The American journal of the medical sciences
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Randomized Controlled Trial Clinical Trial
Bedtime dosing of glyburide and the treatment of type II diabetes mellitus.
Suppression of nocturnal hepatic glucose production is key in the treatment of noninsulin-dependent diabetes mellitus (NIDDM). In this article, the authors compare the effectiveness of dosing glyburide at bedtime versus in the morning on glycemic control in patients with NIDDM under suboptimal control. In a placebo-controlled, double-blind crossover trial, 32 patients with NIDDM with suboptimal control on chronic glyburide treatment fulfilling entry criteria were randomized to receive one of two regimens: (1) glyburide at bedtime and placebo in morning or (2) placebo at bedtime and glyburide in the morning. ⋯ At the end of 12 months, nighttime dosing resulted in better home glucose monitoring values, fasting blood sugar results, and Sustacal tolerance profiles, but the differences were not statistically significant. No hypoglycemia was observed in the monitored data collected. Bedtime dosing of glyburide resulted in measurable improvement in fasting blood sugar and carbohydrate tolerance curves, but not to a degree justifying general recommendation of this technique in patients with NIDDM with secondary failure to oral agents.
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Review Case Reports
Case report: purpura in disseminated strongyloidiasis.
Purpuric lesions have been described previously in 10 patients with disseminated strongyloidiasis. We identified three additional patients in whom purpura developed as a manifestation of disseminated strongyloidiasis. Nine (69%) of the 13 patients were men, and the median age of patients was 61 years (range, 32-75 years). ⋯ Skin biopsies of purpuric lesions were obtained in 12 patients, in 10 (83%) of which larvae were found. Despite recommended treatment with thiabendazole in 12 of 13 patients, 11 (85%) of the patients died, and at least 6 died within 16 days of onset of purpura. Physicians, particularly those in the southeastern United States, should strongly consider the diagnosis of disseminated strongyloidiasis in patients receiving corticosteroids and in whom purpura and systemic toxicity develops.
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To participate effectively in their health care, older patients often are expected to read a wide variety of materials, including written instructions, brochures, and consent forms. This study quantitates the reading ability of older patients and compares it to that of younger patients. Two hundred seventy-two patients 30 and older were selected from five outpatient clinics at a public teaching hospital and tested for objective reading ability using the Peabody Individual Achievement Test--Revised. ⋯ In this study, older patients read significantly worse than younger patients, and a formula that combines age, race, sex, and educational status cannot reliably predict reading ability for individual patients. Most older patients read on a level so low that they cannot be expected to read most commonly used written materials. Routine testing of reading ability may allow more appropriate design and use of written materials.
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The detrimental health effects of cigarette smoking, including the increased risk of cancer, cardiovascular disorders, and pulmonary diseases, are well established. Although most smokers express a desire to quit, 46 million Americans continue to smoke because of the nicotine addiction associated with the habit. The author, in this paper, describes the magnitude of the health risks related to various forms of tobacco use and proposes that smokeless tobacco be recommended as a cigarette substitute by persons who cannot stop smoking. ⋯ If all American smokers used smokeless tobacco instead, this would result in 12,000 cases of oral cancer per year. This is only 1/20 of all smoking-related cancers, less than 1/10 of smoking-related lung cancers, and less than half the number of oral cancers now attributed to smoking. A public health policy that recognizes smokeless tobacco as an alternative to smoking would benefit individuals confronted with the unsatisfactory options of abstinence or continuing to smoke.
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Review Case Reports
Case report: the lupus anticoagulant-hypoprothrombinemia syndrome.
The lupus anticoagulant is a well-described in vitro phenomenon that may be associated with arterial and venous thrombotic episodes. The lupus anticoagulant is never accompanied by a hemorrhagic diathesis unless it is associated with a second coagulation abnormality such as thrombocytopenia or hypoprothrombinemia. The lupus anticoagulant-hypoprothrombinemia syndrome is now a well-defined entity that may cause a severe, life-threatening hemorrhagic diathesis. ⋯ They were able to demonstrate hypoprothrombinemia and the presence of prothrombin-antiprothrombin antibody immune complexes. The patient was treated with prednisone, with correction of the bleeding disorder; however, the patient had resultant death from thrombosis. A literature review of the past 30 years as it relates to the discovery and treatment of this phenomenon is included.