by abdominal pain and bowel symptoms, which reflect colonic transit times. Older subjects with constipation symptoms generally have prolonged rectosigmoid transit. Other potential risk factors do not distinguish symptom subgroups, nor are they associated with altered colonic transit although older people who use laxatives regularly have prolonged colonic transit.

ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes. DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside, Scotland. Medicines Monitoring Unit

OBJECTIVE

To evaluate the association between the use of ACE inhibitors and hospital admission for severe hypoglycemia and to explore the effects of potential confounding variables on this relationship.

RESEARCH DESIGN AND METHODS

The association between the use of ACE inhibitors and the incidence of hypoglycemia is controversial. A recent study reported that 14% of all hospital admissions for hypoglycemia might be attributable to ACE inhibitors. We performed a nested case-control study, using a cohort of 6,649 diabetic patients taking insulin or oral antidiabetic drugs, on the Diabetes Audit and Research in Tayside, Scotland (DARTS) database. From 1 January 1993 to 30 April 1994, we identified 64 patients who had been admitted to Tayside hospitals with hypoglycemia and selected 440 control patients from the same cohort.

RESULTS

Hypoglycemia was associated with the use of ACE inhibitors (odds ratio [OR] 3.2, 95% CI 1.2-8.3, P = 0.023), whereas use of beta-blockers and calcium antagonists was not associated with an increased risk of hospitalization for hypoglycemia with ORs of 0.9 (95% CI 0.3-3.3) and 1.7 (95% CI 0.2-2.1), respectively. There were significant differences between case and control patients in type of diabetes treatment, diabetes duration, place of routine diabetes care, and congestive cardiac failure. These differences did not confound the relationship between ACE inhibitors and hypoglycemia (adjusted OR 4.3, 95% CI 1.2-16.0).

CONCLUSIONS

The results show that the association between ACE inhibitor therapy and hospital admission for severe hypoglycemia is not explained by these confounding factors. Although ACE inhibitors have distinct advantages over other antihypertensive drugs in diabetes, the risk of hypoglycemia should be considered.

Characterization of the binding of [3H]-SB-204269, a radiolabelled form of the new anticonvulsant SB-204269, to a novel binding site in rat brain membranes

1. SB-204269 (trans-(+)-6-acetyl-4S-(4-fluorobenzoylamino)-3, 4-dihydro-2,2-dimethyl-2H-benzol[b]pyran-3R-ol, hemihydrate) shows potent anticonvulsant activity in a range of animal seizure models, with a lack of neurological or cardiovascular side-effects. The profile of the compound suggests that it may have a novel mechanism of action. This study describes the characteristics of a binding site for [3H]-SB-204269 in rat forebrain membranes. 2. Specific [3H]-SB-204269 binding was saturable and analysis indicated binding to a homogenoeous population of non-interacting binding sites with a dissociation constant (KD) of 32 +/- 1 nM and a maximum binding capacity (Bmax) of 253 +/- 18 fmol mg-1 protein. Kinetic studies indicated monophasic association and dissociation. Binding was similar in HEPES or Tris-HCl buffers and was unaffected by Na+, K+, Ca2+ or Mg2+ ions. Specific binding was widely distributed in brain, but was minimal in a range of peripheral tissues. 3. Specific [3H]-SB-204269 binding was highly stereoselective, with a 1000 fold difference between the affinities of SB-204269 and its enantiomer SB-204268 for the binding site. The affinities of analogues of SB-204269 for binding can be related to their activities in the mouse maximal electroshock seizure threshold (MEST) test of anticonvulsant action. 4. None of the standard anticonvulsant drugs, phenobarbitone, phenytoin, sodium valproate, carbamazepine, diazepam and ethosuximide, or the newer anticonvulsants, lamotrigine, vigabatrin, gabapentin and levetiracetam, showed any affinity for the [3H]-SB-204269 binding site. A wide range of drugs active at amino acid receptors, Na+ or K+ channels or various other receptors did not demonstrate any affinity for the binding site. 5. These studies indicate that SB-204269 possesses a specific CNS binding site which may mediate its anticonvulsant activity. This binding site does not appear to be directly related to the sites of action of other known anticonvulsant agents, but may have an important role in regulating neuronal excitability.

Profile of SB-204269, a mechanistically novel anticonvulsant drug, in rat models of focal and generalized epileptic seizures

