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Critical Care Medicine Feb 2015Methanol poisoning can induce death and disability. Treatment includes the administration of antidotes (ethanol or fomepizole and folic/folinic acid) and consideration... (Review)
Review
OBJECTIVE
Methanol poisoning can induce death and disability. Treatment includes the administration of antidotes (ethanol or fomepizole and folic/folinic acid) and consideration of extracorporeal treatment for correction of acidemia and/or enhanced elimination. The Extracorporeal Treatments in Poisoning workgroup aimed to develop evidence-based consensus recommendations for extracorporeal treatment in methanol poisoning.
DESIGN AND METHODS
Utilizing predetermined methods, we conducted a systematic review of the literature. Two hundred seventy-two relevant publications were identified but publication and selection biases were noted. Data on clinical outcomes and dialyzability were collated and a two-round modified Delphi process was used to reach a consensus.
RESULTS
Recommended indications for extracorporeal treatment: Severe methanol poisoning including any of the following being attributed to methanol: coma, seizures, new vision deficits, metabolic acidosis with blood pH ≤ 7.15, persistent metabolic acidosis despite adequate supportive measures and antidotes, serum anion gap higher than 24 mmol/L; or, serum methanol concentration 1) greater than 700 mg/L (21.8 mmol/L) in the context of fomepizole therapy, 2) greater than 600 mg/L or 18.7 mmol/L in the context of ethanol treatment, 3) greater than 500 mg/L or 15.6 mmol/L in the absence of an alcohol dehydrogenase blocker; in the absence of a methanol concentration, the osmolal/osmolar gap may be informative; or, in the context of impaired kidney function. Intermittent hemodialysis is the modality of choice and continuous modalities are acceptable alternatives. Extracorporeal treatment can be terminated when the methanol concentration is <200 mg/L or 6.2 mmol/L and a clinical improvement is observed. Extracorporeal Treatments in Poisoning inhibitors and folic/folinic acid should be continued during extracorporeal treatment. General considerations: Antidotes and extracorporeal treatment should be initiated urgently in the context of severe poisoning. The duration of extracorporeal treatment extracorporeal treatment depends on the type of extracorporeal treatment used and the methanol exposure. Indications for extracorporeal treatment are based on risk factors for poor outcomes. The relative importance of individual indications for the triaging of patients for extracorporeal treatment, in the context of an epidemic when need exceeds resources, is unknown. In the absence of severe poisoning but if the methanol concentration is elevated and there is adequate alcohol dehydrogenase blockade, extracorporeal treatment is not immediately required. Systemic anticoagulation should be avoided during extracorporeal treatment because it may increase the development or severity of intracerebral hemorrhage.
CONCLUSION
Extracorporeal treatment has a valuable role in the treatment of patients with methanol poisoning. A range of clinical indications for extracorporeal treatment is provided and duration of therapy can be guided through the careful monitoring of biomarkers of exposure and toxicity. In the absence of severe poisoning, the decision to use extracorporeal treatment is determined by balancing the cost and complications of extracorporeal treatment to that of fomepizole or ethanol. Given regional differences in cost and availability of fomepizole and extracorporeal treatment, these decisions must be made at a local level.
Topics: Acidosis; Antidotes; Biomarkers; Humans; Methanol; Practice Guidelines as Topic; Renal Dialysis; Severity of Illness Index
PubMed: 25493973
DOI: 10.1097/CCM.0000000000000708 -
Surgical Neurology International 2024This study strives to provide a current and thorough assessment of the comparative efficacy and safety between equiosmolar quantities of hypertonic saline (HS) and...
BACKGROUND
This study strives to provide a current and thorough assessment of the comparative efficacy and safety between equiosmolar quantities of hypertonic saline (HS) and mannitol in facilitating brain relaxation for patients undergoing elective craniotomies.
