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1.
Cornea ; 40(3): 277-281, 2021 Mar 01.
Article in English | MEDLINE | ID: mdl-33264147

ABSTRACT

PURPOSE: To examine the rate and risk factors for band keratopathy after herpes zoster ophthalmicus (HZO) and the outcomes of ethylenediaminetetraacetic acid (EDTA) treatment. METHODS: This is a retrospective review of all subjects with HZO seen at Auckland District Health Board between January 2006 and December 2016. RESULTS: A total of 869 subjects with HZO were included in the study. Median follow-up was 6.3 years (total 5504.4 patient-years). Band keratopathy developed in 13 subjects (1.5%). On multivariate analysis, older age at onset [hazard ratio (HR), 1.092; P = 0.034], intraocular pressure ≥30 mm Hg at presentation (HR, 5.548; P = 0.013), and number of recurrences (HR, 1.849; P < 0.001) were associated with increased risk for band keratopathy. Corneal melt occurred in 22 subjects (2.5%) during the follow-up period. On multivariate analysis, uveitis (HR, 8.618; P = 0.004) and disodium EDTA chelation (HR, 8.666; P < 0.001) were associated with increased risk for corneal melt. EDTA chelation was performed in 8 subjects. Corneal melt occurred after EDTA chelation in 4 subjects, and corneal perforation occurred in 2 subjects. One subject was eviscerated due to severe endophthalmitis after repeated corneal perforation and another required enucleation for recurrent corneal melt and microbial keratitis. CONCLUSIONS: Band keratopathy is an uncommon complication of HZO. Treatment with EDTA chelation might be associated with a significant risk for severe complications in these eyes and should be approached with caution.


Subject(s)
Calcium Chelating Agents/adverse effects , Corneal Dystrophies, Hereditary/drug therapy , Corneal Perforation/chemically induced , Corneal Ulcer/chemically induced , Edetic Acid/adverse effects , Herpes Zoster Ophthalmicus/complications , Aged , Corneal Dystrophies, Hereditary/etiology , Corneal Perforation/diagnosis , Corneal Ulcer/diagnosis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Visual Acuity
2.
J Immunol Methods ; 464: 114-118, 2019 01.
Article in English | MEDLINE | ID: mdl-30343098

ABSTRACT

BACKGROUND: The use of anticoagulants may influence the composition of blood cells and interfere with plasma levels of IL-1ra when unprocessed EDTA blood samples are stored for long periods of time. METHODS: Blood was drawn into EDTA and heparinized blood collection tubes from 11 HIV-1 negative men participating in the Multicenter AIDS Cohort Study (MACS) and 4 healthy volunteers. The blood was processed according to the experiments detailed in the method and after incubation; supernatants were collected and stored at -70 °C until batch testing using IL-1ra ELISA. RESULTS: There was no difference between the levels of IL-1ra in EDTA blood collected into plastic and glass tubes (p = .911). There were significant increases from baseline levels of IL-1ra (p ≤ .05) after 24 h incubation for diluted whole blood and PBMC supernatants but not for granulocytes supernatants. CONCLUSION: EDTA as an anticoagulant influences the blood concentrations of IL-1ra in unprocessed blood. Thus, EDTA blood is not a suitable specimen for measurement of IL-1ra. Other types of anticoagulated blood should be processed within one hour of draw whenever measuring plasma levels of IL-1ra.


Subject(s)
Anticoagulants/adverse effects , Blood Specimen Collection , Calcium Chelating Agents/adverse effects , Disposable Equipment , Edetic Acid/adverse effects , Granulocytes/drug effects , Interleukin 1 Receptor Antagonist Protein/blood , Leukocytes, Mononuclear/drug effects , Biomarkers/blood , Blood Specimen Collection/adverse effects , Blood Specimen Collection/instrumentation , Female , Granulocytes/immunology , Humans , Leukocytes, Mononuclear/immunology , Male , Pregnancy
3.
Nephrology (Carlton) ; 23(7): 669-675, 2018 Jul.
Article in English | MEDLINE | ID: mdl-28603903

