Evaluation of risk of falls and orthostatic hypotension in older, long-term topical beta-blocker users

Background: Falls are a serious problem in the elderly, and have recently been described as cardiovascular-mediated side effects of beta-blocker eye drops. Therefore, we investigated the possible association between the long-term use of beta-blockers, prostaglandins and their combinations in eye drops, and falls, dizziness and orthostatic hypotension in older patients. Methods: All participants were long-term users of eye drops containing beta-blockers, prostaglandins or their combinations. They underwent a structured falls interview and blood pressure measurement for testing of orthostatic hypotension. The odds ratio for presence of orthostatic hypotension or a positive falls history according to use of beta-blocker eye drops was calculated with a binary logistic regression analysis. The main outcome measures were a positive falls history and the presence of orthostatic hypotension. Results: In total, 148 of 286 subjects participated. After adjustment for age, gender, and use of fall-risk-increasing drugs other than beta-blocker eye drops, we found no significant difference in fall risk [odds ratio (OR): 0.60; 95% confidence interval (CI): 0.268-1.327] between patients using ophthalmic beta-blockers or a combination of ophthalmic beta-blockers and prostaglandins, and patients using ophthalmic prostaglandins only. Although prevalence of orthostatic hypotension was higher in the beta-blocker group (OR: 1.67; 95% CI: 0.731-3.793) compared to the prostaglandin group, this was a non-significant difference. Conclusions: In our study, we did not find a significant association between long-term use of beta-blockers eye drops and falls, dizziness or orthostatic hypotension in older ophthalmic outpatients, compared to long-term use of prostaglandin eye drops

Clostridium difficile infection.

Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis - the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota

Análise epidemiológica do suicídio no Brasil entre 1980 e 2006 Epidemiological analysis of suicide in Brazil from 1980 to 2006

OBJETIVO: O objetivo deste estudo foi realizar uma análise epidemiológica dos índices de suicídio registrados entre 1980 e 2006 nas regiões e capitais estaduais. MÉTODO: Dados referentes à taxa de mortalidade devido ao suicídio foram coletados do Departamento de Informática do Sistema Único de Saúde. RESULTADOS: Entre 1980 e 2006, foi registrado um total de 158.952 casos de suicídio, excluindo-se os casos nos quais os indivíduos tinham menos de 10 anos de idade (n = 68). No período estudado, o índice total de suicídio cresceu de 4,4 para 5,7 mortes por 100.000 habitantes (29,5%). Os índices médios mais altos foram registrados nas regiões Sul (9,3) e Centro-Oeste (6,1). Os homens são os que têm a maior probabilidade de cometer suicídio. Os índices mais altos de suicídio foram registrados na faixa etária de 70 anos ou mais, enquanto que os maiores aumentos aconteceram na faixa etária dos 20 aos 59 anos. As principais características sociodemográficas das pessoas que cometeram suicídio durante o período estudado foram baixo nível educacional e estado civil solteiro. Os métodos mais comuns de suicídio foram por enforcamento, armas de fogo e envenenamento. CONCLUSÃO: Embora o índice brasileiro tenha crescido 29,5% em 26 anos, o índice nacional ainda é considerado baixo se comparado aos índices de suicídio mundiais (média de 4,9 por 100.000 habitantes). Os índices de suicídio nas regiões brasileiras variam muito, ou seja, estão entre 2,7 e 9,3.<br>OBJECTIVE: The objective of this study was to carry out an epidemiological analysis of the suicide rates found in Brazilian regions and state capitals between 1980 and 2006. METHOD: Data on mortality rates due to suicide were collected from the Departamento de Informática do Sistema Único de Saúde (Information Technology Department of the Brazilian Public Health System - DATASUS). RESULTS: A total of 158,952 suicide cases were registered between 1980 and 2006, excluding those cases in which the individual was less than 10 years old (n = 68). In the period under study, the total suicide rate in Brazil increased from 4.4 to 5.7 deaths per 100,000 inhabitants (29.5%). Higher average rates were found in the South (9.3) and Central-West (6.1) regions. Men were more likely to commit suicide. The highest suicide rates were found in the 70-years or above age range while the highest increases were found in the 20 to 59 year age bracket. The most dominant social-demographic characteristics of the persons who committed suicide in the period under study were low educational level and singlehood. The most common methods of suicide were hanging, fire arms and poisoning. CONCLUSION: Although in Brazil the rate increased 29.5% in 26 years, the national rate is still considered to be low when compared to worldwide suicide rates (average of 4.9 per 100,000 inhabitants). Suicide rates in Brazilian regions vary broadly, ranging from 2.7 to 9.3