A network meta-analysis on comparative efficacy and all-cause discontinuation of antimanic treatments in acute bipolar mania

BACKGROUND

Evidence synthesis methods enabling direct and indirect comparisons over the entire set of relevant clinical data produce quantitative point estimates for the treatments contrasts between competing interventions, and provide a hierarchical rank ordering between them. We aimed to provide evidence-based guidance on the efficacy and all-cause discontinuation of antimanic treatments.

METHOD

We conducted a network meta-analysis within a Bayesian framework. We searched all standard literature databases without language restrictions up to 15 January 2014 to identify reports of short-term, randomized, blinded trials of putative antimanic drugs as monotherapy for adults with bipolar-I mania.

RESULTS

Altogether, 14256 manic patients randomized to one of 18 active treatments or placebo provided 95 direct comparisons on 128 data points. For the primary outcome, standardized mean difference as Hedges' g (standardized mean difference; SMD), the hierarchies indicated by surface under the cumulative ranking (SUCRA) probabilities were in agreement with the point estimates for all antimanic drugs identified as effective. For the 12 effective antimanic drugs on clinical use, SMDs against placebo ranged from 0.32 to 0.66 without superiority of one over another, except for risperidone v. aripiprazole and valproate. Aripiprazole, olanzapine, quetiapine, risperidone, and valproate had less all-cause discontinuation rates than placebo. Sensitivity analysis by drug class indicated similar efficacy profiles for haloperidol, second-generation antipsychotics, and mood stabilizers.

CONCLUSIONS

Hierarchical rank ordering by comparative efficacy and risk of all-cause discontinuations should help to guide antimanic treatment choices by clinicians, healthcare policy makers, and guideline developers.

Arterial dysfunction in early autosomal dominant polycystic kidney disease independent of fibroblast growth factor 23

INTRODUCTION

Recent studies report reduced vascular compliance and elevated levels of fibroblast growth factor 23 (FGF23) in patients with autosomal dominant polycystic kidney disease (ADPKD) and preserved kidney function. In the present study, we investigated the relationship between vascular compliance and FGF23 in patients in early phases of ADPKD.

MATERIALS AND METHODS

We studied 54 ADPKD patients with preserved kidney function and 24 healthy individuals. All participants underwent noninvasive pulse wave analysis in order to determine large arterial elasticity index (LAEI) and small arterial elasticity index (SAEI) using a modified Windkessel model. Levels of FGF23 in addition to several cardiovascular risk factors were evaluated. Linear regression analyses were performed to determine independent correlates of LAEI, SAEI, and FGF23.

RESULTS

In the ADPKD group, 33 patients were hypertensive and the remaining patients were normotensive. Serum FGF23 levels of both ADPKD groups were significantly higher than that in the controls. Both hypertensive and normotensive ADPKD patients had lower LAEI and SAEI levels compared to the controls. There was no significant correlation between vascular compliance parameters and FGF23 levels. Having ADPKD was independently associated with increased FGF23 levels and decreased SAEI.

CONCLUSIONS

Fibroblast growth factor 23 was found substantially elevated and arterial compliance was found significantly decreased in early ADPKD patients regardless of hypertension. However, there was no significant correlation between FGF23 levels and arterial function parameters. Additional studies are required to determine possible mechanisms of these disturbances and cardiovascular effects of FGF23 in ADPKD patients.

