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  1. Article ; Online: COVID-19 and hypertension

    Spoorthy Kulkarni / Bernadette L. Jenner / Ian Wilkinson

    Journal of the Renin-Angiotensin-Aldosterone System, Vol

    2020  Volume 21

    Keywords Medicine (General) ; R5-920 ; covid19
    Language English
    Publishing date 2020-05-01T00:00:00Z
    Publisher Hindawi - SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Metabolic adverse events associated with systemic corticosteroid therapy—a systematic review and meta-analysis

    Szilard Nemes / Veronica Phillips / Spoorthy Kulkarni / Hannah Durham / Luke Glover / Osaid Ather / Leslie Cousens / Parmis Blomgran / Philip Ambery

    BMJ Open, Vol 12, Iss

    2022  Volume 12

    Abstract: Objectives To assess the risk of new-onset or worsening hyperglycaemia, hypertension, weight gain and hyperlipidaemia with systemic corticosteroid therapy (CST) as reported in published randomised control trial (RCT) studies.Data sources Literature ... ...

    Abstract Objectives To assess the risk of new-onset or worsening hyperglycaemia, hypertension, weight gain and hyperlipidaemia with systemic corticosteroid therapy (CST) as reported in published randomised control trial (RCT) studies.Data sources Literature search using MEDLINE, EMBASE, Cochrane library, Web of Science and ScopusStudy eligibility criteria Published articles on results of RCT with a systemic CST arm with numerical data presented on adverse effect (AE).Participants and interventions Reports of hyperglycaemia, hypertension, weight gain and hyperlipidaemia associated with systemic CST in patients or healthy volunteer’s ≥17 years of age.Study appraisal methods Risk of bias tool, assessment at the level of AE and key study characteristics.Results A total of 5446 articles were screened to include 118 studies with 152 systemic CST arms (total participants=17 113 among which 8569 participants treated with CST). Pooled prevalence of hyperglycaemia in the CST arms within the studies was 10% (95% CI 7% to 14%), with the highest prevalence in respiratory illnesses at 22% (95% CI 9% to 35%). Pooled prevalence of severe hyperglycaemia, hypertension, weight gain and hyperlipidaemia within the corticosteroid arms was 5% (95% CI 2% to 9%), 6% (95% CI 4% to 8%), 13% (95% CI 8% to 18%), 8% (95% CI 4% to 17%), respectively. CST was significantly associated hyperglycaemia, hypertension and weight gain as noted in double-blinded placebo-controlled parallel-arms studies: OR of 2.13 (95% CI 1.66 to 2.72), 1.68 (95% CI 0.96 to 2.95) and 5.20 (95% CI 2.10 to 12.90), respectively. Intravenous therapy posed higher risk than oral therapy: OR of 2.39 (95% CI 1.16 to 4.91).Limitations There was significant heterogeneity in the AE definitions and quality of AE reporting in the primary studies and patient populations in the studies. The impact of cumulative dose effect on incidental AE could not be calculated.Conclusions and implications of key findings Systemic CST use is associated with increased risk of metabolic AEs, which differs ...
    Keywords Medicine ; R
    Subject code 610
    Language English
    Publishing date 2022-12-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: 1.5 Age and Sex Differences in the Association of Brachial and Central Blood Pressure Variability with Arterial Stiffness

    Shikai Yu / Kathleen Connolly / Spoorthy Kulkarni / Viknesh Selvarajah / Jean Woodcock-Smith / Ian Wilkinson / Carmel McEniery

    Artery Research, Vol 25, Iss

    2020  Volume 1

    Abstract: Background: Both blood pressure variability (BPV) and arterial stiffness (AS) are significantly influenced by age and sex. However, whether the association between BPV and AS differs with age and sex remains unclear. We examined age and sex differences ... ...

