CRP does not perform better than the Framingham risk equation for discrimination. The improvement in risk stratification or reclassification from addition of CRP to models based on established risk factors is small and inconsistent. Guidance on the clinical use of CRP measurement in the prediction of coronary events may require updating in light of this large comparative analysis.
Chlorhexidine-Alcohol Versus Povidone-Iodine for Surgical-Site AntisepsisDarouiche RO, Wall MJ Jr, Itani KMF, et al. N Engl J Med 2010;362:18-26. Conclusion: For clean-contaminated surgery, cleansing of the patient's skin with chlorhexidine-alcohol reduces surgical-site infections compared with cleansing with povidone-iodine.Summary: There are 27 million operative procedures performed annually in the United States (Infect Control Hosp Epidemiol 1999;20:250-78). Surgical-site infections occur in 300,000-500,000 patients in the United States each year (J Am Coll Surg 2008;206:814-9; JAMA 2005;294: 2035-42). There are recommendations by the Centers for Disease Control and Prevention (CDC) to use 2% chlorhexidine preparations for preoperative cleansing of sites for insertion of vascular catheters, but no CDC recommendations have been put forth regarding antiseptics to prevent surgical-site infection in surgical procedures.This study compared the efficacy of povidone-iodine and chlorhexidinealcohol in preventing surgical-site infections in patients with clean-contaminated operations in six university-affiliated hospitals. Patients were randomly assigned to preoperative skin preparation with chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. Surgical-site infection Յ30 days was the primary outcome. Secondary outcomes included individual types of surgicalsite infection.There were 849 patients (440 in the povidone-iodine group and 409 in the chlorhexidine-alcohol group) that qualified for intention to treat analysis. Surgical-site infection rates were lower in the chlorhexidine-alcohol group than the povidone-iodine group (9.5% vs 16.1%; relative risk, 0.59; 95% confidence interval, 0.41-0.85; P ϭ .004). With regard to secondary end points, chlorhexidine-alcohol was more protective against surgical-site infections than povidone-iodine for superficial incisional infections (4.2% vs 8.6%, P ϭ .008) and deep incisional infections (1% vs 3%, P ϭ .05). There was no difference in protection against organ-space infections 4.4% vs 4.5%. There were 813 patients who were in the study for 30 days and were subject to a per protocol analysis. Overall results remain similar. No differences were noted in adverse events in the two study groups.Comment: In the accompanying editorial to this article, Dr Richard Wenzel makes the observation that human beings have approximately 10 13 total cells, with a total number of colonizing microbes per human being of 10 14 . Basically, bacteria have a 10:1 numerical advantage! The study indicates that all infections at a specific anatomic site can be reduced with a relatively inexpensive process. By substituting chlorhexidine-alcohol for povidone-iodine, all we need to treat are 17 surgical patients with cleancontaminated wounds to prevent 1 surgical-site infection. Of course, vascular surgical procedures fall primarily into the clean-wound category rather than clean-contaminated, as studied here. Nevertheless, the weight of the available literature with respect to chlorhexidine-alco...
We have used anchored PCR to amplify and sequence 1400 bp of the 15th intron of the Low Density Lipoprotein (LDL) receptor gene, and have determined oligonucleotides and conditions for the genotyping of the previously reported PvuII polymorphism. The cutting site (CAGCTG) is created by the transition of a CpG to a TpG within the sequence CAGCCG at a position roughly 600 bp 5' from the splice acceptor site of exon 16. Genotype was determined in three population-based samples of healthy individuals. In a group of 318 men and women from Iceland the frequencies of the Intron-15 T (cutting) allele was 0.23 (95% CI, 0.19-0.28) and was similar in men and women. In two groups of men from England (n = 385) and Scotland (n = 320), the frequency was similar, being 0.23 (0.19-0.27) and 0.25 (0.22-0.28) respectively. Individuals who were homozygous for the T allele had lower levels of total-cholesterol triglycerides and apolipoprotein B, than those with other genotypes, and in the combined group of UK men this effect reached statistical significance; compared to the C/C group, the T/T group had 6% lower cholesterol (p = 0.02) and 15% lower triglycerides (p = 0.03). The lowering effect associated with the T/T genotype was greater in men who were in the lowest tertile of body mass index (< 25 kg/m2) and for the trait of apoB levels, this genotype x obesity interaction was statistically significant (p = 0.01). We thus confirm the association between this allele and lower levels of plasma lipid levels previously reported. The availability of a PCR-based method to detect this polymorphism will facilitate further investigation of the impact of LDL-receptor gene variation in determining lipid levels.
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