METHODS
This systematic review and meta-analysis, following preferred reporting items for systematic reviews and meta-analyses guidelines, compared the efficacy and safety of equiosmolar concentrations of mannitol and HS in elective craniotomies. PubMed, Scopus, Cochrane Library, ScienceDirect, and Proquest databases were searched using keywords related to mannitol, HS, and craniotomy. Results were analyzed through a random-effects model using Mantel-Haenszel risk ratio and standard mean difference. < 0.05 was considered significant.
RESULTS
Thirteen randomized controlled trials encompassing 965 patients (516 in the HS group and 448 in the mannitol group) were analyzed. The quality of studies was moderate-to-high, and no significant publication bias was observed. The primary outcome, brain relaxation, favored HS over mannitol without significant heterogeneity. Mannitol was associated with increased urine output compared to HS, irrespective of dose, with high heterogeneity. HS was linked to significantly reduced fluid input, confirmed by subgroup analysis with lower heterogeneity. No significant difference was found in serum osmolality between the two agents. Serum sodium (Na) levels favored HS, whereas arterial blood Na levels also favored HS despite considerable heterogeneity. Maximum mean arterial pressure was higher with HS, but it displayed significant heterogeneity. Maximum central venous pressure showed no significant difference between the two agents, with moderate heterogeneity.
CONCLUSION
HS appears more effective than mannitol in achieving brain relaxation, and it may offer advantages in fluid management and Na balance. Clinicians should consider these findings when selecting hyperosmotic agents for neurosurgical procedures. Further research is needed to address heterogeneity in certain outcomes and guide clinical practice.
PubMed: 38741989
DOI: 10.25259/SNI_994_2023 -
European Radiology Feb 2018Many radiologists and clinicians still consider multiple myeloma (MM) and monoclonal gammopathies (MG) a contraindication for using iodine-based contrast media. The ESUR... (Review)
Review
OBJECTIVES
Many radiologists and clinicians still consider multiple myeloma (MM) and monoclonal gammopathies (MG) a contraindication for using iodine-based contrast media. The ESUR Contrast Media Safety Committee performed a systematic review of the incidence of post-contrast acute kidney injury (PC-AKI) in these patients.
METHODS
A systematic search in Medline and Scopus databases was performed for renal function deterioration studies in patients with MM or MG following administration of iodine-based contrast media. Data collection and analysis were performed according to the PRISMA statement 2009. Eligibility criteria and methods of analysis were specified in advance. Cohort and case-control studies reporting changes in renal function were included.
RESULTS
Thirteen studies were selected that reported 824 iodine-based contrast medium administrations in 642 patients with MM or MG, in which 12 unconfounded cases of PC-AKI were found (1.6 %). The majority of patients had intravenous urography with high osmolality ionic contrast media after preparatory dehydration and purgation.
CONCLUSIONS
MM and MG alone are not risk factors for PC-AKI. However, the risk of PC-AKI may become significant in dehydrated patients with impaired renal function. Hypercalcaemia may increase the risk of kidney damage, and should be corrected before contrast medium administration. Assessment for Bence-Jones proteinuria is not necessary.
KEY POINTS
• Monoclonal gammopathies including multiple myeloma are a large spectrum of disorders. • In monoclonal gammopathy with normal renal function, PC-AKI risk is not increased. • Renal function is often reduced in myeloma, increasing the risk of PC-AKI. • Correction of hypercalcaemia is necessary in myeloma before iodine-based contrast medium administration. • Bence-Jones proteinuria assessment in myeloma is unnecessary before iodine-based contrast medium administration.
Topics: Acute Kidney Injury; Contrast Media; Europe; Humans; Incidence; Iodine; Multiple Myeloma; Paraproteinemias; Radiology; Risk Factors; Societies, Medical
PubMed: 28856420
DOI: 10.1007/s00330-017-5023-5 -
American Journal of Therapeutics 2020Intradialytic hypotension (IDH) is one of the most common complications of the hemodialysis procedure. Although there are no clear-cut answers as to the best strategy on...
BACKGROUND, AREAS OF UNCERTAINTY
Intradialytic hypotension (IDH) is one of the most common complications of the hemodialysis procedure. Although there are no clear-cut answers as to the best strategy on the management of IDH, data suggest that the administration of osmotically active drugs may decrease the occurrence of blood pressure decline during dialysis. The use of mannitol for IDH management in hemodialysis patients is scarce. This article highlights the use and benefits of mannitol and to assess the role of mannitol role in the management of IDH.
