Vaping-induced diffuse alveolar hemorrhage.

There are growing reports of adverse health effects from e-cigarette use or vaping. The U.S. Centers for Disease Control and Prevention has reported 2409 cases and 52 deaths associated with e-cigarette use as of December 10, 2019. Vaping has been associated with acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, diffuse alveolar damage, acute respiratory distress syndrome, hypersensitivity pneumonia, and giant cell interstitial pneumonitis. Here we present a case of vaping-associated diffuse alveolar hemorrhage.

Hypomagnesemia linked to new-onset diabetes mellitus after kidney transplantation: A systematic review and meta-analysis.

BACKGROUND: New-onset diabetes after kidney transplantation (NODAT) is associated with both renal allograft failure and increased mortality. The objective of this meta-analysis was to evaluate the risk of NODAT in patients with hypomagnesemia. METHODS: A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through May, 2015. Studies that reported relative risks, odd ratios or hazard ratios comparing the risk of NODAT in patients with hypomagnesemia were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Five cohort studies with 1699 patients were included in the analysis to assess the risk of NODAT in patients with hypomagnesemia. The pooled RR of NODAT in patients with hypomagnesemia was 1.25 (95% CI, 1.08-1.45). When meta-analysis was limited only to studies with the post-transplant hypomagnesemia, the pooled RR of NODAT was 1.22 (95% CI, 1.09-1.38). CONCLUSION: Our meta-analysis demonstrates a significant association between hypomagnesemia and NODAT in kidney transplant recipients. This finding suggests the need for a large randomized controlled trial-with very careful attention to assess the effects of normalizing Mg levels and the risk of NODAT.

Periprocedural Nebivolol for the Prevention of Contrast-Induced Acute Kidney Injury: A Systematic Review and Meta-analysis.

BACKGROUND: Nebivolol provides a protective effect on contrast-induced acute kidney injury (CIAKI) in animal models. However, the reports on the efficacy of nebivolol for the prevention of CIAKI in human remain unclear. AIMS: The objective of this meta-analysis was to assess the effect of nebivolol for the prevention of CIAKI. MATERIALS AND METHODS: Comprehensive literature searches were performed using MEDLINE, EMBASE, and Cochrane Database from inception through February 2015. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of CIAKI in patients who received nebivolol versus those who did not were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Four studies (2 randomized controlled trials and 2 cohort studies) with 543 patients were included in our analysis to assess the risk of CIAKI and the use of nebivolol. Patients in the nebivolol group had an overall lower incidence of CIAKI (14.4%) compared to the control group (18.4%). The pooled RR of CIAKI in patients receiving nebivolol was 0.66 (95% CI: 0.38-1.15, I (2) = 0). When meta-analysis was limited only to randomized control trials (RCTs), the pooled RR of CIAKI in patients receiving nebivolol was 0.79 (95% CI: 0.35-1.79, I (2) = 0%). CONCLUSIONS: Despite no statistical significance, there was a trend toward reduced CIAKI risk in patients receiving nebivolol. The findings of our meta-analysis suggest the need of a large RCT with very careful attention to the balance of benefits and harms.

