Aminoglycoside-associated acute kidney injury in elderly patients with and without shock.

OBJECTIVES: Multiresistant Gram-negative pathogens pose major healthcare concerns with a limited therapeutic armamentarium. Aminoglycosides (AG) are under-utilized due to nephrotoxicity. We aimed to evaluate AG-associated acute kidney injury (AG-AKI) in elderly inpatients, with and without shock. METHODS: We examined the incidence and predictors of AG-AKI by KDIGO criteria and extended renal dysfunction (ERD) in patients aged >60 years. ERD represented a composite of hospital mortality or absence of renal recovery over 6 months following AG-AKI. RESULTS: Two hundred and seventy-eight patients (aged 74 ±â€Š8 years) were studied; 43% and 19% received >7 and >10 days of AG therapy, respectively, and 70% gentamicin (versus amikacin). Thirteen per cent had shock and 17% developed AG-AKI. Comparing all patients with shock versus no shock, AG-AKI developed in 33% versus 14%, respectively (P = 0.005); correspondingly among 47 patients with AG-AKI, more with shock had stage 2/3 AKI (92% versus 43%) and dialysis (50% versus 9%) (P < 0.01), but more had other strong AKI confounders than AG therapy alone (83% versus 40%, P = 0.02). Multivariate analyses identified mechanical ventilation, frusemide administration and AG therapy >10 days as predictors of AG-AKI (P < 0.05), whereas shock, pneumonia and frusemide administration predicted more severe stage 2/3 AG-AKI (P < 0.05). Hospital mortality was 30% versus 7% with AG-AKI versus none (P < 0.001). Twenty-three of 211 (11%) patients with extended analysis had ERD, with 47% experiencing renal recovery following AG-AKI. Mechanical ventilation and contrast administration during index hospitalization predicted ERD (P < 0.05). CONCLUSIONS: AG-AKI is common in the elderly, with a significant risk of ERD, but the cause and severity are greatly influenced by critical illness and shock, more so than AG therapy alone.

Biological analysis of constituents in Spatholobi Caulis by UFLC-MS/MS: Enhanced quantification and application to permeability properties study in Caco-2 cell monolayer model.

Major chemical constituents in medicinal materials are often used as the marker compounds of traditional Chinese medicine (TCM) for treating various diseases. For spatholobi caulis (SPC), it contains a variety of flavones, phenolic acid esters, and lignans which exert many pharmacological effects. However, the absorption and permeability properties of these constituents of SPC are still unclear and require further investigation. Different types and major compounds of SPC were chosen as representative constituents to study their absorption and transepithelial transport characteristics in the human intestinal epithelium-like Caco-2 cell monolayer model. 35 constituents of SPC were evaluated by using ultra fast liquid chromatography combined with electrospray ionization triple quadrupole tandem mass spectrometry (UFLC-MS/MS) method, acetonitrile and water containing with 0.5 mM ammonium acetate were used as mobile phase, these analytes with good linear relationships (R2 was within 0.9967-0.9998), precision (CV values were less than 10.23 %, LLOQ was less than 13.69 %), accuracy (Mean of inter- and intra-day were within 85.02 %-111.61 % and 85.50-112.97 %, respectively) and stability (The mean was within 85.07 %-113.93 %), among which 16 analytes showed good permeability, 5 analytes were considered to be poorly permeable compounds, and the other 14 analytes were assigned for the moderately absorbed compounds in Caco-2 cell monolayer model. The further results showed that the absorption mechanism of 7 well absorbed compounds, 8-O-methylretusin (1), genistein (7), spasuberol B (16), naringenin (18), isoliquiritigenin (19), 4-hydroxy-3-methoxy cinnamic acid methyl ester (23) and (+)-epipinoresinol (31) in SPC was mainly passive diffusion, their bidirectional transport rate was correlated with the concentration and transport time. The chemical structures of these compounds could affect the permeability properties on the cell monolayer. This study demonstrated the utility of Caco-2 cell monolayer model for evaluating the absorption properties and initial mechanisms of compounds in SPC in vitro, and provided important basis for predicting oral bioavailability of SPC compounds.

