Colchicine for primary prevention of atrial fibrillation after open-heart surgery: Systematic review and meta-analysis

Background Atrial fibrillation occurs frequently after open-heart surgery. It is associated with increased morbidity and mortality, longer hospital stays, and increased healthcare costs. Prophylactic administration of colchicine may mitigate post-operative atrial fibrillation (POAF). Methods We searched PubMed, ClinicalTrials.gov and CENTRAL databases to identify randomized controlled trials (RCTs) that; (1) compared prophylactic use of colchicine to placebo, or usual care, in patients with sinus rhythm who underwent elective open-heart surgery and (2) reported POAF-incidence. We excluded trials focused on incidence of atrial fibrillation after percutaneous interventions or colchicine treatment of diagnosed pericarditis or post-pericardiotomy-syndrome. A random-effects model was used to pool data for POAF-incidence as the primary outcome and for drug-related adverse effects, major adverse events (death and stroke), and hospital length-of-stay as secondary outcomes. Results We included five RCTs (1412 patients). Colchicine treatment reduced POAF-events by 30% versus placebo or usual care (18% vs. 27%, risk ratio (RR) 0.69, 95% confidence interval (CI) 0.57 to 0.84, p = 0.0002). Adverse drug-related effects, especially gastrointestinal intolerance, increased with colchicine; (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93, p < 0.0001). However, major adverse events were unchanged (3.2% vs. 3.2%, RR 0.96, 95% CI 0.48 to 1.95, p = 0.92). Length-of-stay decreased by 1.2 days with colchicine (95% CI -1.89 to − 0.44, p = 0.002). Conclusion Colchicine demonstrated superior efficacy versus usual care for prevention of atrial fibrillation after cardiac surgery. Moreover, colchicine treatment was associated with shorter hospital stays. These benefits outweigh increased risk of adverse drug-related effects; although further work is needed to minimize gastrointestinal effects

Distribution and characteristics of glaciokarst on the island of Gotland, Baltic Sea - its role on groundwater recharge and sensitive wetland ecosystems

&amp;lt;p&amp;gt;&amp;amp;#160;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;Glaciokarst is widespread in the Silurian carbonate bedrock on the Island of Gotland. Grikes and limestone pavements are the most common karst features. Although, less well documented, caves and subsurface channels also contribute to the complex hydrogeology in the bedrock. The karst is interpreted to have been formed, primarily, before the Pleistocene when the landscape was covered with acidic organic soils. Glacial erosion and postglacial karstification have also played significant roles in sculpturing the epikarst morphology we see today. The study presents quantitative and qualitative characterization of karst within several pilot areas on the island of Gotland. High resolution aerial photographs were acquired over the pilot areas using a drone. These images were then analysed in GIS-software to provide a statistical evaluation of length, width, and relative area with karst. As well as providing a statistical understanding of the occurrence and geometry of karst, the results also help to clarify the impact of karst on the sensitive and limited groundwater resources on Gotland. Since a large part of the carbonate bedrock surface is barren or covered by thin quaternary deposits the epikarst provides important pathways for the percolation of meteoric water and recharge to the groundwater. It also locally provides guided pathways for surface runoff. Furthermore, the study demonstrates that the presence of karst often is in conjunction with sensitive ecosystems such as temporary wetlands. Extensive development of grikes and limestone pavements also provide conditions for periodically hanging aquifers, which not only promotes groundwater recharge but also the formation of unique habitats for a variety of often threatened ecosystems. This study, which includes both biologists and earth scientists highlights the importance of the identification of catchment areas and mapping of karst. It also emphasises that investigations into the hydrogeology (including aspects such as groundwater recharge, surface runoff and subsurface transport pathways) is essential for a better understanding of wetland dynamics and their protection. The presence of karst and spreading of contaminations in the ground is also discussed. The work summarizes early results from a collaboration between authorities working with Natura 2000 karst habitats and geological classification and mapping of karst.&amp;lt;/p&amp;gt;</jats:p

Hypercalcemia in Children Using the Ketogenic Diet: A Multicenter Study

Abstract Context The ketogenic diet is associated with progressive skeletal demineralization, hypercalciuria, and nephrolithiasis. Acute hypercalcemia has been described as a newly recognized complication of this treatment. Objective To describe the clinical characteristics of acute hypercalcemia in children on the ketogenic diet through analysis of the presentation, response to treatment, and natural history in a large cohort of patients. Design A multicenter case series was performed including children who developed acute hypercalcemia while treated with the ketogenic diet. Information on clinical presentation, treatment, and course of this complication was collated centrally. Results There were 14 patients (median (range) age 6.3 (0.9 to 18) years) who developed hypercalcemia 2.1 (range, 0.2-12) years after starting the ketogenic diet. All had low levels of parathyroid hormone and levels of 1,25-dihydroxyvitamin D were low in all except one. Seven (50%) had impaired renal function at presentation. All except the 2 oldest had low alkaline phosphatase levels for age. Once normocalcemia was achieved, hypercalcemia recurred in only 2 of these patients over observation of up to 9.8 years. One patient discontinued the ketogenic diet prior to achieving normocalcemia while 4 more stopped the diet during follow-up after resolution of hypercalcemia. Conclusions Ketotic hypercalcemia can occur years after starting the ketogenic diet, especially in the setting of renal impairment. The mechanism is unknown but appears to be due to reduced osteoblast activity and impaired bone formation. We recommend close attention to optimizing bone health in these children, and screening for the development of ketotic hypercalcemia. </jats:sec