First Report of Strawberry Dieback Caused by Lasiodiplodia theobromae

With a typical Mediterranean climate, Aydin is the third largest strawberry-producing province, responsible for 13% of the overall strawberry production in Turkey. Strawberries (Fragaria × ananassa Duchesne) are mainly grown in raised, plastic-mulched beds under tunnels and soil solarization is the most effectively used management practice to control soil-borne pathogens. During October 2011 and 2012, 2 months after planting, wilting and collapse of plants were observed on commercial strawberry (cv. strawberry Festival) fields in Sultanhisar town of Aydin Province. Eleven percent of the plants were wilted and died. Symptomatic plants exhibited blackened necrotic discoloration of roots and in the cross section of crowns. A fungus was consistently isolated from pieces of infected tissue cut aseptically from the crowns and placed on potato dextrose agar. Fungus produced white colonies and later turned olivaecious black with dense aerial mycelium after 4 to 5 days incubation at 27°C. Dark brown to black pycnidia that formed on 20- to 30-day-old pure cultures under daylight conditions produced abundant conidia that were two-celled, thick-walled, and oval shaped with longitudinal striations. Single spore isolates from 12 samples were obtained and stored for further identification. The average size of 300 conidia was 25.42 ± 2.12 × 12.87 ± 1.08 μm. The morphology of the fungus was similar to Lasiodiplodia theobromae (Pat.) Griff. & Maubl. (syn. Botryodiplodia theobromae Pat.). To confirm the identity of the isolates, the internal transcribed spacer (ITS) region of ribosomal DNA and the elongation factor 1-alpha gene were amplified with the universal ITS1/ITS4 and EF1-688F/EF1-1251R (1) primers, respectively. The amplicons from 12 isolates were commercially sequenced at Macrogen (Korea) and were deposited in GenBank under consecutive accession numbers KF910369 to KF910380 and KJ641536 to KJ641547. Sequence comparison and phylogenetic analysis revealed that all 12 isolates were closely related and belonged to L. theobromae. Pathogenicity tests were performed by the toothpick technique (2) under greenhouse conditions (28°C, 14/10-h day/night, 70% RH) on potted strawberry plants (cv. strawberry Festival). Toothpicks carrying fungal growth taken from 1-week-old corn meal agar cultures of the tested isolates was placed into the basal crown tissue of the plants by piercing about 5 mm depth. Six plants were inoculated for each isolate and six were treated with sterile toothpick for control. All inoculated plants developed wilting and dieback symptoms resembling those of naturally infected plants within 2 to 3 weeks of incubation. All plants inoculated with the tested isolates collapsed after 4 weeks and showed discoloration of internal crown tissue. Control plants did not exhibit any disease symptoms, and crown tissue was symptomless. L. theobromae was successfully re-isolated from lesions of all inoculated plants. L. theobromae has been reported to cause cankers and dieback in a wide range of hosts in tropical and subtropical regions of the world (3). To the best of our knowledge, this is the first report of L. theobromae causing dieback on strawberry plants. References: (1) A. Alves et al. Fungal Divers. 28:1, 2008. (2) M. E. A. El-Morsi and I. A. Ibrahim. Wudpecker J. Agric. Res. 1:215, 2012. (3) E. Punithalingam. Plant diseases attributed to Botryodiplodia theobromae Pat. J. Cramer, Vaduz, 1980.

Serum ceruloplasmin levels in acute decompensated heart failure

BACKGROUND

Ceruloplasmin (Cp) is a serum protein that belongs to the family of α2-globulins and it is increased in patients with after acute myocardial infarction complicated with heart failure. Aim of the study was to investigate levels of serum Cp in patients with acute decompensated heart failure.

MATERIALS AND METHODS

The present cross-sectional observational study consists of three groups: Fifty patients with decompensated heart failure (Group 1) and same 50 patients after compensation (Group 2); 50 control patients group with comparable age and sex without heart failure (Group 3). Demographic, echocardiographic and biochemical data of patients were collected. Serum Cp level was determined spectrophotometrically.

RESULTS

Serum ceruloplasmin was significantly increased in Groups 1 (820.8 ± 78.5 IU/dL) and 2 (873.5 ± 121.0 IU/dL) compared, to Group 3 (640.6 ± 132.4 IU/dL) (p<0.001). In the sub-group analysis, this difference was due to the difference between Groups 3, Group 1 and 2 (both p=0.0001) whereas no significant difference was present between Group I and Group 2 (p>0.063). A positive correlation was found between Cp and female sex, heart rate, systolic and diastolic blood pressure, acetylsalisilic acid and diuretic use, left ventricular systolic and diastolic diameter, mitral regurgitation, and negative correlation was found between Cp and ejection fraction (p<0.05 for all) whereas none of the parameters were independently associated with serum Cp level (p>0.05).

