Identification of Risk Factors for Exertional Heat Illness: A Brief Commentary on Genetic Testing

2007 ◽  
Vol 16 (3) ◽  
pp. 222-226 ◽  
Author(s):  
Sheila Muldoon ◽  
Rolf Bunger ◽  
Patricia Deuster ◽  
Nyamkhishig Sambuughin
Keyword(s):  
Risk Factors ◽  
Genetic Testing ◽  
Sports Medicine ◽  
Data Extraction ◽  
Data Sources ◽  
Hereditary Diseases ◽  
Heat Illness ◽  
Data Synthesis ◽  
Exertional Heat Illness ◽  
Type Data

Objective:This commentary discusses known links between Exertional Heat Illness (EHI), Malignant Hyperthermia (MH), and other hereditary diseases of muscle. Genetic and functional testing is also evaluated as measures of fitness to return to duty/play.Data Sources:Reviews and research articles from Sports Medicine, Applied Physiology, and Anesthesiology.Data Extraction:Detailed comparisons of existing literature regarding clinical cases of EHI and MH and the potential utility of genetic testing, specifically the ryanodine receptor (RYR1) gene and other genes related to disorders of skeletal muscle.Data Synthesis:EHI is a complex disorder wherein physiological, environmental, and hereditary factors interact to endanger an individual’s ability to maintain thermal homeostasis.Conclusions:Individuals’ genetic background is likely to play an important role, particularly when EHI recurs. Recurrent EHI has been associated with MH and other genetic disorders, highlighting the importance of identification and exclusion of individuals with known high risk factors.

Predisposing Risk Factors on Susceptibility to Exertional Heat Illness: Clinical Decision-Making Considerations

2007 ◽  
Vol 16 (3) ◽  
pp. 204-214 ◽  
Author(s):  
Michelle Cleary
Keyword(s):  
Relative Risk ◽  
High Risk ◽  
Data Extraction ◽  
Heat Stroke ◽  
Data Sources ◽  
Heat Illness ◽  
Potential Health ◽  
Data Synthesis ◽  
Exertional Heat Illness ◽  
Type Data

Objective:To present strategies for identifying predisposing conditions, susceptibility, and incidence reduction for the most common exertional heat illnesses (EHI): heat cramps, heat exhaustion, and most importantly, heat stroke.Data Sources:A comprehensive literature review of MEDLINE and 1996 to 2006, including all retrospective, controlled studies of EHI risk using the following keywords: exertional heat illness risk, exertional heat stroke risk, and exercise-induced dehydration risk. Search limits included the following: English language, published in the last 10 years, clinical trial, meta-analysis, practice guideline, randomized controlled trial, review, and humans. A manual review was conducted of relevant position statements and book chapters including the reference lists.Data Extraction:To evaluate the quality of the empirical studies to be included in this review, each study must have scored at least 17/22 or 77% of items included when reporting a randomized trial using the CONSORT checklist.Data Synthesis:Many cases of EHI are preventable and can be successfully treated if the ATC® identifies individuals at increased relative risk and implement appropriate prevention strategies. The ability to objectively identify individuals at increased relative risk of EHI and to provide appropriate monitoring is critical in EHI prevention and reduction of repeated incidents of EHI.Conclusions:For any heat illness prevention program to be effective, greater attention and continued observation is needed for athletes at high risk for EHI. For many athletic teams or programs, because of the sheer numbers and associated catastrophic injury potential, health care professionals must implement a system by which high-risk individuals are monitored during activity with the highest level of vigilance for prevention of EHI.

Recovery and Return to Activity Following Exertional Heat Stroke: Considerations for the Sports Medicine Staff

2007 ◽  
Vol 16 (3) ◽  
pp. 163-181 ◽  
Author(s):  
Brendon P. McDermott ◽  
Douglas J. Casa ◽  
Susan W. Yeargin ◽  
Matthew S. Ganio ◽  
Lawrence E. Armstrong ◽  
...  
Keyword(s):  
Data Extraction ◽  
Heat Stroke ◽  
Data Sources ◽  
Exertional Heat Stroke ◽  
Data Synthesis ◽  
Residual Symptoms ◽  
Study Selection ◽  
Initial Care ◽  
Type Data ◽  
Return To Activity