ABSTRACT

AIM: Calciphylaxis is a severe complication of advanced chronic kidney disease (CKD). Sodium thiosulphate (STS), an antioxidant and calcium chelating agent, has been used for the treatment of calciphylaxis. However, its efficacy and safety have not been systematically analysed and evaluated. METHODS: MEDLINE, EMBASE, and the Cochrane Library database were systematically searched for case report or cases series on use of STS for calciphylaxis published between July 1974 and October 2016. We extracted data on clinical characteristics, laboratory tests result and medication use. The effective treatment was defined as improvement in skin lesion cicatrisation or pain relief without death. Non-responding effects were defined as stable skin lesions without remission or exacerbation of the disease in patients who remained alive. All-cause mortality after STS treatment was defined as death due to exacerbations of calciphylaxis or other complications of advanced CKD. We compared the baseline parameters of the patients as well as the efficacy and mortality of the STS therapy between case report and multi-case reports. Statistical analyses were performed using SPSS 19. RESULTS: A total of 83 papers were screened, 45 of them (n = 358) met the inclusion criteria, including 36 case reports (n = 64) and nine multi-case reports (n = 294). The mean age of the patients with calciphylaxis was 58 ± 14 years (range 26-91 years). They were female predominant, accounting for 74.1%. Among the patients with calciphylaxis, 96.1% patients were on dialysis with median dialysis vintage of 44.5 months (range 24-84 months). STS was effective in 70.1% of patients, 37.6% patients died. The proportion of patients with sepsis was higher among those who received intravenous STS. There was no significant difference in efficacy between the different STS administration methods (P = 0.19). CONCLUSION: Although the study was unable to assess the efficacy of sodium thiosulphate alone in the treatment of calciphylaxis, it still reveals a promising role of STS as an effective therapy for calciphylaxis. Further prospective studies to define the optimal therapy for calciphylaxis are needed.


Subject(s)
Antioxidants/therapeutic use , Calciphylaxis/drug therapy , Calcium Chelating Agents/therapeutic use , Renal Insufficiency, Chronic/complications , Thiosulfates/therapeutic use , Adult , Aged , Aged, 80 and over , Antioxidants/adverse effects , Calciphylaxis/diagnosis , Calciphylaxis/etiology , Calcium Chelating Agents/adverse effects , Female , Humans , Male , Middle Aged , Renal Insufficiency, Chronic/diagnosis , Thiosulfates/adverse effects , Treatment Outcome
4.
Am J Kidney Dis ; 70(5): 722-724, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28739328

ABSTRACT

Hyperoxaluria can result in oxalate nephropathy with intratubular calcium oxalate crystallization and acute tubular injury. Primary inherited enzymatic deficiency or secondary causes such as excessive dietary intake, enteric increased absorption, or high doses of vitamin C, which is metabolized to oxalate, may underlie hyperoxaluria and oxalate nephropathy. We report a case of acute kidney injury due to oxalate nephropathy in a patient using chelating therapy with oral ethylenediamine tetra acetic acid (EDTA), intravenous supplementation with vitamin C, and chronic diarrhea and discuss the potential kidney damage these factors can cause in particular settings. To our knowledge, this is the first report suggesting an association between oral EDTA and oxalate nephropathy.


Subject(s)
Acute Kidney Injury/etiology , Ascorbic Acid/adverse effects , Calcium Chelating Agents/adverse effects , Calcium Oxalate , Diarrhea/complications , Edetic Acid/adverse effects , Hyperoxaluria/etiology , Vitamins/adverse effects , Acute Kidney Injury/pathology , Acute Kidney Injury/therapy , Aged , Humans , Kidney Tubular Necrosis, Acute/etiology , Kidney Tubular Necrosis, Acute/pathology , Male , Renal Dialysis
5.
Curr Cardiol Rep ; 18(2): 20, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26797807

ABSTRACT

An abundance of data, known for decades, is available linking metals, such as lead and cadmium, with cardiovascular disease. However, the idea that these toxic metals could be a modifiable risk factor for atherosclerosis did not become apparent clinically until the completion of the Trial to Assess Chelation Therapy in 2012. This pivotal study was the first double-blind, randomized, controlled trial of its kind to demonstrate a clear improvement in cardiovascular outcomes with edetate disodium therapy in a secondary prevention, post-myocardial infarction population. This effect size was most striking in diabetic patients, where the efficacy of edetate disodium was comparable, if not superior, to that of current guideline-based therapies. Given the economic burden of diabetes and cardiovascular disease, the potential impact of this therapy could be enormous if the results of this study are replicated.


