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Advances in Nutrition (Bethesda, Md.) Jul 2017Polyols are sugar alcohols found in certain fruits, vegetables, and sugar-free sweeteners. They make up a component of the diet low in fermentable oligosaccharides,... (Review)
Review
Polyols are sugar alcohols found in certain fruits, vegetables, and sugar-free sweeteners. They make up a component of the diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which is gaining popularity in the treatment of patients with irritable bowel syndrome (IBS). We conducted a systematic review to evaluate the effects of polyols on the gastrointestinal tract in healthy men and women and in patients with IBS. Utilizing PubMed, Ovid, and Embase databases, we conducted a search on individual polyols and each of these terms: fermentation, absorption, motility, permeability, and gastrointestinal symptoms. Standard protocols for a systematic review were followed. We found a total of 1823 eligible articles, 79 of which were included in the review. Overall, available work has shown that polyol malabsorption generally occurs in a dose-dependent fashion in healthy individuals, and malabsorption increases when polyols are ingested in combination. However, studies in patients with IBS have shown conflicting results pertaining to polyol malabsorption. Polyol ingestion can lead to intestinal dysmotility in patients with IBS. Regarding the microbiome, moderate doses of polyols have been shown to shift the microbiome toward an increase in bifidobacteria in healthy individuals and may therefore be beneficial as prebiotics. However, data are limited regarding polyols and the microbiome in patients with IBS. Polyols can induce dose-dependent symptoms of flatulence, abdominal discomfort, and laxative effects when consumed by both healthy volunteers and patients with IBS. Further research is needed to better understand the effects of specific polyols on gastrointestinal function, sensation, and the microbiome in health and gastrointestinal disorders such as IBS.
Topics: Fruit; Gastrointestinal Absorption; Gastrointestinal Microbiome; Gastrointestinal Tract; Humans; Irritable Bowel Syndrome; Malabsorption Syndromes; Polymers; Randomized Controlled Trials as Topic; Vegetables
PubMed: 28710145
DOI: 10.3945/an.117.015560 -
Epilepsia Open Apr 2024Antiseizure medications (ASMs) constitute the principal of treatment for patients with epilepsy, where long-term treatment is usually necessary. The purpose of this... (Review)
Review
Antiseizure medications (ASMs) constitute the principal of treatment for patients with epilepsy, where long-term treatment is usually necessary. The purpose of this systematic review is to provide practical and useful information regarding various aspects of the interactions between ASMs and foods and drinks. MEDLINE and ScienceDirect, from the inception to July 15, 2023, were searched for related publications. In both electronic databases, the following search strategy was applied, and the following keywords were used (in title/abstract): "food OR drink" AND "antiepileptic OR antiseizure." The primary search yielded 738 studies. After implementing our inclusion and exclusion criteria, we could identify 19 studies on the issue of interest for our endeavor. Four studies were identified in the recheck process and not by the primary search. All studies provided low level of evidence. Interactions between foods and ASMs are a common phenomenon. Many factors may play a role for such an interaction to come to play; these include drug properties, administration route, and administration schedule, among others. Drugs-foods (-drinks) interactions may change the drug exposure or plasma levels of drugs (e.g., grapefruit juice increases carbamazepine concentrations and the bioavailability of cannabidiol is increased 4-5 folds with concomitant intake of fat-rich food); this may require dosage adjustments. Interactions between ASMs and foods and drinks may be important. This should be taken seriously into consideration when consulting patients and their caregivers about ASMs. Future well-designed investigations should explore the specific interactions between foods (and drinks) and ASMs to clarify whether they are clinically important. PLAIN LANGUAGE SUMMARY: Interactions between antiseizure medications and foods and drinks may be important. This should be taken into consideration in patients with epilepsy.
Topics: Humans; Anticonvulsants; Biological Availability; Benzodiazepines; Food; Epilepsy
PubMed: 38345419
DOI: 10.1002/epi4.12918 -
British Journal of Clinical Pharmacology Dec 2022This study aimed to review the studies evaluating the effect of the inflammatory state on voriconazole (VRZ) levels. (Review)
Review
AIMS
This study aimed to review the studies evaluating the effect of the inflammatory state on voriconazole (VRZ) levels.
