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Annals of Internal Medicine Mar 2016Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN).
PURPOSE
To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures.
DATA SOURCES
PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015.
STUDY SELECTION
Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging.
DATA EXTRACTION
Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results.
DATA SYNTHESIS
None of the 5 studies that compared types of LOCM reported a statistically significant or clinically important difference among study groups, but the strength of evidence was low. Twenty-five randomized, controlled trials found a slight reduction in CIN risk with the iso-osmolar contrast media agent iodixanol compared with a diverse group of LOCM that just reached statistical significance in a meta-analysis (pooled relative risk, 0.80 [95% CI, 0.65 to 0.99]; P = 0.045). This comparison's strength of evidence was moderate. In a meta regression of randomized, controlled trials of iodixanol, no relationship was found between route of administration and comparative CIN risk.
LIMITATIONS
Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment.
CONCLUSION
No differences were found in CIN risk among types of LOCM. Iodixanol had a slightly lower risk for CIN than LOCM, but the lower risk did not exceed a criterion for clinical importance.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Contrast Media; Evidence-Based Medicine; Humans; Incidence; Kidney Diseases; Osmolar Concentration; Risk Factors; Triiodobenzoic Acids
PubMed: 26830055
DOI: 10.7326/M15-1402 -
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 -
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 -
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 -
The Cochrane Database of Systematic... Dec 2011Oral rehydration solution (ORS) is used to treat the dehydration caused by diarrhoeal diseases, including cholera. ORS formulations with an osmolarity (a measure of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oral rehydration solution (ORS) is used to treat the dehydration caused by diarrhoeal diseases, including cholera. ORS formulations with an osmolarity (a measure of solute concentration) of ≤ 270 mOsm/L (ORS ≤ 270) are safe and more effective than ORS formulations with an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310) for treating non-cholera diarrhoea. As cholera causes rapid electrolyte loss, it is important to know if these benefits are similar for people suffering from cholera.
OBJECTIVES
To compare the safety and efficacy of ORS ≤270 with ORS ≥ 310 for treating dehydration due to cholera.
SEARCH METHODS
We searched the Cochrane Infectious Disease Group Specialized Register (April 2011), CENTRAL (The Cochrane Library Issue 4, 2011), MEDLINE (1966 to April 2011), EMBASE (1974 to April 2011), and LILACS (1982 to April 2011). We also contacted organizations and searched reference lists.
SELECTION CRITERIA
Randomized controlled trials comparing ORS ≤ 270 with ORS ≥ 310 for treating adults and children with acute diarrhoea due to cholera.
DATA COLLECTION AND ANALYSIS
Two reviewers independently applied eligibility criteria, assessed trial quality, and extracted data. We pooled dichotomous data using risk ratio (RR), pooled continuous data using mean difference (MD) or the standardized mean difference (SMD), and presented the results with 95% confidence intervals (CI).
MAIN RESULTS
For glucose-based ORS, seven trials (718 participants) met the inclusion criteria. Biochemical hyponatraemia (blood sodium levels < 130 mmol/L) was more common with ORS ≤ 270 (RR 1.67, CI 1.09 to 2.57; 465 participants, four trials), while a higher level of severe biochemical hyponatraemia (blood sodium levels < 125 mmol/L) in the same group was not significant (RR 1.58, CI 0.62 to 4.04; 465 participants, four trials). No instances of symptomatic hyponatraemia or death were noted in the trials that intended to record them. We found no statistically significant difference in the need for unscheduled intravenous infusion. Analyses separating children and adults showed no obvious trends.Two trials also examined rice-based ORS. In the ORS ≤ 270 group, duration of diarrhoea was shorter (MD -11.42 hours, CI -13.80 to -9.04; 102 participants, two trials).
AUTHORS' CONCLUSIONS
In people with cholera, ORS ≤ 270 is associated with biochemical hyponatraemia when compared with ORS ≥ 310, but there are no differences in terms of other outcomes. Although this risk does not appear to be associated with any serious consequences, the total patient experience in existing trials is small. Under wider practice conditions, especially where patient monitoring is difficult, caution is warranted.
