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  1. Article: Gabapentinoids: a therapeutic review.

    Athavale, Akshay / Murnion, Bridin

    Australian prescriber

    2023  Volume 46, Issue 4, Page(s) 80–85

    Abstract: The Australian Therapeutic Goods Administration's approved indications for prescription of gabapentinoids are refractory focal epilepsy and neuropathic pain. Use of gabapentinoids outside of the approved indications is common, but evidence for this is ... ...

    Abstract The Australian Therapeutic Goods Administration's approved indications for prescription of gabapentinoids are refractory focal epilepsy and neuropathic pain. Use of gabapentinoids outside of the approved indications is common, but evidence for this is limited, especially for chronic nonspecific back pain and nonradicular leg pain. Some effects of gabapentinoids encourage their nonmedical use (e.g. euphoria, sedation, disinhibition). Widespread nonmedical use has increased the incidence of accidental and deliberate poisonings. Dependence may develop with chronic use of gabapentinoids and abrupt cessation may induce withdrawal symptoms. If the indication for continued use is unclear, gradual dose tapering as a means of deprescribing is recommended. Clinicians should consider the indication, patient characteristics and harm-benefit profile when prescribing gabapentinoids. Some people, such as those with kidney disease, have an increased risk of harm when using these drugs.
    Language English
    Publishing date 2023-12-26
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 1075442-8
    ISSN 0312-8008
    ISSN 0312-8008
    DOI 10.18773/austprescr.2023.025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3233: Show issues Location:
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  2. Article: Management of proteinuria: blockade of the renin-angiotensin-aldosterone system.

    Athavale, Akshay / Roberts, Darren M

    Australian prescriber

    2020  Volume 43, Issue 4, Page(s) 121–125

    Language English
    Publishing date 2020-08-03
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 1075442-8
    ISSN 0312-8008
    ISSN 0312-8008
    DOI 10.18773/austprescr.2020.021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Data Challenges in Addressing Chronic Kidney Disease in Low- and Lower-Middle-Income Countries.

    Talbot, Benjamin / Athavale, Akshay / Jha, Vivekanand / Gallagher, Martin

    Kidney international reports

    2021  Volume 6, Issue 6, Page(s) 1503–1512

    Abstract: The burden of chronic kidney disease (CKD) is growing globally, particularly in low- and lower-middle-income countries (LLMICs) where access to treatment is poor and the largest increases in disease burden will occur. The individual and societal costs of ...

    Abstract The burden of chronic kidney disease (CKD) is growing globally, particularly in low- and lower-middle-income countries (LLMICs) where access to treatment is poor and the largest increases in disease burden will occur. The individual and societal costs of kidney disease are well recognized, especially in developed health care systems where treatments for the advanced stages of CKD are more readily available. The consequences of CKD are potentially more catastrophic in developing health care systems where such resources are often lacking. Central to addressing this challenge is the availability of data to understand disease burden and ensure that investments in treatments and health resources are effective at a local level. Use of routinely collected administrative data is helpful in this regard, however, the barriers to developing a more systematic focus on data collection should not be underestimated. This article reviews the current tools that have been used to measure the burden of CKD and considers limitations regarding their use in LLMICs. A review of the literature investigating the use of registries, disease specific databases and administrative data to identify populations with CKD in LLMICs, which indicate these to be underused resources, is included. Suggestions regarding the potential use of administrative data for measuring CKD burden in LLMICs are explored.
    Language English
    Publishing date 2021-04-17
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2468-0249
    ISSN (online) 2468-0249
    DOI 10.1016/j.ekir.2021.03.901
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  4. Article: Management of Renal Angiomyolipomas in Tuberous Sclerosis Complex: A Case Report and Literature Review.

    Hunter-Dickson, Mitchell / Wu, Patrick / Athavale, Akshay / Wang, Amanda Ying

    Journal of clinical medicine

    2022  Volume 11, Issue 20

    Abstract: We report a case of misdiagnosed tuberous sclerosis complex (TSC) in a patient without TSC gene variant presenting with bilateral renal angiomyolipomas and seizures in the context of strong family history of polycystic kidney disease. Clinical diagnosis ... ...

    Abstract We report a case of misdiagnosed tuberous sclerosis complex (TSC) in a patient without TSC gene variant presenting with bilateral renal angiomyolipomas and seizures in the context of strong family history of polycystic kidney disease. Clinical diagnosis of tuberous sclerosis complex was made and treatment with everolimus reduced size of renal angiomyolipomas. In this case, report we discuss the association between tuberous sclerosis complex and polycystic kidney disease and novel treatment for TSC.
    Language English
    Publishing date 2022-10-15
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11206084
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  5. Article: Buprenorphine not detected on urine drug screening in supervised treatment.

