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Psychopharmacology Nov 2014The primary antipsychotic-induced creatine kinase elevation (i.e., not due to neuroleptic malignant syndrome, extrapyramidal symptoms, etc.) is a poorly studied... (Review)
Review
RATIONALE
The primary antipsychotic-induced creatine kinase elevation (i.e., not due to neuroleptic malignant syndrome, extrapyramidal symptoms, etc.) is a poorly studied condition.
OBJECTIVES
The aims of the present study were to provide an overview of published cases with antipsychotic-induced creatine kinase elevation and give recommendations for the clinical practice.
METHODS
PubMed and EMBASE were searched for eligible trials, case series, and case reports. We set a threshold at ten times the upper normal limit of the creatine kinase value in order to define an elevation as significant.
RESULTS
The prevalence of significant creatine kinase elevation ranged between 2 and 7%. We found a total of 42 eligible cases. Men were overrepresented in our sample (81%). Patients with myoglobinuria were more likely to be symptomatic (Fisher's exact test, p = 0.006), whereas neither myoglobinuria (Mann-Whitney test, p > 0.10) nor symptoms (Mann-Whitney test, p = 0.64) were related to the magnitude of the creatine kinase (CK) elevation. In the majority of the cases, the antipsychotic medication was discontinued (86%). Forced diuresis was given in 36% of the patients. Eighty-three percent of the patients had no further complications. Only one case was found with a de novo acute renal failure.
CONCLUSIONS
The discontinuation of the antipsychotic medication was a sufficient measure for the CK elevation to subside in the majority of the cases. Cases with myoglobinuria should eventually be treated more aggressively. Further recommendations for the clinical practice are presented.
Topics: Adult; Aged; Aged, 80 and over; Antipsychotic Agents; Creatine Kinase; Female; Humans; Male; Middle Aged
PubMed: 25319963
DOI: 10.1007/s00213-014-3764-2 -
European Journal of Clinical... Oct 2014To assess the efficacy and safety of the novel sodium glucose co-transporter 2 (SGLT2) inhibitor-canagliflozin for type 2 diabetes (T2DM). (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
To assess the efficacy and safety of the novel sodium glucose co-transporter 2 (SGLT2) inhibitor-canagliflozin for type 2 diabetes (T2DM).
METHODS
A search of Medline (1946-January 2014), Embase (1950-January 2014), and The Cochrane Library for randomized controlled trials of canagliflozin compared to placebo or active comparator in T2DM was performed. Clinical Trials website and unpublished U.S. Food and Drug Administration data were also searched.
RESULTS
Ten trials including 6,701 patients were analyzed. Compared with placebo, canagliflozin produced absolute reductions in glycated hemoglobin A1c levels when used as monotherapy (weighted mean difference (WMD) -1.08%, 95% confidence interval (CI) [-1.25 to -0.90], p < 0.00001) or add-on treatment (WMD -0.73%, 95%CI [-0.84 to -0.61], p < 0.00001). When compared with other active comparators, canagliflozin significantly reduced HbA1c by -0.21% (WMD, 95%CI [-0.33 to -0.08], p = 0.001). Canagliflozin led to greater body weight loss (vs. placebo, WMD -2.81 kg, 95%CI [-3.26 to -2.37]; vs. active comparators, WMD -3.49 kg, 95%CI [-4.86 to -2.12]). Hypoglycemia with canagliflozin was similar to placebo or sitagliptin, and was lower than glimepiride (risk ratio (RR) 0.15, 95%CI [0.10 to 0.22]). Genital tract infections were more common with canagliflozin (vs. placebo, RR 3.76, 95%CI [2.23 to 6.35]; vs. active comparators, RR 4.95, 95%CI [3.25 to 7.52]). Similar incidences of urinary tract infections were noted with canagliflozin compared with control groups.
CONCLUSION
Canagliflozin led to improvements in reducing glycated hemoglobin A1c levels and body weight with low risk of hypoglycemia in patients with T2DM. Common adverse effects including genital tract infections and osmotic diuresis-related AEs were identified and reviewed. Risks of cardiovascular events are even less certain, and more data on long-term effects are needed.