The effectiveness and safety of rituximab as induction therapy in ABO-compatible non-sensitized renal transplantation: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The objective of this systematic review and meta-analysis was to evaluate the effectiveness and safety of rituximab as induction therapy in ABO-compatible, non-sensitized renal transplantation. METHODS: A literature search for randomized controlled trials (RCTs) was performed from inception through February 2015. Studies that reported relative risks or hazard ratios comparing the risks of biopsy-proven acute rejection (BPAR), graft loss, leukopenia, infection or mortality in ABO-compatible, non-sensitized renal transplant recipients who received rituximab as induction therapy versus controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method. RESULTS: Four RCTs with 480 patients were included in the meta-analysis. Pooled RR of BPAR in recipients with rituximab induction was 0.90 (95% CI 0.50-1.60). Compared to placebo, the risk of BPAR in rituximab group was 0.76 (95% CI 0.51-1.14, I(2) = 0). The risk of leukopenia was increased in rituximab group with the pooled RR of 8.22 (95% CI 2.08-32.47). There were no statistical differences in the risks of infection, graft loss and mortality at 3-6 months after transplantation with pool RRs of 1.02 (95% CI 0.85-1.21), 0.55 (95% CI 0.21-1.48) and 0.58 (95% CI 0.17-1.99), respectively. CONCLUSION: This meta-analysis demonstrated insignificant reduced risks of BPAR, graft loss or mortality among in ABO-compatible, non-sensitized renal transplant recipients with rituximab induction. Although rituximab induction significantly increases risk of leukopenia, it appears to be safe with no significant risk of infection.

Sugar and artificially sweetened soda consumption linked to hypertension: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: The risk of hypertension (HTN) in patients who regularly drink soda is controversial. The objective of this meta-analysis was to assess the associations between consumption of sugar and artificially sweetened soda and HTN. METHODS: A literature search was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through January 2015. Studies that reported relative risks, odd ratios or hazard ratios comparing the risk of HTN in patients consuming a significant amount of either sugar or artificially sweetened soda versus those who did not consume soda were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Eight studies were included in our analysis to assess the association between consumption of sugar-sweetened soda and HTN. The pooled RR of HTN in patients consuming sugar-sweetened soda was 1.12 (95% CI, 1.03-1.23). Four studies were selected to assess the association between consumption of artificially sweetened soda and HTN. The pooled RR of HTN in patients consuming artificially sweetened soda was 1.15 (95% CI, 1.11-1.19). CONCLUSIONS: Our study demonstrates statistically significant associations between both sugar and artificially sweetened soda consumption and HTN. This finding may impact clinical management and primary prevention of HTN.

Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies.

BACKGROUND: The reported risk of hypomagnesemia in patients with proton pump inhibitor (PPI) use is conflicting. The objective of this meta-analysis was to assess the association between the use of PPIs and the risk of hypomagnesemia. METHODS: A literature search of observational studies was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through September 2014. Studies that reported odd ratios or hazard ratios comparing the risk of hypomagnesemia in patients with PPI use were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Nine observational studies (three cohort studies, five cross-sectional studies and a case-control study) with a total of 109,798 patients were identified and included in the data analysis. The pooled RR of hypomagnesemia in patients with PPI use was 1.43 (95% CI, 1.08-1.88). The association between the use of PPIs and hypomagnesemia remained significant after the sensitivity analysis including only studies with high quality score (Newcastle-Ottawa scale score ≥ 8) with a pooled RR of 1.63 (95% CI, 1.14-2.23). CONCLUSIONS: Our study demonstrates a statistically significant increased risk of hypomagnesemia in patients with PPI use. The finding of this meta-analysis of observational studies suggests that PPI use is associated with hypomagnesemia and may impact clinical management of patients who are taking PPIs and at risk for hypomagnesemia related cardiovascular events.

The Risks of Incident and Recurrent Clostridium difficile-Associated Diarrhea in Chronic Kidney Disease and End-Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The objective of this systematic review and meta-analysis was to assess the risks of incident and recurrent Clostridium difficile-associated diarrhea in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) requiring dialysis. METHODS: A literature search was performed from inception to February 2015. Studies that reported relative risks, odds ratios, or hazard ratios comparing the risks of C. difficile-associated diarrhea in patients with CKD or ESRD versus those without CKD or ESRD were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method. RESULTS: Twenty studies (nine case-control, seven cohort, and four cross-sectional studies with 162,218,041 patients) were included in the meta-analysis. Pooled RRs of C. difficile-associated diarrhea in patients with CKD and ESRD were 1.95 (95% CI 1.81-2.10) and 2.63 (95% CI 2.04-3.38), respectively. When meta-analysis was limited only to cohort and case-control studies with confounder-adjusted analysis, the pooled RRs of C. difficile-associated diarrhea in patients with CKD and ESRD were 1.89 (95% CI 1.75-2.05) and 2.50 (95% CI 1.49-4.17), respectively. The pooled RR of recurrent C. difficile-associated diarrhea in patients with CKD was 2.61 (95% CI 1.53-4.44). Data on the risk of recurrent C. difficile-associated diarrhea were limited. CONCLUSION: This meta-analysis demonstrates significantly increased risks of incident and recurrent C. difficile-associated diarrhea in patients with CKD. Furthermore, the magnitude of increased risk of C. difficile-associated diarrhea in ESRD patients is even higher.

