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Am J Psychiatry 2003 Jan;160(1):174-8
Department of Veteran Affairs Puget Sound Health Care System, MHC/116, 1660 South Columbian Way, Seattle, WA 98108-1597, USA. bradford.felker@med.va.gov
OBJECTIVE: Valproic acid is frequently not recommended for patients with hepatic dysfunction. The authors evaluated the association between hepatitis C and alanine aminotransferase (ALT) values during valproic acid treatment. METHOD: ALT changes in 564 individuals beginning valproic acid treatment were examined. Changes among those with positive hepatitis C status were compared with changes among patients with positive hepatitis C status who were taking other psychotropic agents. RESULTS: ALT elevations with valproic acid were significantly greater among patients with positive hepatitis C status than those with negative or unknown status. Among patients with positive hepatitis C status, ALT increases did not differ significantly between valproic acid and other medications. CONCLUSIONS: Use of valproic acid may be possible for some patients with hepatitis C. ALT increases in seropositive patients may be partially related to chronic hepatitis infection. However, ALT levels should be closely monitored in all hepatitis C patients taking valproic acid.
PMID: 12505820, UI: 22392348
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MMWR Morb Mortal Wkly Rep 2003 Jan 3;51(51-52):1149-52
A Salmonella serotype Enteritidis (SE) epidemic emerged in the 1980s, when increasing numbers of infections were detected in the Northeastern and Mid-Atlantic regions of the United States. In the early 1990s, while SE rates in the Northeast began to decline, the SE epidemic expanded to the Pacific region. Nationwide, the number of SE isolates reported to CDC peaked at 3.8 per 100,000 population in 1995. Although rates of culture-confirmed SE infection reported to CDC declined to 1.9 by 1999 (Figure 1), rates did not decline further through 2001, and outbreaks continue to occur. Investigations of outbreaks and sporadic cases have indicated repeatedly that, when a food vehicle is identified, the most common sources of SE infection are undercooked and raw shell eggs. This report describes two SE outbreaks associated with eating shell eggs and underscores the need to strengthen SE-control measures.
PMID: 12553566, UI: 22440598
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N Engl J Med 2003 Jan 23;348(4):345-7
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PMID: 12540649, UI: 22429021
N Engl J Med 2003 Jan 23;348(4):277-86
Division of Nephrology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Medical College of Chang Gung University, Taipei, Taiwan. jllin99@hotmail.com
BACKGROUND: Previous research suggests that environmental lead exposure correlates with age-related decreases in renal function. METHODS: Two hundred two patients with chronic renal insufficiency (indicated by a serum creatinine level between 1.5 mg per deciliter and 3.9 mg per deciliter) who had a normal total-body lead burden and no history of exposure to lead were observed for 24 months. After the observation period, 64 subjects with an elevated body lead burden were randomly assigned to the chelation control groups. For three months, the patients in the chelation group received lead-chelation therapy with calcium disodium EDTA, and the control group received placebo. During the ensuing 24 months, repeated chelation therapy was administered weekly to 32 patients with high-normal body lead burdens (at least 80 microg but less than 600 microg) unless on repeated testing the body lead burden fell below 60 microg; the other 32 patients served as controls and received weekly placebo infusions for 5 weeks every 6 months. The primary end point was an increase in the serum creatinine level to 1.5 times the base-line value during the observation period. A secondary end point was the change in renal function during the intervention period. RESULTS: The primary end point occurred in 24 patients during the observation period; the serum creatinine levels and body lead burden at base line were the most important risk factors. The glomerular filtration rate improved significantly by the end of the 27-month intervention period in patients receiving chelation therapy: the mean (+/-SD) change in the glomerular filtration rate in the patients in the chelation group was 2.1+/-5.7 ml per minute per 1.73 m2 of body-surface area, as compared with -6.0+/-5.8 ml per minute per 1.73 m2 of body-surface area in the controls (P<0.001). The rate of decline in the glomerular filtration rate in the chelation group was also lower than that in the controls during the 24-month period of repeated chelation therapy or placebo. CONCLUSIONS: Low-level environmental lead exposure may accelerate progressive renal insufficiency in patients without diabetes who have chronic renal disease. Repeated chelation therapy may improve renal function and slow the progression of renal insufficiency. Copyright 2003 Massachusetts Medical Society
PMID: 12540640, UI: 22429012