Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

/pdf/canadian-network-for-mood-and-anxiety-treatments-canmat-and-3lm5mpt404.pdf

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61350-6.pdf

Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis

The majority of infants with wheezing have transient conditions associated with diminished airway function at birth and do not have increased risks of asthma or allergies later in life In a substantial minority of infants, however, wheezing episodes are a precursor of future asthma

Asthma and wheezing in the first six years of life

https://www.kidney-international.org/article/S0085-2538(15)54740-6/pdf

Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality.: A collaborative meta-analysis of high-risk population cohorts

Chronic kidney disease is associated with substantial comorbidity including hypertension, cardiovascular disease, anaemia, and renal bone disease. People with chronic kidney disease have a far greater likelihood of cardiovascular death than progression to established renal failure (requiring dialysis or kidney transplantation).1 2 3 4 Chronic kidney disease has been highlighted as a public health problem through the international adoption of the US National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative staging system and because the prevalence of the disease as defined by the staging system has risen from 10% (in 1988-94) to 13% (in 1999-2004) of the non-institutionalised adult US population.5 6 7 The staging system (which comprises five stages, 1-5) defines chronic kidney disease on the basis of either evidence of kidney damage (proteinuria, haematuria, or anatomical abnormality) or an impaired glomerular filtration rate <60 ml/min/1.73 m2, present on at least two occasions over three months or longer. The use of a threshold of estimated glomerular filtration rate, uncorrected for age or sex, to define disease has been rightly criticised.8 Nevertheless, based on this definition, the age standardised prevalence of stages 3-5 of chronic kidney disease was 8.5% in a representative UK population.9 

This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) for identifying and managing chronic kidney disease.

NICE recommendations are based on systematic reviews of the best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets.

### Classification of chronic kidney disease

Because of evidence about differences in risk of adverse outcomes (particularly cardiovascular disease) with declining glomerular filtration rate, stage 3 should be split into two subcategories defined by glomerular filtration rate (table 1 …

/pdf/early-identification-and-management-of-chronic-kidney-2sf7iknpqf.pdf

Early identification and management of chronic kidney disease: summary of NICE guidance

Objective: To establish the long term cumulative prevalenceof asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting with undiagnosed asthma. Design: Prospective study of a cohort of children previously admitted to hospital with pneumonia, followed up by postal questionnaires totheir general practitioners and the children or their parents. Setting: General practices in southwest England. Participants: 78 children admitted to the Royal Devon and Exeter Hospital between 1989 and 1991 with a diagnosis of pneumonia confirmed on independent review of x ray films. Main outcome measures: Any diagnosis of asthma, use of any treatment for asthma, and asthma symptom scores. Results: On the basis of a 100% response rate from general practitioners and 86% from patients or parents, the cumulative prevalence of asthma was 45%. A diagnosis of asthma was associated with a family history of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36; P=0.0002). Mean symptom scores were higher for all children with asthma (mean score 2.4; χ2=14.88; P=0.0001)and for children with asthma not being treated (mean 1.4; χ2=6.2; P=0.01)than for those without asthma (mean 0.2) Conclusions: A considerable proportion of children presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high cumulative prevalence of asthma suggests that careful follow up of such children is worth while. Asthma is undertreated in these children; a structured symptom questionnaire may help to identify and reduce morbidity due to undertreatment.

https://www.bmj.com/content/bmj/320/7248/1514.1.full.pdf

Asthma after childhood pneumonia: six year follow up study

Early identification and management of chronic kidney disease : summary of NICE guidance. Commentary

EDITOR—Recently the Californian Medical Board dismissed a complaint of medical mistreatment brought against Dr E.1 2 The complaint was dismissed because Dr E was superintendent of medical services at Guantanamo. He works for the military.1 2

By dismissing the complaint on these grounds the board has clearly subjugated its authority to the army and legitimised the employment of a modern day state inquisitor. We think that our …

Guantanamo: a call for action: Would GMC dismiss a complaint against Guantanamo doctor?

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Early identification and management of chronic kidney disease: summary of NICE guidance

Asthma after childhood pneumonia: six year follow up study

Early identification and management of chronic kidney disease : summary of NICE guidance. Commentary

Guantanamo: a call for action: Would GMC dismiss a complaint against Guantanamo doctor?