Azithromycin versus erythromycin infusions prior to endoscopy in upper gastrointestinal bleeding.

Background: Intravenous erythromycin prior to endoscopy for upper gastrointestinal bleeding (GIB) improves outcomes but requires immediate preparation delaying administration in emergency cases. Azithromycin is readily available and does not require prolonged preparation. The aim of the study was to assess the effect of azithromycin in improving the quality of endoscopic visualization in upper GIB compared to erythromycin. Methods: Patients admitted with upper GIB who received erythromycin or azithromycin before urgent endoscopy were included. Primary outcome of the quality of visualization was assessed by two gastroenterologists, blinded to the choice of infusion, using a scoring system ranging from 0 to 8, with a maximum of 2 points assigned to the fundus, body, antrum and bulb. Results: Sixty-six patients were included; 25 received azithromycin and 41 received erythromycin. Mean total visualization score was significantly higher with azithromycin compared to that with erythromycin (6.8±1.4 vs. 5.5±2.2, respectively; P=0.01) and remained significant after adjusting for confounders (Diff: 0.01, 1.88; P=0.05). Secondary outcomes analyses showed a shorter LOS when given azithromycin compared to erythromycin [6 (3 to 9) vs. 8 (7 to 16) days, respectively, 95% CI: 1.03, 3.89; P=0.04]. Time between initiating the infusion and endoscopy was longer with azithromycin (Diff: 40.64 min; 95% CI: 7.23, 74.05; P=0.02). Need for second look endoscopy, procedure time, blood transfusion requirements and procedure-related complications did not differ between the groups. Conclusions: Azithromycin infusion before endoscopy for upper GIB was associated with better visualization than that of erythromycin. Randomized trials are needed to validate these findings.

Is Self-Reported Sleep Duration Associated with Osteoporosis? Data from a 4-Year Aggregated Analysis from the National Health and Nutrition Examination Survey.

OBJECTIVES: To examine the association between self-reported sleep duration and osteoporosis in a national sample of the U.S. elderly population. DESIGN: Population-based cross-sectional study. SETTING: Four-year National Health and Nutrition Examination Survey data from two survey cycles between 2005-06 and 2007-08. PARTICIPANTS: Men and women aged 50 and older with data in the surveys and medical examination data files (N = 5,288). MEASUREMENTS: Osteoporosis diagnosis was based on bone mineral density measurement and self-report. Sleep duration was ascertained from the sleep survey. Simple and multiple logistic regression models were used to evaluate the association between these two factors. RESULTS: Shorter sleep duration (<6 hours) was found to be significantly associated with osteoporosis after adjusting for potential covariates (odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.07-2.37). After stratifying according to age group, this association remained significant (OR = 1.80, 95% CI = 1.20-2.68) only in the older age group (>65). CONCLUSION: These results underscore the possible linkage between sleep and osteoporosis and the need for additional research on this topic.