Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: Defining the role of gastroprotective agents

Treatment with anti-inflammatory drugs and the analgesic efficacy of conventional nonsteroidal anti-inflammatory drugs (NSAIDs) are compromised by a two-to fourfold increased risk of gastrointestinal complications. This increased risk has resulted in an increasing use of the new selective cyclooxygenase-2 inhibitors or coxibs, which, in clinical trials and outcomes studies, reduced gastrointestinal adverse events by 50% to 65% compared with conventional NSAIDs. However, the coxibs are not available to all patients who need them, and NSAIDs are still widely used. Moreover, treatment with a coxib cannot heal preexisting gastrointestinal lesions, and cotherapy with an antisecretory drug or mucosal protective agent may be required. This paper addresses the management of patients with risk factors for gastrointestinal complications who are taking NSAIDs and makes recommendations for the appropriate use of 'gastroproteccontinued on next pag

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Helminth records from eleven species of Emoia (Sauria: Scincidae) from Oceania

As part of an ongoing study of the biogeography of helminth parasites of lizards from Oceania, 53 specimens of Emoia (11 species) were examined, as follows: E. atrocostata, E. boettgeri, E. caerulocauda, E. cyanogaster, E. cyanura, E. impar, E. nigra, E. nigromarginata, E. ponapea, E. sanfordi, E. trossula. One species of Digenea, Paradistomoides gregarium, and six species of Nematoda, Hedruris hanleyae, Maxvachonia chabaudi, Parapharyngodon maplestoni, Physalopteroides arnoensis, Spauligodon gehyrae, and Moaciria sp. indet., were found. These helminths have been reported previously from other lizard species. Seventeen new host records and eight new locality records are reported

Gastrointestinal Helminths in Two Species of Geckos, Gekko vittatus, Gehyra oceanica,

Two species of geckos, Gekko vittatus, Gehyra oceanica and 5 species of skinks, Caledoniscincus atropunctatus, Emoia cyanogaster, Emoia erronan, Emoia nigra, and Emoia sanfordi from the Republic of Vanuatu were examined for helminths. One species of Digenea (Mesocoelium microon), 3 species of Cestoda (Gekkotaenia novaeguineaensis, Cylindrotaenia hickmani, Ophiotaenia greeri), and 7 species of Nematoda, gravid individuals of Hedruris hanleyae, Maxvachonia chabaudi, Parapharyngodon maplestoni, Spauligodon gehyrae, Spauligodon zweifeli, juveniles assigned to the Filarioidea, and larvae of Physocephalus sp. in cysts were found. Eighteen new host records and 7 new locality records are reported. The lizards of Vanuatu are infected by generalist helminths that occur in a variety of lizards throughout Oceania. © The Helminthological Society of Washington