Analysis of the Cochrane review : pharmacotherapy for hyperuricemia in hypertensive patients : Cochrane Database Syst Rev. 2017;4:CD008652

Copyright © Ordem dos Médicos 2017Arterial hypertension is a public health problem that affects approximately 25% of the world’s adult population. The association between hypertension and hyperuricemia has been shown on epidemiological and experimental studies. However, it is unclear whether lowering serum uric acid might lower blood pressure. This Cochrane systematic review - a revised edition of a previously published one - intended as primary objective to evaluate the effect of hypouricemic drugs in patients with primary hypertension or prehypertension. The secondary objectives were to evaluate the efficacy and safety of hypouricemic drugs. A systematic search until February 2016 on controlled, randomized or quasi-randomized trials comparing the effect of hypouricemic drug versus placebo in hypertensive or prehypertensive patients was performed on the following databases: The Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, The World Health Organization International Clinical Trials Registry Platform, e ClinicalTrials.gov. LILACS database up to March 2016 was also searched and the authors of relevant studies were contacted. There were 349 identified papers, 21 were preselected and three randomized clinical trials (211 patients) were included in the qualitative analysis and in the meta-analysis. Two of the trials were conducted exclusively on adolescents. The authors conclude that hypouricemic drugs are not effective in lowering blood pressure in patients with hyperuricemia and primary prehypertension or hypertension. However, this strategy might be more effective in the specific population of adolescents with prehypertension or mild primary hypertension recently diagnosed. Hypouricemic drugs effectively reduce serum uric acid level and withdrawals of therapy due to adverse effects were not superior in the treated group, comparing to placebo; however, one patient withdrew due to a severe cutaneous reaction.A hipertensão arterial é um problema de saúde pública que afeta cerca de 25% da população adulta mundial. A associação entre hiperuricemia e hipertensão arterial tem sido demonstrada em estudos epidemiológicos e experimentais. No entanto, não é claro se a terapêutica hipouricemiante reduz os valores de pressão arterial. Esta revisão sistemática - uma versão atualizada de outra previamente publicada - teve como objetivo primário avaliar o efeito da terapêutica hipouricemiante nos valores de pressão arterial de doentes com pré-hipertensão ou hipertensão arterial primárias. Os objetivos secundários foram avaliar a eficácia da terapêutica na redução da uricemia e o perfil de segurança. Foram selecionados ensaios clínicos aleatorizados ou quasi-aleatorizados que comparassem o efeito nos valores de pressão arterial da terapêutica hipouricemiante versus placebo, em doentes com hiperuricemia e pré-hipertensão ou hipertensão arterial essencial. Foram pesquisadas as seguintes bases de dados até fevereiro de 2016: The Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, The World Health Organization International Clinical Trials Registry Platform, e ClinicalTrials.gov. Foi também pesquisada a LILACS até março de 2016 e contactados os autores dos estudos considerados relevantes. Dos 349 artigos identificados, foram pré-selecionados 21, tendo sido incluídos três ensaios clínicos aleatorizados (211 doentes) na análise qualitativa e na meta-análise. Dois destes ensaios incluíram exclusivamente adolescentes. Os autores concluem que a terapêutica hipouricemiante não é eficaz na redução da pressão arterial na população de doentes com hiperuricemia e pré-hipertensão ou hipertensão arterial essencial. No entanto, esta estratégia poderá ser mais eficaz na população específica dos adolescentes com pré-hipertensão ou hipertensão arterial ligeira diagnosticada recentemente. A terapêutica hipouricemiante é eficaz na redução do valor sérico de ácido úrico e a suspensão da terapêutica devido a efeitos adversos não foi superior nos grupos tratados comparativamente com placebo (embora um doente a tenha suspendido por reação cutânea grave).info:eu-repo/semantics/publishedVersio

Analysis of the Cochrane review: antiplatelet agents for preventing pre-eclampsia and its complications: Cochrane Database Syst Rev. 2019;10:CD004659

