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The American Journal of Medicine Mar 2015Acute kidney injury complicates decompensated heart failure in ∼33% of cases and is associated with morbidity and mortality; thus, we sought to systematically review... (Review)
Review
BACKGROUND
Acute kidney injury complicates decompensated heart failure in ∼33% of cases and is associated with morbidity and mortality; thus, we sought to systematically review this topic in order to summarize novel diagnostic and therapeutic approaches.
METHODS
Structured PubMed searches on these topics were conducted in February 2014 and relevant literature was identified. The PubMed search identified a total of 192 articles that were individually screened for inclusion in this analysis, and 58 were included.
RESULTS
Acute kidney injury, defined by substantial increases in serum creatinine, is associated consistently with prolonged length of stay, rehospitalization, and mortality. Biomarker studies suggested that natriuretic peptides are prognostic for shorter- and longer-term mortality. Novel proteins indicating kidney damage and albumin in the urine are associated with acute kidney injury. The most promising acute pharmacologic treatment appears to be serelaxin, which has been shown to improve acute heart failure symptoms, hemodynamic parameters, and renal function.
CONCLUSIONS
The presence of acute kidney injury results in worse clinical outcomes for patients with acute heart failure. Novel biomarkers and therapies hold the promise of improving both cardiac and renal outcomes in these patients.
Topics: Acute Kidney Injury; Biomarkers; Cardiovascular Agents; Creatinine; Heart Failure; Hemodynamics; Hospitalization; Humans; Kidney Function Tests; Natriuretic Peptides; Prognosis; Recombinant Proteins; Relaxin; Treatment Outcome
PubMed: 25446297
DOI: 10.1016/j.amjmed.2014.10.035 -
Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis.Critical Care (London, England) Sep 2023Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially modifying the operative performance of fluid responsiveness predictors commonly used in clinical practice.
METHODS
A sensitive strategy was conducted in the Medline and Embase databases to search for prospective studies assessing the operative performance of pulse pressure variation, stroke volume variation, passive leg raising (PLR), end-expiratory occlusion test (EEOT), mini-fluid challenge, and tidal volume challenge to predict fluid responsiveness in critically ill and acutely ill surgical patients published between January 1999 and February 2023. Adjusted diagnostic odds ratios (DORs) were calculated by subgroup analyses (inverse variance method) and meta-regression (test of moderators). Variables potentially modifying the operative performance of such predictor tests were classified as technical and clinical.
RESULTS
A total of 149 studies were included in the analysis. The volume used during fluid loading, the method used to assess variations in macrovascular flow (cardiac output, stroke volume, aortic blood flow, volume‒time integral, etc.) in response to PLR/EEOT, and the apneic time selected during the EEOT were identified as technical variables modifying the operative performance of such fluid responsiveness predictor tests (p < 0.05 for all adjusted vs. unadjusted DORs). In addition, the operative performance of fluid responsiveness predictors was also influenced by clinical variables such as the positive end-expiratory pressure (in the case of EEOT) and the dose of norepinephrine used during the fluid responsiveness assessment for PLR and EEOT (for all adjusted vs. unadjusted DORs).
CONCLUSION
Prediction of fluid responsiveness in critically and acutely ill patients is strongly influenced by a number of technical and clinical aspects. Such factors should be considered for individual intervention decisions.
Topics: Humans; Prospective Studies; Aorta; Blood Pressure; Cardiac Output; Databases, Factual
PubMed: 37730622
DOI: 10.1186/s13054-023-04629-w -
The British Journal of Surgery May 2011Extracorporeal liver support (ELS) systems offer the potential to prolong survival in acute and acute-on-chronic liver failure. However, the literature has been unclear... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Extracorporeal liver support (ELS) systems offer the potential to prolong survival in acute and acute-on-chronic liver failure. However, the literature has been unclear on their specific role and influence on mortality. This meta-analysis aimed to test the hypothesis that ELS improves survival in acute and acute-on-chronic liver failure.
METHODS
Clinical trials citing MeSH terms 'liver failure' and 'liver, artificial' were identified by searching MEDLINE, Embase and the Cochrane registry of randomized controlled trials (RCTs) between January 1995 and January 2010. Only RCTs comparing ELS with standard medical therapy in acute or acute-on-chronic liver failure were included. A predefined data collection pro forma was used and study quality assessed according to Consolidated Standards of Reporting Trials (CONSORT) criteria. Risk ratio was used as the effect size measure according to a random-effects model.