Subject(s)
Atherosclerosis/drug therapy , Calcium Chelating Agents/administration & dosage , Chelation Therapy , Edetic Acid/administration & dosage , Myocardial Infarction/drug therapy , Myocardial Infarction/prevention & control , Secondary Prevention/methods , Atherosclerosis/complications , Atherosclerosis/physiopathology , Calcium Chelating Agents/adverse effects , Dose-Response Relationship, Drug , Double-Blind Method , Edetic Acid/adverse effects , Heavy Metal Poisoning , Humans , Metals, Heavy/adverse effects , Myocardial Infarction/physiopathology , Poisoning , Risk Factors , Survivors , Treatment Outcome
6.
Ther Apher Dial ; 20(1): 53-9, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26762698

ABSTRACT

Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) has recently been recommended as first-line over heparin. Evidence suggests that RCA prolongs filter life and may reduce bleeding risk, but there is little research on the benefits to dialysis dose delivery or cost, or the effectiveness of transitioning to RCA first-line. The aim of the present study was to assess the effect on dialysis delivery, cost and safety when transitioning from systemic heparin to RCA for first-line anticoagulation for CRRT. A single-center, retrospective observational study was conducted from 2006 to 2012, during which a transition from heparin to a simplified RCA protocol occurred. Demographic and dialysis data, pathology results and costs were obtained. Data were analyzed for both heparin and RCA, and for before and after the transition. 166 patients had 992 dialysis days (heparin 334 vs. RCA 658); demographics were well matched; RCA used less filters per day (P = 0.03), had more days when prescribed dialysis was achieved (85% vs. 60%, P < 0.001), and less filter "down-time" per day (2.4 vs. 6.1 h, P = 0.02). RCA was estimated to cost AU$487 per day, compared to heparin at $479 per day. When the data were analyzed, comparing before and after the transition, these results remained statistically significant. There was no statistical difference in clinical safety events. Transition to first-line RCA was safe, provided more time on filter and consumed less filter circuits using a simple and user friendly protocol. The adjusted cost difference appears negligible.


Subject(s)
Citric Acid , Heparin , Renal Insufficiency, Chronic , Renal Replacement Therapy , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Australia , Calcium Chelating Agents/administration & dosage , Calcium Chelating Agents/adverse effects , Citric Acid/administration & dosage , Citric Acid/adverse effects , Costs and Cost Analysis , Drug Administration Routes , Female , Hemorrhage/chemically induced , Hemorrhage/prevention & control , Heparin/administration & dosage , Heparin/adverse effects , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Renal Insufficiency, Chronic/economics , Renal Insufficiency, Chronic/therapy , Renal Replacement Therapy/economics , Renal Replacement Therapy/methods , Renal Replacement Therapy/statistics & numerical data , Retrospective Studies
7.
Food Funct ; 6(3): 816-23, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25588126

ABSTRACT

The nano-composites of whey protein hydrolysate (WPH) chelated with calcium were fabricated in aqueous solution at 30 °C for 20 min, with the ratio of hydrolysate to calcium 15 : 1 (w/w). UV scanning spectroscopy, fluorescent spectroscopy, Fourier transform infrared spectroscopy, dynamic light scattering and atomic force microscopy were applied to characterize the structure of the WPH-calcium chelate. The nano-composites showed the successful incorporation of calcium into the WPH, indicating the interaction between calcium and WPH. The chelation of calcium ions to WPH caused molecular folding and aggregation which led to the formation of a WPH-calcium chelate of nanoparticle size, and the principal sites of calcium-binding corresponded to the carboxyl groups and carbonyl groups of WPH. The WPH-calcium chelate demonstrated excellent stability and absorbability under both acidic and basic conditions, which was beneficial for calcium absorption in the gastrointestinal tract of the human body. Moreover, the calcium absorption of the WPH-calcium chelate on Caco-2 cells was significantly higher than those of calcium gluconate and CaCl2 in vitro, suggesting the possible increase in calcium bioavailability. The findings suggest that the WPH-calcium chelate has the potential in making dietary supplements for improving bone health of the human body.