    Jamshidi, Nazila / Athavale, Akshay / Murnion, Bridin

    Journal of opioid management

    2021  Volume 17, Issue 7, Page(s) 69–76

    Abstract: Introduction: Urine drug screens (UDS) assist in clinical planning and assessment of adherence in opioid agonist treatment (OAT). Urine drug screens may also be used in criminal justice and child protection settings. Buprenorphine (BPN) UDS testing is ... ...

    Abstract Introduction: Urine drug screens (UDS) assist in clinical planning and assessment of adherence in opioid agonist treatment (OAT). Urine drug screens may also be used in criminal justice and child protection settings. Buprenorphine (BPN) UDS testing is complex. Immunoassay often does not detect BPN and gas chromatography-mass spectrometry (GC-MS) is needed. A limited understanding of testing can negatively influence UDS interpretation and clinical decision making.
    Objectives: The primary aim was to determine detection rates of BPN in UDS in participants on BPN or buprenorphine/naloxone (BNX) treatment. The secondary aim was to identify if comorbidities, sex, co-prescribed medications, or dosing site and observation were associated with BPN detection.
    Setting: Public outpatient clinic in a specialist addiction treatment service.
    Design/participants: In this retrospective observational study, records of clients on supervised BPN/BNX treatment between September 2017 and 2018 were reviewed.
    Measures: Data extracted included UDS results, age, sex, indication for BPN, frequency of observed doses, dose of BPN, dosing site, comorbid medical conditions, and medications.
    Results: One hundred and sixty-one medical records were reviewed. Ninety-seven (60 percent) underwent screening urine immunoassay. Of these 97, 51 (53 percent) had further GC-MS testing for BPN of which 22 (43 percent) did not detect BPN despite directly observed OAT. Co-prescription of medications known to interact with cytochrome P450 3A4 was associated with nondetection of BPN (p < 0.05). No significant association between median dose, dosing site, and observed dosing and BPN detection was identified.
    Conclusion: Urine drug testing for BPN is complex. Failure to detect BPN does not betoken nonadherence to treatment and is associated with co-prescription of drugs interacting with cytochrome P450 3A4.
    MeSH term(s) Analgesics, Opioid/adverse effects ; Buprenorphine/therapeutic use ; Buprenorphine, Naloxone Drug Combination/therapeutic use ; Child ; Drug Evaluation, Preclinical ; Humans ; Naloxone/therapeutic use ; Narcotic Antagonists/therapeutic use ; Opioid-Related Disorders/diagnosis ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology
    Chemical Substances Analgesics, Opioid ; Buprenorphine, Naloxone Drug Combination ; Narcotic Antagonists ; Naloxone (36B82AMQ7N) ; Buprenorphine (40D3SCR4GZ)
    Language English
    Publishing date 2021-09-14
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 2397614-7
    ISSN 1551-7489
    ISSN 1551-7489
    DOI 10.5055/jom.2021.0644
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    Zs.A 6563: Show issues Location:
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  6. Article ; Online: Kidney dysfunction has a major impact on the effect of idarucizumab for dabigatran reversal.

    Athavale, Akshay / Jamshidi, Nazila / Roberts, Darren M

    European journal of anaesthesiology

    2021  Volume 38, Issue 9, Page(s) 1005–1006

    MeSH term(s) Antibodies, Monoclonal, Humanized ; Antithrombins/adverse effects ; Dabigatran/adverse effects ; Humans ; Kidney
    Chemical Substances Antibodies, Monoclonal, Humanized ; Antithrombins ; idarucizumab (97RWB5S1U6) ; Dabigatran (I0VM4M70GC)
    Language English
    Publishing date 2021-08-16
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001428
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    Zs.A 1955: Show issues Location:
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  7. Article ; Online: Unique approach to continuing medical education in clinical pharmacology across Australia and New Zealand.

    Athavale, Akshay / Murnion, Bridin

    Internal medicine journal

    2019  Volume 49, Issue 12, Page(s) 1488–1495

    Abstract: Background: Advanced physician training in clinical pharmacology lacks a continuing education programme. There is a need for continuing medical education but how to introduce and develop education remains unclear.: Aims: The primary aim was to ... ...