Topics: Adult; Child; Cholera; Dehydration; Diarrhea; Glucose; Humans; Hyponatremia; Osmolar Concentration; Randomized Controlled Trials as Topic; Rehydration Solutions
PubMed: 22161381
DOI: 10.1002/14651858.CD003754.pub3 -
The Cochrane Database of Systematic... 2001Oral rehydration solution (ORS) has reduced childhood deaths from diarrhoea in many countries. Recent studies suggest that the currently recommended formulation of ORS... (Review)
Review
BACKGROUND
Oral rehydration solution (ORS) has reduced childhood deaths from diarrhoea in many countries. Recent studies suggest that the currently recommended formulation of ORS recommended by the World Health Organization (WHO) may not be optimal, and solutions that contain lower concentrations of sodium and glucose may be more effective.
OBJECTIVES
In children with acute diarrhoea, to compare reduced osmolarity glucose-based oral rehydration salt solution with international WHO formulation.
SEARCH STRATEGY
The Cochrane Collaboration Trials Register, MEDLINE, and EMBASE were searched. Additional trials were identified by hand searching. Content experts were contacted.
SELECTION CRITERIA
Randomised controlled trials comparing reduced osmolarity ORS solution with the WHO formulation. Outcomes sought were unscheduled intravenous fluid infusion therapy and measures of clinical illness.
DATA COLLECTION AND ANALYSIS
Data were extracted by two reviewers. We tested for heterogeneity using the chi-square statistic, conducted sensitivity analysis by allocation concealment, and the regression approach to assess funnel plot asymmetry from selective trial publication.
MAIN RESULTS
The primary outcome was reported in 12 trials. In a meta-analysis of nine trials, reduced osmolarity ORS was associated with fewer unscheduled infusions compared with standard WHO ORS (Mantel Haenzel odds ratio 0.61, 95% confidence interval 0.47 to 0.81) with no evidence for heterogeneity between trials. No unscheduled intravenous fluid infusion therapy was required in any participant in three trials. Thirteen trials reported stool output, and data suggested less stool output in the reduced osmolarity ORS group. Vomiting was less frequent in the reduced osmolarity group in the six trials reporting this. Six trials sought hyponatraemia, with events in three studies, but no obvious difference between the two arms.
REVIEWER'S CONCLUSIONS
In children admitted to hospital with diarrhoea, reduced osmolarity ORS when compared to WHO ORS is associated with fewer unscheduled intravenous infusions, smaller stool volume post randomisation, and less vomiting. No additional risk of developing hyponatraemia when compared with WHO ORS was detected.
Topics: Bicarbonates; Child, Preschool; Dehydration; Diarrhea; Fluid Therapy; Glucose; Humans; Infant; Osmolar Concentration; Potassium Chloride; Rehydration Solutions; Sodium Chloride
PubMed: 11406049
DOI: 10.1002/14651858.CD002847 -
European Journal of Sport Science Jul 2020Pre-exercise hypohydration can impair soccer performance and has been extensively studied in different soccer populations. Therefore, the aim of this systematic review...
Pre-exercise hypohydration can impair soccer performance and has been extensively studied in different soccer populations. Therefore, the aim of this systematic review was to report hypohydration prevalence, measured by blood or urine samples, in different soccer populations based on sex (males and females), performance level (professional and recreational players) and context (training sessions and games). The Pubmed, Web of Science and SPORTDiscus databases were systematically searched until November 2018. Data were pooled to compare hypohydration prevalence between the different subgroups. Following the systematic search selection process, 24 studies were included. The results indicated that overall pre-exercise hypohydration prevalence was 63.3%, 37.4% and 58.8% for urine specific gravity (USG), urine osmolality (U Osm) and urine colour, respectively. Furthermore, no study implemented blood samples to examine hypohydration prevalence in soccer players. The subgroup analyses using USG data indicated that pre-exercise hypohydration prevalence was significantly higher amongst males (66.0%; = 0.001), professional soccer players (66.2%; = 0.020) and before a training session (79.6%; < 0.001). Pre-exercise hypohydration prevalence was 46.8% among female soccer players, 55.6% in recreational soccer players and 41,3% before a game. The subgroup analyses using U Osm data indicated that hypohydration prevalence was significantly higher before a training session (52.6%; = 0.023). Based on these results, it can be concluded that hypohydration prevalence in soccer players is of major concern. Future research should explore how pre-exercise hydration status can be improved in a sustainable way.
Topics: Athletic Performance; Bias; Cohort Studies; Cross-Sectional Studies; Dehydration; Female; Humans; Male; Osmolar Concentration; Prevalence; Sex Factors; Soccer; Specific Gravity; Urinalysis; Urine
PubMed: 31526234
DOI: 10.1080/17461391.2019.1669716