Decreased GlycA after lifestyle intervention among obese, prediabetic adolescent Latinos

BACKGROUND

Obese youth with prediabetes are at increased risk for premature morbidity and mortality through multiple mechanisms, including increased systemic inflammation. GlycA is a novel measure of systemic inflammation that predicts type II diabetes, cardiovascular events, and all-cause mortality in adults.

OBJECTIVE

The purpose of the present study was to examine changes in GlycA after lifestyle intervention among obese, prediabetic Latino youth.

METHODS

Obese, prediabetic Latino youth (n = 27; 15.5 ± 1.1 years, 13 males/14 females) completed a 12-week lifestyle intervention that included weekly nutrition education and 3 d/wk of moderate to vigorous physical activity. Prediabetes was characterized by an expanded definition of impaired glucose tolerance, using 2-hour glucose ≥120 mg/dL after an oral glucose tolerance test. GlycA was assessed at baseline and 12 weeks using nuclear magnetic resonance spectroscopy.

RESULTS

After the lifestyle intervention, GlycA was significantly reduced (445.3 ± 51.3 μmol/L to 419.0 ± 50.0 μmol/L, P = .01) (mean ± standard deviation). Additional improvements were observed in multiple cardiovascular risk factors, including body mass index (BMI; 34.8 ± 5.0 kg/m² to 34.0 ± 5.1 kg/m², P < .001), total cholesterol (154.1 ± 30.3 mg/dL to 143.3 ± 29.1 mg/dL, P = .003), and 2-hour glucose (141.0 ± 13.2 mg/dL to 115.9 ± 31.4 mg/dL, P < .001). Decreases in GlycA were associated with decreases in 2-hour glucose (r = 0.49, P = .008) and BMI (r = 0.41, P = .03).

CONCLUSION

These data are consistent with the hypothesis that lifestyle intervention might improve GlycA levels in obese, prediabetic adolescent Latinos, but randomized trial evidence is needed. Healthy lifestyle modifications among high-risk youth may decrease future risk of cardiometabolic disease through reducing systemic inflammation, in addition to improving traditional cardiovascular risk factors.

A Couple-Based Communication Intervention for Hematopoietic Cell Transplantation Survivors and Their Caregiving Partners: Feasibility, Acceptability, and Change in Process Measures

Hematopoietic cell transplantation (HCT) poses significant challenges for recipients and their caregiving partners. Couples may refrain from talking about treatment-related fears and concerns to minimize distress. This single-group, pre-post study examined feasibility and acceptability of an intervention designed to optimize communication between HCT patients and partners; it also assessed change in process measures. Couples met with a therapist 5 times to learn skills for disclosing illness-related thoughts and feelings and responding supportively to one another. The extent to which participants disclosed thoughts, feelings, and information during the session and felt supported was assessed at the close of each session. Forty of 89 eligible couples consented (45%). Thirty couples commenced intervention 1-month post-transplant; 26 of these completed all sessions (87%) and 27 completed follow-up (90%). Ratings of self-disclosure and feeling supported by one's partner increased linearly across intervention sessions among both patients and caregivers (all P ≥ .01). Ratings of satisfaction with the intervention were high. HCT couples can be recruited and retained for this intervention. They found it acceptable and were amenable to skills training. A randomized trial is needed to test efficacy and to identify moderators of treatment response.

Stable isotope ratios using cavity ring-down spectroscopy: determination of 13C/12C for carbon dioxide in human breath

We have constructed a cavity ring-down spectrometer employing a near-IR external cavity diode laser capable of measuring 13C/12C isotopic ratios in CO2 in human breath. The system, which has a demonstrated minimum detectable absorption loss of 3.2 x 10(-11) cm(-1) Hz(-1/2), determines the isotopic ratio of 13C16O16O/12C16O16O by measuring the intensities of rotationally resolved absorption features of each species. As in isotope ratio mass spectrometry (IRMS), the isotopic ratio of a sample is compared to that of a standard CO2 sample calibrated to the Pee Dee Belemnite scale and reported as the sample's delta13C value. Measurements of eight replicate CO2 samples standardized by IRMS and consisting of 5% CO2 in N2 at atmospheric pressure demonstrated a precision of 0.22/1000 for the technique. Delta13C values were also obtained for breath samples from individuals testing positive and negative for the presence of Helicobacter pylori, the leading cause of peptic ulcers in humans. This study demonstrates the ability of the instrument to obtain delta13C values in breath samples with sufficient precision to serve as a useful medical diagnostic.