    Abstract Background: Advanced physician training in clinical pharmacology lacks a continuing education programme. There is a need for continuing medical education but how to introduce and develop education remains unclear.
    Aims: The primary aim was to develop and implement a peer-led, web-based multiple choice question approach to continuing education in clinical pharmacology training across Australia and New Zealand. Secondary aims included determining, quality, difficulty, utility, relevance, user-friendliness, sustainability and potential to form part of formal clinical pharmacology physician training.
    Methods: In February 2018, a survey of clinical pharmacology trainees identified topics for question development. Questions covering requested topics were developed and piloted in PeerWise between March and October 2018. Participants could rate quality and difficulty of questions using categorical rating scales and make free text comments. After questions were piloted, a survey using a 0-10-point Likert scale and yes/no responses assessed utility, relevance, user-friendliness, sustainability and formalisation potential.
    Results: Twenty-four trainees were invited to participate. Nine (38%) of trainees completed the initial survey, 10 (42%) attempted questions and 7 (29%) completed the end survey. Median scores of 8.00 (IQR 6.50 - 9.00), 7.00 (IQR 6.50 - 7.50) and 8.00 (IQR 6.50 - 8.00) using a 0-10-point Likert scale indicated trainees found this approach useful, relevant and user-friendly. Five (71%) out of seven responding trainees felt this approach was sustainable and could be incorporated as part of formal clinical training.
    Conclusion: This study suggests that peer-led multiple choice questions could form an enduring education modality which could be incorporated into clinical pharmacology training.
    MeSH term(s) Attitude of Health Personnel ; Australia ; Curriculum ; Education, Medical, Continuing ; Educational Measurement ; Humans ; New Zealand ; Pharmacology, Clinical/education ; Surveys and Questionnaires
    Language English
    Publishing date 2019-12-20
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2045436-3
    ISSN 1445-5994 ; 1444-0903
    ISSN (online) 1445-5994
    ISSN 1444-0903
    DOI 10.1111/imj.14663
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    Zs.A 792: Show issues Location:
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    Zs.MO 424: Show issues

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  8. Article: Dialysis Disequilibrium: Is Acidosis More Important than Urea?

    Athavale, Akshay / Wyburn, Kate R / Snelling, Paul L / Chadban, Steven J

    Case reports in nephrology

    2022  Volume 2022, Page(s) 4964033

    Abstract: Dialysis disequilibrium syndrome is a severe complication associated with dialysis treatment. Manifestations may range from mild such as headache to severe such as seizures and coma. Risk factors for development include initial dialysis treatment, ... ...

    Abstract Dialysis disequilibrium syndrome is a severe complication associated with dialysis treatment. Manifestations may range from mild such as headache to severe such as seizures and coma. Risk factors for development include initial dialysis treatment, uraemia, metabolic acidosis, and extremes of age. We report a case of dialysis disequilibrium in a patient with a failing kidney transplant secondary to the recurrence of IgA nephropathy. Disturbance in cognition and neurologic functioning occurred six hours after the completion of initiation of intermittent haemodialysis. During two sessions of intermittent haemodialysis of 3 and 4 hours, urea was reduced by 21.9 and 17.2 mmol/L and measured serum osmolality was reduced by 25 and 14 mOsm/kg, respectively. Subsequent admission to the intensive care unit and initiation of continuous renal replacement therapy for 48 hours resulted in complete resolution of symptoms. In this case report, we discuss atypical clinical and radiologic features of dialysis disequilibrium occurring with modest reductions in urea and serum osmolality.
    Language English
    Publishing date 2022-02-22
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2627652-5
    ISSN 2090-665X ; 2090-6641
    ISSN (online) 2090-665X
    ISSN 2090-6641
    DOI 10.1155/2022/4964033
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  9. Article ; Online: Transdermal Magnesium for the Treatment of Peripheral Neuropathy in Chronic Kidney Disease: A Single-Arm, Open-Label Pilot Study.

    Athavale, Akshay / Miles, Natividad / Pais, Riona / Snelling, Paul / Chadban, Steven J

    Journal of palliative medicine

    2023  Volume 26, Issue 12, Page(s) 1654–1661

    Abstract: Introduction: ...

    Abstract Introduction:
    MeSH term(s) Aged ; Female ; Humans ; Male ; Administration, Cutaneous ; Magnesium/therapeutic use ; Peripheral Nervous System Diseases/drug therapy ; Pilot Projects ; Renal Insufficiency, Chronic/complications
    Chemical Substances Magnesium (I38ZP9992A)
    Language English
    Publishing date 2023-07-25
    Publishing country United States
    Document type Clinical Trial ; Journal Article
    ZDB-ID 1427361-5
    ISSN 1557-7740 ; 1096-6218
    ISSN (online) 1557-7740
    ISSN 1096-6218
    DOI 10.1089/jpm.2023.0229
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  10. Article: Antiemetic drugs: what to prescribe and when.

    Athavale, Akshay / Athavale, Tegan / Roberts, Darren M

    Australian prescriber

    2020  Volume 43, Issue 2, Page(s) 49–56

    Language English
    Publishing date 2020-04-01
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 1075442-8
    ISSN 0312-8008
    ISSN 0312-8008
    DOI 10.18773/austprescr.2020.011
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