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Sene PM, Gebai A, Kopel T, Cailhier JF, Lafrance D, Côté JM. Suspected medullary washout leading to severe polyuria following delayed cerebral ischemia: a case report. BMC Nephrol 2023; 24:257. [PMID: 37658303 PMCID: PMC10472600 DOI: 10.1186/s12882-023-03281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/24/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Delayed cerebral ischemia is a clinical entity commonly encountered in patients presenting with acute neurological injury and is often complicated by dysnatremias, such as the cerebral salt wasting syndrome. In this case report, we described an exceptional case of polyuria attributed to an initial cerebral salt wasting phenomenon and iatrogenic-induced medullary washout. CASE PRESENTATION A 53-year-old woman was admitted to our hospital for the management of a Modified Fisher scale grade 4 subarachnoid hemorrhage due to a ruptured posterior communicating aneurysm. She was initially managed with coil embolization and external ventricular drain due to secondary hydrocephalus. Throughout the course of her hospitalization, she developed severe polyuria reaching up to 40L per day. To keep up with the excessive urinary losses and maintain appropriate cerebral perfusion, fluid replacement therapy was adjusted every hour, reaching up to 1.3 L of crystalloid per hour in addition to aminergic support. An initial diagnosis of partial diabetes insipidus, followed by a cerebral salt wasting syndrome was suspected. While the urine output continued to increase, her serum urea concentration progressively decreased to a point of almost being undetectable on day 9. At that time, the presence of an interstitial medulla washout was hypothesized. Various pharmacological and non-pharmacological interventions were progressively introduced to regain normal renal homeostasis, including non-steroidal anti-inflammatory drugs, fludrocortisone, oral urea and high-protein intake. Medications were progressively weaned, and the patient was successfully discharged from the ICU. CONCLUSIONS Cerebral salt wasting should be considered in the initial differential diagnosis of a patient presenting with polyuria in the context of acute neurological injury. Early recognition of this entity is critical to quickly implement proper management. However, as shown in this case report, the concomitance of delayed cerebral ischemia may complexify that management.
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Affiliation(s)
- Pape-Mamadou Sene
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Ahmad Gebai
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Tal Kopel
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Jean-François Cailhier
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Dominique Lafrance
- Division of Intensive Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Jean-Maxime Côté
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
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Côté JM, Desjardins M, Murray PT. Does Vancomycin-Piperacillin-Tazobactam Cause Pseudo-AKI, True Nephrotoxicity, or Both? Chest 2023; 164:273-274. [PMID: 37558318 DOI: 10.1016/j.chest.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Jean-Maxime Côté
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada; CHUM Research Center (CRCHUM), Montreal, QC, Canada; Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
| | - Michaël Desjardins
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada; CHUM Research Center (CRCHUM), Montreal, QC, Canada; Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Patrick T Murray
- Faculty of Medicine, University College Dublin, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
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Ledoux-Hutchinson L, Wald R, Malbrain ML, Carrier FM, Bagshaw SM, Bellomo R, Adhikari NK, Gallagher M, Silver SA, Bouchard J, Connor Jr MJ, Clark EG, Côté JM, Neyra JA, Denault A, Beaubien-Souligny W. Fluid Management for Critically Ill Patients with Acute Kidney Injury Receiving Kidney Replacement Therapy: An International Survey. Clin J Am Soc Nephrol 2023; 18:705-715. [PMID: 36975194 PMCID: PMC10278767 DOI: 10.2215/cjn.0000000000000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND In critically ill patients receiving KRT, high ultrafiltration rates and persistent fluid accumulation are associated with adverse outcomes. The purpose of this international survey was to evaluate current practices and evidence gaps related to fluid removal with KRT in critically ill patients. METHODS This was a multinational, web-based survey distributed by seven networks comprising nephrologists and intensivists. Physicians involved in the care of critically ill patients were invited to complete a 39-question survey about fluid management practices on KRT. The survey was distributed from September 2021 to December 2021. RESULTS There were 757 respondents from 96 countries (response rate of 65%). Most respondents practiced adult medicine (89%) and worked in an academic center (69%). The majority (91%) reported aiming for a 0.5- to 2-L negative fluid balance per day when fluid removal is indicated, although there was important variability in what respondents considered a safe maximal target. Intensivists were more likely than nephrologists to use adjunct volume status assessment methods ( i.e. , ultrasound, hemodynamic markers, and intra-abdominal pressure), while nephrologists were more likely to deploy cointerventions aimed at improving tolerance to fluid removal ( i.e. , osmotic agents and low-temperature dialysate). There was a broad consensus that rapid decongestion should be prioritized when fluid accumulation is present, but the prevention of hypotension was also reported as a competing priority. A majority (77%) agreed that performing trials that compare fluid management strategies would be ethical and clinically relevant. CONCLUSIONS We have identified multiple areas of variability in current practice of fluid management for patients receiving KRT. Most nephrologists and intensivists agreed that several knowledge gaps related to fluid removal strategies should be investigated in future randomized controlled trials.
