Constipation and diarrhoea - common adverse drug reactions? A cross sectional study in the general population

BACKGROUND: Constipation and diarrhoea are common complaints and often reported as adverse drug reactions. This study aimed at finding associations between drugs and constipation and diarrhoea in a general population. METHODS: A selection of inhabitants in Oppland County, Norway participated in a cross-sectional survey. Information about demographics, diseases including gastrointestinal complaints classified according to the Rome II criteria and use of drugs were collected on questionnaires. Constipation was defined as functional constipation and constipation predominant Irritable Bowel Syndrome (IBS), and diarrhoea as functional diarrhoea and diarrhoea predominant IBS. Associations between drugs and constipation and diarrhoea were examined with multivariable logistic regression models. Based on the multivariable model, the changes in prevalence (risk difference) of the abdominal complaints for non-users and users of drugs were calculated. RESULTS: In total 11078 subjects were invited, 4622 completed the questionnaires, 640 (13.8%) had constipation and 407 (8.8%) had diarrhoea. To start using drugs increased the prevalence of constipation and diarrhoea with 2.5% and 2.3% respectively. Polypharmacy was an additional risk factor for diarrhoea. Use of furosemide, levothyroxine sodium and ibuprofen was associated with constipation, and lithium and carbamazepine with diarrhoea. The excess drug related prevalence varied from 5.3% for the association between ibuprofen and constipation to 27.5% for the association between lithium and diarrhoea. CONCLUSIONS: Use of drugs was associated with constipation and diarrhoea in the general population. The associations are most likely adverse drug reactions and show that drug-induced symptoms need to be considered in subjects with these complaints

Drugs and Constipation in Elderly in Nursing Homes: What Is the Relation?

Introduction. Constipation is a common adverse drug reaction. Objective. Study associations between drugs and constipation in nursing home residents. Design. Cross-sectional study. Material and Methods. Nursing home residents above 60 years of age were included. Demographics, diet, physical activity, activity of daily living, nutritional status, use of drugs, and diseases were recorded. Constipation was defined as functional constipation or constipation-predominant IBS according to the Rome III criteria and/or regular use of laxatives. Drugs were classified according to the Anatomical-Therapeutic-Chemical Classification System (ATC), and anticholinergic effect was noted. Results. In all, 79 men and 188 women with a mean age of 85.4 (SD 7.1) years were included. The prevalence of constipation was 71.5%. Use of drugs in general, including polypharmacy, was not associated with constipation. Reduced activity of daily living (OR = 0.71, 95% CI : 0.60–0.84, P < 0.001), other antidepressants (N06AX) (OR 3.08, 95% CI : 1.09–8.68, P = 0.03), and benzodiazepine derivatives (N05BA) (OR = 2.80, 95% CI : 1.12–7.04, P = 0.03) were significantly associated with constipation; drugs with markedly anticholinergic effect (OR = 3.7, 95% CI : 0.78–17.53, P = 0.10), natural opium alkaloid (N02AA) (OR = 5.01, 95% CI : 0.95–25.94, P = 0.06), and propionic acid derivatives (M01AE) (OR = 7.00, 95% CI : 0.75–65.08, P = 0.09) showed a trend. Conclusion. In elderly with constipation, focus should be on specific groups of drugs and nonpharmacological factors, not on drugs in general

DynaCT during EVAR – A Comparison with Multidetector CT

AbstractObjectivesWe have explored the usefulness of an on-table, cross-sectional radiological imaging (DynaCT) in endovascular aortic repair (EVAR). DynaCT images were compared to images from a regular multidetector (16 slice) CT. In the comparison, we tested the accordance of firstly 5 relevant clinical measurements and secondly the visibility of 9 anatomical areas in the two different types of images. This imaging was carried out in addition to the usual angiographic imaging.Design, material and method20 patients with infrarenal abdominal aortic aneurysm (AAA) were prospectively enrolled in the study. We compared Images from DynaCT with two different doses of contrast medium to MDCT-images in two different ways. Firstly relevant arterial diameters and lengths and secondly, 9 anatomical areas were evaluated regarding visibility which was scored on a 4-point scale.ResultsThere were no significant differences in the measured arterial diameters and lengths. MDCT had a significantly higher visibility score than both DynaCT investigations. However, with the highest contrast medium dose we found acceptable diagnostic quality in 78–94% of the cases for 8 of the 9 investigated anatomical areas.ConclusionOur findings indicate that on-table DynaCT are of sufficient quality to give relevant information of arterial measurements, needed in endovascular repair of infrarenal aortic aneurysms