RESULTS
The search strategy revealed 74 clinical studies including 17 RCTs, five case-control studies and 52 cohort studies. Eight RCTs were suitable for inclusion, three addressing acute liver failure (198 participants) and five acute-on-chronic liver failure (157 participants). The mean CONSORT score was 14 (range 11-20). Overall ELS therapy significantly improved survival in acute liver failure (risk ratio 0·70; P = 0·05). The number needed to treat to prevent one death in acute liver failure was eight. No significant survival benefit was demonstrated in acute-on-chronic liver failure (risk ratio 0·87; P = 0·37).
CONCLUSION
ELS systems appear to improve survival in acute liver failure. There is, however, no evidence that they improve survival in acute-on-chronic liver failure.
Topics: End Stage Liver Disease; Epidemiologic Methods; Humans; Liver Failure, Acute; Liver, Artificial; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 21462172
DOI: 10.1002/bjs.7418 -
Clinical Infectious Diseases : An... Nov 2018The microbiome influences malaria parasite fitness and transmission efficiency in mosquitoes and appears to affect malaria dynamics in mammalian hosts as well. Nascent...
BACKGROUND
The microbiome influences malaria parasite fitness and transmission efficiency in mosquitoes and appears to affect malaria dynamics in mammalian hosts as well. Nascent research examining the interrelationship of malaria and the mammalian microbiome has yielded interesting insights inviting further study.
METHODS
We conducted a systematic review of the literature examining associations between the microbiome and malaria in mammalian hosts. An electronic search algorithm was adapted to PubMed, MEDLINE, Scopus, Embase, and Web of Science, and reference lists of relevant sources were manually searched. Identified studies were screened and assessed independently by 2 authors, and results were compiled in a qualitative synthesis of the evidence.
RESULTS
Ten relevant studies were identified. They demonstrate associations between certain intestinal communities and protection against Plasmodium infection and modulation of disease severity. Plasmodium infection acutely and reversibly reshapes gut microbial composition in mice. The makeup of human skin microbial communities may influence mosquito attraction and thus disease transmission.
CONCLUSIONS
Early research supports a relationship between malaria and the microbiome. The evidence is incomplete, but the observed associations are evocative and signal a promising avenue of inquiry. Microbiome-based studies of malaria can be readily integrated into field-based research.
Topics: Animals; Culicidae; Gastrointestinal Microbiome; Host-Parasite Interactions; Humans; Malaria; Mice; Microbiota; Plasmodium; Skin
PubMed: 29701835
DOI: 10.1093/cid/ciy374 -
CNS Drugs Nov 2014Pharmacotherapy remains the mainstay of treatment for acute bipolar mania, but there are many choices, including mood stabilizers (MSs) and antipsychotics (APs). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pharmacotherapy remains the mainstay of treatment for acute bipolar mania, but there are many choices, including mood stabilizers (MSs) and antipsychotics (APs).
OBJECTIVE
To provide an up-to-date and comprehensive review of the efficacy, acceptability and adverse effects of MSs and APs as combination or augmentation therapy versus monotherapy with either drug class for the treatment of acute mania.
DATA SOURCES
The Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, Scopus, and clinical trial databases were searched for articles published between the inception of the databases and July 1, 2014. The following keywords were used: [bipolar disorder, mania, manic, mixed bipolar, schizoaffective] combined with the names of MSs and APs. The reference lists of all the identified randomized controlled trials (RCTs), articles that cited the identified trials, and recent systematic reviews were also checked.
STUDY SELECTION
Double-blind RCTs comparing MS and AP as combination or augmentation therapy with either monotherapy during the acute phase treatment of mania were included in the present study. The electronic search yielded 6,445 potential articles in September 2013 and 264 new references in an updated search performed in July 2014. Finally, 19 RCTs were considered eligible for our meta-analyses: MS plus AP combination or augmentation therapy was compared with MS monotherapy in 14 trials (n = 3,651) and with AP monotherapy in 6 trials (n = 606) [one study compared combination therapy versus both MS monotherapy and AP monotherapy].
