Clinical Pearls in Medical Toxicology: Updates Ranging From Decontamination to Elimination

2019 ◽  
Vol 32 (3) ◽  
pp. 339-346
Author(s):  
Gabrielle L. Procopio ◽  
Ruchi Patel ◽  
Amit Gupta
Keyword(s):  
Lipid Emulsion ◽  
Case Reports ◽  
Medical Toxicology ◽  
Treatment Modalities ◽  
Controlled Trials ◽  
Comprehensive Review ◽  
Randomized Controlled ◽  
The Past ◽  
Drug Overdoses ◽  
Gastrointestinal Decontamination

Such as any field of medicine, it is imperative to stay current with the latest advances and treatment modalities in toxicology. With the absence of rigorous randomized controlled trials, many updated guidelines are created by expert consensus and/or case reports and clinical experience. Over the past 10 years, there have been several changes in the management of drug overdoses in light of new data available. Although this is not a comprehensive review of all available antidotes, this article will focus on several important interventions including the use of gastrointestinal decontamination, hyperinsulinemic–euglycemic therapy, methylene blue, intravenous lipid emulsion, hemodialysis, and extracorporeal membrane oxygenation.

Hiccups: A Non-Systematic Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Alexander K. C. Leung ◽  
Amy A.M. Leung ◽  
Alex H.C. Wong ◽  
Kam Lun Hon
Keyword(s):  
Randomized Controlled Trials ◽  
Case Reports ◽  
English Literature ◽  
Meta Analysis ◽  
Medical Intervention ◽  
Lifestyle Changes ◽  
Treatment Modalities ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Intractable Hiccups

Background: Hiccups are a universal phenomenon. They are usually benign and self-limited. Persistent or intractable hiccups, although rare, can be debilitating and may indicate the presence of an underlying pathological process. Objective: To familiarize physicians with the pathophysiology, etiology, evaluation, and management of children with hiccups. Methods: A search was conducted on December 10, 2019 in Pubmed Clinical Queries using the key terms "hiccup" OR “hiccough” OR “singultus”. The selected publication types included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies, and reviews (including meta-analysis and narrative reviews) published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Results: Overdistension of the stomach is the most commonly identifiable cause of acute hiccups, followed by gastroesophageal reflux and gastritis. Other causes of hiccups, notably persistent and intractable hiccups, include an underlying gastrointestinal, neurological, cardiovascular, pulmonary, infectious, and psychogenic disorder. Persistent or intractable hiccups can be a harbinger of serious medical pathology. A detailed history and thorough physical examination may provide clues for the etiology of the hiccups. The treatment of hiccups should be directed at the underlying cause whenever possible. Bouts of acute hiccups less than 48 hours rarely require medical intervention as they usually resolve within minutes. Treatment may be considered when hiccups are bothersome, persistent, or intractable. Treatment modalities include lifestyle changes, physical maneuvers, pharmacotherapy, and very rarely, surgical intervention. Conclusion: Acute hiccups are usually benign and self-limiting. Persistent or intractable hiccups can be a harbinger of serious medical pathology. The underlying cause should be treated if possible. There are no formal guidelines to the treatment of hiccups. Currently, most of the methods proposed are based on case reports and anecdotal evidence. Terminating an episode of hiccups can be very challenging for a clinician but may tremendously improve the patient’s quality of life. It is hoped that future well-designed and better-powered studies will provide us with more information on the efficacy of various treatment modalities for hiccups.

Periodontopathogens: a new view. Systematic review. Part 2

2020 ◽  
Vol 20 (2) ◽  
pp. 160-167
Author(s):  
E. S. Slazhneva ◽  
E. A. Tikhomirova ◽  
V. G. Atrushkevich
Keyword(s):  
Systematic Review ◽  
Periodontal Disease ◽  
Pathogenic Bacteria ◽  
Periodontal Diseases ◽  
Oral Microbiome ◽  
Controlled Trials ◽  
New Paradigm ◽  
Microbial Composition ◽  
Randomized Controlled ◽  
The Past

Relevance. The modern view of periodontitis as a dysbiotic disease that occurs as a result of changes in the microbial composition of the subgingival region is considered in a systematic review.Purpose. To study a new paradigm of development of generalized periodontitis.Materials and methods. Randomized controlled trials (RCTS) were selected for the study, including cluster RCTS, controlled (non-randomized) microbiological and clinical studies of the oral microbiome in adult patients with generalized periodontitis over the past 10 years.Results. The transition from a symbiotic microflora to a dysbiotic pathogenic community triggers the host's inflammatory response, which contributes to the development of periodontal diseases. Modern ideas about periodontal pathogenic bacteria dictate new requirements for the treatment of periodontal diseases. The second part of the review examines the microbial profiles of periodontal disease in various nosological forms, the mechanisms of the immune response and approaches to the treatment of periodontal disease from the perspective of biofilm infection.Conclusions. As follows from modern literature periodontitis is to a certain extent caused by the transition from a harmonious symbiotic bacterial community to a dysbiotic one. Recent scientific studies have shown that not single microorganism is not able to cause disease but the microbial community as a whole leads to the development of pathology.