Information theoretic security by the laws of classical physics

It has been shown recently that the use of two pairs of resistors with enhanced Johnson-noise and a Kirchhoff-loop-i.e., a Kirchhoff-Law-Johnson-Noise (KLJN) protocol-for secure key distribution leads to information theoretic security levels superior to those of a quantum key distribution, including a natural immunity against a man-in-the-middle attack. This issue is becoming particularly timely because of the recent full cracks of practical quantum communicators, as shown in numerous peer-reviewed publications. This presentation first briefly surveys the KLJN system and then discusses related, essential questions such as: what are perfect and imperfect security characteristics of key distribution, and how can these two types of securities be unconditional (or information theoretical)? Finally the presentation contains a live demonstration.Comment: Featured in MIT Technology Review http://www.technologyreview.com/view/428202/quantum-cryptography-outperformed-by-classical/ ; Plenary talk at the 5th IEEE Workshop on Soft Computing Applications, August 22-24, 2012, (SOFA 2012). Typos correcte

Full-field implementation of a perfect eavesdropper on a quantum cryptography system

Quantum key distribution (QKD) allows two remote parties to grow a shared secret key. Its security is founded on the principles of quantum mechanics, but in reality it significantly relies on the physical implementation. Technological imperfections of QKD systems have been previously explored, but no attack on an established QKD connection has been realized so far. Here we show the first full-field implementation of a complete attack on a running QKD connection. An installed eavesdropper obtains the entire 'secret' key, while none of the parameters monitored by the legitimate parties indicate a security breach. This confirms that non-idealities in physical implementations of QKD can be fully practically exploitable, and must be given increased scrutiny if quantum cryptography is to become highly secure.Comment: Revised after editorial and peer-review feedback. This version is published in Nat. Commun. 8 pages, 6 figures, 1 tabl

Hacking commercial quantum cryptography systems by tailored bright illumination

The peculiar properties of quantum mechanics allow two remote parties to communicate a private, secret key, which is protected from eavesdropping by the laws of physics. So-called quantum key distribution (QKD) implementations always rely on detectors to measure the relevant quantum property of single photons. Here we demonstrate experimentally that the detectors in two commercially available QKD systems can be fully remote-controlled using specially tailored bright illumination. This makes it possible to tracelessly acquire the full secret key; we propose an eavesdropping apparatus built of off-the-shelf components. The loophole is likely to be present in most QKD systems using avalanche photodiodes to detect single photons. We believe that our findings are crucial for strengthening the security of practical QKD, by identifying and patching technological deficiencies.Comment: Revised version, rewritten for clarity. 5 pages, 5 figures. To download the Supplementary information (which is in open access), go to the journal web site at http://dx.doi.org/10.1038/nphoton.2010.21

Critical analysis of the Bennett-Riedel attack on secure cryptographic key distributions via the Kirchhoff-law-Johnson-noise scheme

