Musculoskeletal Safety Outcomes of Patients Receiving Daptomycin With HMG-COA Reductase Inhibitors

Daptomycin, a cyclic lipopeptide antibiotic, and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are commonly administered in the inpatient setting and are associated with creatine phosphokinase (CPK) elevations, myalgias, and muscle weakness. Safety data for coadministration of daptomycin with statins are limited. To determine the safety of coadministration of daptomycin with statin therapy, a multicenter, retrospective, observational study was performed at 13 institutions in the Southeastern United States. Forty-nine adult patients receiving statins concurrently with daptomycin were compared with 171 patients receiving daptomycin without statin therapy. Detailed information, including treatment indication and duration, infecting pathogen, baseline and subsequent CPK levels, and presence of myalgias or muscle complaints, was collected. Myalgias were noted in 3/49 (6.1%) patients receiving combination therapy compared with 5/171 (2.9%) of patients receiving daptomycin alone (P = 0.38). CPK elevations of \u3e1,000 U/liter occurred in 5/49 (10.2%) patients receiving combination therapy compared to 9/171 (5.3%) patients receiving daptomycin alone (P = 0.32). Two of five patients experiencing CPK elevations of \u3e1,000 U/liter in the combination group had symptoms of myopathy. Three patients (6.1%) discontinued therapy due to CPK elevations with concurrent myalgias in the combination group versus 6 patients (3.5%) in the daptomycin-alone group (P = 0.42). CPK levels and myalgias reversed upon discontinuation of daptomycin therapy. Overall musculoskeletal toxicity was numerically higher in the combination group but this result was not statistically significant. Further prospective study is warranted in a larger population

The Hot Gas Exhaust of Starburst Engines in Mergers: Testing Models of Stellar Feedback and Star Formation Regulation

Using archival data from the Chandra X-ray telescope, we have measured the spatial extent of the hot interstellar gas in a sample of 49 nearby interacting galaxy pairs, mergers, and merger remnants. For systems with SFR > 1 M(sun)/yr, the volume and mass of hot gas are strongly and linearly correlated with the star formation rate (SFR). This supports the idea that stellar/supernovae feedback dominates the production of hot gas in these galaxies. We compared the mass of X-ray-emitting hot gas Mx(gas) with the molecular and atomic hydrogen interstellar gas masses in these galaxies (M(H2) and M(HI), respectively), using published carbon monoxide and 21 cm HI measurements. Systems with higher SFRs have larger Mx(gas)/(M(H2) + M(HI)) ratios on average, in agreement with recent numerical simulations of star formation and feedback in merging galaxies. The Mx(gas)/(M(H2) + M(HI)) ratio also increases with dust temperature on average. The ratio Mx(gas)/SFR is anti-correlated with the IRAS 60 micron to 100 micron flux ratio and with the Spitzer 3.6 micron to 24 micron. These trends may be due to variations in the spatial density of young stars, the stellar age, the ratio of young to old stars, the initial mass function, and/or the efficiency of stellar feedback. Galaxies with low SFR (<1 M(sun)/yr) and high K band luminosities may have an excess of hot gas relative to the relation for higher SFR galaxies, while galaxies with low K band luminosities (and therefore low stellar masses) may have a deficiency in hot gas, but our sample is not large enough for strong statistical significance.Comment: Astronomical Journal, in pres

Topical thrombin preparations and their use in cardiac surgery

Brianne L Dunn1, Walter&amp;nbsp;E Uber1, John S Ikonomidis21Department of Pharmacy Services and 2Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USAAbstract: Coagulopathic bleeding may lead to increased morbidity and mortality after cardiac surgery. Topical bovine thrombin has been used to promote hemostasis after surgical procedures for over 60 years and is used frequently as a topical hemostatic agent in cardiac surgery. Recently, use of bovine thrombin has been reported to be associated with increased risk for anaphylaxis, thrombosis, and immune-mediated coagulopathy thought secondary to the production of antifactor V and antithrombin antibodies. In patients who develop bovine thrombin-induced immune-mediated coagulopathy, clinical manifestations may range from asymptomatic alterations in coagulation tests to severe hemorrhage and death. Patients undergoing cardiac surgical procedures may be at increased risk for development of antibodies to bovine thrombin products and associated complications. This adverse immunologic profile has led to the development of alternative preparations including a human and a recombinant thrombin which have been shown to be equally efficacious to bovine thrombin and have reduced antigenicity. However, the potential benefit associated with reduced antigenicity is not truly known secondary to the lack of long-term experience with these products. Given the potentially higher margin of safety and less stringent storage concerns compared to human thrombin, recombinant thrombin may be the most reasonable approach in cardiac surgery.Keywords: bovine thrombin, human thrombin, recombinant thrombin, immune-mediated coagulopathy, topical hemostatic agents, thrombin&amp;nbsp

The hot gas exhaust of starburst engines in mergers

VizieR online Data Catalogue associated with article published in journal Astronomical Journal (AAS) with title \u27The hot gas exhaust of starburst engines in mergers: testing models of stellar feedback and star formation regulation.\u27 (bibcode: 2019AJ....158..169S