Copyright © Ordem dos Médicos 2021. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Pre-eclampsia is associated with deficient intravascular production of prostacyclin, a vasodilator, and excessive production of thromboxane, a vasoconstrictor and stimulant of platelet aggregation. These observations led to the hypotheses that antiplatelet agents, low-dose aspirin in particular, might prevent or delay development of pre-eclampsia. This Cochrane review aimed to assess the effectiveness and safety of antiplatelet agents, such as aspirin and dipyridamole, when given to women at risk of developing preeclampsia. A systematic review of literature was carried out by searching the following databases up to September 2019: Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. Seventy-seven trials were included, including 40 249 women at risk of developing pre-eclampsia. About 80% of these women were evaluated in nine of the 77 trials included, with eight of these nine trials providing individual data. Interventions were administration of an antiplatelet agent, and comparisons were either placebo or no antiplatelet. The present review provides high-quality evidence that administering low-dose aspirin (50 - 150 mg) to pregnant women led to small-to-moderate benefits, including reductions in the risk of pre-eclampsia, preterm birth, small-for-gestational age fetus, and fetal or neonatal death. Overall, administering antiplatelet agents to 1000 women led to 20 fewer pregnancies with serious adverse outcomes.info:eu-repo/semantics/publishedVersio

Efficacy and safety of percutaneous left atrial appendage closure in chronic kidney disease patients with atrial fibrillation : results of a 7-year registry

© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.INTRODUCTION AND AIMS: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, the most devastating complication being thromboembolism leading to fatal or disabling stroke. Although oral anticoagulation (OAC) is the mainstay of prevention therapy in the general population, its benefit in chronic kidney disease (CKD) patients is less well defined. End-stage renal disease patients treated with vitamin K antagonists present increased risk of bleeding, accelerated cardiovascular calcification and increased risk of calciphylaxis. Left atrial appendage closure (LAAC) is performed to prevent complications in high-risk AF patients with contraindications to OAC and in AF patients with events despite OAC.info:eu-repo/semantics/publishedVersio

Caffeine Consumption and Mortality in Diabetes: An Analysis of NHANES 1999–2010

Aim: An inverse relationship between coffee consumption and mortality has been reported in the general population. However, the effect of coffee consumption in diabetes remains unclear. We aimed to evaluate the association of caffeine consumption and caffeine source with mortality among patients with diabetes.Methods: We examined the association of caffeine consumption with mortality among 1974 women and 1974 men with diabetes, using the National Health and Nutrition Examination Survey (NHANES) 1999–2010. Caffeine consumption was assessed at baseline using 24 h dietary recalls. Cox proportional hazard models were fitted to estimate hazard ratios (HR) for all-cause, cardiovascular, and cancer-related mortality according to caffeine consumption and its source, adjusting for potential confounders.Results: A dose-dependent inverse association between caffeine and all-cause mortality was observed in women with diabetes. Adjusted HR for death among women who consumed caffeine, as compared with non-consumers, were: 0.57 (95% CI, 0.40–0.82) for <100 mg of caffeine/day, 0.50 (95% CI, 0.32–0.78) for 100 to <200 mg of caffeine/day, and 0.39 (95% CI, 0.23–0.64) for ≥200 mg of caffeine/day (p = 0.005 for trend). This association was not observed in men. There was a significant interaction between sex and caffeine consumption (p = 0.015). No significant association between total caffeine consumption and cardiovascular or cancer mortality was observed. Women who consumed more caffeine from coffee had reduced risk of all-cause mortality (p = 0.004 for trend).Conclusion: Our study showed a dose-dependent protective effect of caffeine consumption on mortality among women with diabetes

Prescribing of Non-Steroidal Anti-Inflammatory Drugs to Patients with Diabetes Mellitus in Portugal

