Posted by James
Avandia drug, the type-2 diabetes drug manufactured by Glaxo-SmithKline, is the most recent poster child for drug safety hysteria. A meta-analysis published last May by a noted cardiologist fueled concern and headlines over possible cardiovascular side effects from the drug (rosiglitazone maleate), forcing the FDA to revisit Avandia’s labeling in the absence of any new, convincing clinical trials. The result: GSK’s agreement in mid-November to expand Avandia’s existing black-box warning with confusing language saying “a risk of an increase in myocardial ischemic events was not confirmed or excluded in three long-term clinical trials.”
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Posted by James
The major aim of this study was to assess the outcome of severe hyponatremia and characterize factors influencing outcome in hospitalized patients with this disorder. This study suggests that severe hyponatremia is associated with high mortality. It is unclear if this association derives from hyponatremia per se, or the associated comorbidity in these subjects.
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Posted by James
Demographic and Clinical Characteristics of Study Patients
We found severe hyponatremia in 168 patients out of a total of 5994 patients with a diagnosis of hyponatremia at our facility over the study period, yielding an incidence of approximately 2.8%. Tables 1 and 2 summarize the demographic and clinical features of these patients.
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Posted by James
Study Setting
This study was done at Grady Memorial Hospital, a large tertiary teaching hospital , that serves a mostly urban population of city of Atlanta and the surrounding counties of Dekalb and Fulton.
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Posted by James
Hyponatremia is the most common electrolyte disorder in clinical medicine. Severe hyponatremia, defined as a serum sodium concentration of less than 115 mmol/L, may be associated with substantial morbidity and increased mortality. However, considerable controversy surrounds the optimal therapy for severe hyponatremia, as both an overly rapid correction rate and slow correction may be associated with neurologic injury and death. Ayus et al. proposed an hourly correction rate of 1.3mmol/L, using 5% saline with generic furosemide, while avoiding correction to normonatremic or hyperna-tremic levels at 48 hours, or a correction of no greater than 25mmol/L in the first 48 hours. Sterns and his coworkers, on the other hand, suggest that patients with severe chronic hyponatremia are more likely to avoid neurologic complications when hyponatremia was corrected slowly. Furthermore, it appears that chronic hyponatremia is not an entirely benign condition, as a recent report has shown that chronic symptomatic hyponatremia in post-menopausal women can be associated with major morbidity and mortality.
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Posted by James
Physicians do not have successful treatments for fibromyalgia, which has made this a very attractive area for alternative medicine providers who often claim to have successful treatments. Patients with fibromyalgia are more likely than the general population to seek out alternative medicine, with up to ninety one percent of these patients seeing alternative providers. Several therapies have become standard fare for the fibromyalgia patient seeking alternative care. The Internet has become a major source of information with over 100,000 sites showing up on an alta vista search. The following are some of the more common treatments that fibromyalgia patients use.
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Posted by James
The patient most likely to be diagnosed as having fibromyalgia is a women between 25-50 years of age.. Almost all patients with fibromyalgia will have some pain in the head and neck area. The pain is described as tingling, aching, soreness, flowing, and diffuse. Since the disease takes so long to diagnose, most patients suffer from chronic pain syndrome by the time their symptoms are taken seriously and they have trouble localizing the pain to discrete areas. Another common theme in these patients is fatigue. The fatigue is severe, sometimes preventing any movement at all. Sleep in non-restful and not restorative. People wake up feeling like they need eight more hours of sleep. Another frequent complaint is swelling of the hands that is not obvious to the examiner, but the patient is clearly able to discern a difference, regardless of whether the swelling effects the ability to wear jewelry, clothing, and can be shown to not effect the shape and size of the fingers. Forgetfulness and an inability to concentrate and think or plan for long term events is also a hallmark of this condition. This last symptom is called fibrofog by the afflicted and is one of the most bothersome symptoms.
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