Topics: Canagliflozin; Diabetes Mellitus, Type 2; Glucosides; Glycated Hemoglobin; Humans; Hypoglycemia; Hypoglycemic Agents; Sodium-Glucose Transporter 2 Inhibitors; Thiophenes
PubMed: 25124541
DOI: 10.1007/s00228-014-1730-x -
Journal of Intensive Care 2014The background of this study is to determine whether the addition of intravenous colloid to diuretic therapy, in comparison to diuretic therapy alone, improves diuresis...
BACKGROUND
The background of this study is to determine whether the addition of intravenous colloid to diuretic therapy, in comparison to diuretic therapy alone, improves diuresis and oxygenation and prevents intravascular volume depletion in intensive care unit (ICU) patients without shock.
METHODS
We searched MEDLINE, Embase, Cochrane Register of Controlled Trials, Google Scholar, conference abstracts of ACCP, SCCM, ATS, and references of relevant articles. Randomized controlled trials (RCTs) of adult ICU patients, not in shock (defined as patients on low dose or no vasopressors, without need for IV fluid bolus or blood transfusion within 24 h), comparing intravenous colloid therapy (human albumin, plasma, synthetic starches, or gels) plus diuretic to control (diuretic alone, or diuretic plus placebo). Two reviewers independently applied eligibility criteria, assessed quality, and extracted data.
RESULTS
Seven hundred fifty five studies were found in the initial search; 14 were deemed relevant; 2 were found to be eligible. There was good agreement between reviewers for study relevance (k = 0.869) and eligibility (k = 0.811). One study of heart failure patients showed no evidence of improved mean or hourly urine output in the group receiving albumin. The second studied patients hypoproteinemic with ARDS and demonstrated an improved fluid balance in 3 days, improved oxygenation status, and improved serum albumin level in patients treated with albumin. No significant differences were found for other outcomes. No studies evaluating colloids other than albumin were found.
CONCLUSIONS
Our review is limited by the small number of high-quality RCTs available to study this clinical question, both of which only studied albumin. High-quality RCTs are required to evaluate the effect of albumin as well as other colloids as an adjunct to diuresis in a general ICU population.
PubMed: 25960879
DOI: 10.1186/2052-0492-2-37 -
BMC Pediatrics Dec 2013Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Very different models using clinical parameters at an early postnatal age to predict BPD have... (Review)
Review
BACKGROUND
Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Very different models using clinical parameters at an early postnatal age to predict BPD have been developed with little extensive quantitative validation. The objective of this study is to review and validate clinical prediction models for BPD.
METHODS
We searched the main electronic databases and abstracts from annual meetings. The STROBE instrument was used to assess the methodological quality. External validation of the retrieved models was performed using an individual patient dataset of 3229 patients at risk for BPD. Receiver operating characteristic curves were used to assess discrimination for each model by calculating the area under the curve (AUC). Calibration was assessed for the best discriminating models by visually comparing predicted and observed BPD probabilities.
RESULTS
We identified 26 clinical prediction models for BPD. Although the STROBE instrument judged the quality from moderate to excellent, only four models utilised external validation and none presented calibration of the predictive value. For 19 prediction models with variables matched to our dataset, the AUCs ranged from 0.50 to 0.76 for the outcome BPD. Only two of the five best discriminating models showed good calibration.
CONCLUSIONS
External validation demonstrates that, except for two promising models, most existing clinical prediction models are poor to moderate predictors for BPD. To improve the predictive accuracy and identify preterm infants for future intervention studies aiming to reduce the risk of BPD, additional variables are required. Subsequently, that model should be externally validated using a proper impact analysis before its clinical implementation.