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Affiliation(s)
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Manu L.N.G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- Medical Data Management, Medaman, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
| | - François Martin Carrier
- Centre de recherche du CHUM, Montreal, Quebec, Canada
- Critical Care Division, Department of Anesthesiology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Sean M. Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Neill K.J. Adhikari
- Interdepartmental Division of Critical Care Medicine, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Martin Gallagher
- Renal Division, The George Institute for Global Health, University of NSW, Sydney, New South Wales, Australia
| | - Samuel A. Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Josée Bouchard
- Division of Nephrology, Sacré-Coeur Hospital, Montreal, Quebec, Canada
| | - Michael J. Connor Jr
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, Anesthesiology, Montreal Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Maxime Côté
- Centre de recherche du CHUM, Montreal, Quebec, Canada
- Service of Nephrology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Javier A. Neyra
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Centre de recherche du CHUM, Montreal, Quebec, Canada
- Service of Nephrology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
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Côté JM, Kane-Gill SL, Murray PT. A ray of hope in the discord: is adding piperacillin-tazobactam to vancomycin truly more nephrotoxic? Intensive Care Med 2022; 48:1208-1210. [PMID: 36044050 DOI: 10.1007/s00134-022-06861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jean-Maxime Côté
- Division of Nephrology, Department of Medicine, Centre Hospitalier de L'Université de Montréal, Montréal, Canada
- Clinical Research Center (CrCHUM), Centre Hospitalier de L'Université de Montréal, Montréal, Canada
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA
- Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick T Murray
- School of Medicine, University College Dublin, Dublin, Ireland.
- Division of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland.
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Côté JM, Authier R, Ethier I, Cailhier JF, Beaubien-Souligny W, Murray PT, Hétu PO, Bélanger MC. Clinical Implementation of NGAL Testing to Improve Diagnostic Assessment of AKI Episodes in a Canadian Center. Can J Kidney Health Dis 2022; 9:20543581221118991. [PMID: 36004277 PMCID: PMC9393659 DOI: 10.1177/20543581221118991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The differential diagnosis of acute kidney injury (AKI) episodes is often
challenging. Novel AKI biomarkers have shown their utility to improve
prognostic prediction and diagnostic assessment in various research
populations but their implementation in standard clinical practice is still
rarely reported. Objective: To report the differential diagnostic ability and associated clinical utility
of the neutrophil gelatinase-associated lipocalin (NGAL) testing in a
real-life setting of a heterogeneous AKI population. Design: This is a retrospective cohort study combined with a clinical audit using
questionnaires distributed to consultant nephrologists following NGAL
results. Setting: The first 250 consecutive patients with a confirmed AKI where an NGAL test
(plasma NGAL [pNGAL] or urine NGAL [uNGAL]) was ordered from a large
academic center in Montreal, Canada from January 2021 to August 2021. Patients: Patients were classified into 3 groups based on the final AKI etiology
category (functional, intrarenal, and postrenal) following definitive
adjudication by 2 independent nephrologists. Methods: The ability of plasma NGAL (pNGAL), urine NGAL (uNGAL), and
uNGAL-to-creatinine ratio (uNGAL/Cr) to discriminate intrarenal from
functional AKI etiologies was compared to standard urine chemistry (FENa)
and proteinuria. A logistic regression was used to evaluate the association
between intrarenal AKI and increased biomarker levels. The overall clinical
utility and appreciation of the NGAL test was evaluated using a
questionnaire completed prospectively by the consultant nephrologist at the
time of receiving the NGAL result. The NGAL results were prospectively
available to clinicians with a median time of 2.9 (1.3-7.4) hours from the
initial order. Results: A total of 214 uNGAL and 44 pNGAL were ordered from 100 functional, 139
intrarenal and 11 postrenal AKI episodes after final adjudication. The
discriminative ability of FENa (AUC 0.68 [95% CI: 0.61-0.75]) was lower than
