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https://www.readbyqxmd.com/read/28337040/refining-metformin-prescribing-in-new-zealand
#1
Sisira Jayathissa, Paul Dixon, Raymond Bruce, David Reith
Metformin is the mainstay of treatment of type 2 diabetes. However, there has been significant concern on prescribing metformin in patients with renal impairment as a result of metformin-associated lactic acidosis (MALA). Recent studies have cast doubt on the existence of MALA purely related to metformin use. Medsafe recently initiated changes to datasheet so lower doses of metformin could be used in patients with GFR down to 15ml/min. In this paper we outline the context and implications of this change.
March 24, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28333889/normothermic-ex-situ-liver-preservation-the-new-gold-standard
#2
Richard W Laing, Hynek Mergental, Darius F Mirza
PURPOSE OF REVIEW: Normothermic machine perfusion of the liver (NMP-L) is a novel technology recently introduced into the practice of liver transplantation. This review recapitulates benefits of normothermic perfusion over conventional static cold storage and summarizes recent publications in this area. RECENT FINDINGS: The first clinical trials have demonstrated both safety and feasibility of NMP-L. They have shown that machine perfusion can entirely replace cold storage or be commenced following a period of cold ischaemia...
March 22, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28329904/-accumulation-of-metformin-associated-lactic-acidosis
#3
Tabea Rüegg, Basil Caduff
Objective Lactic acidosis has been associated with the use of metformin since its introduction. The cause, however, is highly controversial. The incidence of metformin-associated lactic acidosis (MALA) is quoted at 3,0 to 16,7 cases per 100 000 patient-years according to current studies. The link between metformin and lactic acidosis in metformin therapy has been suggested to be causal and therefore, the use of metformin was restricted to type 2 diabetic patients without renal impairment. Recent studies, however, show an acceptable use and no increased incidence of lactic acidosis in chronic mild to moderate renal insufficiency, respectively...
March 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28324770/a-non-fatal-intoxication-and-seven-deaths-involving-the-dissociative-drug-3-meo-pcp
#4
Anna Johansson, Daniel Lindstedt, Markus Roman, Gunilla Thelander, Elisabet I Nielsen, Ulrica Lennborn, Håkan Sandler, Sten Rubertsson, Johan Ahlner, Robert Kronstrand, Fredrik C Kugelberg
INTRODUCTION: 3-methoxyphencyclidine (3-MeO-PCP) appeared on the illicit drug market in 2011 and is an analogue of phencyclidine, which exhibits anesthetic, analgesic and hallucinogenic properties. In this paper, we report data from a non-fatal intoxication and seven deaths involving 3-MeO-PCP in Sweden during the period March 2014 until June 2016. CASE DESCRIPTIONS: The non-fatal intoxication case, a 19-year-old male with drug problems and a medical history of depression, was found awake but tachycardic, hypertensive, tachypnoeic and catatonic at home...
March 7, 2017: Forensic Science International
https://www.readbyqxmd.com/read/28321601/late-onset-melas-with-m-3243a%C3%A2-%C3%A2-g-mutation-and-its-association-with-aneurysm-formation
#5
Kun Zhu, Shuang Li, Huan Chen, Yao Wang, Miao Yu, Hongyan Wang, Weijie Zhao, Yunpeng Cao
We reported a 53-year-old with late-onset mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) accompanied by aneurysm and large vessel dilations. Most studies have focused on microangiopathy causing stroke-like episodes. We report a case to describe large vessel involvement in clinical considerations, and possible mechanisms of aneurysm formation. We recommended regular angiographic examination for patients with MELAS.
March 21, 2017: Metabolic Brain Disease
https://www.readbyqxmd.com/read/28317631/lactic-acidosis-a-rare-oncological-emergency-in-solid-tumors-at-presentation
#6
Ranjit Nair, Usman Shah
Lactic acidosis is a potentially life-threatening complication characterized by accumulation of blood lactate resulting in low arterial pH. The majority of lactic acidosis in malignancies are reported in association with hematologic malignancies. It may result from an imbalance between lactate production and hepatic lactate utilization, but the exact pathophysiology is far more complex than what we can fathom from current micromolecular studies. We report a case of a 71-year-old male with metastatic lung cancer presenting with fatal lactic acidosis in the absence of liver involvement...
April 2017: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/28306366/serum-osmolal-gap-in-clinical-practice-usefulness-and-limitations
#7
George Liamis, Theodosios D Filippatos, Angelos Liontos, Moses S Elisaf
BACKGROUND: Although serum osmolal gap can be a useful diagnostic tool, clinicians are not familiar with its use in clinical practice. OBJECTIVES: The review presents in a series of questions-answers and under a clinical point of view the current data regarding the use of osmolal gap. DISCUSSION: The definition and the best formula used for the calculation of osmolal gap, the main causes of increased osmolal gap with or without increased anion gap metabolic acidosis, as well as the role of concurrent lactic acidosis or ketoacidosis are presented under a clinical point of view...