A perspective on role of calcium and vitamin D in cardiovascular outcomes and lipid profile

2015 ◽  
Vol 26 (5) ◽  
Author(s):  
Tarun Arora ◽  
Harmeet Singh Rehan
Keyword(s):  
Vitamin D ◽  
Calcium Supplementation ◽  
Meta Analysis ◽  
Disease Status ◽  
Controlled Trials ◽  
Lipid Levels ◽  
Randomized Controlled ◽  
The Past ◽  
Vitamin D Supplements

AbstractRecent concerns on increased incidence of myocardial infarction and stroke on administration of calcium and vitamin D supplements have alarmed the physicians about safety of these drugs. Although both calcium and vitamin D have been shown in the past to have beneficial effect on cardiovascular disease status through lowering of harmful lipids, these findings have been contradicted by some recent meta-analysis and randomized controlled trials that have shown no beneficial or in some cases a deteriorating effect of these supplements on lipid levels. In particular, calcium supplementation has been associated more with increased incidence of cardiovascular morbidity than vitamin D, but the convincing proof is still lacking. Here we have highlighted the results of some significant studies that might impact the prescription of these drugs.

Mirtazapine: only for depression?

2006 ◽  
Vol 18 (3-4) ◽  
pp. 130-143 ◽  
Author(s):  
Luis San ◽  
Belen Arranz
Keyword(s):  
Randomized Controlled Trials ◽  
Case Reports ◽  
Sexual Disorders ◽  
Sufficient Evidence ◽  
Controlled Trials ◽  
Open Label ◽  
Compulsive Disorder ◽  
Off Label ◽  
Randomized Controlled ◽  
Tension Type Headaches

Background:Mirtazapine is an antidepressant first approved in the Netherlands in 1994 for the treatment of major depressive disorder. However, evidence suggests its effectiveness in a variety of other psychiatric disorders and non-psychiatric medical conditions.Objective:The present paper reviews the published literature on the off-label indications of Mirtazapine.Methods:A search of the relevant literature from MEDLINE, PsycLIT and EMBASE databases, included in the Science Citation Index and available up to March 2006, was conducted using the terms mirtazapine, case-reports, open-label trials and randomized controlled trials. Only articles referring to conditions other than major depression were included in this present review.Results:Off-label use of mirtazapine has been reported in panic disorder, post-traumatic stress disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, dysthymia, menopausal depression, poststroke depression, depression as a result of infection with human immunodeficiency virus, elderly depression, Methylenedioxymethamphetamine (MDMA)-induced depression, hot flashes, alcohol and other substance use disorders, sleep disorders, sexual disorders, tension-type headaches, cancer pain, fibromyalgia, schizophrenia and other less frequent conditions.Conclusions:So far, data on the off-label usefulness of mirtazapine are limited and mainly based on observations from case reports or open-label studies. However, positive cues suggest that confirmation of these preliminary data with randomized controlled trials may give sufficient evidence to warrant the use of mirtazapine in a broad range of disorders.

scholarly journals Risks and benefits of hormone replacement therapy in older men

2004 ◽  
Vol 59 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Fábio Firmbach Pasqualotto ◽  
Antônio Marmo Lucon ◽  
Jorge Hallak ◽  
Eleonora Bedin Pasqualotto ◽  
Sami Arap
Keyword(s):  
Replacement Therapy ◽  
Hormone Replacement ◽  
Older Men ◽  
Controlled Trials ◽  
Clinical Effects ◽  
Androgen Replacement Therapy ◽  
Randomized Controlled ◽  
The Past ◽  
Risks And Benefits ◽  
Potential Benefits

The use of testosterone in older men, known as male hormonal replacement therapy or androgen replacement therapy, has become of increasing interest to both the medical and lay communities over the past decade. Even though the knowledge of the potential benefits and risks of male Androgen Replacement Therapy has increased dramatically, there is still much that needs to be determined. Although there are a number of potential benefits of male Androgen Replacement Therapy and data concerning clinical effects of such replacement have accumulated, as yet there have not been any large multicenter randomized controlled trials of this therapy. It is the purpose of this article to review what is currently known about the possible risks and benefits of male Androgen Replacement Therapy by discussing the clinical trials to date.