CONCLUSIONS

Findings of the present study suggest that serum Cp level is increased in both decompensated and compensated HF compared to controls. Further large scale studies are needed to elucidate the pathophysiological mechanisms of increased Cp in HF.

The effect of melatonin on acetylsalicylic acid-induced kidney and testis damage

The aim of this study was to evaluate the acute effect of high-dose acetylsalicylic acid (ASA) on kidney and testis, and the potential protective and therapeutic effects of melatonin on ASA-related pathology. A total of 40 rats were randomly divided into the following 5 groups ( n = 8): group 1: control, not given any drug; group 2: only 200 mg/kg ASA was given; group 3: 5 mg/kg melatonin was given 45 min before administering 200 mg/kg ASA; group 4: 5 mg/kg melatonin was given 45 min after administering 200 mg/kg ASA; and group 5: only 5 mg/kg melatonin was given. The histopathological changes and the biochemical findings; such as malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), reduced glutathione (GSH), and blood urea nitrogen (BUN) as well as serum creatinine (Cr) levels were evaluated. ASA significantly increased MDA levels in both kidney and testis, whereas it significantly decreased the values of SOD, CAT, GPX, and GSH in kidney and CAT levels in testis. Melatonin significantly decreased MDA levels in kidney and ameliorated it in testis, whereas it caused elevation in the levels of antioxidants. BUN and Cr levels were higher after ASA, whereas these levels were diminished after melatonin administration. The improvement obtained by melatonin on ASA-induced histological alterations was more prominent when it was used after ASA in kidney and before ASA in testis. In this study, we demonstrated the beneficial effect of melatonin on high-dose ASA-related pathology of kidney and testis for the first time.

Percutaneous coronary intervention vs. optimal medical therapy--the other side of the coin: medication adherence

WHAT IS KNOWN AND OBJECTIVE

Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence-based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone.

METHODS

We evaluated adherence to statins, beta-blockers, and angiotensin converting enzyme inhibitors (ACEI) during a 6-month follow-up in 232 patients with documented CAD, comparing patients treated with PCI and those receiving medical therapy alone. Medication adherence was measured with reference to national reimbursement database records.

RESULTS AND DISCUSSION

Of the 232 patients who survived the 6-month follow-up, the percentages of adherent patients according to prescription records (prespecified primary endpoint) were 53·6% (n = 82) in the PCI group and 33·8% (n = 27) in the OMT group (P = 0·004). Analysis of the individual medication classes revealed similar results for beta-blockers (86·0% in PCI group vs. 72·5% in OMT group, P = 0·006) and statins (64·5% in PCI group vs. 44·0% in OMT group, P = 0·003). Adherence to ACEI was also higher in the PCI group, but the difference was not statistically significant (77·6% vs. 69·3%, P = 0·17). By logistic regression analysis, belonging to the PCI group was an independent predictor of medication adherence [B = 2·20 (1·06-4·50), P = 0·03)].

WHAT IS NEW AND CONCLUSION

In the present study we demonstrated that adherence to evidence-based medication therapies in patients treated with PCI is significantly higher than in patients treated with OMT alone. Medication adherence should be followed carefully in CAD patients treated with OMT.

Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study

OBJECTIVE

This study aimed at the assessment of the clinical approach to atrial fibrillation (AF) in the older population and the consistency with the guidelines based on the records of the multicenter, prospective AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) study.

PATIENTS AND METHODS

2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination, were included in the study. Among the patients included in the study, 631 individuals aged 75 years and older were analyzed.

RESULTS

The mean age of the patients was determined as 80.3±4.2 years. The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88%. 60% of the patients with AF were female. Hypertension was the most common co-morbidity in patients with AF (76%). While in 16% of patients a history of stroke, transient ischemic attack or systemic thromboembolism was present, a history of bleeding was present in 14% of the patients. 37% of the patients were on warfarin treatment and 60% of the patients were on aspirin treatment. In 38% of the patients who were on oral anticoagulant treatment, INR level was in the effective range.