Objective:To describe the current scientific evidence of recovery and return to activity following exertional heat stroke (EHS).Data Sources:Information was collected using MEDLINE and SPORTDiscus databases in English using combinations of key words, exertional heat stroke, recovery, rehabilitation, residual symptoms, heat tolerance, return to activity, and heat illness.Study Selection:Relevant peer-reviewed, military, and published text materials were reviewed.Data Extraction:Inclusion criteria were based on the article’s coverage of return to activity, residual symptoms, or testing for long-term treatment. Fifty-two out of the original 554 sources met these criteria and were included in data synthesis.Data Synthesis:The recovery time following EHS is dependent on numerous factors, and recovery length is individually based and largely dependent on the initial care provided.Conclusion:Future research should focus on developing a structured return-to-activity strategy following EHS.

scholarly journals Prioritising recommendations following analyses of adverse events in healthcare: a systematic review

2020 ◽  
Vol 9 (4) ◽  
pp. e000843
Author(s):  
Kelly Bos ◽  
Maarten J van der Laan ◽  
Dave A Dongelmans
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Data Extraction ◽  
Data Sources ◽  
Cochrane Library ◽  
High Quality ◽  
Data Synthesis ◽  
Study Selection ◽  
Personal Opinion ◽  
User Friendly

PurposeThe purpose of this systematic review was to identify an appropriate method—a user-friendly and validated method—that prioritises recommendations following analyses of adverse events (AEs) based on objective features.Data sourcesThe electronic databases PubMed/MEDLINE, Embase (Ovid), Cochrane Library, PsycINFO (Ovid) and ERIC (Ovid) were searched.Study selectionStudies were considered eligible when reporting on methods to prioritise recommendations.Data extractionTwo teams of reviewers performed the data extraction which was defined prior to this phase.Results of data synthesisEleven methods were identified that are designed to prioritise recommendations. After completing the data extraction, none of the methods met all the predefined criteria. Nine methods were considered user-friendly. One study validated the developed method. Five methods prioritised recommendations based on objective features, not affected by personal opinion or knowledge and expected to be reproducible by different users.ConclusionThere are several methods available to prioritise recommendations following analyses of AEs. All these methods can be used to discuss and select recommendations for implementation. None of the methods is a user-friendly and validated method that prioritises recommendations based on objective features. Although there are possibilities to further improve their features, the ‘Typology of safety functions’ by de Dianous and Fiévez, and the ‘Hierarchy of hazard controls’ by McCaughan have the most potential to select high-quality recommendations as they have only a few clearly defined categories in a well-arranged ordinal sequence.

Pegfilgrastim-Induced Bone Pain: A Review on Incidence, Risk Factors, and Evidence-Based Management

2017 ◽  
Vol 51 (9) ◽  
pp. 797-803 ◽  
Author(s):  
Donald C. Moore ◽  
Annie E. Pellegrino
Keyword(s):  
Risk Factors ◽  
Bone Pain ◽  
English Language ◽  
Data Extraction ◽  
Treatment Modalities ◽  
Management Options ◽  
Data Synthesis ◽  
Pharmacological Management ◽  
Study Selection ◽  
Incidence Risk

Objective: To review the incidence, risk factors, and management of pegfilgrastim-induced bone pain (PIBP). Data Sources: PubMed was searched from 1980 to March 31, 2017, using the terms pegfilgrastim and bone pain. Study Selection and Data Extraction: English-language, human studies and reviews assessing the incidence, risk factors, and management of PIBP were incorporated. Data Synthesis: A total of 3 randomized, prospective studies and 2 retrospective studies evaluated pharmacological management of PIBP. Naproxen compared with placebo demonstrated a reduction in the degree, incidence, and duration of bone pain secondary to pegfilgrastim. Loratadine was not effective in reducing the incidence of bone pain prophylactically, but a retrospective study evaluating dual antihistamine blockade with loratadine and famotidine demonstrated a decreased incidence in bone pain when administered before pegfilgrastim. Conclusion: Naproxen is effective at managing PIBP. Although commonly used, antihistamines have a paucity of data supporting their use. Dose reductions of pegfilgrastim and opioids may also be potential management options; however, data supporting these treatment modalities are scarce.