Systematic analysis of the metabolites of Angelicae Pubescentis Radix by UPLC-Q-TOF-MS combined with metabonomics approaches after oral administration to rats.

Angelicae Pubescentis Radix (APR) is a typical Traditional Chinese Medicine (TCM) and has been widely used to treat rheumatism and headache diseases in China. This research aimed to illustrate the metabolites of APR in vivo to lay a foundation for the clinics application. A UPLC-Q-TOF-MS method combined with metabonomics approaches is used to address this objective. The separation was achieved on an Agilent SB-C18 column (1.8 µm, 2.1 × 50 mm) with a gradient elution system (ACN and 0.1 % formic acid-water). An electrospray ionization (ESI) was used for mass spectrometer and operated in a full-scan mode at m/z 100 - 800. The data were collected in the positive ion mode and analyzed by the Masslynx 4.1 and SIMCA 13.0 software. Furthermore, an orthogonal partial least-squares discriminant analysis (OPLS-DA) using SIMCA 13.0 software was applied to investigate the differences between the blank and drug groups in bio-samples of rats (plasma, urine, feces). Totally 213 compounds including 41 prototype ingredients, 107 phase I and 65 phase II metabolites were detected, according to the MS and MS/MS data. Among them, 134 metabolites are potential new compounds.

Systematic analysis of the metabolites of Angelol B by UPLC-Q-TOF-MS after oral administration to rats.

Angelicae Pubescentis Radix (APR), a widely used traditional Chinese medicine (TCM), is mainly used to treat rheumatism and headache diseases. Angelol B is one of the bioactive constituents of APR with significant anti-inflammatory activity. This paper is aimed to illustrate the metabolites of angelol B in vivo. To achieve this objective, a metabolomics approach based on a rapid and accurate UPLC-Q-TOF-MS method was used to detect the metabolites of Angelol B in rat. A gradient elution system (ACN and 0.1% formic acid water) equipped with an Agilent SB-C18 column (1.8 µm, 2.1 mm × 50 mm) to complete the separation. Scanning area at m/z 100.800 operated on an electrospray ionization (ESI). The data were collected in both positive and negative ion mode and analyzed by the Masslynx 4.1 and SIMCA 13.0 software. A total of 31 metabolites including 20 phase I and 11 phase II. metabolites were identified. Their structure and fragmentation process were deduced based on the MS and MS/MS data. All of thirty-one metabolites are new compounds based on the search of SCI-Finder database.

Drug use evaluation of transdermal fentanyl in a tertiary hospital.

OBJECTIVES: The primary objective of the study was to assess the rationale of fentanyl patch initiation and continuation for pain. The secondary objectives were to analyse prescribing pattern between disciplines, monitoring criteria and adverse events profile of fentanyl patch in the inpatient wards for a tertiary hospital. METHODS: A retrospective case series review was undertaken of patients who received transdermal fentanyl for pain from April to June 2013 at the National University Hospital, Singapore. Relevant data were collected from electronic and physical medical records and audit criteria applied for indication, opioid tolerance, dosage regimen, adverse events and monitoring criteria. RESULTS: 40 patients were prescribed fentanyl patches for pain in the study period. 15 patients (62.5%) had one or more problems during initiation of fentanyl patch. Appropriate use during initiation was low with only 9 (38%) patients meeting all the required criteria. Most of the inappropriate use involved a lack of bridging opioids (58%), wrong opioid conversion dose (42%) and use in opioid-naïve patients (42%). In addition, three cases of inappropriate placement were observed. Monitoring for efficacy and adverse effects generally met audit criteria. There was a low incidence of discontinuation (21%) due to its well-tolerated side effect profile. CONCLUSIONS: This study highlighted high incidence of inappropriate initiation of fentanyl patch, and we proposed an in-house guideline to aid physicians in initiating fentanyl patches during admission and to educate nursing staff of the monitoring parameters for efficacy and toxicity.