Interactions between Recreational Drugs and Antiretroviral Agents

2002 ◽  
Vol 36 (10) ◽  
pp. 1598-1613 ◽  
Author(s):  
Tony Antoniou ◽  
Alice Lin-In Tseng
Keyword(s):  
Cytochrome P450 ◽  
Opportunistic Infections ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Opiate Withdrawal ◽  
Pharmacokinetic Studies ◽  
Recreational Drugs ◽  
Medline Search ◽  
Clinically Significant

OBJECTIVE: To summarize existing data regarding potential interactions between recreational drugs and drugs commonly used in the management of HIV-positive patients. DATA SOURCES: Information was obtained via a MEDLINE search (1966–August 2002) using the MeSH headings human immunodeficiency virus, drug interactions, cytochrome P450, medication names commonly prescribed for the management of HIV and related opportunistic infections, and names of commonly used recreational drugs. Abstracts of national and international conferences, review articles, textbooks, and references of all articles were also reviewed. STUDY SELECTION AND DATA EXTRACTION: Literature on pharmacokinetic interactions was considered for inclusion. Pertinent information was selected and summarized for discussion. In the absence of specific data, prediction of potential clinically significant interactions was based on pharmacokinetic and pharmacodynamic properties. RESULTS: All protease inhibitors (PIs) and nonnucleoside reverse transcriptase inhibitors are substrates and potent inhibitors or inducers of the cytochrome P450 system. Many classes of recreational drugs, including benzodiazepines, amphetamines, and opioids, are also metabolized by the liver and can potentially interact with antiretrovirals. Controlled interaction studies are often not available, but clinically significant interactions have been observed in a number of case reports. Overdoses secondary to interactions between the “rave” drugs methylenedioxymethamphetamine (MDMA) or γ-hydroxybutyrate (GHB) and PIs have been reported. PIs, particularly ritonavir, may also inhibit metabolism of amphetamines, ketamine, lysergic acid diethylmide (LSD), and phencyclidine (PCP). Case series and pharmacokinetic studies suggest that nevirapine and efavirenz induce methadone metabolism, which may lead to symptoms of opiate withdrawal. A similar interaction may exist between methadone and the PIs ritonavir and nelfinavir, although the data are less consistent. Opiate metabolism can be inhibited or induced by concomitant PIs, and patients should be monitored for signs of toxicity and/or loss of analgesia. PIs should not be coadministered with midazolam and triazolam, since prolonged sedation may occur. CONCLUSIONS: Interactions between agents commonly prescribed for patients with HIV and recreational drugs can occur, and may be associated with serious clinical consequences. Clinicians should encourage open dialog with their patients on this topic, to avoid compromising antiretroviral efficacy and increasing the risk of drug toxicity.

Macrolide Drug Interactions: An Update

2000 ◽  
Vol 34 (4) ◽  
pp. 495-513 ◽  
Author(s):  
Manjunath P Pai ◽  
Danielle M Graci ◽  
Guy W Amsden
Keyword(s):  
Cytochrome P450 ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Case Reports ◽  
Data Extraction ◽  
Depth Information ◽  
Cytochrome P450 Enzyme ◽  
Medline Search ◽  
P450 Enzyme ◽  
Clinically Significant

OBJECTIVE: To describe the current drug interaction profiles for the commonly used macrolides in the US and Europe, and to comment on the clinical impact of these interactions. DATA SOURCES: A MEDLINE search (1975–1998) was performed to identify all pertinent studies, review articles, and case reports. When appropriate information was not available in the literature, data were obtained from the product manufacturers. STUDY SELECTION: All available data were reviewed to provide an unbiased account of possible drug interactions. DATA EXTRACTION: Data for some of the interactions were not available from the literature, but were available from abstracts or company-supplied materials. Although the data were not always explicit, the best attempt was made to deliver pertinent information that clinical practitioners would need to formulate practice opinions. When more in-depth information was supplied in the form of a review or study report, a thorough explanation of pertinent methodology was supplied. DATA SYNTHESIS: Several clinically significant drug interactions have been identified since the approval of erythromycin. These interactions usually were related to the inhibition of the cytochrome P450 enzyme systems, which are responsible for the metabolism of many drugs. The decreased metabolism by the macrolides has in some instances resulted in potentially severe adverse events. The development and marketing of newer macrolides are hoped to improve the drug interaction profile associated with this class. However, this has produced variable success. Some of the newer macrolides demonstrated an interaction profile similar to that of erythromycin; others have shown improved profiles. The most success in avoiding drug interactions related to the inhibition of cytochrome P450 has been through the development of the azalide subclass, of which azithromycin is the first and only to be marketed. Azithromycin has not been demonstrated to inhibit the cytochrome P450 system in studies using a human liver microsome model, and to date has produced none of the classic drug interactions characteristic of the macrolides. CONCLUSIONS: Most of the available data regarding macrolide drug interactions are from studies in healthy volunteers and case reports. These data suggest that clarithromycin appears to have an interaction profile similar to that of erythromycin. Given this similarity, it is important to consider the interaction profile of clarithromycin when using erythromycin. This is especially necessary as funds for further studies of a medication available in generic form (e.g., erythromycin) are limited. Azithromycin has produced few clinically significant interactions with any agent cleared through the cytochrome P450 enzyme system. Although the available data are promising, the final test should come from studies conducted in patients who are taking potentially interacting compounds on a chronic basis.