DATA EXTRACTION
The primary outcomes were the mean change scores on validated rating scales for mania and all-cause discontinuation at 3 weeks. The secondary outcomes included response, remission, the mean change scores for depression, dropouts due to adverse events and to inefficacy, and adverse events at 3 weeks and mean change scores on validated rating scales at 1 week. Using random-effects models, standardized mean difference (SMD), risk ratio (RR) and numbers needed to treat with their 95 % confidence intervals (CIs) were calculated.
RESULTS
Most patients included in trials comparing combination/augmentation therapy versus MS monotherapy had prior treatment with an MS, while more than 70 % of participants in trials comparing combination/augmentation therapy versus AP monotherapy had not been on medications or were washed out from their previous medication before randomization. MS plus AP combination/augmentation therapy was more effective than MS monotherapy in terms of change in scores on mania rating scales at 3 weeks (SMD -0.26; 95 % CI -0.36 to -0.15) and at 1 week (SMD -0.17, -0.29 to -0.04). MS plus AP combination/augmentation therapy was more effective than AP monotherapy at 3 weeks (SMD -0.31, -0.50 to -0.12), but not at 1 week (SMD -0.22, -0.84 to 0.40). No significant differences were seen between the combination/augmentation therapy and either monotherapy group in study withdrawal for any reason (MS + AP vs. MS monotherapy: RR 0.99, 0.88-1.12; MS + AP vs. AP monotherapy: RR 0.70, 0.47-1.04) or adverse events (MS + AP vs. MS monotherapy: RR 1.39, 0.97-1.99; MS + AP vs. AP monotherapy: RR 0.62, 0.27-1.40). The combination/augmentation therapy was associated with more side effects, especially with somnolence, while it did not increase treatment-emergent depression.
CONCLUSIONS
Combining MS and AP is more efficacious and more burdensome than, but overall as acceptable as, the continuation of MS or AP monotherapy, when either monotherapy has not been successful. There is currently no robust evidence to judge whether MS and AP combination therapy is more efficacious than MS monotherapy as the initial therapy for acutely manic patients without prior medication.
Topics: Acute Disease; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Drug Therapy, Combination; Humans; Treatment Outcome
PubMed: 25160685
DOI: 10.1007/s40263-014-0197-8 -
Addiction (Abingdon, England) Dec 2016Performance on cognitive tasks may be sensitive to acute smoking abstinence and may also predict whether quit attempts fail. Our aim was to conduct a systematic review... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Performance on cognitive tasks may be sensitive to acute smoking abstinence and may also predict whether quit attempts fail. Our aim was to conduct a systematic review and meta-analysis to identify cognitive tasks sensitive to acute abstinence and predictive of smoking cessation success.
METHODS
Embase, Medline, PsycInfo and Web of Science were searched up to March 2016. Studies were included if they enrolled adults and assessed smoking using a quantitative measure. Studies were combined in a random effects meta-analysis.
RESULTS
We included 42 acute abstinence studies and 13 cessation studies. There was evidence for an effect of abstinence on delay discounting [d = 0.26, 95% confidence interval (CI) = 0.07-0.45, P = 0.005], response inhibition (d = 0.48, 95% CI = 0.26-0.70, P < 0.001), mental arithmetic (d = 0.38, 95% CI = 0.06-0.70, P = 0.018), and recognition memory (d = 0.46, 95% CI = 0.23-0.70, P < 0.001). In contrast, performance on the Stroop (d = 0 .17, 95% CI = -0.17-0.51, P = 0.333) and smoking Stroop (d = 0.03, 95% CI = -0.11-0.17, P = 0.675) task was not influenced by abstinence. We found only weak evidence for an effect of acute abstinence on dot probe task performance (d = 0.15, 95% CI = -0.01-0.32, P = 0.072). The design of the cessation studies was too heterogeneous to permit meta-analysis.
CONCLUSIONS
Compared with satiated smokers, acutely abstinent smokers display higher delay discounting, lower response inhibition, impaired arithmetic and recognition memory performance. However, reaction-time measures of cognitive bias appear to be unaffected by acute tobacco abstinence. Conclusions about cognitive tasks that predict smoking cessation success were limited by methodological inconsistencies.