Topics: Area Under Curve; Bias; Birth Weight; Bronchopulmonary Dysplasia; Calibration; Diuresis; Early Diagnosis; Female; Gestational Age; Humans; Hypoxia; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Male; Models, Theoretical; Observational Studies as Topic; Predictive Value of Tests; ROC Curve; Weight Loss
PubMed: 24345305
DOI: 10.1186/1471-2431-13-207 -
The Cochrane Database of Systematic... Dec 2013Lower pole kidney stones typically have poor rates of spontaneous clearance from the body. Some studies have suggested that diuresis, percussion and inversion therapy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lower pole kidney stones typically have poor rates of spontaneous clearance from the body. Some studies have suggested that diuresis, percussion and inversion therapy could be beneficial for people with lower pole kidney stones following shock wave lithotripsy. There is however controversy about the relative benefits, harms, and efficacy of these interventions for the management of lower pole kidney stones.
OBJECTIVES
To identify the benefits and harms of percussion, diuresis, and inversion therapy to facilitate the passage of lower pole kidney stones following shock wave lithotripsy.
SEARCH METHODS
We searched the Cochrane Renal Group's specialised register up to 27 November 2013 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.
SELECTION CRITERIA
All randomised controlled trials (RCTs) and quasi-RCTs looking at the benefits and harms of percussion, diuresis, and inversion therapy for aiding passage of lower pole kidney stones following shock wave lithotripsy were sought for assessment. The first phases of randomised cross-over studies were also eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed study quality and extracted data. Results were expressed as relative risk (RR) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) for continuous data with 95% confidence intervals (CI).
MAIN RESULTS
We identified two small studies (177 participants) for inclusion and analysis. One study (69 participants) compared percussion, diuresis and inversion therapy following shock wave lithotripsy versus observation-only after shock wave lithotripsy. This study reported significantly higher stone-free rates in the intervention group (RR 0.62, 95% CI 0.47 to 0.82) and a significant reduction in stone burden (MD -3.30, 95% CI -3.58 to -3.03) compared to the observation-only group. They reported no significant differences in complication rates (RR 3.00, 95% CI 0.12 to 76.24).The second study (108 participants) compared percussion, diuresis, and inversion therapy plus shock wave lithotripsy with shock wave lithotripsy therapy alone. This study reported significantly higher stone-free rates in the intervention group (RR 0.36, 95% CI 0.17 to 0.80) and a significant reduction in stone burden (MD -0.30, 95% CI -0.04 to -0.56) compared to the control group. They reported no significant differences in complication rates (RR 2.54, 95% CI 0.10 to 63.72).For both studies selection bias was unclear; there was high risk of bias for performance bias; and detection, attrition and reporting bias were low.
AUTHORS' CONCLUSIONS
Limited evidence from two small studies indicated that percussion, diuresis, and inversion therapy may be safe and effective therapies to assist clearance of lower pole kidney stone fragments following shock wave lithotripsy. Methodological quality in both studies was assessed as moderate. Further well-designed and adequately powered studies are required to inform clinical practice.
Topics: Diuresis; Diuretics; Drainage; Drinking Water; Furosemide; Head-Down Tilt; Humans; Kidney Calculi; Patient Positioning; Percussion; Randomized Controlled Trials as Topic
PubMed: 24318643
DOI: 10.1002/14651858.CD008569.pub2 -
Psychiatrische Praxis Jan 2014With particular focus on clinical, pathophysiologic and epidemiologic aspects this systematic review article presents the available data on nephrotoxic effects of a... (Review)
Review
With particular focus on clinical, pathophysiologic and epidemiologic aspects this systematic review article presents the available data on nephrotoxic effects of a long-term treatment with lithium. Lithium may lead to tubular dysfunction (LITD = nephrogenic diabetes insipidus, hyperchloremic metabolic acidosis, increased natriuresis) and lithium-induced nephropathy (LIN) with reduced glomerular filtration rate (GFR). The histopathologic finding of LIN is chronic tubulo-interstitial nephritis. LITD frequently presents with polydipsia/-uria and reduced urine osmolality, while LIN features a wide clinical spectrum ranging from clinically asymptomatic presentations with reduced GFR to end-stage renal failure. LIN seems to feature slow progression and is significantly less frequent than LITD. Regular monitoring of renal function is indispensable for patients treated with lithium. Patients with reduced GFR under treatment with lithium should always be presented to a nephrologist. Currently, there are no guidelines for the handling of patients with LIN and ongoing treatment with lithium. Thus, regarding continuation of lithium-treatment an individual benefit/risk assessment is necessary.