Therapeutic Aerosol Delivery during Mechanical Ventilation

1996 ◽  
Vol 30 (6) ◽  
pp. 644-655 ◽  
Author(s):  
Denise M Coleman ◽  
H William Kelly ◽  
Bennie C Mcwilliams ◽  
Annette Pérez ◽  
Marc M Perreault
Keyword(s):  
Mechanical Ventilation ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Aerosol Delivery ◽  
Delivery Device ◽  
Unique Challenge ◽  
Medline Search

Objective To provide an overview of aerosol drug delivery during mechanical ventilation in the pediatric and adult populations. Data Sources Published articles and abstracts identified in a MEDLINE search (1984–July 1994) were reviewed. Study Selection All articles and abstracts found, including review articles, in vivo and in vitro studies, case reports, and case series pertaining to issues involving aerosol delivery during mechanical ventilation, were reviewed. No predetermined selection criteria were used to exclude studies. Data Extraction Percent delivery of the starting dose to either the patients or the various in vitro lung models, as well as each variable possibly affecting delivery for each study, were tabulated for each study reviewed. Data Synthesis The delivery of therapeutic aerosols to endotracheally intubated and mechanically ventilated patients presents a unique challenge for healthcare providers. Delivery can be affected by the diameter of the endotracheal tube and ventilator circuitry, type of ventilator, ventilator modes, type of delivery device, and how the delivery device is operated and introduced into the ventilator circuitry. The drug being aerosolized may behave differently from one delivery system to another. The proper operation of each device requires attention to positioning in the ventilator circuit as well as the mode of ventilation. Conclusions No apparent advantage exists for metered-dose inhalers with a large-volume adapter over jet nebulizers, as each method of delivery is capable of similar efficiency (5–15%). Sufficient attention to detail, including the use of an efficient nebulizer and/or adapter and proper placement and operating method, is required to provide optimal delivery. For bronchodilator administration, careful monitoring of outcomes will provide the most optimal dosing schedule.

Current Issues in Onychomycosis

1998 ◽  
Vol 32 (2) ◽  
pp. 204-214 ◽  
Author(s):  
Eric F Trépanier ◽  
Guy W Amsden
Keyword(s):  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Cost Effective ◽  
Substantial Impact ◽  
Medline Search ◽  
Drug Of Choice ◽  
Calidad De Vida ◽  
Pertinent Data ◽  
Yeasts And Molds