uNGAL (AUC 0.80 [95% CI: 0.73-0.86]) and uNGAL/Cr (AUC 0.83 [95% CI:
0.77-0.88]) but better than pNGAL (AUC 0.66 [95% CI: 0.48-0.85]). According
to consultant nephrologists, the NGAL testing has led to a change in
clinical management in 42% of cases. Limitations: Data reported came from a single center and NGAL was reserved for more
complex cases, which limits generalizability. No biopsy has been performed
for most AKI cases as the final adjudication was based on a retrospective
review of the hospitalization episode. Conclusions: Neutrophil gelatinase-associated lipocalin testing can be successfully
integrated as part of the diagnostic workup for AKI in clinical practice.
The integration of tubular damage biomarkers to functional biomarkers can
further improve the differential diagnostic assessment. However, the impact
of such biomarkers on AKI management and associated outcomes still needs
further validation.
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Affiliation(s)
- Jean-Maxime Côté
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada.,Research Center (CRCHUM), Centre hospitalier de l'Université de Montréal, QC, Canada.,School of Medicine, University College Dublin, Ireland
| | - Roxanne Authier
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada
| | - Isabelle Ethier
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada.,Research Center (CRCHUM), Centre hospitalier de l'Université de Montréal, QC, Canada
| | - Jean-François Cailhier
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada.,Research Center (CRCHUM), Centre hospitalier de l'Université de Montréal, QC, Canada
| | - William Beaubien-Souligny
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada.,Research Center (CRCHUM), Centre hospitalier de l'Université de Montréal, QC, Canada
| | | | - Pierre-Olivier Hétu
- Research Center (CRCHUM), Centre hospitalier de l'Université de Montréal, QC, Canada.,Division of Clinical Biochemistry, Centre hospitalier de l'Université de Montréal, QC, Canada
| | - Marie-Claire Bélanger
- Research Center (CRCHUM), Centre hospitalier de l'Université de Montréal, QC, Canada.,Division of Clinical Biochemistry, Centre hospitalier de l'Université de Montréal, QC, Canada
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Piotte J, Louis F, Buyansky D, Mereniuk E, Lévesque R, Wald R, Cailhier JF, Côté JM, Beaubien-Souligny W. Online hemodiafiltration compared to conventional hemodialysis in critically ill patients. Kidney Int Rep 2022; 7:2376-2387. [DOI: 10.1016/j.ekir.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022] Open
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Côté JM, Beaubien-Souligny W. Dissipating the Fog at the Crossroad: Predicting Survival after the Initiation of Kidney Replacement Therapy. Kidney360 2022; 3:586-589. [PMID: 35721609 PMCID: PMC9136895 DOI: 10.34067/kid.0001122022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Jean-Maxime Côté
- Division of Nephrology, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Research Center, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - William Beaubien-Souligny
- Division of Nephrology, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Research Center, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
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8
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Côté JM, Desjardins M, Cailhier JF, Murray PT, Beaubien Souligny W. Risk of acute kidney injury associated with anti-pseudomonal and anti-MRSA antibiotic strategies in critically ill patients. PLoS One 2022; 17:e0264281. [PMID: 35271615 PMCID: PMC8912201 DOI: 10.1371/journal.pone.0264281] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background An increased risk of acute kidney injury (AKI) with the widely prescribed piperacillin-tazobactam(PTZ)-vancomycin combination in hospitalized patients has recently been reported, but evidence in ICU patients remain uncertain. This study evaluates the association between the exposure of various broad-spectrum antibiotic regimens with Pseudomonas and/or methicillin-resistance Staphylococcus aureus (MRSA) coverage and the risk of AKI in critically ill patients. Methods and findings A retrospective cohort study based on the publicly available MIMIC-III database reporting hospitalization data from ICU patients from a large academic medical center between 2001 and 2012. Adult patients receiving an anti-pseudomonal or an anti-MRSA agent in the ICU for more than 24-hours were included. Non-PTZ anti-pseudomonal agents were compared to PTZ; non-vancomycin agents covering MRSA were