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PURPOSE: To evaluate the association between spironolactone use and controlled ovarian hyperstimulation (COH) outcomes. METHODS: Retrospective study, including patients who underwent COH. Oocyte yield and maturation rates were compared by categories of spironolactone use at the start of their cycle. RESULTS: 402 patients were included. 83 patients continued spironolactone, 44 patients discontinued spironolactone, and 275 matched control patients were spironolactone-naïve. No difference was observed in the number of oocytes retrieved (17 ± 14 vs. 15 ± 13, p = 0.4) or mature oocytes vitrified (15 ± 9.5 vs. 12 ± 11, p = 0.4) in patients who continued spironolactone use and spironolactone naïve patients, respectively. When comparing patients who continued spironolactone use and patients who discontinued spironolactone use, no difference was seen in the number of oocytes retrieved (17 ± 14 vs. 17.5 ± 7.8, p = 0.9) or mature oocytes vitrified (15 ± 9.5 vs. 13.5 ± 6.5, p = 0.5), respectively. There was no observed relationship between total daily spironolactone dose (< 100mg/day, 100mg/day, 150mg/day and > 200 mg/day) and the total number of mature oocytes vitrified (respectively, 14.0 ± 13.0, 16.0 ± 7.8, 14.0 ± 4.5, 11.0 ± 7.0 oocytes, p = 0.4). CONCLUSIONS: This is the first study to evaluate the association between spironolactone and oocyte yield and maturation rates during COH cycles. These findings can assist in counseling patients on the implications of continuing spironolactone during COH cycle.

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INTRODUCTION: Patients undergoing coronary catheterization are at high risk of developing contrast-induced nephropathy (CIN) acute kidney injury (AKI). Several approaches have been supposed to limit such an effect but with mixed results or non-practical methods. Spironolactone is supposed to be effective as a nephroprotective agent in animal studies. This study will try to measure the effect of spironolactone on the incidence of CIN-AKI in patients undergoing coronary catheterization (angiography angioplasty). METHODS: This study is a single-center, investigator-driven, double-blinded randomized controlled study in Iraq-Basra. More than 400 patients admitted for coronary angio unit in our center will be allocated in a 1:1 ratio to receive either spironolactone 200 mg single dose or placebo in addition to their usual premedication. PLANNED OUTCOMES: Primary end point will be CIN defined as more than 25% or 0.3 mg/dl elevation in serum creatinine (S.Cr.) from baseline during the first 2-3 days after the procedure. We hope to identify or answer an important question regarding CIN in such high-risk patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT03329443.

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BACKGROUND: There is currently much interest in generating more individualized estimates of treatment effects. However, traditional statistical methods are not well suited to this task. Post hoc subgroup analyses of clinical trials are fraught with methodological problems. We suggest that the alternative research paradigm of predictive analytics, widely used in many business contexts, can be adapted to help. METHODS: We compare the statistical and analytics perspectives and suggest that predictive modeling should often replace subgroup analysis. We then introduce a new approach, cadit modeling, that can be useful to identify and test individualized causal effects. RESULTS: The cadit technique is particularly useful in the context of selecting from among a large number of potential predictors. We describe a new variable-selection algorithm that has been applied in conjunction with cadit. The cadit approach is illustrated through a reanalysis of data from the Randomized Aldactone Evaluation Study trial, which studied the efficacy of spironolactone in heart-failure patients. The trial was successful, but a serious adverse effect (hyperkalemia) was subsequently discovered. Our reanalysis suggests that it may be possible to predict the degree of hyperkalemia based on a logistic model and to identify a subgroup in which the effect is negligible. CONCLUSION: Cadit modeling is a promising alternative to subgroup analyses. Cadit regression is relatively straightforward to implement, generates results that are easy to present and explain, and can mesh straightforwardly with many variable-selection algorithms.

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The redox behavior of spironolactone (SP) drug in Britton-Robinson (BR) buffer of pH 2-11 was investigated by differential pulse cathodic stripping voltammetry (DPCSV) and cyclic voltammetry (CV) at hanging mercury dropping electrode (HMDE). At pH 9-10.5, the DPCSV of SP drug showed two cathodic peaks at -1.15 and -1.38 V at the HMDE vs. Ag/AgCl reference electrode. In the CV, at pH 9-10, the dependence of the cathodic peak current, Ip , c and peak potential, Ep,c of the second peak (Ep,c2) on the scan rate (ν) and on the depolizer (SP) concentrations was typical of an electrode coupled (EC) chemical reaction type mechanism. The plot of Ip , c at -1.380 V of the DPCSV vs. SP concentration at pH 9 was linear over the concentration range of 1.2×10-10-9.6×10-7 M. The lower limit of detection (LLOD) and limit of quantification (LOQ) of the drug were 1.1×10-11 and 4.14×10-11 M, respectively. The method was successfully applied for the analysis of SP residues in industrial wastewater, in pure form (98.2±3.1%) and in drug formulations e.g. Aldactone® tablet (98.35±2.9%).The method was validated by comparison with HPLC and the official data methods.

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OBJECTIVE:To study the impacts and safety evaluation of aldactone on six-minute walk test performance in patients with high altitude heart disease and heart failure.METHODS:41 inpatients with high altitude heart disease from Feb.2004 to Jun.2009 were randomly divided into treatment group (n=21) and control group (n=20).Both groups were given captopril,furosemide and digoxin,etc.for three months.Treatment group were additionally treated with aldactone (40～60 mg?d-1).RESULTS:The six-minute walking distances were increased in two groups after the treatment (P0.05).CONCLUSION:Aldactone shows sound effect on improvement of heart functions in patients with high altitude heart disease,at the same time it can improve motor functions and life quality of patients.So it is safe to administer aldactone in a short period.