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1.
What is bronchopulmonary dysplasia and does caffeine prevent it?
Jensen, EA
Seminars in fetal & neonatal medicine. 2020;(6):101176
Abstract
Bronchopulmonary dysplasia (BPD) is among the most severe complications of very premature birth. Clinical and laboratory studies indicate that lung immaturity, inflammatory lung injury, and disordered lung repair are the primary mechanisms responsible for the development of BPD. Caffeine, initiated within the first 10 days after birth, is one of few drug therapies shown to significantly decrease the risk of BPD in very low birth weight infants. This benefit is likely derived, at least in part, from reduced exposure to positive airway pressure and supplemental oxygen with caffeine therapy. Additional cardiorespiratory benefits of caffeine that may contribute to the lower risk of BPD include less frequent treatment for a PDA, improved pulmonary mechanics, and direct effects on pulmonary inflammation, alveolarization, and angiogenesis. Routine administration of caffeine is indicated in the vast majority of very low birth weight infants. However, current preventative strategies including widespread use of caffeine do not avert BPD in all cases. As such, there is continued need for novel methods to further reduce the risk of BPD in very low birth weight infants.
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2.
National and international guidelines for neonatal caffeine use: Are they evidenced-based?
Eichenwald, EC
Seminars in fetal & neonatal medicine. 2020;(6):101177
Abstract
The Caffeine for Apnea of Prematurity (CAP) trial showed that caffeine was safe when used with standard dosing and provided both pulmonary and neurological benefits to preterm infants. Since its publication almost 15 years ago, the use of caffeine in extremely premature infants in Newborn Intensive Care Units worldwide has increased, with almost all receiving the drug during their hospital stay. Subsequent observational studies suggested that administration of caffeine before 3 days of age may have greater benefits, leading many neonatologists to start caffeine prophylactically in all very low birth weight infants. Several publicly available national and international guidelines on caffeine advocate prophylactic use, and some recommend higher doses than those used in the CAP trial. This article will review the evidence basis for neonatal caffeine therapy in light of these guidelines.
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3.
Are low doses of caffeine as ergogenic as higher doses? A critical review highlighting the need for comparison with current best practice in caffeine research.
Pickering, C, Kiely, J
Nutrition (Burbank, Los Angeles County, Calif.). 2019;:110535
Abstract
Caffeine is a popular and widely consumed sporting ergogenic aid. Over the years, the effects of different caffeine doses have been researched, with the general consensus being that 3 to 6 mg/kg of caffeine represents the optimal dose for most people. Recently, there has been increased attention placed on lower (≤3 mg/kg) caffeine doses, with some research suggesting these doses are also ergogenic. However, a critical consideration for athletes is not merely whether caffeine is ergogenic at a given dose, but whether the consumed dose provides an optimized performance benefit. Following this logic, the aim of this review was to identify a potential oversight in the current research relating to the efficacy of lower caffeine doses. Although low caffeine doses do appear to bestow ergogenic effects, these effects have not been adequately compared with the currently accepted best practice dose of 3 to 6 mg/kg. This methodological oversight limits the practical conclusions we can extract from the research into the efficacy of lower doses of caffeine, as the relative ergogenic benefits between low and recommended doses remains unclear. Here, we examine existing research with a critical eye, and provide recommendations both for those looking to use caffeine to enhance their performance, and those conducting research into caffeine and sport.
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4.
Drug-Induced Hypertension.
Foy, MC, Vaishnav, J, Sperati, CJ
Endocrinology and metabolism clinics of North America. 2019;(4):859-873
Abstract
Untoward side effects of pharmaceuticals can result in considerable morbidity and expense to the health care system. There is likely a sizable fraction of the hypertensive population with disease either induced or exacerbated by polypharmacy. The elevation of blood pressure in drug-induced hypertension occurs through a variety of mechanisms, most notably, sodium and fluid retention, activation of the renin-angiotensin-aldosterone system, alteration of vascular tone, or a combination of these pathways. Recognition of common medications causing drug-induced hypertension is important to effectively control blood pressure. The epidemiology, pathophysiology, and management of these agents are discussed.
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5.
Pharmacologic Treatment of Eating Disorders.
Crow, SJ
The Psychiatric clinics of North America. 2019;(2):253-262
Abstract
Medications are a useful adjunct to nutritional and psychotherapeutic treatments for eating disorders. Antidepressants are commonly used to treat bulimia nervosa; high-dose fluoxetine is a standard approach, but many other antidepressants can be used. Binge eating disorder can be treated with antidepressants, with medications that diminish appetite, or with lisdexamfetamine. Anorexia nervosa does not generally respond to medications, although recent evidence supports modest weight restoration benefits from olanzapine.
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6.
Effect of caffeine on vestibular evoked myogenic potential: a systematic review with meta-analysis.
Souza, MEDCA, Costa, KVTD, Menezes, PL
Brazilian journal of otorhinolaryngology. 2018;(3):381-388
Abstract
INTRODUCTION Caffeine can be considered the most consumed drug by adults worldwide, and can be found in several foods, such as chocolate, coffee, tea, soda and others. Overall, caffeine in moderate doses, results in increased physical and intellectual productivity, increases the capacity of concentration and reduces the time of reaction to sensory stimuli. On the other hand, high doses can cause noticeable signs of mental confusion and error induction in intellectual tasks, anxiety, restlessness, muscle tremors, tachycardia, labyrinthine changes, and tinnitus. OBJECTIVE Considering that the vestibular evoked myogenic potential is a clinical test that evaluates the muscular response of high intensity auditory stimulation, the present systematic review aimed to analyze the effects of caffeine on vestibular evoked myogenic potential. METHODS This study consisted of the search of the following databases: MEDLINE, CENTRAL, ScienceDirect, Scopus, Web of Science, LILACS, SciELO and ClinicalTrials.gov. Additionally, the gray literature was also searched. The search strategy included terms related to intervention (caffeine or coffee consumption) and the primary outcome (vestibular evoked myogenic potential). RESULTS Based on the 253 potentially relevant articles identified through the database search, only two full-text publications were retrieved for further evaluation, which were maintained for qualitative analysis. CONCLUSION Analyzing the articles found, caffeine has no effect on vestibular evoked myogenic potential in normal individuals.