DATA SOURCES
Primary literature identified through MEDLINE/PubMed database and Google Scholar with no restrictions. Relevant and current literatures related to mannitol and IDH were used.
RESULTS AND DATA SYNTHESIS
Multiple studies have shown the benefits of mannitol for the management of IDH. Because of its oncotic effect, mannitol increases plasma osmolality to maintain adequate blood pressure and prevent the occurrence of IDH. Two observational studies and several reports were identified as being the most recent and applicable to clinical practice. Studies and data on the use of mannitol in IDH are scarce or outdated. The 2 studies used in this article conclude that mannitol carries benefits for both the adult and pediatric population. However, additional research in the future will be needed to confirm the evidence for various age groups. These 2 observational trials were also very small in number, and any future studies conducted should have a longer duration and larger population size. Although lacking data, these studies will suffice in introducing the benefits of mannitol in IDH.
CONCLUSIONS
Mannitol may be considered for the management of IDH; however, additional studies are required to evaluate the long-term risk and benefits associated with mannitol, as it carries a risk of accumulation in the body.
Topics: Blood Pressure; Humans; Hypertonic Solutions; Hypotension; Kidney Failure, Chronic; Mannitol; Observational Studies as Topic; Osmolar Concentration; Practice Guidelines as Topic; Renal Dialysis; Treatment Outcome
PubMed: 30272595
DOI: 10.1097/MJT.0000000000000855 -
Marine Drugs Apr 2021Red alga species belonging to the and genera (commonly known as Nori), which are widely consumed and commercialized due to their high nutritional value. These species... (Meta-Analysis)
Meta-Analysis Review
Red alga species belonging to the and genera (commonly known as Nori), which are widely consumed and commercialized due to their high nutritional value. These species have a carotenoid profile dominated by xanthophylls, mostly lutein and zeaxanthin, which have relevant benefits for human health. The effects of different abiotic factors on xanthophyll synthesis in these species have been scarcely studied, despite their health benefits. The objectives of this study were (i) to identify the abiotic factors that enhance the synthesis of xanthophylls in / species by conducting a systematic review and meta-analysis of the xanthophyll content found in the literature, and (ii) to recommend a culture method that would allow a significant accumulation of these compounds in the biomass of these species. The results show that salinity significantly affected the content of total carotenoids and led to higher values under hypersaline conditions (70,247.91 µg/g dm at 55 psu). For lutein and zeaxanthin, the wavelength treatment caused significant differences between the basal and maximum content (4.16-23.47 µg/g dm). Additionally, in spp., the total carotenoids were considerably higher than in spp.; however, the lutein and zeaxanthin contents were lower. We discuss the specific conditions for each treatment and the relation to the ecological distribution of these species.
Topics: Biomass; Ecosystem; Porphyra; Rhodophyta; Salinity; Salt Stress; Stress, Physiological; Water; Xanthophylls
PubMed: 33921190
DOI: 10.3390/md19040221 -
Children (Basel, Switzerland) Sep 2021Hyponatraemia is a known complication in hospitalised children receiving maintenance intravenous fluid. Several studies have been published to investigate the efficacy...