compared to vancomycin; and their combinations were compared to the PTZ-vancomycin combination. The primary outcome was defined as new or worsening AKI within 7 days of the antibiotic exposure using an adjusted binomial generalized estimating equation. Overall, 18 510 admissions from 15 673 individual patients, cumulating 169 966 days of antibiotherapy were included. When compared to PTZ, exposure to another anti-pseudomonal agent was associated with lower AKI risk (OR, 0.85; 95% CI, 0.80–0.91; p < .001). When compared to vancomycin, exposure to another anti-MRSA was also associated with lower AKI risk (OR, 0.71; 95% CI, 0.64–0.80; p < .001). Finally, when compared to the PTZ-vancomycin combination, exposure to another regimen with a similar coverage was associated with an even lower risk (OR, 0.63; 95% CI; 0.54–0.73; p < .001). A sensitivity analysis of patients with high illness severity showed similar results. Conclusions These results suggest that the risk of AKI in ICU patients requiring antibiotherapy may be partially mitigated by the choice of antibiotics administered. Further clinical trials are required to confirm these findings.
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Affiliation(s)
- Jean-Maxime Côté
- Division of Nephrology, Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Centre de recherche du centre hospitalier de l’Université de Montréal, Montréal, Canada
- Clinical Research Centre, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Michaël Desjardins
- Centre de recherche du centre hospitalier de l’Université de Montréal, Montréal, Canada
- Division of Infectious disease, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Microbiology and Infectious disease, Centre hospitalier de l’Université de Montréal, Montréal, Canada
| | - Jean-François Cailhier
- Division of Nephrology, Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Centre de recherche du centre hospitalier de l’Université de Montréal, Montréal, Canada
- Institut du Cancer de Montréal, Montréal, Canada
| | - Patrick T. Murray
- Clinical Research Centre, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - William Beaubien Souligny
- Division of Nephrology, Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Centre de recherche du centre hospitalier de l’Université de Montréal, Montréal, Canada
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Côté JM, Lyons L, Twomey PJ, Fitzgerald TJ, Teh JW, Holian J, O'Riordan A, Watson A, Clince M, Malik F, O'Regan J, Murray PT. Clinical Implementation and Initial Experience of Neutrophil Gelatinase-Associated Lipocalin Testing for the Diagnostic and Prognostic Assessment of Acute Kidney Injury Events in Hospitalized Patients. Nephron Clin Pract 2021; 146:306-314. [PMID: 34515166 DOI: 10.1159/000518611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The use of novel kidney injury biomarkers has been shown to improve diagnostic assessment and prognostic prediction in various populations with acute kidney injury (AKI), but their use in a standard clinical practice have been rarely reported. METHODS We reported the clinical implementation of neutrophil gelatinase-associated lipocalin (NGAL) measurement for routine AKI diagnostic workup of patients receiving nephrology consultation in a tertiary academic centre. Specific focus was made on the diagnostic performance to discriminate functional ("pre-renal") from intra-renal AKI and to predict AKI progression. RESULTS Forty-five urine NGAL (uNGAL) and 25 plasma NGAL (pNGAL) samples in the first 50 consecutive patients were analysed. KDIGO Stage 1, 2, 3 AKI, and renal replacement therapy occurred in 10%, 40%, 50%, and 24% of cases, respectively. The uNGAL was lower in patients with transient AKI (<48 h) and no sign of urinary tract infections (37 [25-167] ng/mL) than sustained or progressive AKI (298 [74-1,308] ng/mL) (p = 0.016), while pNGAL did not discriminate transient (264 [100-373] ng/mL) from persistent AKI (415 [220-816] ng/mL) (p = 0.137). The median uNGAL level was 63 (35-1,123) ng/mL for functional/pre-renal AKI and 451 (177-1,315) ng/mL for intra-renal AKI (p = 0.043), while the pNGAL was 264 (114-468) and 415 (230-816) ng/mL (p = 0.235), respectively. CONCLUSION NGAL, as part of the routine workup, is useful for diagnostic and prognostic assessment of new-onset AKI in clinical practice. Interpretation of an increased NGAL level should be clinically evaluated in its clinical context, particularly considering concomitant infection (urinary or systemic). Clinical adoption of emerging AKI biomarkers as diagnostic tests in clinical practice should be further encouraged.
