scholarly journals Comparison between the Characteristics of Femtosecond laser Anterior Capsulotomy Versus Manual Capsulorhexis and their Effects on Intra Ocular Lens Centration, Effectiveness and Safety in Cataract Surgery

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
D A M Ali ◽  
I I Hamza ◽  
S H Abdelrahman ◽  
T M Abdelaziz
Keyword(s):  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Significant Difference ◽  
Distant Visual Acuity ◽  
Randomised Controlled ◽  
Anterior Capsulotomy ◽  
Iol Centration

Abstract Background Cataract is characterized with opacity of the crystalline lens that can markedly limit the routine activities of patients such as reading, writing, walking and in the long run reduce the quality of life. Cataract is the main cause of preventable blindness. Despite some modern advances in the field of cataract impending drug treatments, surgical treatment is still known to be the most actual treatment option(1). Objective To perform a meta-analysis on the characteristics of femtosecond laser anterior capsulotomy and manual capsulorhexis and their effects on intra ocular lens (IOL) centration, effectiveness and safety in cataract surgery. Methods This meta-analysis was conducted from 1/1/2015 to 31/7/2018. Literature search on PubMed was done to identify randomised controlled trials (RCT) and comparative studies MedCalc ver. 18.2 (MedCalc, Ostend, Belgium) was used for data analysis. Results Of the 17 articles included, there were 3 (18%) randomised controlled trials and 14 (82%) comparative study. The meta-analysis was based on a total of 18558 eyes. Of them, 9442 (50.88%) underwent femtosecond laser-assisted cataract surgery (FLACS) and 9116 (49.12%) underwent manual continuous curvilinear capsulorrhexis (CCC). Comparative study between the 2 groups revealed; highly significant increase in better IOL centration; in FLACS group compared to CCC group (p < 0.01), there is non-significant difference as regards capsulotomy diameter (p > 0.05) and non-significant difference as regards corrected distant visual acuity (CDVA) ,un corrected distant visual acuity (UDVA) and mean absolute error (MAE) (p > 0.05). As regards the complications; fixed-effect model showed highly significant increase in complications rate in FLACS group; but random-effects model showed non-significant difference between the 2 groups (p < 0.001, p > 0.05 respectively). Conclusion FLACS is better for IOL centration, but there is non-significant difference between FLACS and manual CCC as regards capsulotomy diameter, CDVA, UDVA, MAE and complication rate.

Impact of Janus kinase inhibitors on risk of cardiovascular events in patients with rheumatoid arthritis: systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Vol 78 (8) ◽  
pp. 1048-1054 ◽  
Author(s):  
Wenhui Xie ◽  
Yanrong Huang ◽  
Shiyu Xiao ◽  
Xiaoying Sun ◽  
Yong Fan ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Randomised Controlled Trials ◽  
Kinase Inhibitors ◽  
Meta Analysis ◽  
Janus Kinase ◽  
Controlled Trials ◽  
Janus Kinase Inhibitors ◽  
Significant Difference ◽  
Thromboembolism Events ◽  
Randomised Controlled

ObjectivesTo investigate the effect of Janus kinase inhibitors (Jakinibs) on cardiovascular risk in adult patients with rheumatoid arthritis (RA) via a meta-analysis of randomised controlled trials (RCTs).MethodsPubMed, Embase and Cochrane library were thoroughly searched for RCTs reporting safety issues in patients with RA receiving Jakinibs, from inception to October 2018. The primary and secondary outcomes were all cardiovascular events (CVEs) and major adverse cardiovascular events (MACEs)/venous thromboembolism events (VTEs). OR and 95% CI were calculated using the Mantel-Haenszel fixed-effect method.Results26 RCTs randomising 11 799 patients were included. No significant difference was observed regarding all CVEs risk following Jakinibs usage in general (OR 1.04 (0.61 to 1.76), p = 0.89), tofacitinib (OR 0.63 (0.26 to 1.54), p = 0.31), baricitinib (OR 1.21 (0.51 to 2.83), p = 0.66), upadacitinib (OR 3.29 (0.59 to 18.44), p = 0.18), peficitinib (OR 0.43 (0.07 to 2.54), p = 0.35) or decernotinib (OR 1.12 (0.13 to 10.11), p = 0.92). Likewise, there was no significant difference for Jakinibs treatment overall regarding occurrence of MACEs (OR 0.80 (0.36 to 1.75), p = 0.57) or VTEs (OR 1.16 (0.48 to 2.81), p = 0.74). Dose-dependent impact of Jakinibs on the risks of all CVEs, MACEs and VTEs was not observed in tofacitinib (5 mg vs 10 mg), upadacitinib (15 mg vs 30 mg), whereas baricitinib at 2 mg was found to be safer than 4 mg in all CVEs incidence (OR 0.19 (0.04 to 0.88), p = 0.03).ConclusionThe existing evidence from RCTs indicated no significant change in cardiovascular risk for Jakinib-treated patients with RA in a short-term perspective, but postmarketing data are sorely needed to ascertain their cardiovascular safety, especially at the higher dose, due to increased risk of thromboembolism events for both tofacitinib and baricitinib at higher dosage.