OBJECTIVE: To review the epidemiology, mycology, clinical features and diagnosis, current pharmacotherapy, and pharmacoeconomics of onychomycosis. DATA SOURCES: We conducted a MEDLINE search from 1966 to May 1997. References from these articles, manufacturers of the discussed antimycotics, and relevant abstracts from recent dermatology conferences were used to collect pertinent data. DATA EXTRACTION: Data were obtained from published controlled studies and case reports. In the pharmacotherapy section, the most weight was placed on fully reported, randomized, controlled comparative trials, but abstracts and case series were included when well-controlled studies were unavailable. DATA SYNTHESIS: Onychomycosis is a common nail disorder that has a substantial impact on patients' quality of life. It is most commonly caused by dermatophytes, but yeasts and molds can also be involved. Diagnosis is made through clinical presentation, potassium hydroxide preparations, and culture of tissue/nail samples. Griseofulvin was the drug of choice for many years, but its low cure rates and the development of newer, more effective drugs made it fall out of favor. Current therapeutic alternatives include fluconazole, itraconazole, and terbinafine. Data on the use of fluconazole are limited to case series and reports. Continuous dosing of itraconazole and terbinafine are well-proven therapies. New data are becoming available on the use of pulse itraconazole dosing, which has recently been approved by the Food and Drug Administration for fingernail infections. These drugs are well tolerated, but attention to drug interactions is necessary with the azoles. CONCLUSIONS: Currently, continuous terbinafine appears to be the most cost-effective drug for dermatophyte onychomycosis. OBJETIVO: Repasar la epidemiología, micología, características clínicas y diagnóstico, farmacoterapia actual, y farmacoeconomía de onicomicosis. FUENTES DE INFORMACIÓN: Se realizó una búsqueda en MEDLINE del 1966 al 1997. Referencias de estos artículos, compañías manufactureras de los antimicóticos discutidos y extractos relevantes de conferencias dermatológicas recientes fueron usados para recoger datos pertinentes. MÉTODOS DE EXTRACCIÓN DE INFORMACIÓN: Los datos fueron obtenidos de estudio controlados y casos reportados publicados. En la sección de farmacoterapia, se dió más importancia a estudios comparativos, controlados, aleatorios, reportados completamente, pero extractos y series de casos fueron descritos cuando estudios bien controlados no estuvieron disponibles. SÍNTESIS: Onicomicosis es un desorden de las uñas común que tiene un impacto sustancial en la calidad de vida de pacientes. Es ocasionada más comúnmente por dermatófitos, pero hongos y mohos también pueden estar envueltos. El diagnóstico se hace a través de la presentación clínica, preparaciones de hidróxido de potasio y cultivo de muestras de tejido/uñas. Griseofulvina fue el fármaco de selección por muchos años, pero su baja proporción de curación y el desarrollo de fármacos nuevos más efectivos ha ocasionado su falta de uso. Alternativas terapéuticas incluyen fluconazol, itraconazol, y terbinafina. La información sobre el uso de fluconazol está limitada a series de casos y reportes. La dosificación continua de itraconazol y terbinafina son tratamientos bien comprobados. Recientemente la Administración de Drogas y Alimentes aprobó el uso de la dosificación de itraconazol en pulso para infecciones de las uñas, y nueva información sobre este uso está siendo disponible. Estos fármacos son bien tolerados pero es necesario prestar atención a las interacciones de fármacos con los azoles. CONCLUSIONES: Al presente, terbinafina en administración continua parece ser el fármaco más costo-efectivo de selección para onicomicosis por dermatófitos. OBJECTIF: Revoir les caractéristiques épidémiologiques, mycologiques, cliniques, et diagnostiques, ainsi que le traitement courant, et les particularités pharmacoéconomiques des mycoses des ongles. SOURCE DINFORMATION: Une recherche informatisée sur MEDLINE a été complétée afin d'identifier la littérature pertinente entre les années 1966 et 1997. On a aussi sondé les références des articles identifiés, les compagnies pharmaceutiques qui produisent les agents antifongiques discutés, ainsi que les abstraits récemment présentes aux conférences dermatologiques. SELECTION D'ETUDES ET DES DONNEES: On a obtenu les données à partir de publications d'études contrôlées et d'observations écrites. Dans la section de la pharmacothérapie, on a mis plus d'emphase sur les études comparatives randomisées et contrôlées. Mais les abstraits et les observations écrites ont été utilisés lorsqu'il n'y avait pas d'études contrôlées. RÉSUMÉ: L'onychomycose est une maladie commune qui a un effet significatif sur la qualité de vie des patients. Le plus fréquemment, elle est causée par des dermatophytes mais les levures peuvent être impliqués. La diagnose est faite à partir de la présentation clinique, avec des préparations d'hydroxide de potassium et des cultures de tissu et des ongles. Malgré que la griséofulvine a été utilisée pour plusieurs années, son efficacité limitée et le développement d'agents nouveaux plus efficaces, ont diminué son utilisation. Le fluconazole, l'itraconazole, et la terbinafine sont des alternatives thérapeutiques. Il n'existe que des observations écrites qui décrivent l'efficacité du fluconazole. L'administration continue de l'itraconazole et de la terbinafine est d'ailleurs bien documentee. Il y a de nouvelles données sur la thérapie intermittente par l'itraconazole, cette méthode d'administration de l'itraconazole a été récemment approuvée par le FDA pour les infections fongiques des ongles. Ces médicaments sont bien tolérés, mais, avec les azoles, l'on doit faire attention aux interactions avec d'autres médicaments. CONCLUSIONS: Présentement, il semble que la terbinafine est le médicament le plus cost-effective pour le traitement des onychomycoses à dermatophytes.