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Affiliation(s)
- Jean-Maxime Côté
- Clinical Research Centre, University College Dublin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Liam Lyons
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland
| | - Patrick J Twomey
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland
| | - Ted J Fitzgerald
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland.,Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
| | - Jia Wei Teh
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland.,Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
| | - John Holian
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland.,Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
| | - Aisling O'Riordan
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland.,Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
| | - Alan Watson
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland.,Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
| | - Michelle Clince
- Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
| | - Fahad Malik
- Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
| | - John O'Regan
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland.,Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
| | - Patrick T Murray
- Clinical Research Centre, University College Dublin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland.,Division of Nephrology, St. Vincent's University Hospital, Dublin, Ireland
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Côté JM, Bouchard J, Murray PT, Beaubien-Souligny W. Diuretic strategies in patients with resistance to loop-diuretics in the intensive care unit: A retrospective study from the MIMIC-III database. J Crit Care 2021; 65:282-291. [PMID: 34298494 DOI: 10.1016/j.jcrc.2021.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate various diuretic strategies to alleviate loop-diuretics resistance in critically ill patients. MATERIALS AND METHOD ICU adults requiring more than 1 mg/kg/day of furosemide, from the MIMIC-III database. Four diuretic strategies were investigated: incremental dose of loop diuretics, continuous infusion, combinations with a second class of diuretics and administration of intravenous albumin. A generalized estimating equation was used to investigate the associations between these strategies and endpoints. The primary outcome was the 24-h urine output and secondary endpoints included fluid balance, weight change, electrolyte and acid-base abnormalities, kidney replacement therapy initiation, and mortality. RESULTS A total of 7645 ICU stays from 6358 patients were included. After adjustment, the use of continuous loop-diuretic infusion was associated with a higher 24-h urine output (β: 732, 95% CI:669-795, p < 0.001), lower 24-h fluid balance (p < 0.001) and greater weight loss at 48-h (p < 0.001). Thiazide- and carbonic anhydrase inhibitor combinations were both associated with higher urine output (p < 0.001) and weight loss at 48-h (p < 0.01), while intravenous albumin was associated with fluid gain (p < 0.001). Risks of electrolyte and metabolic disturbances varied across diuretic strategies. CONCLUSIONS Continuous loop-diuretic infusion and thiazide- or acetazolamide-loop diuretic combinations increased urine output significantly, leading to a negative fluid balance and weight loss.
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Affiliation(s)
- Jean-Maxime Côté
- Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada; Clinical Research Centre, University College Dublin, Ireland.
| | - Josée Bouchard
- Division of Nephrology, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Patrick T Murray
- Clinical Research Centre, University College Dublin, Ireland; School of medicine, Division of Nephrology, Mater Misericordiae University Hospital, Ireland
| | - William Beaubien-Souligny
- Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada
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11
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Blair M, Côté JM, Cotter A, Lynch B, Redahan L, Murray PT. Nephrotoxicity from Vancomycin Combined with Piperacillin-Tazobactam: A Comprehensive Review. Am J Nephrol 2021; 52:85-97. [PMID: 33735856 DOI: 10.1159/000513742] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies have identified the combination of vancomycin with piperacillin-tazobactam (VPT) to be associated with increased nephrotoxicity. Multiple, large cohort studies have found this widely used combination to have a higher risk of nephrotoxicity than other regimens in a variety of populations. SUMMARY This review summarizes the epidemiology and clinical features of VPT-associated acute kidney injury (AKI). Potential mechanisms involved in the pathogenesis of this phenomenon are also discussed. Key Message: VPT-associated nephrotoxicity is a recently recognized clinical entity. Clinical strategies to minimize the risk of toxicity in this setting include antimicrobial stewardship, monitoring of kidney function, and emerging data supporting the potential role for novel biomarkers in predicting and managing AKI.
