Search Results (6)

The use of SGLT2 inhibitors (SGLT2is) has been found in large clinical studies to slow the progression of chronic kidney disease (CKD) and to lower the risk of acute kidney injury (AKI). Recent reports suggest that SGLT2is may also reduce the likelihood of developing radiocontrast-associated nephropathy (CAN) following contrast-enhanced imaging and intravascular interventions. This review underscores potential pitfalls and confounders in these studies and calls for caution in adopting their conclusions regarding the safety and renoprotective potency of SGLT2is, in particular in patients at high risk, with advanced CKD and hemodynamic instability undergoing coronary intervention. This caution is particularly warranted since both SGLT2is and contrast media intensify medullary hypoxia in the already hypoxic diabetic kidney and their combination may lead to medullary hypoxic damage, a principal component of CAN. Further studies are needed to evaluate this dispute, particularly in patients at high risk, and to reveal whether SGLT2is indeed provide renal protection or are hazardous during contrast-enhanced imaging and vascular interventions. Full article

Mastocytosis is a myeloproliferative neoplasm characterized by abnormal proliferation and activation of clonal mast cells typically bearing the KITD816V mutation. Symptoms manifest due to the release of bioactive mediators and the tissue infiltration by neoplastic mast cells. Mast cell activation symptoms include flushing, pruritus, urticaria, abdominal cramping, diarrhea, wheezing, neuropsychiatric symptoms, and anaphylaxis. Up to 50% of patients with mastocytosis report a history of provoked and unprovoked anaphylaxis, with Hymenoptera venom and drugs the most common culprits. NSAIDs, antibiotics, vaccines, perioperative medications, and radiocontrast media are often empirically avoided without evidence of reactions, depriving patients of needed medications and placing them at risk for unfavorable outcomes. The purpose of this review is to highlight the most common agents responsible for adverse drug reactions in patients with mastocytosis, with a review of current epidemiology, diagnosis, and management of drug hypersensitivity and Hymenoptera venom allergy. Full article

The development of novel radiocontrast agents, mainly used for the visualization of blood vessels, is still an emerging task due to the variety of side effects of conventional X-ray contrast media. Recently, we have shown that octahedral chalcogenide rhenium clusters with phosphine ligands—Na₂H₁₄[{Re₆Q₈}(P(C₂H₄COO)₃)₆] (Q = S, Se)—can be considered as promising X-ray contrast agents if their relatively high toxicity related to the high charge of the complexes can be overcome. To address this issue, we propose one of the most widely used methods for tuning the properties of proteins and peptides—PEGylation (PEG is polyethylene glycol). The reaction between the clusters and PEG-400 was carried out in acidic aqueous media and resulted in the binding of up to five carboxylate groups with PEG. The study of cytotoxicity against Hep-2 cells and acute toxicity in mice showed a twofold reduction in toxicity after PEGylation, demonstrating the success of the strategy chosen. Finally, the compound obtained has been used for the visualization of blood vessels of laboratory rats by angiography and computed tomography. Full article

Multinuclear complexes of heavy metals, such as tungsten, have demonstrated considerable potential as candidates for advanced radiocontrast agents. Of particular interest is the development of stable non-ionic compounds with high metal content and reasonably low osmolality in solution. Accordingly, we have synthesized a series of neutral W(V) complexes that contain the W₂O₂(µ-O)₂ core and amino acids or disubstituted EDTA derivatives as ligands. The compounds were prepared from the oxalatotungstate(V) complex via a convenient procedure utilizing microwave heating. Their detailed characterization was accomplished by electrospray ionization high-resolution mass spectrometry (ESI-HRMS), ¹H and ¹³C NMR spectroscopy, elemental analysis, and X-ray crystallography. Further experiments to evaluate the utility of the complexes as radiocontrast media were precluded by their poor aqueous solubility. Full article

Hypersensitivity reactions to radiocontrast media seem to be rare in children. Furthermore, the use of radiocontrast media in children remains quite safe in terms of the severity of reactions. Since pediatric guidelines are lacking, the diagnostic workup employed in adults could be adapted to children, taking into account that results have not yet been validated in this age group. Specific protocols for risk stratification and management of severe reactions have been proposed so far. Full article

Although intravenous administration of contrast media may trigger a variety of adverse reactions, sedated patients undergoing computed tomography (CT) scanning usually are not able to report their symptoms, which may delay detection of adverse reactions. Furthermore, changes in vital signs cannot be typically measured during mobile CT scanning, which worsens the situation. We aimed to characterize contrast-related hemodynamic changes that occur during mobile CT scanning and predict sudden hypotension based on subtle but robust changes in the electrocardiogram (ECG). We analyzed the digitized hemodynamic data of 20 consecutive patients who underwent clipping of a cerebral artery aneurysm and contrast-enhanced CT scanning following the surgical procedure. Hemodynamic variables, including ECG findings, invasive blood pressure (BP), pulse oximetry results, capnography findings, cardiac output, and systemic vascular resistance, were monitored simultaneously. We measured morphological changes in ECG-derived parameters, including the R–R interval, ST height, and QRS R-amplitude, on a beat-to-beat basis, and evaluated the correlation between those parameters and hemodynamic changes. After the radiocontrast injection, systolic BP decreased by a median 53 mmHg from baseline and spontaneously recovered after 63 ± 19 s. An increase in QRS R-amplitude (median 0.43 mV) occurred 25 ± 10 s before hypotension developed. The receiver operating characteristic curve showed that a 16% increase in QRS R-amplitude can predict a decrease in systolic BP of >25% (area under the curve 0.852). Increased cardiac output (median delta 2.7 L/min from baseline) and decreased systemic vascular resistance (median delta 857 dyn·s/cm⁵ from baseline) were also observed during hypotension. During mobile CT scanning, profound but transient hypotension can be observed, associated with decreased vascular resistance. Augmentation of QRS R-amplitude from an ECG represents a sensitive surrogate for onset of a hypotensive episode after contrast injection, thereby serving as a simple and continuous noninvasive hemodynamic monitoring tool. Full article