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7.
Analeptic agent from microbes upon cyanide degradation.
Murugesan, T, Durairaj, N, Ramasamy, M, Jayaraman, K, Palaniswamy, M, Jayaraman, A
Applied microbiology and biotechnology. 2018;(4):1557-1565
Abstract
Microbes being the initial form of life and ubiquitous in occurrence, they adapt to the environment quickly. The microbial metabolism undergoes alteration to ensure conducive environment either by degrading the toxic substances or producing toxins to protect themselves. The presence of cyanide waste triggers the cyanide degrading enzymes in the microbes which facilitate the microbes to utilize the cyanide for its growth. To enable the degradation of cyanide, the microbes also produce the necessary cofactors and enhancers catalyzing the degradation pathways. Pterin, a cofactor of the enzyme cyanide monooxygenase catalyzing the oxidation of cyanide, is considered to be a potentially bioactive compound. Besides that, the pterins also act as cofactor for the enzymes involved in neurotransmitter metabolism. The therapeutic values of pterin as neuromodulating agent validate the necessity to pursue the commercial production of pterin. Even though chemical synthesis is possible, the non-toxic methods of pterin production need to be given greater attention in future.
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8.
[Caffeine: traditional and new therapeutic indications and use as a dermatological model drug].
Bors, L, Bajza, Á, Kocsis, D, Erdő, F
Orvosi hetilap. 2018;(10):384-390
Abstract
Coffee consumption had already been described in the 15th century. The spreading of coffee drinking was not only a consequence of its delicious aromatic taste, but also of its pharmacological effects, especially due to its caffeine content. In this review, the mechanisms behind its complex stimulatory effects and the latest studies on the possible new therapeutic indications of caffeine are summarized. Several papers reported the neuroprotective (in Alzheimer's and Parkinson's disease) and hepatoprotective profiles of caffeine, and we show the most promising new results about its preventive properties in dermal malignancies. These findings were described both in cell cultures and in vivo. The application of caffeine and coffee in cosmetology and dermatological products is based on their antioxidant property and on the above-mentioned beneficial effects. Caffeine is also presented here as a dermatological model drug due to its hydrophilic profile. It can be used for designing and comparing different novel drug formulations, although beside the transcellular route, the follicular and transappendageal pathways play also important roles in its skin penetration. Taken together, caffeine molecule has many recently discovered beneficial pharmacological effects, but one should be careful with its excessive consumption. It can result in several adverse events if overdosed and in case of regular intake of high doses, after abandonment, withdrawal symptoms may appear. Orv Hetil. 2018; 159(10): 384-390.
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9.
Caffeine controversies.
Gentle, SJ, Travers, CP, Carlo, WA
Current opinion in pediatrics. 2018;(2):177-181
Abstract
PURPOSE OF REVIEW Caffeine use in preterm infants has endured several paradigms: from standard of care to possible neurotoxin to one of the few medications for which there is evidence of bronchopulmonary dysplasia (BPD) risk reduction. The purpose of the review is to analyze this dynamic trajectory and discuss controversies that still remain after decades of caffeine use. RECENT FINDINGS Following concerns for caffeine safety in preterm infants, a large randomized controlled trial demonstrated a reduction in BPD and treatment for patent ductus arteriosus. The lower rate of death or neurodevelopmental impairment noted at 18-21 months was not statistically different at later timepoints; however, infants in the caffeine group had lower rates of motor impairment at 11-year follow-up. The time of caffeine therapy initiation is now substantially earlier, and doses used are sometimes higher that previously used, but there are limited data to support these practices. SUMMARY Caffeine therapy for apnea of prematurity (AOP) remains one of the pillars of neonatal care, although more evidence to support dosing and timing of initiation and discontinuation are needed.
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10.
Update on treatment for idiopathic hypersomnia.
Evangelista, E, Lopez, R, Dauvilliers, Y
Expert opinion on investigational drugs. 2018;(2):187-192
Abstract
Idiopathic hypersomnia (IH) is a poorly characterized orphan central disorder of hypersomnolence responsible for excessive daytime sleepiness (EDS), prolonged nighttime sleep and sleep inertia that often require long-term symptomatic stimulant medication. To date, no drug has currently the authorization for the treatment of IH patients worldwide. Areas covered: The authors reviewed data on pharmacological treatment of IH obtained from published literature (Medline/PubMed/Web of Science) and Clinicaltrial.gov database from 1997 to 2017. Most of data on treatment of IH derived from observational studies and case series with only three well-designed clinical trials available. Expert opinion: In two recent randomized, double-blind, placebo-controlled trials, modafinil improves EDS in IH. Most of other wakefulness-promoting agents labeled for narcolepsy have similar efficacy in cases series of IH patients. Pitolisant and sodium oxybate show promising results in two retrospective studies. The efficacy of γ-aminobutyric acid-A receptor antagonists on objective EDS needs to be clarified. All these medications are used off-label for the management of EDS in IH. Specific clinical instruments and objective tests are required in IH to better evaluate the severity of EDS and responsiveness to medications, but also prolonged sleep and sleep inertia, to optimize the whole management of IH patients.