Comparison of renal outcomes in off-pump versus on-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials.

AIM: The objective of this meta-analysis was to compare the effects of off-pump and on-pump coronary artery bypass grafting (CABG) on acute kidney injury (AKI) and the need of dialysis after surgery. METHODS: Comprehensive literature searches for randomized controlled trials (RCTs) of CABG with on-pump and off-pump was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception through September 2014. Primary outcomes were the incidence of AKI and the need of dialysis. Mortality was assessed among the studies that reported renal outcomes. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Thirty-three RCTs with 17 322 patients were enrolled in our study. Patients in the off-pump CABG group had overall lower incidence of AKI (19.1%) compared with the on-pump CABG group (22.2%). There was a protective effect of off-pump CABG on the incidence of AKI compared with the on-pump CABG group (RR: 0.87; 95% CI: 0.77-0.98). However, there was no significant difference in the need for dialysis in the off-pump group compared with the on-pump group (RR: 0.84; 95% CI 0.63-1.13). Within the selected trials, post hoc analysis assessing the mortality outcome demonstrated a pooled RR of 0.97 (95% CI, 0.77-1.23) in off-pump versus on-pump CABGs. CONCLUSIONS: Our study demonstrates a beneficial effect of off-pump CABG on the incidence of AKI. However, our meta-analysis does not show benefits of the need of dialysis or survival among patients undergoing off-pump CABG.

Preoperative renin-angiotensin system inhibitors use linked to reduced acute kidney injury: a systematic review and meta-analysis.

BACKGROUND: Previous trials of interventions to prevent acute kidney injury (AKI) have been unsuccessful and additional interventions are needed. Existing reviews of preoperative renin-angiotensin system (RAS) inhibitors have suggested harm. We included more recent studies and conducted this meta-analysis to evaluate the risk of postoperative AKI in patients who received preoperative RAS inhibitors. METHODS: A literature search was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through October, 2014. Studies that reported relative risks, odds ratios or hazard ratios comparing the AKI risk in patients who received preoperative RAS inhibitors versus those who did not were included. We performed the prespecified sensitivity analysis including only propensity score-based studies. Mortality risk was evaluated among the studies that reported AKI outcome. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Twenty-four studies (1 randomized controlled trial and 23 cohort studies) with 102 675 patients were included in the analysis to assess the risk of postoperative AKI and preoperative RAS inhibitors use. The pooled RR of AKI in patients receiving RAS inhibitors was 1.05 (95% CI: 0.92-1.20). The meta-analysis of the RCT and 11 studies with propensity score analysis demonstrated the pooled RR of AKI in patients receiving RAS inhibitors of 0.92 (95% CI: 0.85-0.99). Within the selected studies, preoperative RAS inhibitor therapy was not associated with a significant increase or decrease in mortality (RR: 0.93; 95% CI: 0.80-1.09). CONCLUSIONS: Our meta-analysis demonstrates an association between preoperative RAS inhibitor treatment and lower incidence of AKI.

Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The reports on the efficacy of statins for the prevention of contrast-induced acute kidney injury (CIAKI) remain controversial. The objective of this meta-analysis was to assess the effect of statins for the prevention of CIAKI. METHODS: Comprehensive literature searches for randomized controlled trials (RCTs) of periprocedural statin treatment for prevention of CIAKI were performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception until May 2014. The primary outcome was the incidence of CIAKI. RESULTS: Thirteen prospective RCTs were included in our analysis. Of 5803 patients with contrast exposures, 304 patients (5.2%) had CIAKI. Patients in the statin group had an overall lower incidence of CIAKI (3.6%) compared to the control group (6.9%). Intravenous (IV) fluid hydration was used in both groups of all included studies for prevention of CIAKI. There was a significant protective effect of periprocedural statins on the incidence of CIAKI when compared to the control group [risk ratios (RRs): 0.49; 95% CI: 0.37-0.66, I(2) of 25%]. CONCLUSIONS: Our study demonstrates a statistically significant protective effect of statin treatment during procedures with contrast exposures. This finding suggests the use of statins in addition to standard IV crystalloid hydration may be beneficial in the prevention of CIAKI.

A Pilot Study of the Inability to Fit Hands Around Neck as a Predictor of Obstructive Sleep Apnea.

BACKGROUND: Considering the high estimates of undiagnosed and untreated obstructive sleep apnea (OSA), there is a need for simple and accurate diagnostic tests. Neck circumference has long been correlated with OSA, but its usefulness as a diagnostic tool has been limited. AIMS: We proposed to evaluate the value of a simple neck grasp test to help identify OSA. We hypothesized that the inability of a patient in a sleep clinic to fit their hands around their neck is predictive of OSA. MATERIALS AND METHODS: A retrospective review of medical records of patients evaluated in a general sleep clinic was performed. Easy sleep apnea predictor (ESAP) positive was defined as the inability to place the hands around the neck with digits touching in the anterior and posterior. ESAP negative was the ability to place hands around the neck. Positive for OSA in this symptomatic sleep clinic population was defined as an apnea-hypopnea index (AHI) of ≥5. RESULTS: A total of 47 subjects (36% female) had ESAP data available, which were reviewed. The mean age was 51.6 years (SD 14.4, range 29-81 years). The mean body mass index (BMI) was 38.8 (SD 9.9, range 20.4-69.5). Review showed 87.2% (N = 41) tested positive for OSA by AHI of ≥5. The sensitivity and specificity of ESAP were 68.3% and 100%, respectively. The positive predictive power was 100% and the negative predictive power was 31.6%. CONCLUSION: As we hypothesized, ESAP positive (inability to span neck) was predictive of OSA in a population of sleep clinic patients. An ESAP positive test was 100% predictive of the presence of OSA (AHI of ≥5). ESAP shows promise for ease of clinical use to predict the presence of OSA in a general sleep clinic population.

The Risk of Coronary Heart Disease in Patients with Kidney Stones: A Systematic Review and Meta-analysis.

BACKGROUND: The reported risk of coronary heart disease (CHD) in patients with a history of kidney stones is conflicting. AIMS: The objective of this meta-analysis was to assess the association between a history of kidney stones and CHD risk. MATERIALS AND METHODS: A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception until April 04, 2014. Studies that reported odds ratios or hazard ratios comparing the risk of CHD in patients with a history of kidney stones versus those without a history of kidney stones were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Seven study populations from four cohort studies and one cross-sectional study were identified and included in the data analysis. The pooled risk ratio (RR) of CHD in patients with kidney stones was 1.24 (95% CI, 1.10-1.40). This result remained significant (RR, 1.23 [95% CI, 1.08-1.41]) when the sensitivity analysis was restricted to only cohort studies. A history of kidney stones was associated with increased CHD risk in females (RR, 1.43 [95% CI, 1.12-1.82]), whereas the association was not significant in males (RR, 1.14 [95% CI, 0.94-1.38]). CONCLUSIONS: Our study demonstrates a statistically significant increased risk of CHD in female patients with prior kidney stones. This finding suggests that a history of kidney stones is a risk factor for CHD in females and may impact clinical management.

