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British Journal of Clinical Pharmacology Apr 2018Osmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which... (Comparative Study)
Comparative Study
AIM
Osmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic haemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients.
METHOD
A database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting. The primary end-points were alterations of cardiac output (CO) and other haemodynamic variables, while the impact of osmotic agents on intracranial pressure, brain relaxation, plasma osmolality, electrolyte levels and urinary output constituted secondary outcomes.
RESULTS
Eight studies, enrolling 182 patients in total, were included. HTS exerted a more profound cardiac output augmentation than mannitol, but no distinct difference between groups occurred. Central venous pressure, stroke volume and stroke volume variation were favourably affected by both osmotic agents, whilst the reported changes in blood pressure were inconclusive. HTS infusion yielded a larger intracranial pressure reduction than mannitol but had an equivalent effect on brain relaxation. Mannitol presented a more potent diuretic effect than HTS. Effect on serum osmolality was alike in both osmotic agents, but contrary to HTS-promoted hypernatraemia, mannitol use induced transient hyponatraemia.
CONCLUSIONS
Mannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion. This effect combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics.
Topics: Cardiac Output; Critical Care; Diuretics, Osmotic; Hemodynamics; Humans; Intracranial Hypertension; Intracranial Pressure; Mannitol; Randomized Controlled Trials as Topic; Saline Solution, Hypertonic
PubMed: 29247499
DOI: 10.1111/bcp.13492 -
Burns : Journal of the International... Jun 2018The well documented susceptibility of burn patients to acquired infections via damaged skin mandates application of antimicrobial agents. These agents are dissolved in...
BACKGROUND
The well documented susceptibility of burn patients to acquired infections via damaged skin mandates application of antimicrobial agents. These agents are dissolved in various vehicles that augment skin absorption thus allowing greater efficacy. Polyethylene glycol (PEG) and Propylene glycol (PropG) are among the most commonly used vehicles, and both have been used in numerous medications and cosmetic products over the past few decades. Rarely, burn patients treated with agents containing these glycols present with a life threatening systemic toxidrome of hyperosmolar metabolic acidosis. We present a systematic review of outcomes in burn patients treated with similar agents.
METHODS
Relevant studies were identified through systematic searches conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Thomson Reuters), from database inception to August 4th, 2016. All publications of clinical burn patient studies included at least one arm receiving a glycol based topical therapy.
RESULTS
A total of 61 studies involving 10,282 patients and 4 different antimicrobial medications fulfilled the inclusion criteria. Nine burn patients (0.09%) were documented to present with hyperosmolar metabolic acidosis during topical silver sulfadiazine treatment. Propylene glycol isolated from their blood accounted for the high osmole gap.
CONCLUSION
This first systematic review found very few cases of documented hyperosmolar metabolic acidosis, all within one study that had set to specifically explore this toxidrome. High index of suspicion with frequent osmolar gap monitoring may help identify future toxicities in a timely manner.
Topics: Acidosis; Anti-Infective Agents, Local; Glycols; Humans; Osmolar Concentration; Pharmaceutical Vehicles; Polyethylene Glycols; Propylene Glycol
PubMed: 28797572
DOI: 10.1016/j.burns.2017.06.006 -
Dental Traumatology : Official... Dec 2018The best treatment for an avulsed tooth is immediate replantation. If this is not possible, a proper transport medium is required for the maintenance of viability of the...
BACKGROUND/AIMS
The best treatment for an avulsed tooth is immediate replantation. If this is not possible, a proper transport medium is required for the maintenance of viability of the periodontal ligament cells (PDL). The aim was to systematically review the efficacy of different storage media used for the survival of PDL cells of avulsed teeth in the in vitro setting.
METHODS
The search strategy was based on the MeSH keywords in PubMed/MEDLINE: "Transport media for avulsed teeth," "Storage media for avulsed teeth," "Knocked out teeth," "Tooth avulsion," "Biological transport of avulsed tooth," "Cell survival of avulsed tooth," "Cell viability of avulsed tooth," "Tooth replantation," and "Periodontal ligament in avulsed teeth." The "AND" and "OR" Boolean operators were applied to combine keywords. Each study was evaluated for eight criteria, including use of human PDL, in vitro cell culture models, the number of passages, types of storage media, percentages of surviving PDL cells, pH and osmolality of storage media, and the type of test used to asses PDL viability.