Topics: Bipolar Disorder; Diabetes Insipidus, Nephrogenic; Drug Monitoring; Glomerular Filtration Rate; Humans; Kidney; Kidney Concentrating Ability; Kidney Failure, Chronic; Kidney Function Tests; Lithium Compounds; Long-Term Care; Natriuresis; Nephritis, Interstitial; Referral and Consultation; Water-Electrolyte Balance
PubMed: 24089323
DOI: 10.1055/s-0033-1349490 -
Neurourology and Urodynamics Sep 2014There is an agreement to use simple formulae (expected bladder capacity and other age based linear formulae) as bladder capacity benchmark. But real normal child's... (Review)
Review
BACKGROUND
There is an agreement to use simple formulae (expected bladder capacity and other age based linear formulae) as bladder capacity benchmark. But real normal child's bladder capacity is unknown.
AIMS
To offer a systematic review of children's normal bladder capacity, to measure children's normal maximum voided volumes (MVVs), to construct models of MVVs and to compare them with the usual formulae.
METHODS
Computerized, manual and grey literature were reviewed until February 2013. Epidemiological, observational, transversal, multicenter study. A consecutive sample of healthy children aged 5-14 years, attending Primary Care centres with no urologic abnormality were selected. Participants filled-in a 3-day frequency-volume chart. Variables were MVVs: maximum of 24 hr, nocturnal, and daytime maximum voided volumes.
FACTORS
diuresis and its daytime and nighttime fractions; body-measure data; and gender. The consecutive steps method was used in a multivariate regression model.
RESULTS
Twelve articles accomplished systematic review's criteria. Five hundred and fourteen cases were analysed. Three models, one for each of the MVVs, were built. All of them were better adjusted to exponential equations. Diuresis (not age) was the most significant factor. There was poor agreement between MVVs and usual formulae. Nocturnal and daytime maximum voided volumes depend on several factors and are different.
CONCLUSIONS
Nocturnal and daytime maximum voided volumes should be used with different meanings in clinical setting. Diuresis is the main factor for bladder capacity. This is the first model for benchmarking normal MVVs with diuresis as its main factor. Current formulae are not suitable for clinical use.
Topics: Adolescent; Child; Child, Preschool; Humans; Models, Biological; Reference Values; Urinary Bladder; Urination
PubMed: 23847007
DOI: 10.1002/nau.22452 -
Interactive Cardiovascular and Thoracic... Oct 2012A best evidence topic was constructed according to a structured protocol. The question addressed was 'Does perioperative furosemide usage reduce the need for renal... (Review)
Review
A best evidence topic was constructed according to a structured protocol. The question addressed was 'Does perioperative furosemide usage reduce the need for renal replacement therapy in cardiac surgery patients?' Forty-seven papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Current best available evidence to resolve the issue includes a systematic review and nine randomized controlled trials (RCTs). The systematic review of seven RCTs and one observational study has demonstrated that in patients who have undergone cardiac surgery, a more consistent and sustained diuresis is produced by a continuous infusion of furosemide compared with intermittent bolus doses of furosemide. However, there does not appear to be a significant difference in the total urine output or a change in serum electrolyte levels when furosemide is administered as a continuous infusion compared with intermittent bolus doses. Three RCTs recruiting neonatal and paediatric patients after open heart surgery also validated the safety and efficacy of furosemide infusion as well as intermittent bolus doses. Two of the five RCTS in adult cardiac surgery patients showed that furosemide infusion was associated with a reduced need for renal replacement therapy (RRT), while two RCTs failed to show any benefit and one reported an increased incidence of renal impairment. We conclude that continuous furosemide infusion in the perioperative period promotes a gentle and sustained diuresis in cardiac surgery patients. The evidence supporting the benefit of this strategy in terms of reducing the need for RRT is weak. At the same time, current best available evidence, albeit from small RCTs, suggests that the timely introduction of continuous furosemide infusion does not increase the incidence of renal impairment after cardiac surgery.