Topics: Adult; Cognitive Behavioral Therapy; Female; Humans; Male; Psychomotor Performance; Recurrence; Sample Size; Smoking Cessation; Treatment Outcome
PubMed: 27338804
DOI: 10.1111/add.13507 -
The Journal of Sports Medicine and... Jun 2018The independent predictor of cardiovascular mortality, central arterial stiffness (CAS), is modulated by exercise depending on type of exercises, arteries assessed,... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The independent predictor of cardiovascular mortality, central arterial stiffness (CAS), is modulated by exercise depending on type of exercises, arteries assessed, sample features and time to exposure. Thus, this study aim to determine the endurance, resistance and combined exercise effects on CAS over time in humans.
EVIDENCE ACQUISITION
MEDLINE database for studies published between January 1st, 1990 and February 3rd, 2015. Studies measuring the effects of exercise on CAS, measured by aortic pulse wave velocity or carotid arterial compliance measured by ultrasound were included. Two independent reviewers extracted the 56 studies meta-analyzed and allocated among type of exercise and time effects categories: acute (10 minutes to 24 hours post-exercise session effect), short-term (interventional studies testing basal CAS from 1 to 24 weeks of exercise) and long-term (cross-sectional studies comparing trained and untrained individuals).
EVIDENCE SYNTHESIS
We calculated standard difference in means 95% CIs, applying random or fixed-effects models, according to presence or absence of true heterogeneity, respectively. Endurance exercise reduced CAS in short and long-term analysis (-0.42 [-0.53 to -0.31] and -0.62 [-0.95 to -0.29], respectively), however it did not modify CAS acutely; higher magnitude of reduction occurred in normal weight individuals, with longer duration, higher weekly frequency and continuous (rather than interval) protocols. Resistance exercise increases CAS acutely (0.30 [0.01 to 0.58]) and after long-term (0.47 [0.19 to 0.75]), while short-term resistance exercise did not modify CAS significantly. No significant effect was found for short-term combined exercises and there was not enough number of studies for acute and long-term effects to be meta-analysed.
CONCLUSIONS
Endurance and resistance exercise have opposite long-term effects, being beneficial and deleterious, respectively, while the combined exercise showed to be innocuous.
Topics: Cross-Sectional Studies; Exercise; Exercise Therapy; Female; Humans; Male; Pulse Wave Analysis; Time Factors; Vascular Stiffness
PubMed: 29877680
DOI: 10.23736/S0022-4707.17.07486-2 -
Journal of Sports Sciences Sep 2023We performed a systematic review and meta-analysis on the acute effects of prior conditioning activity (CA) on change of direction (COD) performance. Eligible studies,... (Meta-Analysis)
Meta-Analysis Review
We performed a systematic review and meta-analysis on the acute effects of prior conditioning activity (CA) on change of direction (COD) performance. Eligible studies, involving healthy participants undergoing acute CA with at least one measure of COD performance, were analysed across diverse databases. A total of 34 studies were included for systematic review with 19 studies included for the meta-analysis. The intervention condition resulted in significantly faster (Z = 4.39; standard mean difference [SMD] = 0.49; < 0.05) COD performance compared with the control condition. Both unloaded and light loaded CA resulted in significantly greater (SMD = 0.58-0.59) COD performance compared to the control condition. Moreover, heavy loaded CA demonstrated a significant but small (SMD = 0.24) improvement in COD performance compared to the control condition. Age and study design had no effect on the overall meta-analysis outcomes. Both males and females exhibited similar moderate effects with CA but only males demonstrated significantly greater COD performance compared to control conditions. Our findings indicate that a range of CA protocols can acutely improve COD performance with unloaded and light-loaded CA resulting in the greatest performance enhancements. These findings will assist practitioners with the design and implementation of appropriate acute CA to improve COD performance.
Topics: Male; Female; Humans; Athletic Performance; Exercise; Research Design
PubMed: 38124253
DOI: 10.1080/02640414.2023.2293556 -
Clinical Journal of Oncology Nursing Jun 2017Identifying and implementing evidence-based interventions for cancer-related acute pain can decrease adverse effects and improve quality of life. . (Review)
Review
BACKGROUND
Identifying and implementing evidence-based interventions for cancer-related acute pain can decrease adverse effects and improve quality of life. .
OBJECTIVES
This article presents current evidence supporting interventions to reduce cancer-related acute pain. .
METHODS
PubMed and CINAHL® databases were searched to identify studies addressing interventions to manage acute pain in patients with cancer. The interventions are categorized according to the Putting Evidence Into Practice classification schema. .
