Potential CYP2C9-mediated drug-drug interactions in hospitalized type 2 diabetes mellitus patients treated with the sulphonylureas glibenclamide, glimepiride or glipizide

OBJECTIVES

Sulphonylureas are widely used in the treatment of type 2 diabetes mellitus (T2DM). Based on laboratory findings, we determined the clinical significance of potential CYP2C9-mediated drug-drug interactions in hospitalized patients receiving glibenclamide, glimepiride or glipizide, all of which are metabolized by CYP2C9, together with a CYP2C9 inhibitor.

DESIGN, SETTING AND SUBJECTS

An observational pharmaco-epidemiological database study was performed in a university hospital setting with 3884 patients with T2DM.

MAIN OUTCOME MEASURES

Efficacy and safety of sulphonylurea therapy during the potential interaction (sulphonylurea treatment with a CYP2C9 inhibitor) vs. control periods (sulphonylurea treatment without a CYP2C9 inhibitor) were estimated using laboratory parameters.

RESULTS

Almost 20% of patients were exposed to a potential drug-drug interaction with a CYP2C9 inhibitor during sulphonylurea treatment. More than 75% of the potential interactions occurred with trimethoprim, metronidazole and fluconazole. When all sulphonylureas were pooled and adjusted for age, gender, ward and sulphonylurea dose, mean and maximum fasting plasma glucose concentrations as well as maximum values of glycosylated haemoglobin were significantly lower during the interaction periods compared with control periods, whereas mean and minimum activities of alanine amino transferase and gamma-glutamyl transferase were higher. The minimum fasting plasma glucose values were more often below the target range in patients with potential interactions. The sulphonylurea dose did not differ significantly between patients who were or were not concomitantly treated with a potentially interacting drug.

CONCLUSIONS

Concomitant use of a CYP2C9 inhibitor results in exaggerated pharmacodynamic effects of sulphonylureas and increases the risk of hypoglycaemia in T2DM patients receiving glibenclamide, glimepiride or glipizide.

High genetic relatedness among Mycobacterium avium strains isolated from pigs and humans revealed by comparative IS1245 RFLP analysis

Members of the Mycobacterium avium complex cause pig mycobacteriosis and opportunistic human infections. Infections due to environmental mycobacteria are increasing in both industrial and developing countries. Mycobacterium-infected pig carcasses can pass for human consumption due to the poor specificity of meat control by visual detection at the slaughter houses. The genetic relatedness of porcine and human MAC isolates in Finland has been unknown. M. avium isolates isolated from pig organs (n=16) and clinical samples (n=13) were compared by IS1245 RFLP analysis to evaluate the similarity of the isolates obtained from human and porcine samples. Nearly identical multicopy M. avium subsp. hominissuis IS1245 RFLP fingerprints were obtained for isolates of porcine and human origin. IS1245 RFLP patterns of 38% of the porcine and human M. a. hominissuis isolates were >90% similar. The RFLP patterns of two porcine and two human isolates showed >95% similarity. The high similarity of the IS1245 RFLP patterns of the human and porcine M. a. hominissuis isolates indicates close genetic relatedness, suggesting that M. a. hominissuis is transmitted between pigs and humans, or that pigs and humans share common environmental sources of infection. Porcine and human isolates with RFLP patterns differing by only one or two bands were found, which shows that the same M. a. hominissuis strains may infect both humans and pigs.

Proliferation of mycobacteria in a piggery environment revealed by mycobacterium-specific real-time quantitative PCR and 16S rRNA sandwich hybridization

Pig mycobacteriosis is the most common animal mycobacterial disease in Finland with a long-term average prevalence of 0.34% and temporary peaks as high as 0.85%. In the current study Mycobacterium-specific real-time qPCR and 16S rRNA sandwich hybridization were utilized for culture-independent detection and measurement of potentially infectious mycobacteria in selected piggeries. Participating herds (n=5) were selected according to prevalence of tuberculous lesions (>4%) in slaughtered carcasses. When DNA extracted from piggery bedding materials was analyzed by Mycobacterium-targeted qPCR using the SYBR green I dye for detection of amplification products, 10(5) to 10(7) cell equivalents of mycobacterial DNA were detected in unused bedding materials and 10(8) to 10(10)g(-1) dry weight in used bedding materials. When Mycobacterium-specific hybridization probes were used for detection of amplification products, 10(5) to 10(7) cell equivalents of mycobacterial DNA g(-1) dry weight were detected in unused bedding materials in four out of the five piggeries studied and up to 10(8) cell equivalents in used bedding material. The results were confirmed by the Mycobacterium-specific 16S rRNA sandwich hybridization assay. The present results show, that mycobacteria occur in organic materials commonly used on pig farms, and may proliferate in bedding materials during use. We also show that DNA- and RNA-based methods may be utilized for detection of environmental reservoirs of mycobacteria causing porcine and human infection.

