Weight Loss, Dietary Preferences, and Reduction in the Sense of Smell with the Use of a Novel Nasal Device.

INTRODUCTION: Exposure to food odors are known to increase food intake. Olfaction declines from age 50 years. OBJECTIVE: We examined changes in the sense of smell, body weight, food preferences, and parameters of metabolic status, following the use of a specially designed nasal device. METHODS: This is a randomized, placebo-controlled study. Participants wore a nasal device (soft silicone insert) for 5-12 h daily (device group) or inserted 2 drops of normal saline into each nostril daily (control group). Follow-up visits occurred every 2 weeks. All participants were given a 500 kcal/day reduced diet and instructed not to change their regular physical activity. Weight, food preferences, olfactory sensitivity, and blood tests were performed at baseline and after 12 weeks. RESULTS: Of 156 participants, 65 (42%) completed the study. Sense of smell decreased in the device group (from 6.4 ± 0.9 to 4.4 ± 1.5, on a scale of 0-7, p < 0.001), and did not change in the control group. Weight loss decreased by 6.6 ± 3.7% (p = 0.001) and by 5.7 ± 3.5% (p = 0.001) in the respective groups (between-group difference, p > 0.05). Among participants aged ≤50 years, weight loss was greater in the device than in the control group (7.7 ± 4.2% vs. 4.1 ± 2.9%, p = 0.02). Insulin level and the homeostatic model assessment of insulin resistance (HOMA-IR) were significantly reduced in the device group (p = 0.02 and p = 0.01, respectively), but not in the control group. Food preferences for sugar (p < 0.02), sweet beverages (p < 0.001), and artificial sweeteners (p < 0.02) were significantly reduced in the device group compared to the control group. CONCLUSIONS: The use of a novel self-administrated nasal device led to reduced olfactory sensitivity, improved insulin sensitivity, weight loss, and lesser preference for sweets in adults aged ≤50 years.

Venous thromboembolism: the prevailing approach to diagnosis, prevention and treatment among Internal Medicine practitioners.

BACKGROUND: Venous thromboembolism (VTE) is the third most common cause of death and the leading cause of sudden death in hospitalized medical patients. Despite the existence of guidelines for prevention and treatment of this disorder, their implementation in everyday life is not always accomplished. METHODS: We performed a survey among directors of Internal Medicine departments in our country in order to evaluate their attitude and approach to this issue. A questionnaire with pertinent questions regarding prevention and treatment of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE) was sent to each one of the directors of Internal Medicine Departments around the country. RESULTS: Sixty-nine out of 97 (71%) of the Internal Medicine departments directors responded the questionnaire. We found that several of the current guidelines were followed in a reasonable way. On the other hand, heterogeneity of responses was also present and the performance of current guidelines was imperfectly followed, and showed to be deficient in several aspects. CONCLUSIONS: An effort should be done in order to reemphasize and put in effect current guidelines for the prevention and treatment of VTE among hospitalists and Internal Medicine practitioners.

Seasonal Influenza Vaccination Effectiveness and Compliance among Hospital Health Care Workers.

BACKGROUND: Recent studies show that vaccination of health care workers (HCW) might reduce influenza transmission and mortality among hospitalized patients. No studies have compared the incidence of laboratory-proven influenza in vaccinated versus unvaccinated hospital HCW. OBJECTIVES: To evaluate the effectiveness of influenza vaccination among hospital HCW and to examine the attitudes of this population towards influenza vaccination. METHODS: We performed a prospective cohort study between 1 January and 30 April 2014 of 1641 HCW at our medical center; 733 were vaccinated and 908 were not. A random sample of 199 subjects was obtained: 97 vaccinated and 102 non-vaccinated. Participating individuals were contacted on a weekly basis during the flu season and were asked to report any respiratory or flu symptoms and, if positive, to undergo a polymerase chain reaction (PCR) test for influenza. Results: In the general HCW population vaccination was more frequent among physicians (298/498, 58%) than among nurses (324/862, 38%) and among males than females. Flu symptoms were reported by 20 of 199 participants, 13 in the non-vaccinated group (12.7%) and 7 in the vaccinated group (7.2%). A positive PCR test for influenza A virus was present in 4 of 20 people tested (20%). All positive cases were from the non-vaccinated group (P = 0.0953). CONCLUSIONS: Non-vaccinated HCW showed a higher, although not statistically significant, tendency for contracting laboratory-proven influenza than the vaccinated population. The main reasons for vaccination and non-vaccination were personal beliefs and habits. Education efforts are needed to improve compliance. Larger studies could further clarify this issue.