Effectiveness of Physical Therapy Treatments on Lateral Epicondylitis

2008 ◽  
Vol 17 (2) ◽  
pp. 119-136 ◽  
Author(s):  
Mohamed Kohia ◽  
John Brackle ◽  
Kenny Byrd ◽  
Amanda Jennings ◽  
William Murray ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Treatment Options ◽  
Lateral Epicondylitis ◽  
Data Sources ◽  
Cochrane Library ◽  
Future Research ◽  
Data Synthesis ◽  
Study Selection ◽  
Type Data ◽  
Therapy Interventions

Objective:To analyze research literature that has examined the effectiveness of various physical therapy interventions on lateral epicondylitis.Data Sources:Evidence was compiled with data located using the PubMed, EBSCO, The Cochrane Library, and the Hooked on Evidence databases from 1994 to 2006 using the key words lateral epicondylitis, tennis elbow, modalities, intervention, management of, treatment for, radiohumeral bursitis, and experiment.Study Selection:The literature used included peer-reviewed studies that evaluated the effectiveness of physical therapy treatments on lateral epicondylitis. Future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.Data Synthesis:Shockwave therapy and Cyriax therapy protocol are effective physical therapy interventions.Conclusions:There are numerous treatments for lateral epicondylitis and no single intervention has been proven to be the most efficient. Therefore, future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.

Linearity in Dose—Response from Zinc Lozenges in Treatment of Common Colds

1995 ◽  
Vol 11 (3) ◽  
pp. 110-122 ◽  
Author(s):  
George A Eby
Keyword(s):  
Dose Response ◽  
Common Cold ◽  
Data Extraction ◽  
Cold Treatment ◽  
Electric Circuit ◽  
Zinc Ion ◽  
Data Sources ◽  
Data Synthesis ◽  
Zinc Speciation

Objective: To test the hypothesis that major variations in daily zinc ion availability (ZIA) between lozenge formulations caused greatly differing results and to describe the biologically closed electric circuit between the mouth and nose. Data Sources: Data sources included clinical and in vitro reports, zinc speciation computations, and unpublished data from the original researchers and manufacturers. Data Extraction: Data were extracted to determine the composition and usage of lozenges and resultant changes in common cold duration. Lozenge ZIA values were determined from Zn2+ ion concentrations and oral contact time. Data Synthesis: Data synthesis disclosed that lozenges releasing Zn2+ ions at physiologic pH (positive ZIA values) shortened the duration of colds. Conversely, lozenges that released negatively charged zinc complexes (ZnLN−) at physiologic pH (negative ZIA values) lengthened the duration of colds. ZIA 100 lozenges reduced the duration of colds by 7 days. ZIA 0 lozenges had no effect. ZIA −55 lozenges lengthened the duration of colds by 4.4 days. Conclusions: The hypothesis is valid that major variations in ZIA from different zinc lozenge formulations used in clinical trials caused greatly differing results. A linear dose-response relationship exists between ZIA values of zinc lozenges and changes in duration of common colds. In agreement with in vitro activity, Zn2+ ions from lozenges inhibit replication of rhinoviruses, induce interferon release, and stabilize cell membranes in common cold treatment. Linearity in dose-response shows efficacy against common cold duration from clinically untested lozenges to be predictable on the basis of readily determined ZIA values of experimental lozenges.

Hepatic and Renal Dysfunction following Nafcillin Administration

1992 ◽  
Vol 26 (7-8) ◽  
pp. 985-990 ◽  
Author(s):  
Mitchell R. Lestico ◽  
Karen E. Vick ◽  
Cyril M. Hetsko
Keyword(s):  
Risk Factors ◽  
Adverse Event ◽  
Lactate Dehydrogenase ◽  
Liver Function ◽  
Total Bilirubin ◽  
Renal Toxicity ◽  
Liver Function Tests ◽  
Hepatic Function ◽  
Data Sources ◽  
Data Synthesis

OBJECTIVE: To review four cases of combined hepatic and renal toxicity that may be associated with the administration of nafcillin in adults. This type of adverse event with the use of nafcillin has not been previously documented in the literature. DATA SOURCES: References from pertinent articles are identified throughout the text. DATA SYNTHESIS: Nafcillin is a widely used penicillinase-resistant penicillin. In four patients receiving nafcillin doses greater than 9 g/24 hours, changes in renal and hepatic function markers were noted within 72 hours of the initiation of nafcillin therapy. Laboratory values returned toward baseline when nafcillin therapy was discontinued. Elevations in blood urea nitrogen, creatinine, total bilirubin, and lactate dehydrogenase have been previously described in the literature for penicillin-like agents other than nafcillin. The exact mechanism for such toxicities as well as patient risk factors have not been clearly established. CONCLUSIONS: Caution should be taken when initiating nafcillin therapy. Evaluation of renal and liver function tests prior to initiating nafcillin therapy and within the first 72 hours appears warranted. If hepatic and/or renal toxicity is observed, discontinuation of nafcillin should be considered.

