A1C underestimates glycemia in HIV infection.

OBJECTIVE: The objective of this study was to determine the relationship between A1C and glycemia in HIV infection. RESEARCH DESIGN AND METHODS: We completed a prospective cross-sectional study of 100 HIV-infected adults with type 2 diabetes (77%) or fasting hyperglycemia (23%) with measured glucose, A1C, mean corpuscular volume (MCV), and fructosamine. A total of 200 HIV-uninfected type 2 diabetic subjects matched for key demographic characteristics served as control subjects. RESULTS: Relative to the control subjects, A1C underestimated glucose by 29 +/- 4 mg/dl in the HIV-infected subjects. Current nucleoside reverse transcriptase inhibitors (NRTIs), higher MCV and hemoglobin, and lower HIV RNA and haptoglobin were associated with greater A1C-glucose discordance. However, only MCV and current NTRI use, in particular abacavir, remained significant predictors in multivariate analyses. Fructosamine more closely reflected glycemia in the HIV-infected subjects. CONCLUSIONS: A1C underestimates glycemia in HIV-infected patients and is related to NRTI use. Use of abacavir and increased MCV were key correlates in multivariate analyses. Fructosamine may be more appropriate in this setting.

Rosiglitazone increases small dense low-density lipoprotein concentration and decreases high-density lipoprotein particle size in HIV-infected patients.

After 12 weeks of rosiglitazone treatment, significant increases in total and small dense low-density lipoprotein, and the total: high-density lipoprotein (HDL)-cholesterol ratio were found. The large HDL concentration and HDL particle size decreased significantly with rosiglitazone compared with placebo. These data indicate the production of a more atherogenic lipid profile with rosiglitazone, a consideration when selecting treatment for the growing population of HIV-infected patients with type 2 diabetes and dyslipidemia.

Analgesia administration for acute abdominal pain in the pediatric emergency department.

OBJECTIVE: To document the use of analgesia for children with acute abdominal pain in the Pediatric Emergency Department (PED) and to compare between children with suspected appendicitis in a high versus low probability. STUDY DESIGN: Patients 0-16 years recruited prospectively as part of another PED study in Toronto. History of present illness and physical examination was available, and information on analgesia administered in the PED was retrospectively collected from charts. Physicians' probability of appendicitis before any imaging was recorded. A follow-up call was made to verify final diagnosis. RESULTS: We included 438 patients, 16% with appendicitis. Analgesics were given 154 times to 112 patients. Thirty-one percent of the cohort received analgesia before seeing the physician, mostly febrile, 37% after seeing the physician, and 17% after seeing a pediatric-surgery consultant. Fifteen percent received multiple dosages. Underdosing was recorded in 14% of medications, mostly morphine (24%). Analgesia was given significantly more often to children with high probability of appendicitis. Age was not a factor in analgesia administration. CONCLUSION: Children with abdominal pain receive more analgesia when the physician suspects appendicitis, yet only in half of the cases, and only 15% receive opioids. Opioid underdosing happens in a quarter of times it is given.