In This Issue of Archives of Internal Medicine FREE

In a case-control study of hospitalized elderly patients, hypoglycemia was common and occurred in 281 patients (5.2%). In comparing this group with a randomly selected group of hospitalized elderly patients without hypoglycemia, hypoglycemia was associated with sepsis, hypoalbuminemia, malignancy, and renal failure. Among the patients with hypoglycemia, 42% had diabetes mellitus and 25% were receiving sulfonylurea or insulin treatment. In-hospital and 3-month mortality were about 2-fold higher in the hypoglycemic group, and multivariate analysis found that sepsis, low albumin level, and malignancy were independent predictors of mortality, while hypoglycemia was not. These findings indicate that hypoglycemia in elderly patients is a marker of severe comorbidities.

The quality of therapeutic outcome determinations made by credentialed pharmaceutical care practitioners was studied by a 12-member panel of physicians and pharmacists who used randomly selected patient records. Among 2524 patients, 5780 drug therapy problems had been resolved, and the rate of therapeutic goals achieved increased by 15 percentage points from patients' initial to latest pharmaceutical encounters. Panelists agreed with the therapeutic outcome determinations in 94% of the clinical decision evaluations using structured implicit review, and intraclass correlation coefficients ranged from 0.73 to 0.85. This study provides information on the quality of care and clinical credibility of decisions made by pharmacists collaborating with physicians to provide drug therapy management services.

Recent otolaryngologic reports document significant fatigue and bodily pain in patients with chronic rhinosinusitis, but studies of general medical patients are lacking. To determine the prevalence and significance of rhinosinusitis symptoms in those with unexplained chronic fatigue (UCF) and/or bodily pain, 297 consecutive general medical outpatients were studied: 65 patients noted UCF; 33, unexplained bodily pain; and 26, both. When patients with UCF were compared with the 232 remaining patients without UCF, the following rhinosinusitis symptoms were significantly more common in patients with UCF: facial pressure, heavy headedness, nasal obstruction, frontal headache, postnasal drip, sore throat, and tender anterior cervical lymph nodes. A similar predominance of rhinosinusitis symptoms was noted in patients with bodily pain and in 15 UCF patients with chronic fatigue syndrome. No increased prevalence of pollen allergy was noted in patients with UCF, unexplained bodily pain, or chronic fatigue syndrome. When those with UCF were compared with 38 patients with explained fatigue, rhinosinusitis symptoms were more common in UCF. This study notes an increased prevalence of rhinosinusitis symptoms but not pollen allergy in general medical outpatients with UCF and/or bodily pain.

Heyde syndrome is the association between arteriovenous malformations (AVMs) of the gastrointestinal tract and aortic stenosis (AS); however, the existence of Heyde syndrome has been questioned. Batur et al identified all who were diagnosed with AVMs between 1990 and 2000, using gastrointestinal endoscopy or mesenteric angiography, and compared the prevalence of AS and mitral stenosis (MS) in patients who also had echocardiograms. For a general population comparison, the prevalence of AS and MS in all patients who had echocardiograms between 1990 and 2000 was calculated. In patients with AVMs, the prevalence of AS was 31.7%, which was significantly higher than the 14.0% found in the general population comparison group. Between the 2 groups, MS prevalence was not statistically different. Significant AS was 2.6 times more common and severe AS was 4.1 times more common in patients with AVMs than in the general population. Our study confirmed an association between AVMs and AS, although its etiology remains unclear. Clinicians need to be aware of this syndrome because it may affect management of patients with gastrointestinal tract bleeding or AS.