Nonthrombocytopenic Purpura Associated Sequentially with Nifedipine and Diltiazem

1992 ◽  
Vol 26 (9) ◽  
pp. 1089-1090 ◽  
Author(s):  
Margaret Kuo ◽  
Nancy Winiarski ◽  
Serafino Garella
Keyword(s):  
Adverse Effect ◽  
Channel Blocker ◽  
Case Reports ◽  
Data Extraction ◽  
Data Sources ◽  
Cutaneous Vasculitis ◽  
Laboratory Studies ◽  
Pertinent Literature ◽  
Data Synthesis ◽  
Purpuric Rash

OBJECTIVE: To report the case of a patient who developed nonthrombocytopenic purpura sequentially following the administration of nifedipine and diltiazem. DATA SOURCES: Case reports, MEDLINE review of pertinent literature, and review of relevant studies. DATA EXTRACTION: Data were extracted from direct patient observation and review of laboratory studies and published reports. DATA SYNTHESIS: Nonthrombocytopenic purpura secondary to cutaneous vasculitis is a known, although rare, adverse effect of nifedipine. It has not been reported in association with diltiazem. We report the case of a 75-year-old woman in whom a purpuric rash demonstrated by biopsy to be attributable to cutaneous vasculitis developed in the course of nifedipine therapy. The rash disappeared after discontinuation of the drug; however, it recurred when diltiazem therapy was initiated. CONCLUSIONS: Nonthrombocytopenic purpura may be associated with diltiazem as well as with nifedipine. When this adverse effect occurs following administration of a calcium-channel blocker, caution is advised in using other agents of the same class.

Diagnostic Studies for Thrombophilia in Women on Hormonal Therapy and During Pregnancy, and in Children

2002 ◽  
Vol 126 (11) ◽  
pp. 1296-1303
Author(s):  
Benjamin R. Brenner ◽  
Ulrike Nowak-Göttl ◽  
Andrea Kosch ◽  
Marilyn Manco-Johnson ◽  
Michael Laposata
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Oral Contraceptive ◽  
Medical Literature ◽  
Data Extraction ◽  
Data Sources ◽  
Current Clinical Practice ◽  
Extensive Review ◽  
Prothrombotic Risk Factors

Abstract Objective.—To review the role of acquired and inherited prothrombotic risk factors that increase the risk of thrombosis in oral contraceptive users, during pregnancy, and in neonates, infants, and children; and to determine by the consensus opinion of recognized experts in the field which risk factors should be determined in which individuals at which time. Data Sources.—Review of the medical literature and current clinical practice by a panel of experts in the field of thrombophilia. Data Extraction and Synthesis.—The experts made an extensive review of the published literature and prepared a draft manuscript, which included preliminary recommendations. The draft manuscript was circulated to participants in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. The manuscript and recommendations were then presented at the conference for discussion. Recommendations were accepted if a consensus of the 26 experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—This report reviews the options for testing for thrombophilic states in women using oral contraceptives, during pregnancy, and in neonates and children. General guidelines for testing in these clinical situations are provided, along with citation of the appropriate supporting literature.

scholarly journals Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies

2020 ◽  
Vol 17 (19) ◽  
pp. 7037
Author(s):  
Faith O. Alele ◽  
Bunmi S. Malau-Aduli ◽  
Aduli E. O. Malau-Aduli ◽  
Melissa J. Crowe
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Heat Stroke ◽  
Previous History ◽  
Clinical Manifestations ◽  
Heat Illness ◽  
Extrinsic Factors ◽  
Service Unit ◽  
Exertional Heat Illness ◽  
The Military

Exertional heat illness (EHI) is an occupational hazard among military personnel. This systematic review describes the incidence, risk factors, clinical manifestations, and biomarkers of EHI in the military. Six databases from inception to 28 May 2020 were systematically reviewed using the PRISMA guidelines. Forty-one articles met the inclusion criteria and the incidence of EHI ranged from 0.2 to 10.5 per 1000 person years, while the prevalence rates ranged from 0.3% to 9.3%. Intrinsic risk factors influencing EHI were gender, physical fitness, obesity, previous history of heat illness, and motivation, while the extrinsic factors included hot environmental conditions and service unit. Evidence suggests that loss of consciousness, absence of sweating and confusion were the common clinical features of exertional heat stroke (EHS). The mean core temperature ranged from 40 to 41.6 °C, while elevated levels of creatine phosphokinase, liver enzymes, and creatinine were common biochemical markers of EHS. The findings of the review suggest a variation in the incidence of EHI among military populations possibly due to the varying definitions used. Although some risk factors of EHI were identified, more analytical studies are needed to investigate the association between EHI and other important factors such as acclimatisation and occlusive clothing.

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