    Abstract Background: Both blood pressure variability (BPV) and arterial stiffness (AS) are significantly influenced by age and sex. However, whether the association between BPV and AS differs with age and sex remains unclear. We examined age and sex differences in the association between brachial and central BPV and AS in a cohort of healthy individuals, covering a wide age-span. Methods: 24-hour brachial and central blood pressures (Mobil-O-Graph) and aortic pulse wave velocity (aPWV) (SphygmoCor) were measured in 957 healthy individuals (age range: 18–88 yrs; mean age: 46 ± 18 yrs; 45% males). BPV was calculated as standard deviations of 24-hour (time-weighted, 24wSD), daytime (dSD) and night-time systolic blood pressures. Correlation analyses were performed, separately, in groups stratified by age (≤40, 41–60, and >60 yrs) and sex. Results: aPWV significantly correlated to brachial and central 24wSD and dSD (p ≤ 0.02 for all) in both males and females, but females showed significantly stronger correlations of aPWV to brachial 24wSD (correlation coefficient [r]: 0.31 vs. 0.11, p = 0.001) and dSD (r: 0.32 vs. 0.12, p = 0.001) and to central 24wSD (r: 0.34 vs. 0.20, p = 0.02) and dSD (r: 0.34 vs. 0.21, p = 0.03), compared to males (Table 1). After stratification by age and sex, in both males and females, significant correlations between aPWV and BPV indices were observed in middle-aged and older adults, but not in younger adults (Tables 2 and 3). Table 1Correlation between SBP variability and aortic pulse wave velocity in males and females SBP variability Males (n = 431) Females (n = 526) p* r p r p Brachial 24 h time-weighted SD 0.11 0.02 0.31 <0.0001 0.001 Day SD 0.12 0.01 0.32 <0.0001 0.001 Night SD 0.01 0.81 0.16 0.0002 0.02 Central 24 h time-weighted SD 0.20 <0.0001 0.34 <0.0001 0.02 Day SD 0.21 <0.0001 0.34 <0.0001 0.03 Night SD 0.08 0.08 0.18 <0.0001 0.12 *p-value derived from Z-test; SD, standard deviation; r, correlation coefficient. Table 2Correlation between SBP variability and aortic ...
    Keywords Specialties of internal medicine ; RC581-951 ; Diseases of the circulatory (Cardiovascular) system ; RC666-701
    Subject code 590
    Language English
    Publishing date 2020-02-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Repurposed immunomodulatory drugs for Covid-19 in pre-ICu patients - mulTi-Arm Therapeutic study in pre-ICu patients admitted with Covid-19 – Repurposed Drugs (TACTIC-R)

    Spoorthy Kulkarni / Marie Fisk / Michalis Kostapanos / Edward Banham-Hall / Simon Bond / Elena Hernan-Sancho / Sam Norton / Joseph Cheriyan / Andrew Cope / James Galloway / Frances Hall / David Jayne / Ian B. Wilkinson

    Trials, Vol 21, Iss 1, Pp 1-

    A structured summary of a study protocol for a randomised controlled trial

    2020  Volume 3

    Abstract: Abstract Objectives To determine if a specific immunomodulatory intervention reduces progression of COVID-19-related disease to organ failure or death, compared to standard of care (SoC). Trial design Randomised, parallel 3-arm (1:1:1 ratio), open-label, ...