March 23, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28302226/severe-anaphylactic-reaction-to-preoperative-aspiration-prophylaxis
#8
Faraz Shafiq, Muhammad Irfan -Ul- Haq, Muhammad Sohaib
It is a case of severe anaphylactic reaction in a young female who had received aspiration prophylaxis preoperatively. Patient required intensive care and developed severe lactic acidosis. She responded very well to fluid and phenylephrine boluses and later on norepinephrine infusion.
March 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28299952/n-acetylcysteine-s-role-in-sepsis-and-potential-benefit-in-patients-with-microcirculatory-derangements
#9
Jason Chertoff
OBJECTIVE: To review the data surrounding the utility of N-acetylcysteine (NAC) in sepsis and identify areas needed for additional research. DATA SOURCES: A review of articles describing the mechanisms of action and clinical use of NAC in sepsis. SUMMARY OF REVIEW: Despite many advances in critical care medicine, still as many as 50% of patients with septic shock die. Treatments thus far have focused on resuscitation and restoration of macrocirculatory targets in the early phases of sepsis, with less focus on microcirculatory dysfunction...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28288687/effectiveness-of-isosorbide-dinitrate-in-cyanide-poisoning-as-a-function-of-the-administration-timing
#10
Ophir Lavon, Amit Avrahami, Arik Eisenkraft
BACKGROUND: Better and safer antidotes against cyanide poisoning are needed. Prior study has shown a favorable effect of isosorbide dinitrate (ISDN) on the survival of cyanide-poisoned rabbits when administered as early as 1 min after poisoning. The aim of the current study was to further evaluate the efficacy of intravenous ISDN administered in clinically relevant timing for first responders. METHODS: A comparative animal study using 24 rabbits in 4 randomized study groups was performed...
March 14, 2017: BMC Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28283275/kidney-involvement-in-melas-syndrome-description-of-2-cases
#11
Pau Alcubilla-Prats, Manel Solé, Albert Botey, Josep Maria Grau, Glòria Garrabou, Esteban Poch
INTRODUCTION: MELAS syndrome -myopathy, encephalopathy, lactic acidosis and stroke-like episodes- is a maternally-inherited mitochondrial cytopathy related to several mitochondrial DNA mutations, with the A3243G mutation in tRNA(Leu) gene being the most frequent of them. PATIENTS AND METHODS: Apart from its typical symptomatology, patients usually exhibit a maternally-inherited history of neurosensory deafness and insulin-dependent type 2 diabetes mellitus (T2DM)...
March 7, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/28279569/lifetime-exercise-intolerance-with-lactic-acidosis-as-key-manifestation-of-novel-compound-heterozygous-acad9-mutations-causing-complex-i-deficiency
#12
Bertold Schrank, Benedikt Schoser, Thomas Klopstock, Peter Schneiderat, Rita Horvath, Angela Abicht, Elke Holinski-Feder, Sarunas Augustis
We report a 36-year-old female having lifetime exercise intolerance and lactic acidosis with nausea associated with novel compound heterozygous Acyl-CoA dehydrogenase 9 gene (ACAD9) mutations (p.Ala390Thr and p.Arg518Cys). ACAD9 is an assembly factor for the mitochondrial respiratory chain complex I. ACAD9 mutations are recognized as frequent causes of complex I deficiency. Our patient presented with exercise intolerance, rapid fatigue, and nausea since early childhood. Mild physical workload provoked the occurrence of nausea and vomiting repeatedly...
February 14, 2017: Neuromuscular Disorders: NMD
https://www.readbyqxmd.com/read/28275242/uqcrc2-mutation-in-a-patient-with-mitochondrial-complex-iii-deficiency-causing-recurrent-liver-failure-lactic-acidosis-and-hypoglycemia
#13
Pauline Gaignard, Didier Eyer, Elise Lebigot, Christophe Oliveira, Patrice Therond, Audrey Boutron, Abdelhamid Slama
An isolated mitochondrial complex III (CIII) defect constitutes a rare cause of mitochondrial disorder. Here we present the second case involving UQCRC2 gene, which encodes core protein 2, one of the 11 structural subunits of CIII. The patient has the same mutation (c.547C>T; p.Arg183Trp) as the first case and presented with neonatal lactic acidosis, hypoglycemia and severe episodes of liver failure. Our study expands the few reported cases of CIII deficiency of nuclear origin.Journal of Human Genetics advance online publication, 9 March 2017; doi:10...