scholarly journals Short-term risk of major adverse cardiovascular events or congestive heart failure in patients with psoriatic arthritis or psoriasis initiating a biological therapy: a meta–analysis of randomised controlled trials

RMD Open ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e000763 ◽  
Author(s):  
Bénédicte Champs ◽  
Yannick Degboé ◽  
Thomas Barnetche ◽  
Alain Cantagrel ◽  
Adeline Ruyssen-Witrand ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Events ◽  
Randomised Controlled Trials ◽  
Biological Therapy ◽  
Meta Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Controlled Trials ◽  
Short Term ◽  
Significant Difference ◽  
Randomised Controlled

ObjectiveThe objective was to investigate the short-term risk of major adverse cardiovascular events (MACEs) or congestive heart failure (CHF) in patients with psoriatic arthritis (PsA) or psoriasis initiating a biological therapy.MethodsScreening for the study was carried out using MEDLINE, Cochrane and Embase, from the inception of the database to December 2017. Randomised controlled trials (RCTs) of anti-tumour necrosis factor (TNF), anti-interleukin (IL)12/23, anti-IL23 and anti-IL17 agents for the treatment of PsA or psoriasis were included. Two investigators independently extracted MACEs or CHF data reported during the placebo-controlled phase. The primary outcome measures were the incidence of MACEs or CHF.ResultsOf 753 references screened, 62 articles were selected, and 12 articles were added by manual searches. Accordingly 77 RCTs were included in the meta-analysis (MA) (10 174 patient-years (P-Y)). No significant difference was observed in MACE incidences in patients receiving anti-TNF, anti-IL12/23, anti-IL23 or anti-IL17 agents in comparison to the placebo. However, 10 MACEs were observed in the anti-IL12/23 group (1150 P-Y) compared with 1 in the placebo group (652 P-Y), with 0.01 −0.00 to 0.02 event/P-Y risk difference, which is not statistically significant. This trend was not observed in the anti-IL23 group. No significant difference was observed in CHF incidence in patients receiving biological agents in comparison to placebo.ConclusionThis MA of 77 RCTs did not reveal any significant change in the short-term risk of MACE or CHF in patients with PsA or psoriasis initiating a biological therapy.

Effects of different delivering matrices of β-glucan on lipids in mildly hypercholesterolaemic individuals: a meta-analysis of randomised controlled trials

2020 ◽  
pp. 1-14
Author(s):  
Dengfeng Xu ◽  
Hechun Liu ◽  
Chao Yang ◽  
Hui Xia ◽  
Da Pan ◽  
...  
Keyword(s):  
Randomised Controlled Trials ◽  
Ldl Cholesterol ◽  
Meta Analysis ◽  
Hdl Cholesterol ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Significant Difference ◽  
Liquid Products ◽  
Randomised Controlled