Subject(s)
Bone Density Conservation Agents/chemistry , Calcium, Dietary/analysis , Dietary Supplements/analysis , Intestinal Absorption , Nanocomposites/chemistry , Protein Hydrolysates/chemistry , Whey Proteins/chemistry , Absorption, Physiological , Binding Sites , Bone Density Conservation Agents/administration & dosage , Bone Density Conservation Agents/adverse effects , Bone Density Conservation Agents/metabolism , Caco-2 Cells , Calcium Chelating Agents/adverse effects , Calcium Chelating Agents/chemistry , Calcium Chloride/adverse effects , Calcium Chloride/metabolism , Calcium Gluconate/adverse effects , Calcium Gluconate/metabolism , Calcium, Dietary/administration & dosage , Calcium, Dietary/adverse effects , Calcium, Dietary/metabolism , Cell Survival , Chemical Phenomena , Dietary Supplements/adverse effects , Endopeptidases/metabolism , Enterocytes/metabolism , Humans , Nanocomposites/adverse effects , Particle Size , Protein Folding , Protein Hydrolysates/adverse effects , Protein Hydrolysates/metabolism , Proteolysis , Solubility , Whey Proteins/adverse effects , Whey Proteins/metabolism
8.
Int J Artif Organs ; 37(4): 308-14, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24811185

ABSTRACT

BACKGROUND: Cardiovascular calcification (CVC) in hemodialysis patients (HDP) causes cardiovascular pathology. Up until now very few drugs and therapeutic interventions have been able to reduce cardiovascular calcium deposits in hemodialysis patients and the process requires more than a year. Our idea in this study was to test 2 calcium binders--sodium thiosulfate (STS) and dinatrium ethylene diamine tetraacetic acid (DNEDTA)--for prevention and treatment of cardiovascular calcification of hemodialysis patients, using both substances not as an intravenous infusion but by adding them to the liquid bicarbonate part of the dialysis fluid. MATERIAL AND METHODS: 6 HDPs were treated with sodium thiosulphate (STS), 6 with dinatrium ethylene diamine tetraacetic acid (DNEDTA), and 6 patients served as controls. Electrolytes, liver function, markers of inflammation, oxidative stress, bone metabolism, spiral computed tomography (SCT) of coronary CVC and bone densitometry were performed twice (start and end of the study). RESULTS: Starting blood parameters were similar to the end (STS group). No toxic or side effects from STS were observed. Initially in the DNEDTA group all the patients had vomiting so we excluded DNEDTA from the study. SCT found a significant reduction of calcification in 4 patients (STS group) and retardation in 2 patients comparatively to controls. CONCLUSIONS: The first results are hopeful, but the number of the patients was small, so we are enlarging the enrollment in the expectation of corroborating our results soon.


Subject(s)
Calcium Chelating Agents/therapeutic use , Coronary Artery Disease/prevention & control , Hemodialysis Solutions/therapeutic use , Renal Dialysis/methods , Thiosulfates/therapeutic use , Vascular Calcification/prevention & control , Biomarkers/blood , Calcium Chelating Agents/adverse effects , Coronary Artery Disease/blood , Coronary Artery Disease/diagnosis , Coronary Artery Disease/etiology , Edetic Acid/therapeutic use , Hemodialysis Solutions/adverse effects , Humans , Pilot Projects , Renal Dialysis/adverse effects , Thiosulfates/adverse effects , Time Factors , Treatment Outcome , Vascular Calcification/blood , Vascular Calcification/diagnosis , Vascular Calcification/etiology
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