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Affiliation(s)
- Matthew Blair
- Division of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jean-Maxime Côté
- Service of Nephrology, Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
- Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Aoife Cotter
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Breda Lynch
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lynn Redahan
- Division of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patrick T Murray
- Division of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland,
- Clinical Research Centre, University College Dublin, Dublin, Ireland,
- Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland,
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Côté JM, Meunier RS, Tremblay JA, Weber F, Mahone M. Henoch-Schonlein purpura in pregnancy: A case report. Obstet Med 2018; 11:195-197. [PMID: 30574183 DOI: 10.1177/1753495x17745391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/15/2017] [Indexed: 11/15/2022] Open
Abstract
Henoch-Schonlein purpura is a relatively common pediatric vasculitis. Very few cases of Henoch-Schonlein purpura during pregnancy have been described. Henoch-Schonlein purpura is variable in its presentation, from completely benign to possibly catastrophic complications. This rarely encountered condition in adults can also be a recurrence of a previous childhood disease. We present a case of a pregnant 40-year-old woman with Henoch-Schonlein purpura, resulting in a viable birth with no fetal complications. Her presentation is discussed in detail and a general presentation of Henoch-Schonlein purpura is explored, with particular attention to its rare onset during pregnancy.
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Affiliation(s)
- Jean-Maxime Côté
- Internal Medicine Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Rosalie-Sélène Meunier
- Internal Medicine Division, Department of Medicine, Hôpital Sacré-Coeur, Montréal, QC, Canada
| | - Jan-Alexis Tremblay
- Internal Medicine Division, Department of Medicine, Hôpital Sacré-Coeur, Montréal, QC, Canada
| | - Florence Weber
- Internal Medicine Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Michèle Mahone
- Internal Medicine Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
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13
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Côté JM, Zhang X, Dahhou M, Sapir-Pichhadze R, Foster B, Cardinal H. The impact of repeated mismatches in kidney transplantations performed after nonrenal solid organ transplantation. Am J Transplant 2018; 18:238-244. [PMID: 28891113 DOI: 10.1111/ajt.14495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 01/25/2023]
Abstract
The aim of this study was to determine whether kidney transplantations performed after previous nonrenal solid organ transplants are associated with worse graft survival when there are repeated HLA mismatches (RMM) with the previous donor(s). We performed a retrospective cohort study using data from the Scientific Registry of Transplant Recipients. Our cohort comprised 6624 kidney transplantations performed between January 1, 1990 and January 1, 2015. All patients had previously received 1 or more nonrenal solid organ transplants. RMM were observed in 35.3% of kidney transplantations and 3012 grafts were lost over a median follow-up of 5.4 years. In multivariate Cox regression analyses, we found no association between overall graft survival and either RMM in class 1 (hazard ratio [HR]: 0.97, 95% confidence interval [CI] 0.89-1.07) or class 2 (HR: 0.95, 95% CI 0.85-1.06). Results were similar for the associations between RMM, death-censored graft survival, and patient survival. Our results suggest that the presence of RMM with previous donor(s) does not have an important impact on allograft survival in kidney transplant recipients who have previously received a nonrenal solid organ transplant.