Management of Drug Interactions in Patients with HIV

1997 ◽  
Vol 31 (9) ◽  
pp. 1040-1058 ◽  
Author(s):  
Alice Lin-In Tseng ◽  
Michelle M Foisy
Keyword(s):  
Drug Therapy ◽  
Drug Interactions ◽  
Drug Disposition ◽  
Opportunistic Infections ◽  
Data Extraction ◽  
Management Strategies ◽  
Relevant Information ◽  
Management Options ◽  
Medline Search ◽  
Clinically Significant

Objective To provide a compilation of relevant information on drug interactions to assist healthcare practitioners in managing complex HIV-related pharmacotherapy. Data Sources Information was retrieved via a MEDLINE search (January 1966–December 1996) using MeSH headings “human immunodeficiency virus,” “drug interactions,” and names of medications commonly prescribed for the management of HIV infection and related opportunistic infections. Abstracts of international and national conferences, review articles, textbooks, and references of all articles were also searched. Study Selection and Data Extraction All literature on pharmacokinetic or pharmacodynamic interactions was considered for inclusion. Pertinent information, as assessed by the authors, was selected and summarized for discussion. Data Synthesis Drug disposition and/or pharmacologic effect may be affected either by HIV-related physiologic changes or by the presence of concomitant drug therapy. Modifications in drug selection, dosage, dosing regimen, or route of administration may be needed to avoid or manage drug–disease, drug–drug, or drug-food interactions. Management options may depend on the mechanism and the clinical significance of the interaction, the availability of therapeutic alternatives, patient convenience, and cost restrictions. In the absence of specific data, consideration of pharmacokinetic and pharmacodynamic characteristics to assist practitioners in predicting the likelihood of possible interactions was included. Results A comprehensive table of clinically significant drug interactions is provided. Drug interaction principles and practical management strategies are also discussed. Conclusions The potential for drug interactions is extremely common, given the increasing complexity of managing patients infected with HIV. To avoid compromising therapeutic efficacy or increasing drug toxicity, practitioners need to be aware of potential interactions and are encouraged to use a systematic approach when managing patient drug therapy.

Doesciprofloxacin Interact with Cyclosporine?

1994 ◽  
Vol 28 (1) ◽  
pp. 93-96 ◽  
Author(s):  
Lori L. Hoey ◽  
Kathleen D. Lake
Keyword(s):  
Drug Interaction ◽  
Case Reports ◽  
Data Extraction ◽  
Clear Correlation ◽  
Pharmacokinetic Studies ◽  
Review Of The Literature ◽  
Medline Search ◽  
Pharmacokinetic Profiles ◽  
Immune Mediated ◽  
Study Selection

OBJECTIVE: To provide the reader with a review of the literature that evaluates whether a pharmacokinetic or pharmacodynamic drug interaction exists between ciprofloxacin and cyclosporine. DATA SOURCES: A MEDLINE search was used to identify pertinent review articles, pharmacokinetic studies, and case reports. STUDY SELECTION: As both pharmacokinetic trials and case reports were few in number, all available sources were reviewed. DATA EXTRACTION: A few case reports were reviewed; however, data were extracted primarily from prospective human studies involving cyclosporine pharmacokinetic profiles. DATA SYNTHESIS: Ciprofloxacin has been reported to interact with cyclosporine during concomitant use through an interaction with the cytochrome P-450 system or by additive nephrotoxicity. Because ciprofloxacin may be used to treat a variety of infections in transplant recipients who receive cyclosporine, it is important to determine whether an interaction exists. Although cyclosporine is known to cause nephrotoxicity, only a few reports of ciprofloxacin-induced acute renal failure exist, all involving an immune-mediated interstitial nephritis. Four case reports have suggested a possible pharmacokinetic or pharmacodynamic drug interaction between cyclosporine and ciprofloxacin; however, many pharmacokinetic studies have refuted these reports. Several studies performing cyclosporine pharmacokinetic profiles have documented no increased cyclosporine concentrations, thus supporting the premise that ciprofloxacin does not interact with cyclosporine. CONCLUSIONS: Controlled studies involving cyclosporine pharmacokinetic profiles do not support a pharmacokinetic or pharmacodynamic drug interaction between ciprofloxacin and cyclosporine. Although anecdotal case reports have suggested synergistic nephrotoxicity, no clear correlation can be made. Based on our review of the literature, it can be concluded that cyclosporine and ciprofloxacin may be used together safely at the recommended dosages without increased cyclosporine monitoring.