Topics: Acute Kidney Injury; Aged; Benchmarking; Cardiac Surgical Procedures; Diuretics; Drug Administration Schedule; Evidence-Based Medicine; Female; Furosemide; Humans; Infusions, Parenteral; Male; Perioperative Care; Renal Replacement Therapy; Time Factors; Treatment Outcome
PubMed: 22761122
DOI: 10.1093/icvts/ivs208 -
International Urology and Nephrology Apr 2012The purpose of this analysis was to evaluate the efficacy and safety of desmopressin for the treatment of nocturia. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this analysis was to evaluate the efficacy and safety of desmopressin for the treatment of nocturia.
METHODS
Databases including MEDLINE, EMBASE, ISI web of knowledge, the Cochrane Controlled Trial Register of Controlled Trials and Chinese Biological Medical Database were searched to identify randomized controlled trials (RCTs) that referred to the efficacy and safety of desmopressin for the treatment of nocturia. A systematic review and meta-analysis were conducted.
RESULTS
Five studies involving 619 participants were included for the meta-analysis, and 8 RCTs of cross-over design were also identified for the systematic review. The analysis revealed that desmopressin might significantly decrease the frequency of nocturnal voids, nocturnal urine volume and nocturnal diuresis, potentially resulting in an extended duration of the first sleep period and improved sleep quality. The adverse effects of desmopressin were similar to those observed in the placebo group.
CONCLUSIONS
Administered desmopressin was an effective and well-tolerated treatment for nocturia.
Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Nocturia; Treatment Outcome; Urination
PubMed: 21898039
DOI: 10.1007/s11255-011-0054-3 -
The Cochrane Database of Systematic... Jan 2010Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium.
OBJECTIVES
To determine the benefits and harms of HS versus IS solutions administered to patients undergoing surgery.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library) Issue 1, 2009; MEDLINE (1966 to 2009); EMBASE (1980 to 2009); LILACS (to August 2009) and CINAHL (1982 to 2009) without language restrictions.
SELECTION CRITERIA
We included randomized clinical trials where HS was compared to IS in patients undergoing surgery, irrespective of blinding, language, and publication status.
DATA COLLECTION AND ANALYSIS
We assessed the impact of HS administration on mortality, organ failure, fluid balance, serum sodium, serum osmolarity, diuresis and physiologic measures of cardiovascular function. We pooled data using odds ratio or mean difference (MD) for binary and continuous outcomes, respectively, using random-effects models.
MAIN RESULTS
We included 15 studies with 614 participants. One death in each group and no other serious adverse events were reported. While all patients were in a positive fluid balance postoperatively, the excess was significantly less in HS patients (standardized mean difference (SMD) -1.43L, 95% confidence interval (CI) 0.8 to 2.1 L less; P < 0.00001). Patients treated with HS received significantly less fluid than IS-treated patients (MD -2.4L 95% (CI) 1.5 to 3.2 L less; P < 0.00001) without differences in diuresis between the groups. Maximum intraoperative cardiac index was significantly increased with HS (SMD 0.6 L/min/M2 higher, 95% CI 0.1 to 1.0, P = 0.02) but Intraoperative pulmonary artery wedge pressure remained unchanged. While the maximum serum sodium and the serum sodium at the end of the study were significantly higher in HS patients, the level remained within normal limits (136 to 146 meq/L).
AUTHORS' CONCLUSIONS
HS reduces the volume of intravenous fluid required to maintain patients undergoing surgery but transiently increases serum sodium. It is not known if HS effects patient survival and morbidity but it should be tested in randomized clinical trials that are designed and powered to test these outcomes.
Topics: Fluid Therapy; Humans; Isotonic Solutions; Randomized Controlled Trials as Topic; Saline Solution, Hypertonic; Sodium; Surgical Procedures, Operative
PubMed: 20091580
DOI: 10.1002/14651858.CD005576.pub2