Ten patients were treated with conventional dosing (CD) and continuous-infusion (CI) vancomycin therapy in this prospective, randomized, crossover study. Patients were randomized to receive either CD or CI therapy for 2 consecutive days and then crossed over to receive the opposite regimen for 2 days. CD therapy consisted of 1 g of vancomycin every 12 h. CI therapy consisted of a 500-mg loading dose followed by 2 g infused over 24 h. Ten serum samples were obtained on the second day of each therapy for pharmacokinetic and pharmacodynamic analyses. Two clinical isolates of Staphylococcus aureus, one methicillin sensitive (MSSA 1199) and one methicillin resistant (MRSA 494), were chosen for pharmacodynamic evaluation of both regimens. The patient demographics (means +/- standard deviations [SD]) were as follows: sex, six males, four females; age, 36 +/- 11 years; and serum creatinine, 0.72 +/- 0.18 mg/dl. Mean pharmacokinetic parameters +/- SD for CD therapy were as follows: elimination rate constant, 0.16 +/- 0.07 h-1; half-life, 5.6 +/- 3.5 h; volume of distribution, 33.7 +/- 25 liters, 0.5 +/- 0.2 liters/kg; maximum concentration in serum, 53.4 +/- 19.3 micrograms/ml; and minimum concentration, 8.4 +/- 5.9 micrograms/ml. The steady-state concentration for CI was 20.2 +/- 11.1 micrograms/ml. Overall, both regimens resulted in the MIC being exceeded 100% of the time. The mean CD trough serum bactericidal titer (SBT) was 1:8, and the average CI SBTs were 1:16 for both isolates. Even though there was no statistically significant difference between CD trough and CI SBTs, the CI SBTs remained > 1:8 for 100% of the time versus 60% of the time for CD therapy. During CI therapy, 20 and 40% of the patients maintained SBTs of > 1:32 throughout the dosing interval for MSSA 1199 and MRSA 494, respectively. During CD therapy, however, only 10% of patients maintained SBTs of > 1:32 during the entire dosing interval for both isolates. The mean areas under the bactericidal titer-time curve (AUBC24s) +/- SD for MSSA 1199 were 528 +/- 263 for CD therapy and 547 +/- 390 for CI therapy. The mean AUBC24s +/- SD against MRSA 494 were 531 +/- 247 for CD and 548 +/- 293 for CI therapy. Similar to the AUBC24, the mean area under the concentration-time curve for a 24-h dosing interval divided by the MIC (AUC/MIC24) ratios +/- SD were 550.0 +/- 265.7 for CD and 552.6 +/- 373.4 for CI therapy, respectively. No statistically significant differences were found between any of the pharmacodynamic parameters for CD and CI therapy. In addition, no adverse effects with either CD or CI therapy were observed during the study. We conclude that CI and CD vancomycin therapy demonstrated equivalent pharmacodynamic activities. Although CI therapy was more likely to result in SBTs that remained above 1:8 for the entire regimen, the clinical impact of this result is unknown. Serum drug concentration variability was observed with both treatment regimens but to a lesser extent with CI administration. CI administration of vancomycin should be further evaluated to determine the clinical utility of this method of administration.

Schools offer a unique environment to influence children’s physical activity (PA) levels positively. This study aims to systematically review the evidence surrounding how PA affects academic performance by analysing how the frequency, intensity, time, and type of PA mediate academic performance outcomes. This review was conducted using the PRISMA framework. Keyword searches were conducted in Science Direct, PubMed, and SPORTDiscus. Children that were obese, typically developing, typical weight, disabled, with a developmental disability, from a low socio-economic background, or an ethnic minority were included. A total of 19 studies were included, with a total of 6788 participants, a mean age of 9.3 years (50.2% boys, and 49.8% girls). Overall, 63.2% were nondisabled, while 36.8% were diagnosed with a disability. Two authors met, reviewed papers with regard to the inclusion criteria, and agreed on outputs to be included. Evidence suggests that associations between PA and academic performance were primarily positive or nonsignificant. PA levels of 90 min plus per week were associated with improved academic performance, as was PA performed at moderate to vigorous intensity. The optimal duration of PA was 30–60 min per session, whilst various sports induced positive academic effects. Importantly, findings support that PA does not have a deleterious effect on academic performance but can enhance it.

A 45-year-old man with a 15-year history of hypertension was treated with angiotensinconverting enzyme inhibitor (ACEI) monotherapy for the past 8 years. On treatment, his current serum creatinine is 1.1 mg ⁄ dL and the estimated glomerular filtration rate (eGFR) is 79.4 mL ⁄ min ⁄ 1.73 m 2 using the 4-variable Modification of Diet in Renal Disease (MDRD) equation. Does this patient have stage 2 chronic kidney disease (CKD) according to the eGFR? The answer is no, not by the eGFR alone. This patient had a normal urine albumin:creatinine ratio (6 mg ⁄ g) and has no history of kidney injury or damage. Because ACEIs reduce intraglomerular pressure by dilating both afferent and efferent arterioles, less creatinine is filtered from the blood into the urine, elevating the blood creatinine level. For this reason, cystatin C, an alternative measure of renal filtration, was assessed on the same blood draw and found to be 0.65 mg ⁄ L. Equations used to estimate eGFR from cystatin C generated values from 117.0 to 132.9 mL ⁄ min for this patient. Why was the eGFR using cystatin C approximately 40 mL ⁄ min higher than the creatininebased measures? This paper will review the differences between serum creatinine and cystatin C as filtered proteins by the glomerulus and their further processing by the renal tubules. It is possible that cystatin C, based on its different properties, may be a more reasonable measure of renal filtration function in patients on drugs that block the renin-angiotensin system (RAS), particularly in the setting of normal renal function. CASE PRESENTATIONA 45-year-old Caucasian man presented with headaches 15 years ago and was found at age 33 to have a blood pressure level of 160 ⁄ 110 mm Hg. Findings of an evaluation at that time for secondary causes of hypertension with blood and urine testing, 24-hour urine collection, and renal magnetic resonance angiography were unremarkable. Over the following 15 years, the patient made consistent efforts to lose weight, reduce dietary salt and alcohol intake, and improve fitness. He was treated initially with amlodipine 10 mg po qd for 7 years and then was switched to ramipril 10 mg po qd for the next 7 years. Within the last year, he has been taking benazepril 40 mg po qd. Throughout this period the blood pressure has consistently been <130 ⁄ 85 mm Hg. His current physical examination results are unremarkable, and

No abstract

No abstract