Clinical Briefs
By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim.
Telithromycin Impact in Acute Asthma
Most exacerbations of asthma are related to viral infection. Hence, antibiotics are usually not useful unless there is a suspicion of bacterial infection. Indeed, a Cochrane review of antibiotics in asthma identified 2 prior studies in which antibiotics (not telithromycin [TEL]) provided no benefit for acute asthma exacerbations.
TEL is a macrolide antibiotic with effects on atypical bacteria that are sometimes recovered during acute asthma exacerbations, and often colonize patients with asthma, eg, Chlamydia and Mycoplasma. TEL also possesses some immunomodulatory effects. This study compared TEL 800 mg/d with placebo for patients with acute asthma exacerbations (n = 278). The end points were changes in symptoms and peak expiratory flow rate (PEFR).
Although TEL treatment was not superior to placebo for PEFR, there was a statistically significant effect on symptoms favoring TEL. Subgroup analysis of Chlamydia/Mycoplasma serostatus indicated that subjects who were bacteria sero-positive did enjoy a statistically significant improvement in FEV1 compared to sero-negative subjects. The role of serostatus is uncertain, since only a very small percentage of subjects were PCR-positive for bacteria, which should be a more sensitive test. Because telithromycin has a potential for severe liver injury, and because the increments of asthma benefit in this study were small, the potential role of TEL in asthma treatment remains to be determined.
Johnston SL, et al. N Engl J Med. 2006;354:1589-1600.
Comorbid Hypo-gonadism in Diabetic Men with Erectile Dysfunction
Erectile dysfunction (ed) most commonly reflects endothelial dysfunction, usually as a consequence of hypertension, dyslipidemia, smoking, or diabetes. Since diabetic men also have a proclivity to neuropathy (motor, sensory, and autonomic), the combination of vasculopathy with neuropathy is particularly burdensome to erectile function.
In non-diabetic men, hypogonadism is responsible for only a small proportion of ED, typically reported as 5-10%. Recently, an association between diabetes and hypogonadotropic hypogonadism—the situation where both pituitary trophic hormones and testosterone are concomitantly low—has been noted.
A study of consecutive patients attending a sexual dysfunction clinic (n = 1,246) was done which included measurement of LH, TSH, and testosterone (total and free testosterone). Eighteen percent of this population had diabetes. Using the threshold criteria adopted by the authors, the prevalence of hypogonadism in diabetic men was much higher than the non-diabetic men: 24.5% vs 12.6%; P < 0.0001. These data also confirmed a disproportionate incidence of hypogonadotropic hypogonadism.
This high prevalence of hypogonadism in diabetic men cannot be extrapolated to the general population of diabetic men since these subjects were preselected for suffering sexual dysfunction. PDE5 inhibitors have shown lesser efficacy in diabetics than other populations. Comorbid hypogonadism may explain some of this discrepancy.
Corona G, et al. Int J Impot Res. 2006;18:190-197.
Is Iron Deficiency Related to Alopecia?
The relationship between iron status and hair loss is complex. Most of the data set has evaluated women, who experience iron deficiency anemia 3-5 times more often than men, usually attributable to the combination of lower baseline body stores combined with menstrual blood loss. In trials that have evaluated iron status in women with respect to alopecia, results have been mixed and inconclusive. Some investigators have supplemented iron for women with androgenetic alopecia (in combination with the anti-androgen spironolactone), and found a subgroup of responders.
Despite an the lack of a consensus in the dermatologic literature about the relationship between low iron status and alopecia, these Cleveland Clinic authors screened male and female patients presenting with alopecia with a CBC and serum ferritin, commenting that despite an inconclusive evidence base, their anecdotal experience indicates superior responses in patients with alopecia when depleted iron stores are replenished.
When a low ferritin is observed, with or without anemia, the authors provide iron supplementation (dietary or supplement) to maintain a ferritin concentration greater than 70 ng/mL. Their recommendation includes maintenance of iron treatment for 3-6 months, to ensure replenishment of iron stores.
Trost LB, et al. J Am Acad Dermatol. 2006;54:824-844.
Most exacerbations of asthma are related to viral infection; Erectile dysfunction (ed) most commonly reflects endothelial dysfunction; and the relationship between iron status and hair loss is complex.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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