METHODS
The study included randomized clinical trials, cohort studies, and case-control studies that focused on the influence of the inflammatory state on VRZ levels. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, relevant articles published until 2021 were searched in several databases, including PubMed, Embase, Web of Science and the Cochrane Library.
RESULTS
Twenty studies were included in this review, of which 15 described adult populations, three described paediatric populations, and two included both adult and paediatric populations. Seventeen studies used C-reactive protein (CRP) as an indicator of inflammation, six described a dose-response relationship for the effect of inflammation represented by CRP on VRZ concentrations, and four examined the effect of CRP on the metabolic rate of VRZ.
CONCLUSIONS
Our findings showed that the level of inflammation can significantly affect VRZ levels. However, the effect of inflammation on VRZ concentrations in children is controversial and must be analysed along with age. Clinicians dosing VRZ should take into account the patient's inflammatory state. The impact of inflammation on genotype-based dosing decisions requires further study to explain the high pharmacokinetic variability of VRZ.
Topics: Humans; Adult; Child; Voriconazole; Inflammation; C-Reactive Protein; Case-Control Studies
PubMed: 35973037
DOI: 10.1111/bcp.15495 -
Nutrients Jun 2018Magnesium (Mg) status has recently drawn close attention in chronic kidney disease and in kidney transplant recipients. This review aims to evaluate the body of evidence... (Review)
Review
Magnesium (Mg) status has recently drawn close attention in chronic kidney disease and in kidney transplant recipients. This review aims to evaluate the body of evidence linking hypomagnesemia to clinical consequences in these specific populations. After a brief summary of the main mechanisms involved in Mg regulation and of Mg status in end-stage renal disease, the review focuses on the relationship between hypomagnesemia and cardiovascular risk in kidney transplant recipients. A body of evidence in recent studies points to a negative impact of hypomagnesemia on post-transplant diabetes mellitus (PTDM) and cardiovascular risk, which currently represent the main threat for morbidity and mortality in kidney transplantation. Deleterious biological mechanisms induced by hypomagnesemia are also discussed. While data analysis enables us to conclude that hypomagnesemia is linked to the development of PTDM, studies prospectively evaluating the impact of hypomagnesemia correction after kidney transplantation are still lacking and needed.
Topics: Animals; Biomarkers; Cardiovascular Diseases; Diabetes Mellitus; Humans; Kidney; Kidney Failure, Chronic; Kidney Transplantation; Magnesium; Magnesium Deficiency; Renal Elimination; Renal Reabsorption; Risk Factors; Treatment Outcome
PubMed: 29882768
DOI: 10.3390/nu10060729 -
Archives of Disease in Childhood Jan 2015To determine the extent of inter-individual variation in clearance of midazolam in children and establish which factors are responsible for this variation. (Review)
Review
OBJECTIVES
To determine the extent of inter-individual variation in clearance of midazolam in children and establish which factors are responsible for this variation.
METHODS
A systematic literature review was performed to identify papers describing the clearance of midazolam in children. The following databases were searched: Medline, Embase, International Pharmaceutical Abstracts, CINAHL and Cochrane Library. From the papers, the range in plasma clearance and the coefficient of variation (CV) in plasma clearance were determined.
RESULTS
25 articles were identified. Only 13 studies gave the full range of clearance values for individual patients. The CV was greater in critically ill patients (18%-170%) than non-critically ill patients (13%-54%). Inter-individual variation was a major problem in all age groups of critically ill patients. The CV was 72%-106% in preterm neonates, 18%-73% in term neonates, 31%-130% in infants, 21%-170% in children and 47%-150% in adolescents. The mean clearance was higher in children (1.1-16.7 mL/min/kg) than in neonates (0.78-2.5 mL/min/kg).