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

2021 ◽  
Vol 41 (3) ◽  
pp. 261-272
Author(s):  
Chau Wei Ling ◽  
Kamal Sud ◽  
Connie Van ◽  
Syed Tabish Razi Zaidi ◽  
Rahul P. Patel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Case Reports ◽  
Plasma Concentrations ◽  
Case Series ◽  
Therapeutic Drug ◽  
Pharmacokinetic Studies ◽  
Pharmacokinetic Data ◽  
Automated Peritoneal Dialysis ◽  
Final Study ◽  
Drug Plasma

The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.

Drug-Induced Restless Legs Syndrome

2018 ◽  
Vol 52 (7) ◽  
pp. 662-672 ◽  
Author(s):  
Edna Patatanian ◽  
Melanie K. Claborn
Keyword(s):  
Restless Legs Syndrome ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Predisposing Factors ◽  
Drug Induced ◽  
Restless Legs ◽  
Drug Classes ◽  
Study Selection

Objective: To review the literature on drug-induced restless legs syndrome (DI-RLS). Data Sources: The review included a search for English-language literature from 1966 to December 2017 in the MEDLINE, PubMed, and Ovid databases using the following search terms: restless legs syndrome (RLS), periodic limb movement, adverse effects, and drug-induced. In addition, background articles on the pathophysiology, etiology, and epidemiology of RLS were retrieved. Bibliographies of relevant articles were reviewed for additional citations. Study Selection and Data Extraction: All case reports, case series, and review articles of DI-RLS were identified and analyzed. There were only a small number of controlled clinical trials, and most data were from case reports and case series. Results: Several drugs and drug classes have been implicated in DI-RLS, with antidepressants, antipsychotics, and antiepileptics having the most evidence. In addition, RLS may be linked with a number of disorders or underlying predisposing factors as well. Conclusions: The prevalence of RLS is variable and ranges from 3% to 19% in the general population. There are many predisposing factors to RLS, but an emerging body of evidence suggests that there is an association between numerous drugs and RLS.

scholarly journals Antiretroviral drugs and acute pancreatitis in HIV/AIDS patients: is there any association? A literature review

2014 ◽  
Vol 12 (1) ◽  
pp. 112-119 ◽  
Author(s):  
Natalia Mejias Oliveira ◽  
Felipe Augusto Yamauti Ferreira ◽  
Raquel Yumi Yonamine ◽  
Ethel Zimberg Chehter
Keyword(s):  
Acute Pancreatitis ◽  
Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Case Reports ◽  
Case Series ◽  
Antiretroviral Drugs ◽  
Pancreatic Involvement ◽  
Frequent Event ◽  
Hiv Seropositive ◽  
Hiv Aids

In HIV-seropositive individuals, the incidence of acute pancreatitis may achieve 40% per year, higher than the 2% found in the general population. Since 1996, when combined antiretroviral therapy, known as HAART (highly active antiretroviral therapy), was introduced, a broad spectrum of harmful factors to the pancreas, such as opportunistic infections and drugs used for chemoprophylaxis, dropped considerably. Nucleotide analogues and metabolic abnormalities, hepatic steatosis and lactic acidosis have emerged as new conditions that can affect the pancreas. To evaluate the role of antiretroviral drugs to treat HIV/AIDS in a scenario of high incidence of acute pancreatitis in this population, a systematic review was performed, including original articles, case reports and case series studies, whose targets were HIV-seropositive patients that developed acute pancreatitis after exposure to any antiretroviral drugs. This association was confirmed after exclusion of other possible etiologies and/or a recurrent episode of acute pancreatitis after re-exposure to the suspected drug. Zidovudine, efavirenz, and protease inhibitors are thought to lead to acute pancreatitis secondary to hyperlipidemia. Nucleotide reverse transcriptase inhibitors, despite being powerful inhibitors of viral replication, induce a wide spectrum of side effects, including myelotoxicity and acute pancreatitis. Didanosine, zalcitabine and stavudine have been reported as causes of acute and chronic pancreatitis. They pose a high risk with cumulative doses. Didanosine with hydroxyurea, alcohol or pentamidine are additional risk factors, leading to lethal pancreatitis, which is not a frequent event. In addition, other drugs used for prophylaxis of AIDS-related opportunistic diseases, such as sulfamethoxazole-trimethoprim and pentamidine, can produce necrotizing pancreatitis. Despite comorbidities that can lead to pancreatic involvement in the HIV/AIDS population, antiretroviral drug-induced pancreatitis should always be considered in the diagnosis of patients with abdominal pain and elevated pancreatic enzymes.