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Affiliation(s)
- J M Côté
- Research centre, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - X Zhang
- Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - M Dahhou
- Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | | | - B Foster
- Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - H Cardinal
- Research centre, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
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Bélanger SA, Warren AE, Hamilton RM, Gray C, Gow RM, Sanatani S, Côté JM, Frcpc JL, Leblanc J, Martin S, Miles B, Mitchell C, Gorman DA, Weiss M, Schachar R. Cardiac risk assessment before the use of stimulant medications in children and youth. Paediatr Child Health 2011; 14:579-92. [PMID: 21037835 DOI: 10.1093/pch/14.9.579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Regulatory decisions and scientific statements regarding the management of attention-deficit hyperactivity disorder (ADHD) raise questions about the safety of medications and the appropriate pretreatment evaluation to determine suitability for treatment with medication. This is particularly true in the setting of known structural or functional heart disease. The present paper reviews the available data, including peer-reviewed literature, data from the United States Food and Drug Administration Web site on reported adverse reactions in children using stimulant medication, and Health Canada data on the same problem. A consensus-based guideline on appropriate assessment is provided, based on input from members of the Canadian Paediatric Society, the Canadian Cardiovascular Society and the Canadian Academy of Child and Adolescent Psychiatry, with specific expertise and knowledge in the areas of both ADHD and paediatric cardiology. The present statement advocates a thorough history and physical examination before starting stimulant medications, with an emphasis on the identification of risk factors for sudden death, but does not routinely recommend electrocardiographic screening or cardiac sub-specialist consultation unless indicated by history or physical examination findings. A checklist for identifying children who are potentially at risk of sudden death (independent of ADHD or medications used to treat it) is provided. Although recommendations are based on the best evidence currently available, the committee further agrees that more research on this subject is necessary to optimize the approach to this common clinical scenario.
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Affiliation(s)
- S A Bélanger
- Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec
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Abstract
Syncope in children is most often neurally mediated and usually has a natural history of spontaneous resolution or improvement. Syncope is defined as the temporary loss of consciousness resulting from a reversible disturbance of cerebral function. It is characterized by a loss of consciousness due to a lack of cerebral blood flow, rapid or sudden onset, falling of the patient, if not supported, and transiency of the attack. In children, it is most often benign, but may sometimes herald a more serious, potentially life-threatening cause. The main purpose of the present paper is to propose an evaluation scheme that will allow the physician involved in the care of children to differentiate the life-threatening causes of syncope with potential for injury or sudden death from the common, more benign neurally mediated syncope. Secondarily, the present article facilitates the identification of the patient with neurally mediated syncope who may benefit from medical therapy and distinguishes syncope from the more frequent noncardiac 'spells' of childhood.
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Affiliation(s)
- J M Côté
- Centre hospitalier universitaire de Québec, Pavillon CHUL, Sainte-Foy, Quebec
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Abstract
OBJECTIVE To document the natural history and surgical outcomes for discrete subaortic stenosis in children. DESIGN Retrospective review. SETTING Tertiary care paediatric cardiology centres. PATIENTS 92 children diagnosed between 1985 and 1998. MAIN OUTCOME MEASURES Echocardiographic left ventricular outflow gradient (echograd), and aortic insufficiency (AI). RESULTS The mean (SEM) age at diagnosis was 5.3 (0.4) years; the mean echograd was 30 (2) mm Hg, with AI in 22% (19/87) of patients. The echograd and incidence of AI increased to 35 (3) mm Hg and 53% (36/68) (p < 0.05) 3.6 (0.3) years later. The echograd at diagnosis predicted echograd progression and appearance of AI. 42 patients underwent surgery 2.2 (0.4) years after diagnosis. Preoperatively echograd and AI incidence increased to 58 (6) mm Hg and 76% (19/25) (p < 0.05). The echograd was 26 (4) mm Hg 3.7 (0.4) years postoperatively, with AI in 82% (31/38) of patients. Surgical morbidities included complete heart block, need for prosthetic valves, and iatrogenic ventricular septal defects. Eight patients underwent reoperation for recurrent subaortic stenosis. The age at diagnosis of 44 patients followed medically and 42 patients operated on did not differ (5.5 (0.6) v 5. 0 (0.6) years, p < 0.05). However, the echograd at diagnosis in the former was less (21 (2) v 40 (5) mm Hg, p < 0.05) and did not increase (23 (2) mm Hg) despite longer follow up (4.1 (0.4) v 2.2 (0. 4) years, p < 0.05). The incidence of AI at diagnosis and at last medical follow up was also less (14% (6/44) v 34% (13/38); 40% (17/43) v 76% (19/25), p < 0.05). CONCLUSIONS Many children with mild subaortic stenosis exhibit little progression of obstruction or AI and need not undergo immediate surgery. Others with more severe subaortic stenosis may progress precipitously and will benefit from early resection despite risks of surgical morbidity and recurrence.
