Short-term comparison of once- versus twice-daily administration of glimepiride in patients with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To investigate the metabolic effects and frequency of adverse events with 6 mg of glimepiride, a new oral sulfonylurea, given both in once- and twice-daily dosages to patients with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: This 15-week study involved 161 subjects with NIDDM. Subjects were randomized into two groups. For 4 weeks, group 1 received glimepiride 3 mg twice daily, and group 2 received glimepiride 6 mg once daily. After a 3-week placebo-washout period, twice- and once-daily regimens were crossed over for a second 4-week treatment period. Subjects were hospitalized at the end of each placebo or active-treatment phase. Their glucose concentrations were recorded at 20 time points over a 24-hour period, and their insulin and C-peptide concentrations were recorded at 16 time points over the same period. Parameters that were calculated included fasting, 24-hour, and postprandial concentrations of glucose, insulin, and C-peptide. RESULTS: One hundred six patients were randomized to receive treatment; 94 completed the entire study. Existing physiologic mechanisms of glucose control were apparently unimpaired by glimepiride treatment. Insulin concentrations increased more during the postprandial glucose peaks than when subjects were fasting. Both twice- and once-daily regimens proved equally effective in reducing concentrations of fasting, postbreakfast, postlunch, and postdinner plasma glucose. Twenty-four-hour mean glucose concentrations showed a slightly greater decrease from baseline for the twice-daily regimen; the difference between the regimens was statistically significant but not clinically meaningful. The incidence of adverse events with glimepiride approximated that obtained with placebo, with both groups reporting only one adverse event, headache, in more than 5% of the subjects. CONCLUSIONS: Glimepiride is equally effective whether administered once or twice daily. Glimepiride seems to stimulate insulin production primarily after meals, when plasma glucose concentrations are highest, but controls blood glucose throughout the day.

Metabolism and metal binding by surface-colonizing bacteria: results of microgradient measurements.

Short-term (65-h) bacterial colonization of 0.2-mum (pore size) filters submerged in water from Lake Charlotte, Nova Scotia, was characterized by a well-defined succession of cell types, in which small cocci gave way to larger, rod-shaped cells. This succession agrees with the concept of attachment as a strategy for survival, in which inactive cocci can attach to a surface and grow into larger, rod-shaped cells by using endogenous nutrients and the nutrients accumulated at the solid-liquid interface. Analyses of oxygen and CO(2) microgradients above colonized surfaces indicated that a peak of respiration accompanied the succession of rods from cocci. CO(2) fixation then became apparent as the rods began to bind manganese and iron to their surfaces. This means that survival by attachment may not be just the province of heterotrophs. It could also be a strategy adopted by metal-oxidizing chemoautotrophs. Long-term (34-day) colonization of similar filters indicated that, while a succession of attached cell types may indeed be a natural occurrence, other factors (such as the selective grazing of larger cells) tend to obscure the development of this succession.

Opportunistic infection of chronic skin ulcers with Pseudomonas putrefaciens.

Heavy growth of Pseudomonas putrefaciens was isolated repeatedly in mixed culture with other Gram-negative rods from chronic ulcers on the extremities of an elderly patient with burnt-out leprosy. Treatment was with systemic cotrimoxazole, topical framycetin and general supportive therapy, and the ulcers gradually healed over a period of 4 weeks.

Comparative efficacy of triazolam, flurazepam and placebo in out-patients insomniacs.

The short-term hypnotic efficacy of triazolam was compared to that of flurazepam and placebo in 120 out-patient insomniacs. Each patient was studied with a two-night, double-blind crossover trial. Triazolam (0.5 mg) was compared to placebo and flurazepam (30 mg). Triazolam (0.25 mg) was compared to flurazepam (15 mg and 30 mg). Triazolam (0.5 mg) was preferred to both placebo and flurazepam (30 mg). Triazolam (0.5 mg) was superior to placebo in improving quality of sleep, shortening sleep onset, increasing sleep duration, and reducing the number of night-time awakenings. Triazolam (0.5 mg) was superior to flurazepam (30 mg) in speeding sleep onset and increasing the quality of sleep. Triazolam (0.25 mg) was preferred to flurazepam (15 mg) and was significantly better than flurazepam on all sleep questions. Triazolam (0.25 mg) was preferred by more patients than flurazepam (30 mg) and was judged equally efficacious on individual sleep questions. Reports of side-effects were minimal for both drugs.

Streptococcus pneumoniae resistant to penicillin and chloramphenicol.

Three cases of meningitis and two of septicaemia were caused by pneumococci resistant to the penicillins/cephalosporins and chloramphenicol. No beta-lactamase was demonstrated in any of the organisms. All three patients with meningitis died, but the patients with septicaemia recovered after being given appropriate antibiotic therapy.