Mark L. Christensen

Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial

Background Despite concerns that non-steroidal anti-inflammatory drugs (NSAIDs) contribute to acute kidney injury (AKI), up to 75% of ultramarathon runners ingest these during competition. The effect of NSAID on AKI incidence in ultramarathon runners is unclear. Methods Multisite randomised double-blind placebo-controlled trial in the Gobi, Atacama, Ecuador and Sri Lankan deserts to determine whether ibuprofen (400 mg every 4 hours) would be non-inferior to placebo during a 50-mile (80 km) foot race. The primary outcome was incidence of AKI defined as severity categories of ‘risk’ of injury of 1.5× baseline creatinine (Cr) or ‘injury’ as 2× Cr, combined to calculate total incidence at the finish line. Non-inferiority margin for difference in AKI rates was defined as 15%. Results Eighty-nine participants (47% ibuprofen and 53% placebo) were enrolled with similar demographics between groups. The overall incidence of AKI was 44%. Intent-to-treat analysis found 22 (52%) ibuprofen versus 16 (34%) placebo users developed AKI (18% difference, 95% CI –4% to 41%; OR 2.1, 95% CI 0.9 to 5.1) with a number needed to harm of 5.5. Greater severity of AKI was seen with ibuprofen compared with placebo (risk=38% vs 26%; 95% CI –9% to 34%; injury=14% vs 9%; 95% CI –10% to 21%). Slower finishers were less likely to encounter AKI (OR 0.67, 95% CI 0.47 to 0.98) and greater weight loss (−1.3%) increased AKI (OR 1.24, 95% CI 1.00 to 1.63). Conclusion There were increased rates of AKI in those who took ibuprofen, and although not statistically inferior to placebo by a small margin, there was a number needed to harm of 5.5 people to cause 1 case of AKI. Consideration should therefore be taken before ingesting NSAID during endurance running as it could exacerbate renal injury. Trial registration number NCT02272725.

Improvised Method for Increasing the Temperature of an i-STAT Analyzer and Cartridge in Cold Environments

extubated. The patient recovered completely by the seventh day. Follow-up brain MRI was done on the seventh day and revealed moderate T2 and FLAIR hyperintensity in deep white matter, corpus callosum, and posterior limb of the internal capsule. Relatively increased diffusibility was noted on DWI, with near normal appearance in centrum semiovale and reduced restriction in corona radiata and corpus callosum. The patient was discharged on the eighth day, with advice to avoid further induction into high altitude. The most common MRI finding in HACE is that of increased T2 and FLAIR signal in the splenium of the corpus callosum with restricted diffusion, which is completely reversible on recovery. The predominant involvement of white matter without significant gray matter involvement suggests the presence of vasogenic edema. In our case, there was improvement in restricted diffusion, but FLAIR and T2 signal changes were noted to increase and became more prominent in the follow-up scan. Thus, T2 and FLAIR sequences can be used for diagnosis even after clinical recovery, as the vasogenic edema appears to take time to normalize. The diffusion studies and ADC maps in the previous reports show curious findings. In some cases, they are seen to be reversible, and in others they are not. The latter cases often have gliotic changes over time. That suggests the coexistence of both vasogenic and cytotoxic edema in the pathophysiology of the disease process. Our patient had findings of restricted diffusion in the initial scan that normalized in the follow-up scan, suggesting reversal of cytotoxic edema before progression to irreversibility. The vasogenic edema as seen in the FLAIR images persisted, and even resolved in the follow-up study. This finding raises the possibility that DWI and ADC maps can be used as key indicators of response to treatment as well as prognostic markers for future gliotic change. HACE is a life-threatening condition requiring aggressive management, and MRI scans of the brain may provide an understanding of the pathophysiology of the disease process. Involvement of the splenium of the corpus callosum is characteristic. The T2, FLAIR, DWI, and ADC maps are the essential sequences in the study: FLAIR can be used to confirm diagnosis even after clinical normalization of the patient, and DWI and ADC maps may be useful in prognostication of the cases.

Biochemistry in Endeavor Adventure Racers Study (BEARS)@@@Correction

[This corrects the article DOI: 10.7759/cureus.1024.].