Efficacy and Safety of Isotonic and Hypotonic Intravenous Maintenance Fluids in Hospitalised Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
Hyponatraemia is a known complication in hospitalised children receiving maintenance intravenous fluid. Several studies have been published to investigate the efficacy and safety of intravenous fluids in children. However, there is still an ongoing debate regarding the ideal solution to be used in the paediatric population. Therefore, the aim of this meta-analysis was to investigate the safety and efficacy of administering isotonic versus hypotonic intravenous maintenance fluid in hospitalised children. An extensive search was undertaken on PubMed, Web of Science, Scopus, ScienceDirect, Google Scholar and Cochrane Library on 28 December 2020. Only randomised controlled trials (RCTs) were included. We used the random-effects model for all analyses. Risk ratio (RR) and mean difference with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. The quality of each study was assessed using the Joanna Briggs Institute critical appraisal tool for RCTs. This study is registered with PROSPERO (CRD42021229067). Twenty-two RCTs with a total of 3795 participants were included. The studies encompassed surgical and medical patients admitted to intensive care unit as well as to general wards. We found that hypotonic fluid significantly increases the risk of hyponatremia at both ≤24 h (RR 0.34; 95% CI: 0.26-0.43, < 0.00001) and >24 h (RR 0.48; 95% CI: 0.36-0.64, < 0.00001). Isotonic fluid increases the risk of hypernatraemia at ≤24 h (RR 2.15; 95% CI: 1.24-3.73, = 0.006). The prevalence of hyponatraemia was also higher in the hypotonic group at both ≤24 h (5.7% vs. 23.3%) and >24 h (6.0% vs. 26.3%). There was no statistically significant difference in the risk of developing adverse outcomes between the two groups. Mean serum and urine sodium as well as serum osmolality/osmolarity was lower in the hypotonic group. Isotonic solution is protective against the development of hyponatraemia while hypotonic solution increases the risk of hyponatraemia.
PubMed: 34572217
DOI: 10.3390/children8090785 -
Revista Panamericana de Salud Publica =... Jul 2015To examine the usefulness of "spot" urine iodine concentrations (UICs) in predicting 24-hour urine iodine excretion (UIE) for estimating average population iodine intake. (Review)
Review
OBJECTIVE
To examine the usefulness of "spot" urine iodine concentrations (UICs) in predicting 24-hour urine iodine excretion (UIE) for estimating average population iodine intake.
METHODS
An electronic literature search was conducted for articles published through 19 May 2013 in MEDLINE (from 1950), EMBASE (from 1980), and the Cochrane Library (from 1993) using the terms "urinary excretion (timed or spot or random) and (24 h or 24 hour), iodine (iodine deficiency), iodine (intake)," and "urine (timed, spot, random, 24-hour)." Full-text articles about studies that examined > 40 healthy human subjects and measured UIE using the 24-hour urine collection method and UIC and/or UIE using one alternative method (spot (random), timed, and "overnight" (first morning urine), fasting or not fasting) were selected and reviewed.
RESULTS
The review included data from 1 434 participants across the six studies that met the inclusion criteria. The main statistical methods for comparing data from the 24-hour urine collections with the values obtained from the alternative method(s) were either regression (β) or correlation (r) coefficients and concordance analysis through Bland-Altman plots. The urine samples collected using the alternative methods were subject to greater intra-individual and inter-individual variability than the 24-hour urine collections. There was a wide range in coefficient values for the comparisons between 24-hour URE measured in 24-hour urine collection and 24-hour UIE estimated using the alternative sampling methods. No alternative sampling method (spot, timed, or "overnight") was appropriate for estimating 24-hour UIE.
CONCLUSIONS
The results of this systematic review suggest current data on UICs as a means of predicting 24-hour UIE for estimating population sodium intake are inadequate and highlight the need for further methodological investigations.
