Fatal Recurrent Staphylococcus aureus Infection in a Patient With an Aortic Endostent Under Alirocumab.

PURPOSE: Aortic stent-graft infection (SGI) entails a high mortality. Alirocumab is a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), approved for treatment of therapy-refractory hypercholesterolemia. Proprotein convertase subtilisin/kexin type 9 might play a role in infections. CASE REPORT: A 68-year-old male suffered from fatigue, fever, and back pain. Twelve months previously, a 4-fold-fenestrated aortic endoprosthesis was implanted because of an aortic aneurysm. Four months later, alirocumab 150 mg was initiated. Staphylococcus aureus grew in several blood cultures, and he received cefazolin and fosfomycin. Fludeoxyglucose positron emission tomography computed tomography indicated an infected endoprosthesis. Puncture of the periprosthetic space under antibiotic therapy revealed different strains of Staphylococcus epidermidis. The therapy was changed to dalbavancin. The patient died suddenly 11 days later after complaining about back pain for several days. No autopsy was carried out. CONCLUSIONS: The most probable cause of the patient's recurrent bacteremia with S aureus was an infection of the aortic prosthesis. Although this report is very speculative, it can be concluded that data about infections in patients under PCSK9 inhibitors should be collected systematically and more research is needed about the biological consequences of decreasing cholesterol to extreme low levels.

Impact of depression on health related quality of life in patients with diabetes.

INTRODUCTION: Diabetes mellitus (DM) is a serious chronic illness that has a major impact on the quality of life of the individuals. Our aim was to examine the determinants of health-related quality of life (HRQOL) in patients with DM. MATERIALS AND METHODS: Adult outpatients attending a Diabetes Centre were recruited on consecutive basis between August 2006 and February 2007. Clinical data were collected from interviews with the subjects and from medical records. Assessment of depressive symptoms was done using the Center for Epidemiologic Studies Depression Scale (CES-D) and HRQOL using the Short Form 36 Health Survey (SF-36). A two-step regression analysis was conducted for identifying factors affecting patients' quality of life. RESULTS: Five hundred and thirty-seven patients participated in the study. The mean (SD) age of the participants was 54.7 (13.3) years and 315 (58.7%) were males. The prevalence of depressive symptoms was 31.1% (n = 167). After adjusting for other variables, the effects of depressive symptoms persisted for all the 8 domains of SF-36 (P <0.001 for all). The medical factors that were negatively associated with HRQOL were a diagnosis of Type 1 DM, duration of the illness of more than 10 years, HbA1c levels of ≥7%, and comorbidity of stroke and retinopathy. Being male and a regular exerciser had a positive effect on HRQOL. CONCLUSION: These findings highlight the importance of detecting and treating comorbid depression in DM.

Comorbid depression and increased health care utilisation in individuals with diabetes.

OBJECTIVE: The objective of this study was to examine the extent of health care utilisation (excluding costs) of diabetic patients with and without depressive symptoms attending a specialist clinic in Singapore. METHODS: A total of 537 Asian outpatients (aged 21 years and above) who were attending a Diabetes Centre were recruited on a consecutive basis between August 2006 and February 2007. Sociodemographic data, clinical and health care utilisation data were collected from the participants. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. RESULTS: Individuals with depressive symptoms, on average, had more hospitalizations and hospitalization days. Those with depression reported losing significantly more working days as compared to the nondepressed individuals (1.9 vs. 1.4, P=.001). CONCLUSIONS: Our findings in this population suggest that the presence of depressive symptoms has an independent effect on the greater utilization of medical services.

Depressive symptoms and diabetes mellitus in an Asian multiracial population.

INTRODUCTION: Singapore has one of the world's highest rates of diabetes mellitus (DM). DM is also associated with depression, the nature of this relation is possibly bidirectional and complex and there are a number of putative associated factors. AIMS: To establish the prevalence of depressive symptoms in an Asian multiracial population with diabetes and identify some of these putative risk factors including ethnicity for depressive symptoms while controlling for multiple confounding variables. METHODS: This is a cross-sectional epidemiological study in an Asian multiracial population with DM. The subjects were 537 outpatients (aged 21 years and above) attending a specialist diabetes treatment centre in a general hospital. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) with a cut-off score of 16 or more indicating the presence of depressive symptoms. RESULTS: The prevalence of depressive symptoms was 31.1%. Following a logistic regression with depression as the dependent variable, Indian race, type of treatment, activity level and marital status (divorced/separated) were significantly associated with a high risk of depression. CONCLUSIONS: This is the first study done among 3 ethnic groups Chinese, Malays and Indians within the same geographical location, and the findings show that depressive symptoms are common among diabetic patients and highest among those of Indian ethnicity.

Screening for depressive symptoms: validation of the center for epidemiologic studies depression scale (CES-D) in a multiethnic group of patients with diabetes in Singapore.

OBJECTIVE: We determined the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) against the DSM-IV-based diagnostic inventory, Schedule for Clinical Assessment in Neuropsychiatry (SCAN), in a multiethnic sample of adult subjects with diabetes attending a diabetes center in Singapore. RESEARCH DESIGN AND METHODS: A total of 522 subjects (74.7% Chinese, 11.1% Malay, and 14.2% Indian) completed culturally adapted versions of the CES-D; 291 subjects were administered the SCAN inventory. RESULTS: The CES-D (cutoff score 16) showed high negative predictive values of more than 90% in all three ethnic groups. The prevalence of depressive symptoms (CES-D) and depression (SCAN) was significantly different between the Chinese and Indian subjects (CES-D 27.4 vs. 43.2%, P = 0.006); (SCAN 15.0 vs. 31.1%, P = 0.01). CONCLUSIONS: The CES-D proved to be a reliable instrument for identifying patients with depressive symptoms in the multiethnic setting of this study.