scholarly journals Manipulative and Manual Therapies in the Management of Patients with Prior Lumbar Surgery: A Systematic Review

2020 ◽  
Author(s):  
Clinton J Daniels ◽  
Zachary A. Cupler ◽  
Jordan A Gliedt ◽  
Sheryl Walters ◽  
Alec L Schielke ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Clinical Decision ◽  
Manual Therapies ◽  
Lumbar Surgery ◽  
Pilot Studies ◽  
Surgical Interventions

Abstract BackgroundThe purpose was to identify, summarize, and rate scholarly literature that describes manipulative and manual therapy following lumbar surgery.MethodsThe review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with PROSPERO. PubMed, Cochrane Database of Systematic Reviews, ICL, CINAHL, and PEDro were searched through July 2019. Articles were screened independently by at least two reviewers for inclusion. Articles included described the practice, utilization, and/or clinical decision making to post surgical intervention with manipulative and/or manual therapies. Data extraction consisted of principal findings, pain and function/disability, patient satisfaction, opioid/medication consumption, and adverse events. Scottish Intercollegiate Guidelines Network critical appraisal checklists were utilized to assess study quality.ResultsLiterature search yielded 1916 articles, 348 duplicates were removed, 109 full-text articles were screened and 50 citations met inclusion criteria. There were 37 case reports/case series, 3 randomized controlled trials, 3 pilot studies, 5 systematic/scoping/narrative reviews, and 2 commentaries. ConclusionThe findings of this review may help inform practitioners who utilize manipulative and/or manual therapies regarding levels of evidence for patients with prior lumbar surgery. Following lumbar surgery, the evidence indicated inpatient neural mobilization does not improve outcomes. There is inconclusive evidence to recommend for or against most manual therapies after most surgical interventions.Trial registrationProspectively registered with PROSPERO (#CRD42020137314). Registered 24 January 2020.

The Contact System

2002 ◽  
Vol 126 (11) ◽  
pp. 1382-1386 ◽  
Author(s):  
Craig S. Kitchens
Keyword(s):  
Antiphospholipid Syndrome ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Meta Analysis ◽  
Factor Xii ◽  
Activity Levels ◽  
Medline Search ◽  
Apparent Association

Abstract Objectives.—To review the literature for conditions, diseases, and disorders that affect activity of the contact factors, and further to review the literature for evidence that less than normal activity of any of the contact factors may be associated with thrombophilia. Data Sources.—MEDLINE search for English-language articles published from 1988 to 2001 and pertinent references contained therein, as well as search of references in recent relevant articles and reviews. Study Selection.—Relevant clinical and laboratory information was extracted from selected articles. Meta-analysis was not feasible because of heterogeneity of reports. Data Extraction and Synthesis.—Evidence for association of altered levels of the contact factors and thrombophilia was sought. A wide variety of disorders is associated with decreased activity of the contact factors; chief among these disorders are liver disease, hepatic immaturity of newborns, the antiphospholipid syndrome, and, for factor XII, being of Asian descent. These disorders are more common than homozygous deficiency. The few series and case reports of thrombophilic events in patients homozygous for deficiency of contact factors are not persuasive enough to support causality. The apparent association between levels consistent with heterozygosity (40%–60% of normal) of any of the contact factors (but especially factor XII) in persons with antiphospholipid antibodies appears to be due to falsely decreased in vitro activity levels of these factors, which are normal on antigenic testing. The apparent association with thrombosis is better explained by the antiphospholipid syndrome than by the modest reduction of the levels of contact factors. Conclusions.—Presently, it is not recommended to measure activity of contact factors during routine evaluation of patients who have suffered venous or arterial thromboembolism or acute coronary syndromes.

Sign in / Sign up

Export Citation Format

Share Document