Background/AimsGastroparesis is characterized by delayed gastric emptying without obstruction. Diabetes is frequently associated with poor glycemic control and delayed gastric emptying. Gastric emptying scintigraphy (GES) is the standard for measuring gastric emptying. Serum hemoglobin A1C (HbA1C) measures prolonged glycemic control with normal as < 7% glycated. To date, no correlation of serum HbA1C level with gastric emptying, demonstrated by GES, in diabetics has been performed. The aim of the present investigation is to determine if a relationship exists between serum HbA1C levels and gastric emptying, assessed by GES, in diabetics.MethodsAll diabetics, having both GES and serum HbA1C level within 3 months from July 1, 2003 - June 30, 2008 were eligible for study. Demographic data collected included gender, age and ethnicity. Abnormal gastric emptying was defined as T½ > 120 minutes and serum HbA1C as percent glycated.ResultsNuclear Medicine GES database review revealed 431 examinations performed during the study interval. A total of 181 were not eligible due to the following: 29 duplicates, 22 diabetes not documented and 130 without HbA1C levels, resulting a study group of 250 cases. No significant correlation was observed between gastric emptying time, HbA1C or age. Among patients with HbA1C ≥ 7%, HbA1C was inversely related to age with a coefficient of correlation of r = -0.175 (p = 0.038).ConclusionsThere is no correlation observed between gastric emptying time, using GES, and serum HbA1C levels. In diabetics, serum HbA1C is not as important as daily glycemic control regarding gastric emptying.

Background:We aimed to systematically review the effectiveness of healthcare behavioral and education interventions for gout patients on clinical outcomes.Methods:We searched multiple databases to identify trials or observational studies of educational or behavioral interventions in gout. Risk of bias was assessed with the Cochrane tool for randomized control trials (RCTs) and the Newcastle–Ottawa Scale for observational studies. We estimated odds ratios (ORs) for categorical and standardized mean difference (SMD) for continuous measures using a random-effects model.Results:Overall, eight (five RCTs and three observational) studies met the inclusion criteria and examined pharmacist-led interventions (n = 3), nurse-led interventions (n = 3) and primary care provider interventions (n = 2). Compared with the control intervention (usual care in most cases), a higher proportion of those in the educational/behavioral intervention arm achieved serum urate (SU) levels <6 mg/dl, 47.2% versus 23.8%, the OR was 4.86 [95% confidence interval (CI), 1.48, 15.97; 4 RCTs] with moderate quality evidence. Compared with the control intervention, a higher proportion of those in the educational/behavioral intervention arm were adherent to allopurinol, achieved at least a 2 mg/dl decrease in SU, achieved an SU < 5 mg/dl, had a reduction in the presence of tophi at 2 years, had improved quality of life as assessed with SF-36 physical component scores, had a higher knowledge about gout and higher patient satisfaction (moderate-low quality evidence).Conclusion:Educational and behavioral interventions can improve gout outcomes in the short-intermediate term. Randomized trials are needed to assess its impact on long-term gout outcomes.

Reduced calcium absorption is a risk factor for osteoporosis. This study examined factors associated with fractional calcium absorption (FCA) and net calcium absorption (NCA) in postmenopausal women in a post-hoc analysis of three completed dual isotope studies. Data were analyzed from fifty postmenopausal women undergoing 121 inpatient research visits in three studies evaluating changes in FCA related to correction of vitamin D insufficiency (n=19), use of proton pump inhibitors (n=21) and use of aromatase inhibitors to treat breast cancer (n=10). NCA was the product of FCA and total calcium intake in mg/day. Variables included subjects’ age, race, body mass index, serum calcium, creatinine, parathyroid hormone, 1,25(OH)2D, 25(OH)D and habitual intake of kilocalories, protein, fat, carbohydrate, fiber, calcium, iron, magnesium, oxalate, phosphorus, potassium and vitamin D based on outpatient diet diaries. In multivariate models, subjects’ age, dietary intake of kilocalories, carbohydrates, fat, fiber, calcium and potassium were significant predictors of FCA. In multiple variable models predicting NCA, dietary intake of kilocalories, fat, fiber, calcium, potassium and serum 1,25(OH)2D were significant. The square of the correlation between actual and predicted values (an approximation of R2) was 0.748 for FCA and 0.726 for NCA. Similar to other studies, this study found that age, 1,25(OH)2D and dietary calcium and fat were associated with calcium absorption. Dietary intake of kilocalories, carbohydrates and potassium were new factors that significantly associated with FCA and NCA. In summary, the study suggests that several dietary habits play a role in calcium absorption, beyond vitamin D and calcium.

Background: To systematically review the diagnostic accuracy of salivary gland ultrasound in primary Sjögren’s syndrome (pSS). Methods: PubMed, Embase, CINAHL, Cochrane Central and Scopus and ClinicalTrials.gov were searched to identify diagnostic or validation studies in patients with pSS meeting the diagnostic criteria. A diagnostic test meta-analysis was performed using a bivariate model to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios, and the diagnostic odds ratio. Meta-regression analyses were done for several pSS covariates. Results: Sixty-five studies met our criteria for the qualitative review. Fifty-four studies with a total of 6087 patients were included in the meta-analysis. Pooled sensitivity for salivary gland ultrasound was 80% [95% confidence interval (CI): 77–83%; I2 = 78%], and specificity was 90% (95% CI: 87–92%; I2 = 76%). The pooled positive and negative likelihood ratios were 8 (95% CI: 6.4–10) and 0.22 (95% CI: 0.19–0.25), respectively. The corresponding pooled diagnostic odds ratio (DOR) was 37 (95% CI: 28–48). Separate meta-regression models resulted in similar diagnostic estimates: (a) adjusted for mean age: sensitivity 81% (95% CI:77–84%; I2 = 99%) and specificity 90% (95% CI: 87–93%; I2 = 99%); (b) adjusted for mean disease duration, sensitivity 79% (95% CI:72–84%; I2 = 99%), and specificity 90% (89–94%; I2 = 99%). The diagnostic estimates were robust to sensitivity analyses by quality criteria, pSS diagnostic criteria and ultrasound scoring systems. Conclusion: Salivary gland ultrasound is a valuable modality for the diagnosis of Sjögren’s syndrome. It is plausible that salivary gland ultrasound can be used as an important criterion for the diagnosis of pSS.