Recently, Bennett and Riedel (BR) (http://arxiv.org/abs/1303.7435v1) argued that thermodynamics is not essential in the Kirchhoff-law–Johnson-noise (KLJN) classical physical cryptographic exchange method in an effort to disprove the security of the KLJN scheme. They attempted to demonstrate this by introducing a dissipation-free deterministic key exchange method with two batteries and two switches. In the present paper, we first show that BR's scheme is unphysical and that some elements of its assumptions violate basic protocols of secure communication. All our analyses are based on a technically unlimited Eve with infinitely accurate and fast measurements limited only by the laws of physics and statistics. For non-ideal situations and at active (invasive) attacks, the uncertainly principle between measurement duration and statistical errors makes it impossible for Eve to extract the key regardless of the accuracy or speed of her measurements. To show that thermodynamics and noise are essential for the security, we crack the BR system with 100% success via passive attacks, in ten different ways, and demonstrate that the same cracking methods do not function for the KLJN scheme that employs Johnson noise to provide security underpinned by the Second Law of Thermodynamics. We also present a critical analysis of some other claims by BR; for example, we prove that their equations for describing zero security do not apply to the KLJN scheme. Finally we give mathematical security proofs for each BR-attack against the KLJN scheme and conclude that the information theoretic (unconditional) security of the KLJN method has not been successfully challenged.Laszlo B. Kish, Derek Abbott, Claes G. Granqvis

Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study

<p>Abstract</p> <p>Background</p> <p>To assess safety, risk factors and clinical outcomes in elderly patients with spinal stenosis after decompressive laminectomy.</p> <p>Methods</p> <p>A prospective cohort of patients 70 years and older with spinal stenosis undergoing conventional laminectomy without fusion (n = 101) were consecutively enrolled from regular clinical practice and reassessed at 3 and 12 months. Primary outcome was change in health related quality of life measured (HRQL) with EuroQol-5 D (EQ-5D). Secondary outcomes were safety assessment, changes in Oswestry disability index (ODI), Visual Analogue Scale (EQ-VAS) score for self reported health, VAS score for leg and back pain and patient satisfaction. We used regression analyses to evaluate risk factors for less improvement.</p> <p>Results</p> <p>The mean EQ-5 D total score were 0.32, 0.63 and 0.60 at baseline, 3 months and 12 months respectively, and represents a statistically significant (P < 0.001) improvement. Effect size was > 0.8. Mean ODI score at baseline was 44.2, at 3 months 25.6 and at 27.9. This represents an improvement for all post-operative scores. A total of 18 (18.0%) complications were registered with 6 (6.0%) classified as major, including one perioperative death. Patients stating that the surgery had been beneficial at 3 months was 82 (89.1%) and at 12 months 73 (86.9%). The only predictor found was patients with longer duration of leg pain had less improvement in ODI (P < 0.001). Increased age or having complications did not predict a worse outcome in any of the outcome variables.</p> <p>Conclusions</p> <p>Properly selected patients of 70 years and older can expect a clinical meaningful improvement of HRQL, functional status and pain after open laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery.</p

Drugs and Constipation in Elderly in Nursing Homes: What Is the Relation?

Introduction. Constipation is a common adverse drug reaction. Objective. Study associations between drugs and constipation in nursing home residents. Design. Cross-sectional study. Material and Methods. Nursing home residents above 60 years of age were included. Demographics, diet, physical activity, activity of daily living, nutritional status, use of drugs, and diseases were recorded. Constipation was defined as functional constipation or constipation-predominant IBS according to the Rome III criteria and/or regular use of laxatives. Drugs were classified according to the Anatomical-Therapeutic-Chemical Classification System (ATC), and anticholinergic effect was noted. Results. In all, 79 men and 188 women with a mean age of 85.4 (SD 7.1) years were included. The prevalence of constipation was 71.5%. Use of drugs in general, including polypharmacy, was not associated with constipation. Reduced activity of daily living (OR = 0.71, 95% CI : 0.60-0.84, P &lt; 0.001), other antidepressants (N06AX) (OR 3.08, 95% CI : 1.09-8.68, P = 0.03), and benzodiazepine derivatives (N05BA) (OR = 2.80, 95% CI : 1.12-7.04, P = 0.03) were significantly associated with constipation; drugs with markedly anticholinergic effect (OR = 3.7, 95% CI : 0.78-17.53, P = 0.10), natural opium alkaloid (N02AA) (OR = 5.01, 95% CI : 0.95-25.94, P = 0.06), and propionic acid derivatives (M01AE) (OR = 7.00, 95% CI : 0.75-65.08, P = 0.09) showed a trend. Conclusion. In elderly with constipation, focus should be on specific groups of drugs and nonpharmacological factors, not on drugs in general