1. Earlier optimization of structure-activity relationships in a novel series of 4-(benzoylamino)-benzopyrans, led to the discovery of SB-204269 (trans-(+)-6-acetyl-4S-(4-fluorobenzoylamino)-3,4-dihydro-2, 2-dimethyl-2H-benzo[b]pyran-3R-ol, hemihydrate), a potent orally-active anticonvulsant in the mouse maximal electroshock seizure threshold (MEST) test. 2. Studies have now been undertaken to determine the effects of SB-204269 in a range of seizure models and tests of neurological deficits in rats. In addition, the compound has been evaluated in a series of in vitro mechanistic assays. 3. SB-204269 proved to be an orally-effective anticonvulsant agent, at doses (0.1-30 mg Kg-1) devoid of overt behavioural depressant properties, in models of both electrically (MEST and maximal electroshock (MEST)) and chemically (i.v. pentylenetetrazol (PTZ) infusion)-evoked tonic extension seizures. However, the compound did not inhibit PTZ-induced myoclonic seizures at doses up to 30 mg kg-1, p.o. 4. SB-204269 also selectively reduced focal electrographic seizure activity in an in vitro elevated K+ rat hippocampal slice model at concentrations (0.1-10 microM) that had no effect on normal synaptic activity and neuronal excitability. 5. In all of these seizure models, SB-204269 was equivalent or better than the clinically established antiepileptic drugs carbamazepine and lamotrigine, in terms of anticonvulsant potency and efficacy. 6. Unlike SB-204269, the corresponding trans 3S,4R enantiomer, SB-204268, did not produce marked anticonvulsant effects, an observation in accord with previous findings for other related pairs of trans enantiomers in the benzopyran series. 7. In the rat accelerating rotarod test, a sensitive paradigm for the detection of neurological deficits such as sedation and motor incoordination, SB-204269 was inactive even at doses as high as 200 mg kg-1, p.o. This was reflected in the excellent therapeutic index (minimum significantly effective dose in the rotarod test/ED50 in the MES test) for SB-204269 of > 31, as compared to equivalent values of only 7 and 13 for carbamazepine and lamotrigine, respectively. 8. At concentrations (> or = 10 microM) well above those required to produce anticonvulsant activity in vivo (i.e. 0.1 microM in brain), SB-204269 did not interact with many of the well known mechanistic targets for established antiepileptic drugs (e.g. Na+ channels or GABAergic neurotransmission). Subsequent studies have shown that the anticonvulsant properties of SB-204269 are likely to be mediated by a novel stereospecific binding site present in the CNS. 9. The overall efficacy profile in rodent seizure models, together with a minimal liability for inducing neurological impairment and an apparently unique mechanism of action, highlight the therapeutic potential of SB-204269 for the treatment of refractory partial and generalized tonic-clonic seizures.

Direct diode-pumped continuous-wave near-inf rared tunable laser operation of Cr(4+):forsterite and Cr(4+):Ca(2)GeO(4)

Continuous-wave tunable laser operation of direct diode-pumped Cr(4+):Mg(2)SiO(4) (Cr:forsterite) and Cr(4+):Ca(2)GeO(4) (cunyite) crystal were demonstrated. Diode-pumped Cr:forsterite was tunable over the 1236-1300-nm spectral range. The maximum output of 10 mW was measured at 1260 nm for 640 mW of pump power absorbed by the crystal. Diode-pumped laser operation of cunyite was also demonstrated over the 1390-1475-nm range. Free-running 20-mW output was centered at 1410 nm.

Non-steroidal anti-inflammatory drugs are associated with emergency admission to hospital for colitis due to inflammatory bowel disease

BACKGROUND

To evaluate the relation between non-steroidal anti-inflammatory drugs (NSAIDs) and colitis due to inflammatory bowel disease.

METHODS

A case-control study was conducted using a prospectively constructed, record linkage database containing hospital event and dispensed drug data (1989-93). The study population consisted of 319,465 people resident in Tayside in January 1989, and still resident (or dead) in October 1994.

RESULTS

Of the 785 patients admitted to hospital as emergencies with colitis between July 1989 and June 1993, 200 fulfilled the case criterion of colitis due to inflammatory bowel disease. A further 1198 persons were used as community controls. Odds ratios were calculated for three exposure periods (current, recent, and past exposure). The overall odds ratios (with 95% confidence intervals) for current and recent exposure to NSAIDs were 1.77 (1.01 to 3.10) and 1.93 (1.20 to 3.09) respectively. Current and recent exposure to NSAIDs was also associated for incident cases, with odds ratios of 2.96 (1.32 to 6.64) and 2.51 (1.13 to 5.55). There was a trend for recent exposure among non-incident cases.

CONCLUSION

The use of NSAIDs may be associated with an increased risk of emergency admission to hospital for colitis due to inflammatory bowel disease, particularly among patients with no previous history.

No association between non-steroidal anti-inflammatory drugs and acute appendicitis in a case-control study

BACKGROUND

A recent case-control study reported an association between non-steroidal anti-inflammatory drug (NSAID) use and acute appendicitis. This association was investigated in a case-control study of patients, aged 30 years and over, admitted as an emergency to hospitals in Tayside between 1989 and 1992, who had appendicectomy for acute appendicitis.

METHODS

A record-linkage database containing records of dispensed prescriptions and hospital admissions was used. A total of 223 patients were identified. The medical records of 161 were checked, of which 138 were valid cases, and information on white cell count and NSAID exposure was recorded. Community and hospital controls were generated.

RESULTS

Some 9.0 per cent of patients were prescribed NSAIDs within 90 days of hospitalization, compared with 7.6 per cent of community controls and 11.5 per cent of hospital controls. The odds ratio was 1.21 (95 per cent confidence interval 0.73-2.01) and 0.75 (0.43-1.32) respectively. There was no significant difference in white cell count between exposed and non-exposed cases. No increased risk of appendicectomy was associated with aspirin use: odds ratio 1.67 (0.52-5.30) and 0.37 (0.12-1.13) using community and hospital controls respectively.

CONCLUSION

Appendicectomy for acute appendicitis is not associated with increased prior use of NSAIDs.