Could a Coagulation Nurse Liaison Improve Compliance With Venous Thromboembolism Prophylaxis in Medical Patients?

Medical patients worldwide are undertreated with venous thromboembolism prophylaxis. Our hypothesis was that the rate of prophylactic anticoagulation therapy for high-risk patients would improve with the use of a coagulation nurse liaison. Six months after appointing a nurse for this role, prophylaxis rates significantly improved, and patients were more likely to receive appropriate thromboprophylaxis. A coagulation nurse liaison substantially improves thromboprophylaxis in a medical ward.

[THIAMINE--"THE ROAD EXPERIENCE" OF THE VITAMIN AS A MANIFESTATION OF DEFICIENCY IN A WORLD OF ABUNDANCE].

Thiamine or vitamin B1 is a water soluble vitamin of the vitamin B complex. It is synthetized by bacteria, fungi and plants and is an essential component of multicellular living organisms. Humans are not able to synthetize this vitamin and have to obtain it from different foods. Thiamin has a vital role in the normal function of the human body. It functions as a coenzyme in the catabolism of carbohydrates and amino acids and has an antioxidant role. It has an essential function in a series of metabolic processes related to energy production and conversion of sugar to ATP, as a catalyst in the Krebs cycle. It takes part in the synthesis of neurotransmitters and has a main role in the central nervous system and immune system. Deficiency results in Wernicke-Korsakoff syndrome, optic neuropathy, Beri-Beri and other disorders. Vitamin B deficiency in not rare and may occur in conditions related to malnutrition, alcoholism, diabetes, congestive heart failure and others. In this review an effort has been made to demonstrate the presence of thiamine deficiency in various clinical situations frequent in modern medicine, attributed in the past to populations with "classical" inadequate feeding and starvation, or severe malnutrition. Identification of potential causes of vitamin B1 deficiency, knowledge of its metabolic properties and the clinical manifestations of its deficiency are important for the implementation of early therapeutic response required for the reduction and prevention of symptoms related to this disorder.

Thiamine deficiency in self-induced refeeding syndrome, an undetected and potentially lethal condition.

Rapid restoration of nutrients and electrolytes after prolonged starvation could result in a life threatening condition characterized by sensory and neurological dysfunction and severe metabolic imbalance that has been designated as refeeding syndrome. Its diagnosis is frequently missed resulting in severe complications and even death. We describe a 25-years-old female patient with mental disorders and severe malnutrition who developed severe clinical manifestations and biochemical abnormalities characteristic of the refeeding syndrome, after restarting oral feeding on her own. Schizophrenia was later diagnosed. Increased awareness of this condition and its complications is necessary to prevent its detrimental complications.

Diagnostic challenges of Wilson's disease presenting as acute pancreatitis, cholangitis, and jaundice.

Wilson's disease is a rare disorder of copper transport in hepatic cells, and may present as cholestatic liver disease; pancreatitis and cholangitis are rarely associated with Wilsons's disease. Moreover, cases of Wilson's disease presenting as pigmented gallstone pancreatitis have not been reported in the literature. In the present report, we describe a case of a 37-year-old man who was admitted with jaundice and abdominal pain. The patient was diagnosed with acute pancreatitis, cholangitis, and obstructive jaundice caused by pigmented gallstones that were detected during retrograde cholangiopancreatography. However, because of his long-term jaundice and the presence of pigmented gallstones, the patient underwent further evaluation for Wilson's disease, which was subsequently confirmed. This patient's unique presentation exemplifies the overlap in the clinical and laboratory parameters of Wilson's disease and cholestasis, and the difficulties associated with their differentiation. It suggests that Wilson's disease should be considered in patients with pancreatitis, cholangitis, and severe protracted jaundice caused by pigmented gallstones.

Trends in the burden of infectious disease hospitalizations among the elderly in the last decade.