Topics: Adolescent; Adult; Child; Diet; Humans; Iodine; Nutritional Status; Osmolar Concentration; Research Design; Time Factors; Urine Specimen Collection
PubMed: 26506324
DOI: No ID Found -
Environmental Toxicology and Chemistry Dec 2022Industries such as unconventional natural gas have seen increased global expansion to meet the increasing energy needs of our increasing global population.... (Review)
Review
Industries such as unconventional natural gas have seen increased global expansion to meet the increasing energy needs of our increasing global population. Unconventional gas uses hydraulic fracturing that produces significant volumes of produced waters, which can be highly saline and pose a toxic threat to freshwater invertebrates if exposure via discharges, spills, leaks, or runoff were to occur. The primary aim of the present review was to determine the sodium (Na ) and chloride (Cl ) content of these waters as an approximate measure of salinity and how these values compare to the NaCl or synthetic marine salt acute toxicity values of freshwater invertebrate taxa. Shale gas produced waters are much more saline with 78 900 ± 10 200 NaCl mg/L and total dissolved solids (TDS) of 83 200 ± 12 200 mg/L compared to coal bed methane (CBM) produced waters with 4300 ± 1100 NaCl mg/L and TDS of 5900 ± 1300 mg/L and pose a far greater toxicity risk from NaCl to freshwater invertebrates. In addition, the toxicity of other major ions (Ca , K , Mg , , HCO , and ) and their influence on the toxicity of Na and Cl were evaluated. Exposure of untreated and undiluted shale gas produced waters to freshwater invertebrates is likely to result in significant or complete mortality. Shale gas produced waters have higher concentrations of various metals compared with CBM produced waters and are more acidic. We recommend future research to increase the reporting and consistency of water quality parameters, metals, and particularly organics of produced waters to provide a better baseline and help in further investigations. Environ Toxicol Chem 2022;41:2928-2949. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
Topics: Animals; Fresh Water; Invertebrates; Natural Gas; Salinity; Sodium Chloride; Water Pollutants, Chemical
PubMed: 36193756
DOI: 10.1002/etc.5492 -
Drug Discovery Today Jan 2019Chemical-stimuli-responsive nanotherapeutics have gained great interest in drug delivery and diagnosis applications. These nanotherapeutics are designed to respond to...
Chemical-stimuli-responsive nanotherapeutics have gained great interest in drug delivery and diagnosis applications. These nanotherapeutics are designed to respond to specific internal stimuli including pH, ionic strength, redox, reactive oxygen species, glucose, enzymes, ATP and hypoxia for site-specific and responsive or triggered release of payloads and/or biomarker detections. This review systematically and comprehensively addresses up-to-date technological and design strategies, and challenges nanomaterials to be used for triggered release and sensing in response to chemical stimuli.
Topics: Adenosine Triphosphate; Animals; Drug Delivery Systems; Enzymes; Glucose; Humans; Hydrogen-Ion Concentration; Hypoxia; Nanostructures; Osmolar Concentration; Oxidation-Reduction
PubMed: 30292916
DOI: 10.1016/j.drudis.2018.09.019 -
Marine Environmental Research Feb 2021Multiple stressors are ubiquitous in coastal ecosystems as a result of increased human activity and development along coastlines. Accurately assessing multiple stressor... (Review)
Review
Multiple stressors are ubiquitous in coastal ecosystems as a result of increased human activity and development along coastlines. Accurately assessing multiple stressor effects is essential for predicting stressor impacts and informing management to efficiently and effectively mitigate potentially complex ecological responses. Extracting relevant information on multiple stressor studies conducted specifically within coastal wetlands is not possible from existing reviews, posing challenges in highlighting knowledge gaps and guiding future research. Here, we systematically review manipulative studies that assess multiple anthropogenic stressors within saltmarsh, mangrove, and seagrass ecosystems. In the past decade, there has been a rapid increase in publications, with seagrasses receiving the most attention (76 out of a total of 143 studies). Across all studies, nutrient loading and temperature were tested most often (N = 64 and N = 48, respectively), while the most common stressor combination was temperature with salinity (N = 12). Stressor application and study design varied across ecosystems. Studies are mostly conducted in highly controlled environments, without considering how natural variations in the physicochemical environment of coastal ecosystems may influence stressor intensity and timing under these conditions. This may result in vastly different ecological responses across levels of biological organisation. Shifting focus from univariate analytical approaches to multivariate, particularly path analysis, will help elucidate complex ecological relationships and highlight direct and indirect effects of multiple stressors in coastal ecosystems. There is a solid foundation of multiple stressor research in coastal wetlands. However, we recommend future research enhance ecological realism in experimental design by studying the effects of stressor combinations whilst accounting for spatiotemporal variability that reflects natural conditions of coastal ecosystems.
Topics: Ecosystem; Humans; Salinity; Temperature; Wetlands
PubMed: 33422898
DOI: 10.1016/j.marenvres.2020.105239