Nutritional Strategies of an Athlete with Type 1 Diabetes Mellitus During a 217-km Ultramarathon.

Considering the challenges in meeting the high nutritional demand during ultramarathons, the aim of this study was to analyze the nutritional strategies and glycemic response of an athlete with type 1 diabetes (DM1) during participation in a 217-km ultramarathon. A 36-y-old male athlete who was diagnosed with DM1 15 y earlier was studied during participation in the Brazil 135 ultramarathon. Food consumption and blood glucose were recorded during the race, and nutritional intake was calculated after the race. The athlete completed the race in 51 h 18 min. He consumed a total of 15.0 MJ (3593 kcal), 532 g carbohydrate, 166 g protein, 92 g lipid, and 14 L of water during the race. Glycemic values ranged from 3.6 to 18.2 mmol·L-1. Most glycemic values (47%) ranged from 3.9 to 10 mmol·L-1, whereas 5% were <3.9 mmol·L-1, 16% were >10 to 13.9 mmol·L-1, and 32% were >13.9 mmol·L-1. This case report describes the dietary profile of an athlete with DM1 during a 217-km ultramarathon. Although the athlete implemented strategies that differed from those recommended in the literature, food and nutrient intake and the glycemic management strategy adopted allowed him to successfully finish the race. These results suggest that past personal experiences can be considered and that nutritional recommendations for athletes with DM1 should be individualized.

Intravaginal Tolterodine Formulation Intended for Overactive Bladder Treatment-Results of a Pharmacokinetic Phase I Pilot Study in Healthy, Postmenopausal Women.

The aim was to assess the pharmacokinetics of tolterodine released from vaginal rings and of its active metabolite 5-hydroxymethyl tolterodine (5-HMT) compared to the respective pharmacokinetics resulting from oral administration of extended-release tolterodine in healthy, postmenopausal women. In this single-center, open-label trial, subjects received 4 treatments in a fixed sequence: fasted oral extended-release tolterodine 2.74 mg/d (reference, 5 days), single vaginal rings; tolterodine releasing rates: 0.95 mg/d (test 1, 13 days), 1.40 mg/d (test 2, 28 days), 1.90 mg/d (test 3, 28 days). Systemic exposure of tolterodine, 5-HMT, and the molar sum of unbound tolterodine/5-HMT (active moiety [AM]) in steady state was determined. Sixteen of 18 included women completed the study. For the oral formulation, peak-trough fluctuations of tolterodine, 5-HMT, and AM plasma concentrations (AM: mean maximum/minimum concentration, 2580/574 pmol/L = 4.5) were large. Intravaginal application led to steadier plasma concentrations (AM, test 3: mean maximum/minimum concentration, 1880/814 pmol/L = 2.3; fluctuation due to initial peak), which is the result of constant releasing rates after ring insertion over the 28-day application period. The vaginal rings demonstrated a favorable local tolerability. The most common adverse events with oral and vaginal tolterodine were headache (n = 11) and dry mouth (n = 8). Vaginal rings releasing tolterodine represent a promising new formulation for overactive bladder treatment with little fluctuation of drug plasma levels. This is expected to lead to a more predictable and continuous therapeutic effect and a reduced frequency of side effects compared to oral tolterodine.

Acute kidney injury and tools for risk-stratification in 456 patients with hantavirus-induced nephropathia epidemica.

BACKGROUND: Puumala virus (PUUV) is the most common species of hantavirus in Central Europe. Nephropathia epidemica (NE), caused by PUUV, is characterized by acute kidney injury (AKI) and thrombocytopenia. The major goals of this study were to provide a clear clinical phenotyping of AKI in patients with NE and to develop an easy prediction rule to identify patients, who are at lower risk to develop severe AKI. METHODS: A cross-sectional prospective survey of 456 adult patients with serologically confirmed NE was performed. Data were collected from medical records and prospectively at follow-up visit. Severe AKI was defined by standard criteria according to the RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) classification. Fuller statistical models were developed and validated to estimate the probability for severe AKI. RESULTS: During acute NE, 88% of the patients had AKI according to the RILFE criteria during acute NE. A risk index score for severe AKI was derived by using three independent risk factors in patients with normal kidney function at time of diagnosis: thrombocytopenia [two points; odds ratios (OR): 3.77; 95% confidence intervals (CI): 1.82, 8.03], elevated C-reactive protein levels (one point; OR: 3.02; 95% CI: 1.42, 6.58) and proteinuria (one point; OR: 3.92; 95% CI: 1.33, 13.35). On the basis of a point score of one or two, the probability of severe AKI was 0.18 and 0.28 with an area under the curve of 0.71. CONCLUSION: This clinical prediction rule provides a novel and diagnostically accurate strategy for the potential prevention and improved management of kidney complications in patients with NE and, ultimately, for a possible decrease in unnecessary hospitalization in a high number of patients.

Comparison of the efficacy of povidone-iodine 1.0%, 5.0%, and 10.0% irrigation combined with topical levofloxacin 0.3% as preoperative prophylaxis in cataract surgery.

PURPOSE: To compare the efficacy of povidone-iodine 1.0%, 5.0%, and 10.0% in combination with topical levofloxacin 0.3% in reducing the preoperative conjunctival bacterial load before cataract surgery. SETTING: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. DESIGN: Randomized clinical trial. METHODS: This study enrolled patients scheduled for cataract surgery between July 2010 and January 2011. All patients received topical levofloxacin 0.3% 4 times on the preoperative day and were randomly assigned to these study groups: Group 1 (povidone-iodine 1.0%), Group 2 (povidone-iodine 5.0%), and Group 3 (povidone-iodine 10.0%). In all groups, the conjunctiva was flush irrigated with 10 mL of povidone-iodine of the respective concentration. Conjunctival specimens were obtained at 4 timepoints: baseline (no-surgery eye), before povidone-iodine irrigation, after povidone-iodine irrigation, and at the end of surgery. All specimens were inoculated onto blood and chocolate agars and into thioglycolate broth. RESULTS: The study was completed by 271 patients. In the control smear (no-surgery eye), no significant difference in positive cultures was found. After 10 mL povidone-iodine irrigation, a considerable reduction in the conjunctival bacterial load occurred in all groups. The difference in positive cultures was statistically significant between Group 1 and Group 3 (P=.024) and between Group 2 and Group 3 (P=.029). Coagulase-negative Staphylococcus was the most commonly isolated bacteria in all groups. CONCLUSION: Povidone-iodine 10.0% was more effective than povidone-iodine 1.0% and 5.0% in decreasing the conjunctival bacterial load before surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.