Effects of poor and short sleep on glucose metabolism and obesity risk

"The importance of sleep to hormones and glucose metabolism was first documented more than four decades ago. since then, sleep curtailment has become an endemic behavior in modern society. in addition, the prevalence of sleep disorders, particularly obstructive sleep apnea (OsA), has increased. OsA is very common in endocrine and metabolic disorders, but often remains undiagnosed. A review (Spiegel, K. et al. Nat. Rev. Endocrinol. 5, 253–261 (2009); doi:10.1038/nrendo.2009.23) summarizes the laboratory and epidemiologic evidence that suggests how sleep loss, either behavioral or disease-related, and poor quality of sleep might promote the development of obesity and diabetes mellitus, and exacerbate existing endocrine conditions. Treatment of sleep disorders has the potential to improve glucose metabolism and energy balance. screening for habitual sleep patterns and OsA might be critically important for patients with endocrine and metabolic disorders."

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GREACE STUDY

Safety and effi cacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis

Background
Long-term statin treatment reduces the frequency of cardiovascular events, but safety and efficacy in patients with abnormal liver tests is unclear. We assessed whether statin therapy is safe and effective for these patients through post-hoc analysis of the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study population.

Methods
GREACE was a prospective, intention-to-treat study that randomly assigned by a computer-generated randomisation list 1600 patients with coronary heart disease (aged <75>2·6 mmol/L and triglycerides <4·5>Findings
Of 437 patients with moderately abnormal liver tests at baseline, which were possibly associated with non-alcoholic fatty liver disease, 227 who were treated with a statin (mainly atorvastatin 24 mg per day) had substantial improvement in liver tests (p<0·0001) p="0·0074)">Interpretation
Statin treatment is safe and can improve liver tests and reduce cardiovascular morbidity in patients with mild-to-moderately abnormal liver tests that are potentially attributable to non-alcoholic fatty liver disease

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Cardio classics revisited – focus on the role of candesartan

Author: Maria Leonarda De Rosa
Published Date November 2010 , Volume 2010:6 Pages 1047 - 1063 DOI 10.2147/VHRM.S9433

Maria Leonarda De Rosa
University of Naples Federico II, Department of Cardiology, Naples, Italy

Abstract: Angiotensin II receptor blockers (ARBs) are antihypertensive agents with considerable evidence of efficacy and safety for the reduction of cardiovascular (CV) disease risk in numerous patient populations across the CV continuum. There are several agents within this class, all of which have contributed to various degrees, to this evidence base. The evidence with ARBs continues to accumulate, with ongoing trials investigating their role in additional patient populations, potentially expanding their efficacy across a broad spectrum of CV disease states. Cardiovascular disease (CVD) is a leading cause of death around the world, accounting for approximately 29.2% of total global deaths. Of all the deaths attributed to CVD, approximately 43% are due to ischemic heart disease, 33% to cerebrovascular disease, and 23% to hypertensive and other heart conditions. CVD has been represented as a "CV continuum". This continuum concept can be used to describe CVD in general or in specific vascular beds (eg, coronary artery disease or cerebrovascular disease). This review article will discuss the results of the landmark ARB candesartan clinical trials published over the past decade. The evidence presented spans the entire CV continuum, including the effects of ARBs in at-risk patients, stroke, myocardial infarction (MI), and heart failure (HF), as well as a brief discussion of ongoing trials.

Keywords: candesartan, cardiovascular disease, angiotensin II receptor blockers

(Reference : http://www.dovepress.com/articles.php?article_id=5718)

FAPA 2010: A Snapshot

The delegates from Malaysian Pharmaceutical Society-Young Pharmacist Chapter (MPS-YPC) [being part of the bigger MPS delegation] attended the 23rd Federations of Asian Pharmaceutical Associations (FAPA) Congress at Taipei, Taiwan on 4th November-8th November 2010! Check out their experience HERE!

Vancomycin Update - Extracted from DiPiro

DiPiro Joseph T, "Updated Guidelines for Vancomycin Dosing" (Update). Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey: Pharmacotherapy: A Pathophysiologic Approach, 7e: http://www.accesspharmacy.com.ezp.imu.edu.my/updatesContent.aspx?aid=4000077.

Vancomycin has been in continuous use since the 1950’s, primarily for treatment of methicillin-resistant staphylococcal infections. However, dosing recommendations continue to be refined. The Infectious Diseases Society of America along with the American Society of Health-System Pharmacists and the Society of Infectious Diseases Pharmacists published updated, evidence-based guidelines for vancomycin dosing with Staphylococcus aureus infections.¹ The purpose of optimal dosing is to maximize the therapeutic benefits while minimizing risks of toxicity.

Factors that influence vancomycin dosing include patient weight and renal function, as well as the susceptibility of the infecting organism and the severity of the infection. The primary pharmacodynamic measure of vancomycin efficacy is the area under the serum concentration–time curve divided by the minimal inhibitory concentration (MIC).

The guidelines recommend that vancomycin dosing should be based on serum trough levels obtained just before the fourth dose when steady-state concentrations have been reached. Subsequent doses should be determined by vancomycin levels and changes in renal function.

The recommended trough serum levels are 15-20 mg/L for complicated S. aureus infections (such as bacteremia, endocarditis, osteomyelitis, meningitis, and hospital-acquired pneumonia) and at least 10 mg/L for less serious infections. Measurement of peak levels is not recommended. Trough levels less than 10 mg/L can result in development of vancomycin intermediately-susceptible S. aureus strains (VISA). The authors stated that there are limited data suggesting a direct causal relationship between toxicity and specific serum vancomycin concentrations.

Vancomycin is typically dosed at 15-20 mg/kg based on actual body weight (including for obese patients). For seriously ill patients a loading dose of 25-30 mg/kg can be given based on actual body weight. Subsequent doses are based on serum trough levels. Doses of 15-20 mg/kg (based on actual body weight) given every 8-12 hours are required in most patients with normal renal function, when the MIC is less than or equal to 1 mg/L. When the individual dose exceeds 1 g the infusion period should be extended to 1.5-2 hours.

Monitoring of serum trough vancomycin concentrations to reduce nephrotoxicity is recommended for patients receiving aggressive doses to achieve sustained trough levels of 15-20 mg/L and for patients at risk of nephrotoxicity (such as patients receiving concurrent treatment with nephrotoxins), as well as patients with unstable renal function and those receiving prolonged courses of therapy.

Frequent serum concentration monitoring for patients receiving short-course therapy (less than 5 days) or lower-intensity dosing (to achieve trough concentrations less than 15 mg/L) is not recommended. Once-weekly measurement of serum trough concentrations is recommended in patients receiving sustained dosing to achieve trough levels of 15-20 mg/L. Monitoring of trough levels to reduce ototoxicity is not recommended.

Readers are referred to the original article for more in-depth presentation of vancomycin serum concentration level monitoring.

Reference

1. Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin therapeutic guidelines: A summary of consensus recommendations from the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2009;49:325-7. [PMID: 19569969]