Perforated jejunal diverticulum in the use of mycophenolate mofetil.

CONTEXT: Jejunal diverticulosis is a rare disease. Common acute complications include diverticulitis, intestinal obstruction, bleeding and perforation. Gastrointestinal tract perorations have also been rarely observed in the use of mycophenolate mofetil. CASE REPORT: We report a 44-year-old man with end-stage renal disease post failed kidney transplant on low-dose mycophenolate mofetil who presented with acute onset of abdominal pain. He was successfully given the diagnosis of perforated jejunal diverticulum. The patient successfully underwent a segmental jejunal resection and anastomosis. He unfortunately developed a recurrent jejunal perforation a month later and again had the second segmental jejunal resection operation. Mycophenolate mofetil then was discontinued. CONCLUSION: The present case illustrates jejunal diverticulum perforation in the use of mycophenolate mofetil. Physicians should increase the awareness of this association of perforated jejunal diverticulum in patients using mycophenolate mofetil.

Associations of sugar-sweetened and artificially sweetened soda with chronic kidney disease: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: The risk of chronic kidney disease (CKD) in patients who regularly drink soda is controversial. The objective of this meta-analysis was to evaluate the associations between consumption of sugar-sweetened and artificially sweetened soda and CKD. METHODS: A literature search was performed using MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from inception until 30 June 2014. Studies that reported odds ratios or hazard ratios comparing the risk of CKD in patients consuming significant amounts of either sugar-sweetened or artificially sweetened soda versus those who did not consume soda were included. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects, generic inverse variance method. RESULTS: Five studies were included in our analysis of the association between consumption of sugar-sweetened soda and CKD. The pooled RR of CKD in patients consuming sugar-sweetened soda was 1.58 (95% CI 1.00-2.49). Four studies were selected to assess the association between consumption of artificially sweetened soda and CKD. The pooled RR of CKD in patients consuming artificially sweetened soda was 1.33 (95% CI 0.82-2.15). CONCLUSIONS: Our study demonstrates statistically significant increased risks of CKD in patients consuming sugar-sweetened soda, but not in patients consuming artificially sweetened soda. This finding suggests that sugar-sweetened soda consumption is associated with CKD and may impact clinical management and primary prevention of CKD in high-risk patients.

Oral hydration for prevention of contrast-induced acute kidney injury in elective radiological procedures: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The reports on efficacy of oral hydration treatment for the prevention of contrast-induced acute kidney injury (CIAKI) in elective radiological procedures and cardiac catheterization remain controversial. AIMS: The objective of this meta-analysis was to assess the use of oral hydration regimen for prevention of CIAKI. MATERIALS AND METHODS: Comprehensive literature searches for randomized controlled trials (RCTs) of outpatient oral hydration treatment was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews, and clinicaltrials.gov from inception until July 4(th), 2014. Primary outcome was the incidence of CIAKI. RESULTS: Six prospective RCTs were included in our analysis. Of 513patients undergoing elective procedures with contrast exposures,45 patients (8.8%) had CIAKI. Of 241 patients with oral hydration regimen, 23 (9.5%) developed CIAKI. Of 272 patients with intravenous (IV) fluid regimen, 22 (8.1%) had CIAKI. Study populations in all included studies had relatively normal kidney function to chronic kidney disease (CKD) stage 3. There was no significant increased risk of CIAKI in oral fluid regimen group compared toIV fluid regimen group (RR = 0.94, 95% confidence interval, CI = 0.38-2.31). CONCLUSIONS: According to our analysis,there is no evidence that oral fluid regimen is associated with more risk of CIAKI in patients undergoing elective procedures with contrast exposures compared to IV fluid regimen. This finding suggests that the oral fluid regimen might be considered as a possible outpatient treatment option for CIAKI prevention in patients with normal to moderately reduced kidney function.