VIDEOS IN CLINICAL MEDICINE: Male Urethral Catheterization

VIDEOS IN CLINICAL MEDICINE: Male Urethral Catheterization: "Urethral catheterization may be indicated for diagnostic or therapeutic purposes: to decompress the bladder in patients with urinary retention, to permit irrigation to remove blood and clots from the urinary bladder, to obtain sterile urine for diagnostic purposes, to measure urinary output in critically ill patients or during surgical procedures, or to measure the residual urinary volume after voiding. This procedural video demonstrates how to perform male urethral catheterization."

VIDEOS IN CLINICAL MEDICINE: Arthrocentesis of the Knee

VIDEOS IN CLINICAL MEDICINE: Arthrocentesis of the Knee: "Arthrocentesis is used to establish the cause of an acute monoarthritis or polyarthritis. It is also used to drain large effusions or hemarthroses and to instill steroids or local anesthetic. This procedure video demonstrates how to perform arthrocentesis."

Acute Pancreatitis

CLINICAL PRACTICE: Acute Pancreatitis: "A 56-year-old woman presents with severe epigastric abdominal pain and vomiting of 14 hours' duration, symptoms that developed shortly after dinner the previous evening. She has no history of alcohol use, takes no medications, and has no family history of pancreatitis. On physical examination, she has a heart rate of 110 beats per minute and moderate epigastric abdominal tenderness without peritoneal signs. The white-cell count is 16,500 per cubic millimeter, and the hematocrit is 49 percent. Amylase, lipase, alanine aminotransferase, and lactate dehydrogenase levels are elevated. Calcium, albumin, triglyceride, and electrolyte values are normal. How should this patient be further evaluated and treated?"

Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury - no difference

ORIGINAL ARTICLE: Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury: "Hemodynamic monitoring is a common physiological intervention in patients with acute lung injury. In this randomized, controlled trial in which patient care was dictated by a specific hemodynamic protocol, there was no significant difference in 60-day mortality whether monitoring was performed with a pulmonary-artery catheter or a central venous catheter. "

Dipeptidyl peptidase-IV inhibitors can restore glucose homeostasis in type 2 diabetics via incretin enhancement

Dipeptidyl peptidase-IV inhibitors can restore glucose homeostasis in type 2 diabetics via incretin enhancement: "Incretin levels approach normal physiological values following treatment with dipeptidyl peptidase DPP-4 inhibitors. This is in contrast to incretin levels resulting from the exogenous administration of glucagon-like peptide (GLP)-1 and its analogs, which can reach super-physiological values. This review describes the role of DPP-IV inhibitors as incretin enhancers in the regulation of glucose homeostasis in type 2 diabetic patients. The roles of incretins and the effect of DPP-IV on their actions are described, as are new therapeutic interventions based on the restoration of impaired incretin secretion in type 2 diabetic patients and obese individuals. In addition, the relevance of DPP-IV inhibition for weight control, its potential influence on beta-cell mass, and possible new indications are discussed, as are the implications of the currently available clinical data."

Rates of heart disease and retinopathy in Type 1 Diabetes not improving

In one of the most comprehensive, long-term studies to date of the complications associated with type 1 diabetes, researchers at the University of Pittsburgh Graduate School of Public Health (GSPH) discovered that while cases of premature death and a few other complications have declined, rates of other serious diabetes-related disorders such as heart and eye disease have not improved over the past 25 to 30 years.

Diabetes 55:1463-1469, 2006

Obesity drugs in the pipeline

A number of anti-obesity drugs are currently undergoing clinical development. These include: (i) centrally-acting drugs, such as the noradrenergic and dopaminergic reuptake inhibitor radafaxine, the endocannabinoid antagonist rimonabant, the selective serotonin5-HT2C agonist APD-356, and oleoyl-estrone; (ii) drugs that target peripheral episodic satiety signals, such as glucagon-like peptide-1 (exenatide, exenatide-LAR and liraglutide), peptide YY (intranasal PYY3-36 and AC-162325) and amylin (pramlintide); (iii) drugs that block fat absorption, such as the novel lipase inhibitors cetilistat and GT-389255; and (iv) a human growth hormone fragment (AOD-9604) that increases adipose tissue breakdown. Of these, only rimonabant has got as far as completing phase III clinical trials.

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18 weeks waiting time target

"Senior clinicians are concerned over how the Government expects waiting times to be reduced to 18 weeks for the whole patient journey.

The target, covering the time from GP referral to hospital treatment, will be fully in place by December 2008.

According to new guidance from the DoH, orthopaedics - which accounts for over 14 per cent of referrals - will need particularly focused work to achieve the 18-week pathway. But Mr John Carvell, chairman of the BMA's orthopaedic subcommittee and a member of the Government's 18-week project team, questioned whether the target was desirable."