FINDINGS
Interventions that are recommended for practice in the management of acute pain include epidural analgesia and local anesthetic infusions. Interventions likely to be effective include pharmacologic interventions, such as gabapentin and intraspinal analgesia, and nonpharmacologic interventions, such as music therapy. Methodologically stronger clinical trials of new and existing therapies are needed to provide clinicians with accurate resources for managing cancer-related acute pain.
Topics: Acute Pain; Cancer Pain; Education, Nursing, Continuing; Evidence-Based Nursing; Humans; Practice Guidelines as Topic
PubMed: 28524911
DOI: 10.1188/17.CJON.S3.13-30 -
Clinical Toxicology (Philadelphia, Pa.) Sep 2021Three consensus classifications of acute kidney injury have been published. These are RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease... (Comparative Study)
Comparative Study Meta-Analysis
RATIONALE
Three consensus classifications of acute kidney injury have been published. These are RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease published by the workgroup), AKIN (published by the ) and KDIGO (published by the workgroup). Acute kidney injury has been reported consistently as associated with worsened outcomes. However, toxicant-related acute kidney injury has been excluded from the studies used to validate the classifications of acute kidney injury.
OBJECTIVE
To study whether poisoned patients who develop acute kidney injury, as defined by consensus definitions/classifications, have higher mortality compared to those who did not.
METHODS
Databases were searched from 2004 to 2019 using the following keywords (KDIGO OR "Kidney Disease: Improving Global Outcomes" OR "Kidney Disease Improving Global Outcomes" OR AKIN OR "AKI network" OR "Acute kidney Injury Network" OR ADQI OR RIFLE OR "Acute dialysis quality initiative") AND (intoxication OR poisoning OR overdose OR ingestion) AND (AKI OR kidney OR renal OR ARF). If data were available, we used a random-effects meta-analysis model and Fisher's exact test to compare mortality in patients according to kidney function definitions (acute kidney injury not) and stages (stages no acute kidney injury), respectively. If data were available, we assessed the correlation between mortality and renal function (no acute kidney injury, risk/stage 1, injury/stage 2 and failure/stage 3) using the Spearman correlation. If available, we collected the results of statistical analyses in studies that have used acute kidney injury to predict mortality.
RESULTS
Thirty-three relevant studies were found, 22/33 retrospective studies (67%) and 11/33 prospective studies (33%). Paraquat was the most frequent toxicant involved (13/33, 39%). We found a disparity between studies regarding the timeframe during which mortality was assessed, the temporality of the renal function considered to predict mortality (initial/worst) and the criteria used to define/grade acute kidney injury across studies. Consensus definitions/staging of acute kidney injury were associated with higher mortality, using univariate analyses, in twenty-eight (RIFLE = 7; AKIN = 12; KDIGO = 9) studies included but not in five (AKIN = 4, KDIGO = 1). When available data were pooled, RIFLE (5 studies), AKIN (16 studies) and KDIGO definitions (8 studies) of acute kidney injury were associated with a higher mortality (Log unadjusted Odds ratios [95%-confidence interval], 2.60 [2.23; 2.97], 2.02 [1.48; 2,52] and 3.22 [2,65; 3.78], respectively). However, we found high heterogeneity (I=54,7%) and publication bias among studies using AKIN. In ten studies with available data, the correlation between renal function (no acute kidney injury, risk/stage 1, injury/stage 2, failure/stage 3) and mortality was significant in 5 studies (RIFLE = 2; AKIN = 3), but not in five studies (RIFLE = 1; AKIN = 3; KDIGO = 1).. The definitions of acute kidney injury were associated with higher mortality in two studies (RIFLE = 2), but not in four studies (AKIN = 1 and KDIGO = 3. The stages of acute kidney injury (including one or more stages) were associated with higher mortality in four (RIFLE = 1, AKIN = 1 and KDIGO = 2).
CONCLUSIONS
All three consensus definitions/classifications were associated independently with increased mortality in poisoning but with disparity between studies reporting acute kidney injury.
Topics: Acute Kidney Injury; Hospital Mortality; Humans; Odds Ratio; Poisoning; Prospective Studies; Retrospective Studies; Risk Factors; Severity of Illness Index
PubMed: 34080503
DOI: 10.1080/15563650.2021.1928161