CONCLUSIONS
Large inter-individual variation was seen in midazolam clearance values in critically ill neonates, infants, children and adolescents.
Topics: Adolescent; Child; Critical Illness; Humans; Hypnotics and Sedatives; Infant; Infant, Newborn; Metabolic Clearance Rate; Midazolam
PubMed: 25281734
DOI: 10.1136/archdischild-2013-305720 -
Advanced Drug Delivery Reviews 2020Vaccines are one of the most powerful technologies supporting public health. The adaptive immune response induced by immunization arises following appropriate activation...
Vaccines are one of the most powerful technologies supporting public health. The adaptive immune response induced by immunization arises following appropriate activation and differentiation of T and B cells in lymph nodes. Among many parameters impacting the resulting immune response, the presence of antigen and inflammatory cues for an appropriate temporal duration within the lymph nodes, and further within appropriate subcompartments of the lymph nodes- the right timing and location- play a critical role in shaping cellular and humoral immunity. Here we review recent advances in our understanding of how vaccine kinetics and biodistribution impact adaptive immunity, and the underlying immunological mechanisms that govern these responses. We discuss emerging approaches to engineer these properties for future vaccines, with a focus on subunit vaccines.
Topics: Adjuvants, Immunologic; B-Lymphocytes; Drug Carriers; Humans; Immunity, Humoral; Inflammation Mediators; Liposomes; Lymph Nodes; Nanoparticles; Plasmids; RNA, Messenger; T-Lymphocytes; Tissue Distribution; Vaccines
PubMed: 32598970
DOI: 10.1016/j.addr.2020.06.019 -
Reumatologia Clinica 2018To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience.
OBJECTIVE
To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience.
METHODS
A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).
RESULTS
Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text.
CONCLUSIONS
The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Biological Availability; Clinical Decision-Making; Dose-Response Relationship, Drug; Drug Administration Routes; Evidence-Based Medicine; Humans; Medication Adherence; Methotrexate; Patient Education as Topic; Practice Guidelines as Topic; Quality of Life; Randomized Controlled Trials as Topic; Rheumatic Diseases; Self Administration
PubMed: 28082032
DOI: 10.1016/j.reuma.2016.12.001 -
Journal of the American Heart... Oct 2017Time in the therapeutic range (TTR) is associated with the effectiveness and safety of vitamin K antagonist (VKA) therapy. To optimize prescribing of VKA, we aimed to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Time in the therapeutic range (TTR) is associated with the effectiveness and safety of vitamin K antagonist (VKA) therapy. To optimize prescribing of VKA, we aimed to develop and validate a prediction model for TTR in older adults taking VKA for nonvalvular atrial fibrillation and venous thromboembolism.
METHODS AND RESULTS
The study cohort comprised patients aged ≥65 years who were taking VKA for atrial fibrillation or venous thromboembolism and who were identified in the 2 US electronic health record databases linked with Medicare claims data from 2007 through 2014. With the predictors identified from a systematic review and clinical knowledge, we built a prediction model for TTR, using one electronic health record system as the training set and the other as the validation set. We compared the performance of the new models to that of a published prediction score for TTR, SAMe-TTR. Based on 1663 patients in the training set and 1181 in the validation set, our optimized score included 42 variables and the simplified model included 7 variables, abbreviated as PROSPER (Pneumonia, Renal dysfunction, Oozing blood [prior bleeding], Staying in hospital ≥7 days, Pain medication use, no Enhanced [structured] anticoagulation services, Rx for antibiotics). The PROSPER score outperformed SAMe-TTR when predicting both TTR ≥70% (area under the receiver operating characteristic curve 0.67 versus 0.55) and the thromboembolic and bleeding outcomes (area under the receiver operating characteristic curve 0.62 versus 0.52).
CONCLUSIONS
Our geriatric TTR score can be used as a clinical decision aid to select appropriate candidates to receive VKA therapy and as a research tool to address confounding and treatment effect heterogeneity by anticoagulation quality.