Hospital Doctor

Tribal warfare?

"A company appointed by the Government to advise on deals with private providers owns a provider company, raising questions of conflicts of interest.

Prof Allyson Pollock, a leading academic at Edinburgh University, criticised the DoH for appointing Tribal Group, owners of Mercury Health, to a panel managing DoH and trust procurement. Mercury Health, which is bidding for several NHS contracts, is a wholly owned subsidiary of Tribal.

The DoH has not confirmed the panel's remit, but Rob Garner, managing director with Tribal Consulting, said from the autumn the panel will provide commercial advice on 'all potential future commercial relationships with healthcare providers'.

Under new EU rules all firms on the panel must be invited to bid for a piece of work.

The arrangement means Tribal could manage tenders under which Mercury's competitors are bidding. Prof Pollock suggested Tribal could potentially use information gleaned while managing one contract to inform Mercury's bid on another."

Hospital Doctor

Good Hope Hospital ... costly shambles

"A report leaked to Hospital Doctor reveals the first private management take-over of an NHS hospital left the trust in dire financial straits, threatening the local health economy.

The draft Audit Commission report on the deal between Good Hope Hospital NHS Trust and Secta Group Ltd describes a costly shambles, which failed in many of its objectives."

Hospital Doctor

Muraglitazar and tesaglitazar development stopped because of the suspicion of toxicity

These two combined PPAR alpha / gamma agonists, which have favourable effects on glycaemic control and blood lipids, have stumbled in development. They have already undergone an extended 2 year period of testing in rats for carcinogenicity as stipulated by the FDA. They join a growing list of other similar compounds that have not made it as a prescription drug. Ragaglitazar, for example, caused bladder cancer.

"That whole nuclear receptor field is still a wonderful area for basic research, but turning things into useful drugs has been harder than anticipated. For a while there, it looked as if we'd be able to take all sorts of combination of the three subtypes and turn out drugs for all sorts of indications - diabetes, high blood lipids, various cancers, wound healing, what have you. And perhaps we still can, after another ten or twenty years of hard labor." Waiting for Pargluva

Bristol-Myers Squibb Company today announced that it has discontinued the development of muraglitazar, a dual alpha/gamma PPAR (peroxisome proliferator-activated receptor) agonist in development for type 2 diabetes. There was a suspicion of an increased cardiovascular risk which would require a 5 year phase III trial to clarify. BMS has therefore dropped the development to focus on other drugs.

BMS news

AstraZeneca also dropped the dual PPAR agonist, GALIDA (tesaglitazar) earlier this month GALIDA is a dual PPAR alpha and gamma agonist and was in phase III development for the treatment of the glucose and lipid abnormalities associated with type 2 diabetes.

Following analysis and interpretation of recently obtained results from the first four of eight Phase III clinical trials (GALLANT 6,7,8 and 9) and one Phase II trial (ARMOR), which were reviewed in consultation with external experts, the company considers that the overall benefit / risk profile is unlikely to offer patients significant advantage over currently available therapy.

Central to the decision was data showing elevations in serum creatinine and an associated decrease in Glomerular Filtration Rate (GFR). The magnitude of the serum creatinine elevation was greater than anticipated based on earlier clinical studies. Such elevations reversed towards baseline upon stopping treatment with the drug and have not been associated with kidney toxicity.

AstraZeneca news

Exubera reviewed by German group

There is currently no evidence available that inhaled insulin (Exubera) in diabetes therapy shows advantages over short-acting human insulin or insulin analogues administered subcutaneously. The available studies do not provide evidence that Exubera would improve the quality of life or treatment satisfaction of diabetes patients in Germany.

Exubera: So far no evidence of an additional benefit - 09.05.2006

Roflumilast for the treatment of chronic obstructive pulmonary disease

Roflumilast for the treatment of chronic obstructive pulmonary disease: "Chronic obstructive pulmonary disease (COPD) is a progressive disease of the airways that is triggered primarily by smoking. It manifests clinically with dyspnea, cough and sputum production, all of which become aggravated with disease progression. The only intervention that can halt the decline in lung function in COPD is smoking cessation - other interventions and therapeutic treatments can only slow down the progression of the disease. Pharmacologic treatment of stable COPD consists primarily of bronchodilators, which are used for relieving symptoms and reducing lung function decline, and corticosteroids, which are used for minimizing the associated inflammation. Methylxanthines are non-selective phosphodiesterase (PDE) inhibitors with bronchodilatory and anti-inflammatory effects; however, their use in COPD and other respiratory conditions is limited by their narrow therapeutic index and poor safety profile. Cilomilast and roflumilast are selective PDE4 inhibitors that are currently in pre-registration and phase III clinical trials, respectively, for the treatment of COPD (cilomilast and roflumilast) and asthma (roflumilast)."

Current Opinion in investigational Drugs