March 9, 2017: Journal of Human Genetics
https://www.readbyqxmd.com/read/28261380/adverse-effects-of-oral-antiviral-therapy-in-chronic-hepatitis-b
#14
REVIEW
Bircan Kayaaslan, Rahmet Guner
Oral nucleoside/nucleotide analogues (NAs) are currently the backbone of chronic hepatitis B (CHB) infection treatment. They are generally well-tolerated by patients and safe to use. To date, a significant number of patients have been treated with NAs. Safety data has accumulated over the years. The aim of this article is to review and update the adverse effects of oral NAs. NAs can cause class adverse effects (i.e., myopathy, neuropathy, lactic acidosis) and dissimilar adverse effects. All NAs carry a "Black Box" warning because of the potential risk for mitochondrial dysfunction...
February 18, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28259720/abnormal-liver-tests-and-persistent-lactic-acidosis-in-an-18-year-old-woman
#15
Thomas Malikowski, Badr Al-Bawardy, Amy S Oxentenko
No abstract text is available yet for this article.
March 1, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28251580/experimental-assessment-of-oxygen-homeostasis-during-acute-hemodilution-the-integrated-role-of-hemoglobin-concentration-and-blood-pressure
#16
Tiffanie Kei, Nikhil Mistry, Albert K Y Tsui, Elaine Liu, Stephen Rogers, Allan Doctor, David F Wilson, Jean-Francois Desjardins, Kim Connelly, C David Mazer, Gregory M T Hare
BACKGROUND: Low hemoglobin concentration (Hb) and low mean arterial blood pressure (MAP) impact outcomes in critically ill patients. We utilized an experimental model of "normotensive" vs. "hypotensive" acute hemodilutional anemia to test whether optimal tissue perfusion is dependent on both Hb and MAP during acute blood loss and fluid resuscitation, and to assess the value of direct measurements of the partial pressure of oxygen in tissue (PtO2). METHODS: Twenty-nine anesthetized rats underwent 40% isovolemic hemodilution (1:1) (or sham-hemodilution control, n = 4) with either hydroxyethyl starch (HES) (n = 14, normotensive anemia) or saline (n = 11, hypotensive anemia) to reach a target Hb value near 70 g/L...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28242802/uncommon-mutation-in-mitochondrial-encephalomyopathy-lactic-acidosis-and-stroke-like-episodes-melas
#17
Jasna David, Julie Omolola Okiro, Kevin Murphy, Marwa Elamin
A 26-year-old man presented to the emergency department with new-onset generalised tonic-clonic seizures. His clinical picture suggested either autoimmune or infectious encephalitis while his brain imaging raised the possibility of a stroke. A detailed developmental and childhood medical history added suspicion of a mitochondrial defect to the differential. After several molecular genetic analyses, an uncommon mitochondrial mutation was confirmed, unequivocally consistent with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome...
February 27, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28229804/immediately-functioning-grafts-from-brain-dead-donors-treated-with-extracorporeal-membrane-oxygenation
#18
Faissal A M Shaheen, Mohamed Shalabi, Ahmed Zain, Mahmood Hasanain, Abdulla Al Sayyari
A brain-dead donor experienced repeated cardiac arrests followed by severe hypotension requiring multiple vasoactive agents. These events were associated with severe lactic acidosis and dysregulated kidney function in the donor. A 10-hour treatment with extracorporeal membranous oxygenation was instituted, which was able to hemodynamically stabilize the donor. This treatment protocol resulted in the procurement of 2 viable kidney grafts transplanted into 2 recipients, who had immediate kidney graft function and excellent serum creatinine levels upon hospital discharge...
February 23, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28228835/recurrent-alternate-sided-homonymous-hemianopia-due-to-mitochondrial-encephalomyopathy-with-lactic-acidosis-and-stroke-like-episodes-melas-a-case-report
#19
Kristen M Krysko, Arun N E Sundaram
Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) can rarely cause alternate-sided homonymous hemianopia due to stroke-like episodes involving the occipital lobes, as reported in three previously published cases. The authors report an interesting case of a 16-year-old presenting with myoclonic epilepsy due to MELAS with the rare ND3 mitochondrial mutation T10191C, with recurrent alternate-sided homonymous hemianopia. Visual field and corresponding magnetic resonance imaging (MRI) findings are presented...
February 2017: Neuro-ophthalmology
https://www.readbyqxmd.com/read/28223003/treatment-of-metformin-intoxication-complicated-by-lactic-acidosis-and-acute-kidney-injury-the-role-of-prolonged-intermittent-hemodialysis
#20
Giuseppe Regolisti, Riccardo Antoniotti, Filippo Fani, Paolo Greco, Enrico Fiaccadori
Metformin intoxication with lactic acidosis, a potentially lethal condition, may develop in diabetic patients when the drug dose is inappropriate and/or its clearance is reduced. Diagnosis and therapy may be delayed due to nonspecific symptoms at presentation, with severe anion gap metabolic acidosis and elevated serum creatinine values being the most prominent laboratory findings. Confirmation requires measurement of serum metformin by high-performance liquid chromatography-tandem mass spectrometry, but this technique is available only at specialized institutions and cannot be relied on as a guide to immediate treatment...
February 17, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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