RESULTS
In 15 selected studies, nine storage media (HBSS, tap water, DMEM, milk, saliva, 10% and 20% propolis, Gatorade, and Viaspan) were analyzed at six time points. For storage up to 2 hours, HBSS, DMEM, milk, 10% propolis, 20% propolis, and Viaspan conserved more than 80% of PDL viability. For storage at 24 hours, Viaspan showed best cell survival at 88.4%, followed by DMEM (70.9%) and 10% propolis (68.3%). Milk and HBSS showed similar PDL survival at 24 hours (57.2% and 57.3%, respectively).
CONCLUSIONS
Milk remains the most convenient, cheapest, and readily available solution in most situations while also being capable of keeping PDL cells alive. Further studies are required to evaluate the efficacy of more commonly found storage media besides milk.
Topics: Cell Culture Techniques; Cell Survival; Humans; Organ Preservation Solutions; Periodontal Ligament; Tooth Avulsion
PubMed: 30193009
DOI: 10.1111/edt.12437 -
Cancer Imaging : the Official... Jun 2019Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a... (Comparative Study)
Comparative Study Meta-Analysis
Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: a systematic review and meta-analysis.
BACKGROUND
Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a difference in CI-AKI incidence between iso-osmolar (IOCM) and low-osmolar contrast media (LOCM) among diabetic patients is controversial.
METHODS
Randomized controlled trials comparing the nephrotoxic effects between IOCM and LOCM in diabetic patients with or without CKD (eGFR< 60 ml/min/1.73 m) were included in the analysis. The incidence of CI-AKI was defined as an initial increase in serum creatinine (SCr) concentration of at least 0.5 mg/dl or a rise in creatinine of 25% from baseline.
RESULTS
A total of 2190 patients were included, among whom 1122 patients received IOCM and 1068 received LOCM. When compared to LOCM, IOCM had no significant benefit in preventing CI-AKI (OR = 1.66, [CI: 0.97-2.84], P = 0.06, I = 54%). However, the difference between IOCM and LOCM was found when CI-AKI was defined as an absolute SCr increase (≥0.5 mg/dl) rather than a relative SCr increase (≥25%). Further analysis showed that LOCM resulted in more adverse events.
CONCLUSIONS
Whether there is a difference of CI-AKI incidence between IOCM and LOCM in diabetic patients was related to the selected diagnostic criteria. The incidence of adverse events was significantly lower with IOCM when compared with LOCM. Therefore, we suggest that IOCM may be used in diabetic and CKD (eGFR< 60 ml/min/1.73 m) patients.
Topics: Acute Kidney Injury; Contrast Media; Diabetes Mellitus; Female; Humans; Male; Osmolar Concentration; Randomized Controlled Trials as Topic
PubMed: 31215488
DOI: 10.1186/s40644-019-0224-6 -
Environmental Microbiology Reports Jun 2024The pathogenic fungus Batrachochytrium dendrobatidis has caused declines of amphibians worldwide. Yet our understanding of how water quality influences fungal...
The pathogenic fungus Batrachochytrium dendrobatidis has caused declines of amphibians worldwide. Yet our understanding of how water quality influences fungal pathogenicity is limited. Here, we reviewed experimental studies on the effect of water quality on this pathogen to determine which parameters impacted disease dynamics consistently. The strongest evidence for protective effects is salinity which shows strong antifungal properties in hosts at natural levels. Although many fungicides had detrimental effects on the fungal pathogen in vitro, their impact on the host is variable and they can worsen infection outcomes. However, one fungicide, epoxiconazole, reduced disease effects experimentally and likely in the field. While heavy metals are frequently studied, there is weak evidence that they influence infection outcomes. Nitrogen and phosphorous do not appear to impact pathogen growth or infection in the amphibian host. The effects of other chemicals, like pesticides and disinfectants on infection were mostly unclear with mixed results or lacking an in vivo component. Our study shows that water chemistry does impact disease dynamics, but the effects of specific parameters require more investigation. Improving our understanding of how water chemistry influences disease dynamics will help predict the impact of chytridiomycosis, especially in amphibian populations affected by land use changes.
Topics: Animals; Batrachochytrium; Amphibians; Water Quality; Mycoses; Salinity; Fungicides, Industrial; Chytridiomycota; Pesticides; Disinfectants; Antifungal Agents
PubMed: 38775382
DOI: 10.1111/1758-2229.13274