Antibiotic therapy in preterm premature rupture of membranes: a randomized, prospective, double-blind trial

The use of antibiotics in the management of preterm, premature rupture of membranes remains controversial. By use of a prospective randomized double-blind design we investigated the maternal-fetal benefits associated with antibiotic therapy in 85 women with premature rupture of membranes at 34 weeks' estimated gestational age. In the treatment group 40 patients received intravenous mezlocillin for 48 hours followed by oral ampicillin until delivery. In the control group 45 patients received intravenous and oral placebo. Patients who received antibiotics had chorioamnionitis and endometritis less frequently than the control group (p less than 0.01 and p less than 0.05). Pathologic examination of the placentas showed a lower incidence of chorioamnionitis in the treatment group (p less than 0.05). The period from premature rupture of membranes to delivery (latency) was prolonged with antibiotics (p less than 0.05) and resulted in significant weight gain in the infants in the antibiotic group (p less than 0.0001). These infants also had higher 1- and 5-minute Apgar scores. Clinically suspected sepsis, respiratory distress syndrome, intraventricular hemorrhage, perinatal death rate, and prolonged hospitalization (greater than 30 days) were also increased in the control group.

Treatment of serious urinary tract infections at a university teaching hospital: a retrospective chart review

A retrospective chart review of all adult patients treated empirically for urinary tract infections (including pyelonephritis) with parenteral antibiotics over a 3-month period was conducted at this university teaching hospital. A total of 92 patient charts were located and reviewed. All patients had a complicating condition. Blood cultures were obtained on 67% of the patients; 23% were positive. E coli was the primary infecting organism (56%). All organisms tested against ceftriaxone and amikacin were found to be sensitive. Only 38% of isolates were sensitive to ampicillin. Empiric ceftriaxone therapy was used in 70% of the cases. The average length of parenteral therapy was 3.8 days. Based on the results of this study, the following recommendations were made: blood cultures should be obtained in all patients; the use of ampicillin alone should be avoided due to the drug's poor activity against isolated urinary pathogens; and ceftriaxone should be used for empiric therapy in the majority of patients, including diabetics, due to the drug's excellent activity against isolated urinary pathogens.

Multidisciplinary approach to cost reduction of C-section prophylaxis

Runaway cefoxitin costs prompted a thorough usage evaluation by the P & T Committee, the antibiotic review subcommittee, and the pharmacy department at this 450-bed teaching hospital. C-section prophylaxis accounted for 25% of all cefoxitin usage. With the assistance of the ob/gyn department, a major campaign was initiated to alter prescribing habits and evaluate more cost effective prophylaxis. Single dose cefotetan replaced multidose cefoxitin regimen for a 6-month trial basis. Annualized cost savings for drug and supplies were approximately $49,086, and no change in morbidity was noted. The ob/gyn department then agreed, at the request of the antibiotic subcommittee, to conduct a trial comparing single dose cefotetan with single dose cefazolin in women undergoing C-section. The results indicated that both treatments were equally effective, consequently, cefazolin replaced cefotetan, producing an additional $10,384 annual savings. Overall, our approach to C-section cost reduction resulted in a total of $59,470 annual savings and demonstrated the effectiveness of an organized multidisciplinary approach.

Development and implementation of a comprehensive, criteria-based drug-use review program

A comprehensive drug-use review (DUR) program based on established criteria for use of each drug is described. The DUR program was developed to promote cost-effective drug therapy and satisfy Joint Commission on Accreditation of Hospitals standards for drug-use evaluation. Antibiotic and ambulatory-care drug-use subcommittees composed of physicians, pharmacists, nurses, and clinical laboratory personnel were formed as advisory groups to the pharmacy and therapeutics (P&T) committee. The subcommittees review overall drug-use patterns in their respective areas monthly and investigate the use of specific problem drugs. Drug-use reviews have been facilitated by the implementation of a mandatory antibiotic order form and pharmacy computer systems. Nonformulary drug use is monitored. The procedure for adding drugs to the formulary was modified to require the submission of specific criteria for appropriate drug use; when a drug is added to the formulary, the criteria for use are also adopted. The program has been successful in curtailing inappropriate drug use, reducing drug expenditures, and integrating P&T committee decisions into daily pharmacy practice. The implementation of this DUR program has enabled the P&T committee to conduct ongoing, systematic, criteria-based drug-use evaluations.