    Abstract Abstract Objectives To determine if a specific immunomodulatory intervention reduces progression of COVID-19-related disease to organ failure or death, compared to standard of care (SoC). Trial design Randomised, parallel 3-arm (1:1:1 ratio), open-label, Phase IV platform trial of immunomodulatory therapies in patients with late stage 1 or stage 2 COVID-19-related disease, with a diagnosis based either on a positive assay or high suspicion of COVID-19 infection by clinical and/or radiological assessment. Participants Patients aged 18 and over, with a clinical picture strongly suggestive of COVID-19-related disease (with/without a positive COVID-19 test) AND a Risk count (as defined below) >3 OR ≥3 if risk count includes “Radiographic severity score >3”. A risk count is calculated by the following features on admission (1 point for each): radiographic severity score >3, male gender, non-white ethnicity, diabetes, hypertension, neutrophils >8.0 x109/L, age >40 years and CRP >40 mg/L. Patients should be considered an appropriate subject for intervention with immunomodulatory therapies in the opinion of the investigator and be able to be maintained on venous thromboembolism prophylaxis during the inpatient dosing period, according to local guidelines. The complete inclusion and exclusion criteria as detailed in the additional file 1 should be fulfilled. Patients will be enrolled prior to the need for invasive mechanical ventilation, cardiac or renal support. Participants will be recruited across multiple centres including initially at Cambridge University Hospitals NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, Guy’s and St Thomas’ NHS Foundation Trust, University Hospital of Wales, Gloucestershire Royal Hospitals NHS Foundation Trust and The Royal Wolverhampton NHS Trust. Intervention and comparator Each active comparator arm will be compared against standard of care (SoC). The immunomodulatory drugs were selected from a panel of licenced candidates by a drug evaluation ...
    Keywords COVID-19 ; Randomised controlled trial ; Protocol ; Baricitinib ; Ravulizumab ; Open-label ; Medicine (General) ; R5-920 ; covid19
    Subject code 610
    Language English
    Publishing date 2020-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: muLTi-Arm Therapeutic study in pre-ICu patients admitted with Covid-19-Experimental drugs and mechanisms (TACTIC-E)

    Ing Ni Lu / Spoorthy Kulkarni / Marie Fisk / Michalis Kostapanos / Edward Banham-Hall / Sonakshi Kadyan / Simon Bond / Sam Norton / Andrew Cope / James Galloway / Frances Hall / David Jayne / Ian B. Wilkinson / Joseph Cheriyan

    Trials, Vol 21, Iss 1, Pp 1-

    A structured summary of a study protocol for a randomized controlled trial

    2020  Volume 3

    Abstract: Abstract Objectives To determine if a specific intervention reduces the composite of progression of patients with COVID-19-related disease to organ failure or death as measured by time to incidence of any one of the following: death, invasive mechanical ... ...

    Abstract Abstract Objectives To determine if a specific intervention reduces the composite of progression of patients with COVID-19-related disease to organ failure or death as measured by time to incidence of any one of the following: death, invasive mechanical ventilation, ECMO, cardiovascular organ support (inotropes or balloon pump), or renal failure (estimated Cockcroft Gault creatinine clearance <15ml/min). Trial design Randomised, parallel arm, open-label, adaptive platform Phase 2/3 trial of potential disease modifying therapies in patients with late stage 1/stage 2 COVID-19-related disease, with a diagnosis based either on a positive assay or high suspicion of COVID-19 infection by clinical, laboratory and radiological assessment. Participants Patients aged 18 and over, with a clinical picture strongly suggestive of COVID-19-related disease (with/without a positive COVID-19 test) AND a risk count (as defined below) >3 OR ≥3 if risk count includes “Radiographic severity score >3”. A risk count is calculated by the following features on admission (1 point for each): radiographic severity score >3, male gender, non-white ethnicity, diabetes, hypertension, neutrophils >8.0 x109/L, age >40 years and CRP >40 mg/L. Patients should be considered an appropriate subject for intervention with immunomodulatory or other disease modifying agents in the opinion of the investigator and are able to swallow capsules or tablets. The complete inclusion and exclusion criteria as detailed in the Additional file 1 should be fulfilled. Drug specific inclusion and exclusion criteria will also be applied to the active arms. Patients will be enrolled prior to the need for invasive mechanical ventilation, cardiac or renal support. Participants will be recruited across multiple centres in the UK including initially at Cambridge University Hospitals NHS Foundation Trust and St George’s University NHS Foundation Trust. Other centres will be approached internationally in view of the evolving pandemic. Intervention and ...
    Keywords COVID-19 ; Randomised controlled trial ; Protocol ; Open-label ; Adaptive trial ; EDP1815 ; Medicine (General) ; R5-920 ; covid19
    Subject code 610
    Language English
    Publishing date 2020-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

    Full text online

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    Inter-library loan at ZB MED

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