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Affiliation(s)
- C V Rohlicek
- Division of Cardiology, Montréal Children's Hospital, 2300 Tupper Street, Montréal, Québec H3H 1P3, Canada
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Lachapelle MF, Leduc L, Côté JM, Grignon A, Fouron JC. Potential value of fetal echocardiography in the differential diagnosis of twin pregnancy with presence of polyhydramnios-oligohydramnios syndrome. Am J Obstet Gynecol 1997; 177:388-94. [PMID: 9290456 DOI: 10.1016/s0002-9378(97)70203-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our purpose was to establish whether index values of cardiac performance could discriminate between the twin-twin transfusion syndrome and placental insufficiency as the etiology of the polyhydramnios-oligohydramnios sequence in monochorionic diamniotic twins. STUDY DESIGN Thirteen monochorionic diamniotic twin pregnancies with ultrasonographic evidence of polyhydramnios-oligohydramnios sequence had a complete echocardiography. The etiology was confirmed postnatally: placental insufficiency in eight pairs and the twin-twin transfusion syndrome in five. Intertwin comparisons were made for the following cardiac parameters: cardiothoracic index, end-diastolic thickness of the ventricular walls and septum, aortic and pulmonary artery Doppler peak velocities, ejection and acceleration times, left ventricular shortening fraction, and combined cardiac output and output indexed to fetal weight. RESULTS All five recipient twins had thickened ventricular walls. The left ventricular shortening fractions and outputs were significantly increased in the donor twin with twin-twin transfusion syndrome and normal in placental insufficiency. CONCLUSION In twin-twin transfusion syndrome the donor twin shows evidence of a hyperdynamic cardiac state. Intertwin comparison of cardiac parameters, especially the left ventricular shortening fraction, can be considered a useful tool in diagnosing the different etiologies of the polyhydramnios-oligohydraminos sequence.
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Affiliation(s)
- M F Lachapelle
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Quebec, Canada
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Côté JM. [Temporal epilepsy]. Vie Med Can Fr 1974; 3:811-5. [PMID: 4411095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Villeneuve A, Turcotte J, Bouchard M, Côté JM, Jus A. Release phenomena and iterative activities in psychiatric geriatric patients. Can Med Assoc J 1974; 110:147-53. [PMID: 4810188 PMCID: PMC1947121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This survey was undertaken to assess the frequency of some of the so-called release phenomena and iterative activities in an aged psychiatric population. Three groups of geriatric psychiatric patients with diagnoses of (I) organic brain syndrome, including senile dementia (56), (II) functional psychoses, predominantly schizophrenia (51) and (III) chronic schizophrenia never treated by neuroleptics or other biologic agents (16), were compared with (IV) a control group of 32 elderly people in good physical and mental health.In general, for the manifestations studied, the geriatric psychiatric patients suffering from an organic brain syndrome and treated with neuroleptics differed notably from the control group. This latter group, although older, had few neurological signs of senescence and the spontaneous oral movements usually associated with the use of neuroleptics were absent. Release phenomena such as the grasp and pouting reflexes, as well as the stereotyped activities, were encountered significantly more frequently in patients with an organic brain syndrome than in the two other groups of patients. Our survey has yielded limited results with regard to the possible influence of type of illness and neuroleptic treatment on the incidence of release phenomena and iterative activities.
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Jus A, Villeneuve A, Gautier J, Pires A, Côté JM, Jus K, Villeneuve R, Perron D. Influence of lithium carbonate on patients with temporal epilepsy. Can Psychiatr Assoc J 1973; 18:77-8. [PMID: 4571309 DOI: 10.1177/070674377301800116] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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