Plastic and reconstructive surgery

2016 ◽  
Keyword(s):  
Randomized Controlled Trials ◽  
Plastic Surgery ◽  
Reconstructive Surgery ◽  
Controlled Trials ◽  
Evidence Based ◽  
Trial And Error ◽  
Plastic And Reconstructive Surgery ◽  
Randomized Controlled ◽  
The Past ◽  
Evidence Based Surgery

In plastic and reconstructive surgery, innovation and creativity have been foremost, with science and evidence following. Unlike for a number of other specialties, the advances in plastic surgery have largely come from imagination, innovations, and trial and error, rather than from scientific trials. Somewhat more than for the rest of surgery, in plastics (where the art and craft of each particular surgeon counts immeasurably), randomized controlled trials of techniques have failed to be generated in the past, due to the difficulty of objectively assessing the success of surgery with an aesthetic-based nature. Consequently, evidence-based study of plastic surgery is a relatively new and developing field. This chapter focuses on the growing importance of evidence-based surgery in this specialty, showing that scientific trials are now being performed with increasing frequency.

scholarly journals Characteristic of Clinical Studies on Baduanjin during 2000–2019: A Comprehensive Review

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Jing Zhou ◽  
Yunyang Yu ◽  
Biwei Cao ◽  
Xiaoya Li ◽  
Miao Wu ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Clinical Studies ◽  
Methodological Quality ◽  
Case Reports ◽  
Case Series ◽  
Small Sample ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
Randomized Controlled

To date, a growing number of clinical studies have demonstrated the safety and health benefits from Baduanjin intervention. Based on this, our objective is to systematically retrieve and summarize the clinical studies on Baduanjin, with a view to providing more evidence-based evidence in support of the application of Baduanjin for healthcare, and to identify the shortcomings of existing research and provide feasibility suggest for further clinical research. Both four English language and four Chinese language electronic databases were used to search articles related to Baduanjin during 2000–2019. SPSS 22.0 software was used to analyze the data, and the risk of bias tool in the RevMan 5.3.5 software was used to evaluate the methodological quality of randomized controlled trials. A total of 810 publications were identified, including 43 (5.3%) systematic reviews, 614 (75.8%) randomized controlled trials, 66 (8.1%) nonrandomized controlled clinical studies, 84 (10.4%) case series, and 3 (0.4%) case reports. The top 10 diseases/conditions included diabetes, chronic obstructive pulmonary disease, hypertension, low back pain, neck pain, stroke, coronary heart disease, cognitive impairment, insomnia, and osteoporosis or osteopenia. The style of State General Administration of Sport of China in 2003 was the most commonly used version of Baduanjin, and Baduanjin was practiced with an average of 35 minutes, 1 or 2 times a day, 3–5 days per week, and a 18-week average duration. It is also worth noting that there were no serious adverse events related to Baduanjin intervention. Most studies were small sample size research, and the methodological quality of randomized controlled trials is generally low. The clinical studies of Baduanjin have a substantial quantity and evidence base. However, there are significant differences among different studies in the specific intervention measures such as style, intensity, duration, learning, and practice methods, which need to be further standardized and unified. Further high-quality designed and reporting studies are recommended to further validate the clinical benefits of Baduanjin.

scholarly journals Liver-related safety assessment of green tea extracts in humans: a systematic review of randomized controlled trials

2016 ◽  
Vol 70 (11) ◽  
pp. 1221-1229 ◽  
Author(s):  
T Isomura ◽  
S Suzuki ◽  
H Origasa ◽  
A Hosono ◽  
M Suzuki ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Green Tea ◽  
Case Reports ◽  
Intervention Group ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled

Abstract There remain liver-related safety concerns, regarding potential hepatotoxicity in humans, induced by green tea intake, despite being supposedly beneficial. Although many randomized controlled trials (RCTs) of green tea extracts have been reported in the literature, the systematic reviews published to date were only based on subjective assessment of case reports. To more objectively examine the liver-related safety of green tea intake, we conducted a systematic review of published RCTs. A systematic literature search was conducted using three databases (PubMed, EMBASE and Cochrane Central Register of Controlled Trials) in December 2013 to identify RCTs of green tea extracts. Data on liver-related adverse events, including laboratory test abnormalities, were abstracted from the identified articles. Methodological quality of RCTs was assessed. After excluding duplicates, 561 titles and abstracts and 119 full-text articles were screened, and finally 34 trials were identified. Of these, liver-related adverse events were reported in four trials; these adverse events involved seven subjects (eight events) in the green tea intervention group and one subject (one event) in the control group. The summary odds ratio, estimated using a meta-analysis method for sparse event data, for intervention compared with placebo was 2.1 (95% confidence interval: 0.5–9.8). The few events reported in both groups were elevations of liver enzymes. Most were mild, and no serious liver-related adverse events were reported. Results of this review, although not conclusive, suggest that liver-related adverse events after intake of green tea extracts are expected to be rare.

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