BACKGROUND: Infectious disease is a leading cause of hospitalization. We investigated trends in infectious disease hospitalizations among the elderly in the last decade. METHODS: A total of 81,077 hospitalizations of elderly patients between 2001 and 2010 were available on the computerized database of the Ha'emek Medical Center, Israel. The proportion of hospitalizations attributable to infectious diseases was calculated. RESULTS: Overall, lower respiratory tract infection (LRTI) accounted for 41.0% of hospitalizations attributable to infectious diseases followed by kidney, urinary tract and bladder infections (UTI) (21.4%), upper respiratory tract infections (URTI) (10.2%), and hepatobiliary tract infections (9.8%). The proportion of hospitalizations attributable to infectious diseases increased by 14.2% during the study period, rising from 16.9% in 2001 (1023 infectious disease hospitalizations of a total of 6043 hospitalizations) to 19.3% in 2010 (1907 infectious disease hospitalizations of a total of 9876 hospitalizations) (P for trend<0.001). A significant increasing trend persisted after adjustment for age, ethnicity, and season, resulting in an increase from 16.9% in 2001 to 18.8% in 2010 (P for trend=0.001). A significant increasing trend was observed in males (P for trend<0.001) and a borderline significant trend was observed in females (P for trend=0.062). The proportion of hospitalizations attributable to infectious diseases was higher in males and increased with age. LRTI and URTI were the major contributors to the increasing trend (P for trend=0.018 and <0.001, respectively). CONCLUSIONS: This study shows an increasing trend in infectious disease hospitalizations among the elderly in the last decade. Public health measures are needed to reduce infectious disease hospitalizations.

The resurgence of niacin: from nicotinic acid to niaspan/laropiprant.

Hypercholesterolemia is one of the main factors in the development of atherosclerotic cardiovascular disease. The advent of statins led to huge progress in the treatment of hypercholesterolemia, yet the proportion of patients with prohibitive lipid values and the high incidence of cardiovascular events despite treatment are still very high. Niacin, one of the older drugs used to treat hyperlipidemia, was shown to reduce low-density lipoprotein-cholesterol (LDL-C) and triglycerides and to markedly increase high-density lipoprotein-cholesterol (HDL-C) levels. This drug came into disuse owing to frequent side effects, mainly flushing, but in recent years a reemergence of its application has occurred, and multiple clinical trials have shown its effectiveness in the treatment of hyperlipidemia and in the reduction of cardiovascular events. New formulations such as extended-release niacin (ERN) have been developed with the purpose of reducing side effects. Lately, a new compound, laropiprant, which selectively antagonizes the prostaglandin 2 (PGD2) receptor responsible for flushing, has been developed. Laropiprant, when combined with ERN, significantly reduces the incidence of flushing. New and ongoing trials will definitively prove in the long term whether this drug combination significantly reduces the severity of flushing and the incidence of cardiovascular events.

Gardner's syndrome in a 75-year-old woman.

Familial adenomatous polyposis (FAP) is an inherited disease characterized by the presence of multiple polyps in the colon or other areas of the gastrointestinal tract. In Gardner's syndrome, which is considered by some as a variant of FAP, polyps in the colon present with extracolonic manifestations, such as osteomas, lipomas, fibromas or other soft tissue tumors. In 100% of all untreated patients, cancer of the large intestine develops before the age of 40. Subjects with this disorder usually die from complications related to this and other tumors. Older patients surviving this disease only did so after total colectomy was performed. We describe a 75-year-old patient with the typical lesions of Gardner's syndrome who survived without treatment for the disease for more than 40 years after diagnosis.

Allopurinol-induced recurrent DRESS syndrome: pathophysiology and treatment.

Hyperuricemia is present in approximately 5% of the population. The vast majority is asymptomatic and at no clinical risk. Allopurinol, an analog of hypoxanthine, has been widely used in clinical practice for more than 30 years for the treatment of hyperuricemia and gout. Two percent of patients develop a mild exanthema when on this drug, which usually resolves after withdrawal of the drug. A syndrome characterized by exfoliative dermatitis, hepatitis, interstitial nephritis, and eosinophilia, termed allopurinol hypersensitivity syndrome, has been described, and its etiology related to the accumulation of one of allopurinol's metabolites, oxypurinol, of which clearance is decreased in the setting of renal insufficiency and the use of thiazide diuretics. The term DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) Syndrome has been recently used to describe an entity presenting with similar features.

Allopurinol-induced DRESS syndrome.

Hyperuricemia is present in approximately 5% of the population, the vast majority of whom are asymptomatic and at no clinical risk. Complications, including renal calculi, uric acid nephropathy and gout, occur in a small proportion of patients. Allopurinol, an analog of hypoxanthine, has been widely used in clinical practice for over 30 years for the treatment of hyperuricemia and gout. Two percent of patients taking this medication develop a mild exanthema. A syndrome characterized by exfoliative dermatitis, hepatitis, interstitial nephritis and eosinophilia has been described previously. Termed allopurinol hypersensitivity syndrome, its etiology is related to the accumulation of one of the allopurinol metabolites, oxypurinol; clearance of oxypurinol is decreased in the setting of renal insufficiency and the use of thiazide diuretics. The term DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) was recently introduced to describe a disorder associated with various drugs or viral infections and characterized by similar features. The pathophysiology of allopurinol-induced hypersensitivity, clinical presentation and treatment are reviewed.