Youth sport: Friend or Foe?

Participation in youth sport has been promoted as part of a healthy lifestyle, with benefits for physical fitness, social development, and mental wellbeing. Yet, sport carries an inherent risk of injury, which for young athletes may have both immediate and long-term consequences. Amidst significant public debate about the pros and cons of youth sport, this review considers the physiological, psychological, and social factors that inform decisions around youth sport participation. With particular emphasis on growth and maturation, early sport specialization, and injury prevention, it highlights the unique features of the youth sport environment that can influence lifelong musculoskeletal health and physical activity behaviour. Though there have been few robust, longitudinal studies, current evidence suggests that sport has positive effects on child and adolescent wellbeing when maturity status and training load are managed appropriately.     

Opioids in Acute Coronary Syndromes: Friend or Foe?

Cardiovascular Drugs and Therapy -     

Statins and Renal Disease: Friend or Foe?

The role of statins in the treatment and prevention of cardiovascular diseases, such as coronary artery disease, acute coronary syndromes, diabetes, or stroke, is well established. However, there are still some questions regarding the role of statins in patients with chronic kidney disease (CKD). Dyslipidemia is a known cardiovascular risk factor in individuals without CKD. In these patients, however, the relation of dyslipidemia to cardiovascular risk is complex, and the underlying pathobiological mechanisms are complex. Statins have proven to be highly effective in patients with initial stages of CKD; however, their effects in patients with advanced-stage CKD have been neutral despite a low-density lipoprotein cholesterol–lowering effect. In this review, we summarize the findings of the recent clinical trials of statins in renal disease and make recommendations for our patients.     

Anastomotic Leak and the Loop Ileostomy: Friend or Foe?

Purpose Anastomotic disruption is an uncommon but morbid complication of colon and rectal surgery. This study was designed to evaluate the use of proximal diversion and surgical drainage as an alternative to anastomotic resection in the operative management of patients with anastomotic complications. Methods A retrospective chart review was undertaken of all patients on the colon and rectal surgery service at an academic medical center requiring operative intervention for an anastomotic complication between 1998 and 2005. Demographic data, operative management, morbidity, and mortality were collected and analyzed for each patient. Results Twenty-seven patients with anastomotic leaks were included in the study. Nineteen patients were managed with proximal diversion and surgical drainage, six patients had resection of their anastomosis and creation of an end colostomy, and two patients were treated by primary reanastomosis. There was 0 percent mortality. Sixty-three percent of the patients treated with proximal diversion had restoration of intestinal continuity vs. 33 percent of the patients who had the anastomosis resected. Of the 13 patients treated with proximal diversion who underwent fluoroscopic evaluation, 92 percent were normal without evidence of persistent leak or stricture. Conclusions Based on this retrospective study, proximal diversion without resection of the anastomosis seems to be a safe and effective alternative for the treatment of anastomotic complications. Sepsis is well controlled with limited mortality and there is a high rate of anastomotic salvage. Prospective studies are needed to further delineate the optimal management for this complicated patient population. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.     

Nicotinic Acid Supplementation in the Context of Alcoholic Liver Injury: Friend or Foe?

Li and colleagues (2014) in this issue report that dietary nicotinic acid (NA) supplementation ameliorates ethanol‐induced hepatic steatosis, but a deficiency does not worsen injury induced by alcohol alone. The authors further present some mechanistic insights into the protective role of NA supplementation. Results of this and other previous studies in the context of alcoholic liver injury raise one important question as to what should be an adequate dose of NA that will provide the maximum benefit to hepatic and extrahepatic tissues and with minimum adverse effects.     

Hyperkalemia in heart failure: Foe or friend?

Hyperkalemia is a frequent and sometimes life-threatening condition that may be associated with arrhythmia and cardiac dysfunction in patients with heart failure (HF). High potassium levels in HF represent both a direct risk for cardiovascular complication and an indirect biomarker of the severity of the underlying disease, reflecting neurohormonal activation and renal dysfunction. Evaluating the prevalence and significance of hyperkalemia in HF patients is essential for optimizing the use of potassium sparing agents, such the renin–angiotensin–aldosterone system inhibitors (RAASi) or angiotensin receptor-neprilysin inhibitors and mineralocorticoid receptor antagonists, which represent a well-established cornerstone and life-saving therapy. In this review we discuss recent findings and current concepts related to the epidemiology, pathological mechanisms and implications of hyperkalemia, as well as novel therapeutic approaches to counteract it in patients with HF. The balance between optimizing life-saving potassium sparing medication and minimizing hyperkalemia-associated risk is much needed in patients with HF. Although older potassium-binding agents are associated with serious adverse events, novel potassium-binding drugs are effective in lowering potassium levels and are generally well tolerated. Novel potassium-binding drugs, such as patiromer and sodium zirconium cyclosilicate, may help to optimize therapy in HF and achieve guideline-recommended doses. Hyperkalemia is common in HF patients and is associated with a poorer prognosis and an increased risk of cardiovascular complications: Contrariwise, “moderate” potassium levels go with a better prognosis, while the emergence of new drugs, potassium binders, could allow target doses of RAASi to be achieved.     

Molecular Therapies in Hepatocellular Carcinoma: What Can We Target?

Numerous signaling pathways, such as Ras/Raf/MAPK, have been implicated in hepatic carcinogenesis. There are at least 35 combination therapy studies for advanced stage hepatocellular carcinoma (HCC) ongoing, and numerous reagents are being tested targeting novel signaling cascades. The management of HCC has changed substantially in recent times, and the successful development of sorafenib has prompted further expansion on molecular targeted therapies to potentially inhibit different pathways in hepatocarcinogenesis.     

Cardiac Myosin Activators in Systolic Heart Failure: More Friend than Foe?

Despite the rising prevalence of HF, new evidence-based novel therapies for patients with worsening HF remain lacking, e.g., safe inotropic therapies. Traditional inotropes increase contractility by altering intracellular calcium flux, a pathway that may be responsible for the multitude of adverse effects associated with current options. Omecamtiv mecarbil, a direct myosin activator, increases contractility through a distinct pathway by increasing the proportion of myosin heads that are bound to actin in a high-affinity state. Phase II clinical trials in patients with chronic HF with this agent seem promising. A phase III trial investigating this therapy has not yet been pursued to date.