Introduction: Portugal presents the highest incidence of stage 5 chronic kidney disease in Europe. It is speculated that a high consumption of non-steroidal anti-inflammatory drugs (NSAIDS) may contribute to this high incidence. Our aim was to characterize the prescription of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus in Portugal. Material and Methods: We analyzed the national prescription database in triennium 2015 - 2017. In patients with diabetes mellitus, we evaluated the prescription of non-steroidal anti-inflammatory drugs according to age, gender and region of the patient and specialty of the prescribing physician. We evaluated the prescription of non-steroidal anti-inflammatory drugs in all patients with diabetes mellitus, in patients with presumed renal impairment, and in those with concomitant prescription of angiotensin converting enzyme inhibitors or angiotensin receptor antagonists. Results: We analyzed 23 320 620 prescriptions, corresponding to 610 157 adults, including 104 306 patients with diabetes mellitus. The most prescribed non-steroidal anti-inflammatory drugs were ibuprofen (20.1%), metamizole (14.7%), and diclofenac (11.4%). The prescription of non-steroidal anti-inflammatory drugs was higher in females, in patients aged 51 - 70 years and in the Alentejo region. Non-steroidal anti-inflammatory drugs were prescribed to 70.6% of patients with diabetes mellitus, from which 10.6% were prescribed ≥ 10 packages during the three years. Among patients with diabetes mellitus on angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and with presumed reduction in kidney function, 69.3% were prescribed non-steroidal anti-inflammatory drugs and 11.5% were prescribed ≥ 10 packages during the three years. Discussion: The level of prescribing of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus is high. The concern of reducing non-steroidal anti-inflammatory drugs prescription to patients already on angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and/or decreased renal function does not seem to exist. Conclusion: In Portugal, the level of prescribing of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus should be reduced, particularly in the subgroups identified with higher prescription and with higher risk of progression to stage 5 chronic kidney disease

Choosing Wisely Portugal – Escolhas Criteriosas em Saúde

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The Role of Vascular Lesions in Diabetes Across a Spectrum of Clinical Kidney Disease

Introduction: The clinical-histologic correlation in diabetic nephropathy is not completely known. Methods: We analyzed nephrectomy specimens from 90 patients with diabetes and diverse degrees of proteinuria and glomerular filtration rate (GFR). Results: Thirty-six (40%) subjects had normoalbuminuria, 33 (37%) microalbuminuria, and 21 (23%) non-nephrotic proteinuria. Mean estimated GFR (eGFR) was 65±23 (40% 10% to 20% of the sample. Moderate hyalinosis and arteriolar sclerosis were observed in 80% to 100% of cases with normoalbuminuria, microalbuminuria, proteinuria, as well as in class I, II, or III. Conclusions: Weak correspondence between analytical parameters and kidney histology was found. Thus, disease may progress undetected from the early clinical stages of the disease. Finally, vascular damage was a very common finding, which highlights the role of ischemic intrarenal disease in diabetes

Analysis of the Cochrane Review: Early Discharge Hospital at Home. Cochrane Database Syst Rev. 2017;6:CD000356.

Hospital at home is a service that provides active treatment by healthcare professionals in the patient’s home for a condition that otherwise would require acute hospital in-patient care. However, the clinical benefit of this intervention and its effect on health costs are not established. This Cochrane systematic review aimed to assess the effectiveness and costs of managing patients with hospital at home compared with inpatient hospital care. A systematic review of the literature was carried out by searching the following databases to 9 January 2017: Cochrane Effective Practice and Organization of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, EconLit and clinical trials registries. Thirty-two randomized trials (2 of which unpublished), including 4746 patients, were included. The present review provides insufficient objective evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes

Bacteriuria. Cochrane Database Syst Rev. 2015;4:CD009534.

Asymptomatic bacteriuria is frequently detected in women aged up to 60 years, patients with diabetes and elderly patients. The benefit of antibiotic treatment for this condition is controversial. The objective of this Cochrane systematic review was to assess the effectiveness and safety of antibiotic treatment for asymptomatic bacteriuria in adults. A systematic review of the literature up to 24 February 2015 was performed using the Cochrane Renal Group’s Specialised Register. Randomised controlled trials (RCTs) and quasirandomised controlled trials comparing antibiotics to placebo or no treatment for asymptomatic bacteriuria in adults were included. The outcomes of interest were the development of symptomatic urinary tract infection, complications, death, adverse events, development of antibiotic resistance, bacteriological cure, and decline in kidney function. Nine studies (1614 participants) were included in this review. The incidence of symptomatic urinary tract infection, complications or death was similar between groups. Antibiotic use was significantly associated with bacteriological cure and an increase in minor adverse events. No decline in kidney function was observed with any one of the treatments. According to the results of the studies included in this revision, authors have concluded that there is no clinical benefit in treating asymptomatic bacteriuria in adults