CONCLUSIONS

The rate of anticoagulant use in the elderly with AF was 37% and considering the reason of this situation was the medication not being prescribed by the physician, one should pay more attention particularly in the field of treatment.

Association of serum paraoxonase activity and coronary artery calcification

AIM

It has been known that there was a relation between the activities of serum paraoxonase (PON) and the severity of the coronary artery disease. However, little is known about association of coronary artery calcification (CAC) and serum PON activities. The aim of this study is to evaluate the relationship between CAC and serum PON activities.

PATIENTS AND METHODS

We measure serum PON activities from 122 patients (42 female, mean age = 62±10 years) with angiographically documented CAC (Group I), and 138 patients (54 female, mean age = 60±10 years) without CAC (Group II). Coronary calcification was detected with fluoroscopy before coronary angiography. Serum PON activities were measured by spectrophotometrically method. Patient characteristics and baseline data were recorded from patient's files.

RESULTS

The triglyceride levels is lower in group I than group II (p = 0.040). Diastolic blood pressure and frequency of diabetes mellitus was higher in the group I than group II (respectively p = 0.012 and p = 0.022). The other clinic and laboratory parameters were similar in two groups (all p > 0.05). The only statistically significant differences between with CAC and without CAC groups in respect to serum PON activities were present (170.6 ± 59.6 vs. 209.6 ± 69.8 U/ml; respectively, p < 0.001). There was a negative correlation between serum PON activities and presence of CAC (p < 0.001).

CONCLUSIONS

These data indicate that the serum PON activities are decreased in patients with CAC. The serum PON activities may play a role in development of the CAC and reduced serum PON activity might represent a biochemical marker of CAC.

Antioxidant properties, chemical composition and nutritional value of Terfezia boudieri (Chatin) from Turkey

Our objectives were to investigate the chemical composition, nutritive value and antioxidant activity potentials of Terfezia boudieri Chatin collected from different areas from Southeast of Turkey. The amounts of energy, protein, fat, carbohydrate, crude fibre, moisture and ash were 34.00–65.00 (kcal/100 g), 1.40–2.73, 0.86–1.71, 4.84–11.60, 80.86–90.33 (g/100 g, f.w.) and 1.02–1.98 g/100 g dry mass, respectively. Fatty acids and amino acids analyses revealed that linoleic acid and glutamic acid were, respectively the most abundant. Among the essential amino acids leucine was the highest amount and this was followed by threonine. Magnesium was the most abundant element with a concentration value of 182.30 mg/100 g dry mass. T. boudieri exhibited excellent antioxidant activity when compared with standard compounds. In total antioxidant and chelating effect on ferrous ions activity T. boudieri showed the highest activity against the standards. Additionally, at all studied tests antioxidant activity of the mushroom increased with increasing concentration. The total phenolic content of T. boudieri was found as 8.45 mg/g.

N-acetylcysteine ameliorates γ-radiation-induced deterioration of bone quality in the rat femur

This animal study evaluated the radioprotective effects of N-acetylcysteine (NAC) and amifostine on the biomechanical properties of bone in Wistar albino rats of both genders. The rats were randomly divided into four groups of eight: a control group (C); a group given a single dose of 40 Gy of γ-irradiation (R); a group given γ-irradiation plus 200 mg/kg amifostine (R + amifostine); and a group given γ-irradiation plus 1000 mg/kg NAC (R + NAC). Extrinsic and intrinsic properties of bone, bone mineral density (BMD) and the cross-sectional area of the femoral shaft were determined. The cross-sectional area was significantly higher in the R + NAC and R + amifostine groups compared with the R and C groups. The BMD, maximum load and stiffness were also significantly higher in the R + NAC and R + amifostine groups than in the R group, and energy absorption capacity was higher in the R + NAC group than in the R group. These findings indicate that NAC and amifostine preserve bone quality in rats exposed to γ-irradiation.