Topics: Age Factors; Aged; Analgesics; Anti-Bacterial Agents; Anticoagulants; Area Under Curve; Atrial Fibrillation; Blood Coagulation; Clinical Decision-Making; Databases, Factual; Decision Support Techniques; Drug Monitoring; Electronic Health Records; Female; Hemorrhage; Humans; International Normalized Ratio; Length of Stay; Male; Patient Selection; Predictive Value of Tests; Quality Control; Quality Indicators, Health Care; ROC Curve; Reproducibility of Results; Risk Factors; Time Factors; Treatment Outcome; Venous Thromboembolism
PubMed: 28982676
DOI: 10.1161/JAHA.117.006814 -
International Journal of Molecular... Apr 2021Chronic kidney disease (CKD) is an important global public health problem due to its high prevalence and morbidity. Although the treatment of nephrology patients has... (Meta-Analysis)
Meta-Analysis Review
Chronic kidney disease (CKD) is an important global public health problem due to its high prevalence and morbidity. Although the treatment of nephrology patients has changed considerably, ineffectiveness and side effects of medications represent a major issue. In an effort to elucidate the contribution of genetic variants located in several genes in the response to treatment of patients with CKD, we performed a systematic review and meta-analysis of all available pharmacogenetics studies. The association between genotype distribution and response to medication was examined using the dominant, recessive, and additive inheritance models. Subgroup analysis based on ethnicity was also performed. In total, 29 studies were included in the meta-analysis, which examined the association of 11 genes (16 polymorphisms) with the response to treatment regarding CKD. Among the 29 studies, 18 studies included patients with renal transplantation, 8 involved patients with nephrotic syndrome, and 3 studies included patients with lupus nephritis. The present meta-analysis provides strong evidence for the contribution of variants harbored in the , , , , and genes that creates some genetic predisposition that reduces effectiveness or is associated with adverse events of medications used in CKD.
Topics: Azathioprine; Cyclosporine; Humans; Pharmacogenomic Testing; Pharmacogenomic Variants; Polymorphism, Genetic; Prednisolone; Renal Insufficiency, Chronic; Tacrolimus; Treatment Outcome
PubMed: 33923087
DOI: 10.3390/ijms22094480 -
British Journal of Clinical Pharmacology Sep 2022Linezolid is often used for the infections caused by drug-resistant Gram-positive bacteria. Recent studies suggest that large between-subject variability (BSV) and... (Review)
Review
AIMS
Linezolid is often used for the infections caused by drug-resistant Gram-positive bacteria. Recent studies suggest that large between-subject variability (BSV) and within-subject variability could alter drug pharmacokinetics (PK) during linezolid therapy due to pathophysiological changes. This review synthesized information on linezolid population PK studies and summarized the significant covariates that influence linezolid PK.
METHODS
A literature search was performed using PubMed, Web of Science and Embase from their inception to 30 September 2021. Published studies were included if they contained data analysing linezolid PK parameters in humans using a population approach with a nonlinear mixed-effects model.
RESULTS
Twenty-five studies conducted in adults and five in paediatrics were included. One- and two-compartment models were the commonly used structural models for linezolid. Body size (weight, lean body weight and body surface area), creatinine clearance (CLcr) and age significantly influenced linezolid PK. The median clearance (CL) values (ranges) in infants (0.128 L/h/kg [0.121-0.135]] and children (0.107 L/h/kg [0.088-0.151]] were higher than in adults (0.098 L/h/kg [0.044-0.237]]. For patients with severe renal impairment (CLcr ≤ 30 mL/min), the CL was 37.2% (15.2-55.3%) lower than in patients with normal renal function.
CONCLUSION
The optimal linezolid dosage should be adjusted based on the patient's body size, renal function and age. More studies are needed to explore the exact mechanism of linezolid elimination and evaluate the PK characteristics in paediatric patients.
Topics: Adult; Anti-Bacterial Agents; Child; Humans; Linezolid; Models, Biological; Nonlinear Dynamics; Renal Insufficiency
PubMed: 35484096
DOI: 10.1111/bcp.15368