Elderly African-American and Caucasian men are infrequently screened for osteoporosis.

INTRODUCTION: To retrospectively examine the factors that initiated a request for dual x-ray absorptiometry (DXA) in elderly males in a rheumatology practice and to determine if there were differences between African Americans and Caucasians, MATERIALS AND METHODS: The records of 98 consecutive male patients in the rheumatology clinic were reviewed for demographic data and risk factors and treatment for osteoporosis. DXA results were noted and classified as normal, osteopenic or osteoporotic. RESULTS: There were 59 (60%) African Americans, 38 (39%) Caucasians and one (1%) Native American included for study. Fourteen patients had DXA-three (5%) among the African Americans and 11 (29%) among the Caucasians. Age was not found to be a significant predictor of obtaining DXA. Caucasians were 7.69 times more likely to have a DXA than African Americans. After adjusting for ethnicity, oral glucocorticoid use and rheumatoid arthritis were significant predictors of obtaining a DXA, although only 31% and 35% of patients on glucocorticoids or with rheumatoid arthritis, respectively, had DXA. Using a logistic regression model, ethnicity (odds ratio 4.61) remained the only significant predictor of requests for DXA. CONCLUSION: Male patients infrequently had DXA despite the presence of well-established risk factors for osteoporosis. Compared to Caucasians, fewer African Americans were screened even in the presence of similar risk factors for osteoporosis.

Surgical therapy for biliary dyskinesia: a meta-analysis and review of the literature.

BACKGROUND: Although biliary dyskinesia is treated commonly with cholecystectomy, the supporting literature is limited. A review and meta-analysis of the literature were performed to assess the efficacy of surgical therapy for biliary dyskinesia. MATERIALS AND METHODS: A MEDLINE search for the period 1965 to 2003, using the search strings "biliary," "acalculous," "dyskinesia," "cholecystitis," "cholecystectomy," and "therapy" returned 187 articles. Inclusion criteria required a study design that placed patients with biliary dyskinesia into one of two treatment groups, cholecystectomy or nonoperative therapy, and a follow-up assessment of symptomatic improvement. RESULTS: Five studies met the inclusion criteria, representing a total of 274 patients. Surgical therapy resulted in 98% symptomatic relief compared to 32% with nonoperative management (P<0.0001). Patients undergoing surgical therapy for biliary dyskinesia were 2.79 times more likely to have symptomatic relief versus nonoperative therapy (95% confidence interval, 2.05-3.79). CONCLUSION: Based on this meta-analysis, cholecystectomy for biliary dyskinesia is an effective therapy and offers significant symptomatic relief over nonoperative therapy.

Impact of worsening renal function during hospital admission on resource utilization in patients with heart failure.

Renal impairment frequently accompanies heart failure (HF) and is a recognized independent risk factor for morbidity and mortality. Few data are available assessing the impact of worsening renal function (WRF) during hospitalization on health care resource use in patients with HF. Health Insurance Portability and Accountability Act-compliant, de-identified, clinical, laboratory, and economic data for patients admitted to a tertiary care medical center with a primary diagnosis of HF were extracted by MedMining and reviewed retrospectively by the authors. Patients were excluded if they had no previous HF or were admitted for acute coronary syndrome or coronary artery bypass grafting within 30 days of index hospitalization. WRF was defined as ≥ 0.3 mg/dl increase in serum creatinine from baseline at any time during hospitalization. Of 5,803 hospitalized patients with primary HF diagnosis, 827 patients (14%) fulfilled all prespecified inclusion and exclusion criteria (74 ± 14 years of age, 43% men, 98% white, admission serum creatinine 1.4 ± 0.9 mg/dl, estimated glomerular filtration rate < 90 ml/min/1.73 m(2) at admission in 83%). During index hospitalization, WRF was identified in nearly 33%. Compared to patients without WRF, those with WRF had greater prevalence of diabetes (54% vs 43%), lower estimated glomerular filtration rate (44 ± 30 vs 62 ± 35 ml/min/1.73 m(2)), higher serum potassium (4.3 ± 0.7 vs 4.2 ± 0.7 mEq/L), and higher B-type natriuretic peptide (845 ± 821 vs 795 ± 947 pg/ml) at baseline (all p values < 0.05). Patients developing WRF incurred higher total inpatient costs ($10,977, range 671 to 212,819, vs $7,820, range 697 to 269,797, p < 0.001) and longer hospital stay (8.2 ± 6.8 vs 5.7 ± 5.5 days, p < 0.001). In conclusion, occurrence of WRF during HF-related hospitalization is associated with higher hospitalization costs and longer hospital stay.

Salmonella enteritidis in broiler chickens, United States, 2000-2005.

US Department of Agriculture Food Safety and Inspection Service (FSIS) data on Salmonella enterica serotype Enteritidis in broiler chicken carcass rinses collected from 2000 through 2005 showed the annual number of isolates increased >4-fold and the proportion of establishments with Salmonella Enteritidis-positive rinses increased nearly 3-fold (test for trend, p<0.0001). The number of states with Salmonella Enteritidis in broiler rinses increased from 14 to 24. The predominant phage types (PT) were PT 13 and PT 8, 2 strains that a recent Foodborne Diseases Active Surveillance Network (FoodNet) case-control study associated with eating chicken. FSIS is directing more sampling resources toward plants with marginal Salmonella control to reduce prevalence in products including broilers. The policy targets establishments with common Salmonella serotypes of human illness, including Salmonella Enteritidis. Voluntary interventions should be implemented by industry.