Experimental trichinellosis in reindeer

Six female reindeer calves were inoculated intraruminally with various doses of Trichinella muscle larvae. Four calves were inoculated with T. nativa, receiving 15,000 (n = 1), 5,000 (1), and 2,500 (2) larvae each. Two calves were inoculated with 5,000 T. spiralis larvae each. Blood samples were collected twice per week for total white blood cell (WBC) and differential counts and for serology using enzyme-linked immunosorbent assay (ELISA) based on T. spiralis excretory-secretory antigen. On day 56, the calves were slaughtered and muscle samples were examined according to the standard digestion method for Trichinella larvae. Blood samples were also collected twice a week from 4 uninoculated, but otherwise similar, reindeer calves corralled separately. Both the total WBC and eosinophil counts of the inoculated animals were, on average, higher during the experimental period. All the inoculated calves seroconverted, showing an increase in the optical density (OD) in the ELISA starting between day 23 and day 27 postinoculation. Very few muscle larvae (<0.08 larvae/g [lpg]) were to be found from the animals inoculated with T. nativa, but about 4 and 6 lpg were recovered from the masseter muscles of those inoculated with T. spiralis.

Smoking and drinking habits in adolescence--links with psychiatric disturbance at the age of 8 years

Smoking and drinking habits were studied among 1098 14-15-year-old adolescents using a mailed questionnaire. The subjects were drawn from a representative population of 5813 randomly selected 8-year-old children previously studied in the National Epidemiological Child Psychiatry Study in Finland in 1989. The questionnaire included items on the adolescents' smoking habits and alcohol consumption. Regular smoking was more common among boys (and girls) who, in childhood, had been rated by their parents (Rutter Parent Questionnaire) (RA2) as disturbed, 14.6% (30.3%), than among the nondisturbed, 6.6% (8.4%). Similarly, more of the previously disturbed (according to the RA2) adolescent boys drank alcohol regularly, 19.7%, as compared to the nondisturbed boys, 9.3%. Among girls, regular alcohol consumption was more common among those who previously had behavioural or mixed type problems (according to the RA2), 70.7%, as compared to those who previously had emotional or no problems, 12.2%. More of the previously depressed girls smoked regularly, 45.1%, than those who had not been depressed, 7.9%. Behavioural and emotional problems in childhood seemed to predispose to smoking and drinking in adolescence. The parents were more sensitive than the teachers in recognising the long-lasting problems of their children.

A follow-up of enuresis from childhood to adolescence

OBJECTIVE

To determine the prevalence and treatment of enuresis in a national population-based follow-up study of children aged 8-14 years, to evaluate possible factors that enhance or hamper the attainment of continence and to examine the relationships between enuresis and psychiatric disturbance.

SUBJECTS AND METHODS

An initial study was carried out in 1989 as part of the Finnish Child Psychiatric National Epidemiological Study. Three types of questionnaires were used; the Rutter Scale A for completion by parents, including a question about enuresis, the Rutter scale B for completion by teachers and the Children's Depression Inventory (CDI), completed by the children. Parents were also asked about demographic and family issues, teachers about school achievements and children about additional psychosomatic symptoms. In a follow-up in 1995, the target population comprised all previous enuretics and their controls, matched by age, gender, class and school, in the first phase of the study. Replies were received from 315 enuretic boys and 186 girls, with the corresponding values for controls being 310 and 183. The parents were asked about the adolescents' present enuresis and for permission for a treatment trial, if needed. The adolescents completed the CDI, and a questionnaire about enuresis, previous treatments and possible willingness for a treatment trial. They also reported basic somatic data, their life events and living habits.

RESULTS

In the initial study, the enuretic children had higher total and subscores as reported by parents, teachers and themselves, except for emotional items reported by the teachers. Additionally, a significantly greater proportion of these children soiled, had sleeping difficulties and difficulties in falling asleep. Enuretic boys had more frequent nightly arousal and early morning waking, while the enuretic girls had more nightmares than non-enuretic girls. At 14 years old, the parents reported that 13 adolescents were enuretic; from the children's replies, nine boys and seven girls were enuretic.

CONCLUSIONS

The prevalence of enuresis in those previously enuretic was surprisingly low, probably because of the efficient treatment methods, conditioning and medication. There were evident connections between childhood enuresis and mental well-being.