Archive for July 22nd, 2009
Air in the Urinary Tract
N Engl J of Medicine July 23, 2009 V.361 N.4 p.388
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A 53-year-old woman was admitted to the hospital for evaluation of a 1-week history of lower abdominal pain and dysuria. She was afebrile. Plain abdominal radiography showed air throughout the urinary tract in the kidneys, ureters, and bladder (arrows). The laboratory data showed elevated levels of blood glucose (519 mg per deciliter [28.8 mmol per liter]), C-reactive protein (37.1 mg per liter), and serum creatinine (1.6 mg per deciliter [141 µmol per liter]). The white-cell count was 11.9×103 per cubic millimeter. Computed tomography confirmed the radiographic finding of acute emphysematous cystitis. A urine culture grew Escherichia coli, and the patient had a good response to antibiotic treatment. Patients with diabetes mellitus have a predisposition to complicated urinary tract infections such as emphysematous cystitis, which is thought to be caused by fermentation of glucose by bacterial and fungal pathogens.
abstract
http://content.nejm.org/cgi/content/full/361/4/388?query=TOC
Add comment July 22, 2009
Peginterferon Alfa-2b or Alfa-2a with Ribavirin for Treatment of Hepatitis C Infection
N Engl J of Medicine July 23, 2009 V.361 N.4
John G. McHutchison, M.D., Eric J. Lawitz, M.D., Mitchell L. Shiffman, M.D., Andrew J. Muir, M.D., Greg W. Galler, M.D., Jonathan McCone, M.D., Lisa M. Nyberg, M.D., William M. Lee, M.D., Reem H. Ghalib, M.D., Eugene R. Schiff, M.D., Joseph S. Galati, M.D., Bruce R. Bacon, M.D., Mitchell N. Davis, M.D., Pabak Mukhopadhyay, Ph.D., Kenneth Koury, Ph.D., Stephanie Noviello, M.D., Lisa D. Pedicone, Ph.D., Clifford A. Brass, M.D., Janice K. Albrecht, Ph.D., Mark S. Sulkowski, M.D., for the IDEAL Study Team
Background Treatment guidelines recommend the use of peginterferon alfa-2b or peginterferon alfa-2a in combination with ribavirin for chronic hepatitis C virus (HCV) infection. However, these regimens have not been adequately compared.
Methods At 118 sites, patients who had HCV genotype 1 infection and who had not previously been treated were randomly assigned to undergo 48 weeks of treatment with one of three regimens: peginterferon alfa-2b at a standard dose of 1.5 µg per kilogram of body weight per week or a low dose of 1.0 µg per kilogram per week, plus ribavirin at a dose of 800 to 1400 mg per day, or peginterferon alfa-2a at a dose of 180 µg per week plus ribavirin at a dose of 1000 to 1200 mg per day. We compared the rate of sustained virologic response and the safety and adverse-event profiles between the peginterferon alfa-2b regimens and between the standard-dose peginterferon alfa-2b regimen and the peginterferon alfa-2a regimen.
Results Among 3070 patients, rates of sustained virologic response were similar among the regimens: 39.8% with standard-dose peginterferon alfa-2b, 38.0% with low-dose peginterferon alfa-2b, and 40.9% with peginterferon alfa-2a (P=0.20 for standard-dose vs. low-dose peginterferon alfa-2b; P=0.57 for standard-dose peginterferon alfa-2b vs. peginterferon alfa-2a). Estimated differences in response rates were 1.8% (95% confidence interval [CI], –2.3 to 6.0) between standard-dose and low-dose peginterferon alfa-2b and –1.1% (95% CI, –5.3 to 3.0) between standard-dose peginterferon alfa-2b and peginterferon alfa-2a. Relapse rates were 23.5% (95% CI, 19.9 to 27.2) for standard-dose peginterferon alfa-2b, 20.0% (95% CI, 16.4 to 23.6) for low-dose peginterferon alfa-2b, and 31.5% (95% CI, 27.9 to 35.2) for peginterferon alfa-2a. The safety profile was similar among the three groups; serious adverse events were observed in 8.6 to 11.7% of patients. Among the patients with undetectable HCV RNA levels at treatment weeks 4 and 12, a sustained virologic response was achieved in 86.2% and 78.7%, respectively.
Conclusions In patients infected with HCV genotype 1, the rates of sustained virologic response and tolerability did not differ significantly between the two available peginterferon–ribavirin regimens or between the two doses of peginterferon alfa-2b.
abstract
http://content.nejm.org/cgi/content/full/NEJMoa0808010?query=TOC
Add comment July 22, 2009