Abstract β-Glucan has been reported for its health benefits on blood lipids in hypercholesterolaemic individuals for years. However, people have paid little attention to the effects of β-glucan in populations with mild hypercholesterolaemia as well as the various delivering matrices. Our objective was to perform a meta-analysis to analyse the effects of β-glucan with different delivering matrices in mildly hypercholesterolaemic individuals. After conducting a comprehensive search in Web of Science, PubMed, Scopus and Cochrane Library, a total of twenty-one randomised controlled trials involving 1120 participants were identified to measure the pooled effect. The overall results indicated that consuming a dose of ≥3 g/d of β-glucan for at least 3 weeks could significantly reduce total cholesterol (TC) (−0·27 mmol/l, 95 % CI −0·33, −0·21, P < 0·001) and LDL-cholesterol (−0·26 mmol/l, 95% CI −0·32, −0·20, P < 0·001) compared with the control group in mildly hypercholesterolaemic individuals, while no significant difference was observed in TAG (−0·03 mmol/l, 95% CI −0·11, 0·06, P = 0·521) and HDL-cholesterol (0·01 mmol/l, 95% CI −0·03, 0·04, P = 0·777). There was evidence for modest unexplained heterogeneity in the meta-analysis. In conclusion, β-glucan can significantly reduce risk factors like TC and LDL-cholesterol for CVD in mildly hypercholesterolaemic individuals; furthermore, it appears that the effects of food matrices with both ‘solid products’ and ‘liquid products’ where β-glucan was incorporated into were ranked as the best way to exert its beneficial properties, while ‘liquid’ and ‘solid’ products were ranked as the second and third positions, respectively.

scholarly journals Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028855 ◽  
Author(s):  
Shicong Lai ◽  
Panxin Peng ◽  
Tongxiang Diao ◽  
Huimin Hou ◽  
Xuan Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Transurethral Resection ◽  
Prospective Studies ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Green Light ◽  
Controlled Trials ◽  
Significant Difference ◽  
Green Light Laser ◽  
Randomised Controlled

ObjectiveTo assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).DesignSystematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.Data sourcesPubMed, EMBASE, the Cochrane Library until October 2018.Eligibility criteriaRandomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH.Data extraction and synthesisPerioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF).Results22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p<0.05). No significant difference in IPSS, Qmax, QoL, PVR or IIEF at 3, 24, 36 or 60 months was identified. There was a significant difference in QoL at 6 months (MD=−0.08; 95% CI −0.13 to −0.02; p=0.007), and IPSS (MD = −0.10; 95% CI −0.15 to −0.05; p<0.0001) and Qmax (MD=0.62; 95% CI 0.06 to 1.19; p=0.03) at 12 months, although these differences were not clinically relevant.ConclusionPVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.

scholarly journals Impact of levothyroxine in women with positive thyroid antibodies on pregnancy outcomes: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043751
Author(s):  
Lorraine Lau ◽  
Jamie L Benham ◽  
Patricia Lemieux ◽  
Jennifer Yamamoto ◽  
Lois E Donovan
Keyword(s):  
Systematic Review ◽  
Preterm Delivery ◽  
Pregnancy Outcomes ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Significant Difference ◽  
Randomised Controlled

ObjectiveTo evaluate the effect of levothyroxine therapy on pregnancy outcomes compared with placebo or no treatment in women without overt hypothyroidism with presence of thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb).DesignSystematic review and meta-analysis of randomised controlled trialsStudy eligibility criteriaPrespecified criteria for inclusion were: randomised trials of levothyroxine versus control (placebo or no treatment) among women with positive TPOAb or TgAb who were pregnant or considering conception.Data sourcesOvid MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched from 1980 to 5 November 2020.Outcome measuresPrespecified data elements were extracted and where appropriate, meta-analyses were conducted. Main outcomes include pregnancy achieved, miscarriage, preterm delivery and live birth.Risk of bias assessmentCochrane Risk of Bias Tool for Quality Assessment of Randomised Controlled Trials.ResultsFrom 3023 citations, 79 citations were identified for full-text review. Of these, six trials (total of 2263 women) were included for qualitative and quantitative analyses. Risk of bias was deemed low for only one trial. There was no significant difference in the relative risk (RR) of pregnancy achieved (RR 1.03; 95% CI 0.93 to 1.13), miscarriage (RR 0.93; 95% CI 0.76 to 1.14), preterm delivery (RR 0.66; 95% CI 0.39 to 1.10) or live births (RR 1.01; 95% CI 0.89 to 1.16) in thyroid autoimmune women treated with levothyroxine compared with controls. Sensitivity analyses of preterm birth identified study quality and timing of levothyroxine initiation as sources of heterogeneity.ConclusionsAmong pregnant women or women planning conception, with thyroid autoimmunity, there is a lack of evidence of benefit for levothyroxine use (moderate to high Grading of Recommendations, Assessment, Development and Evaluations). Recommendations to use levothyroxine in this setting need to be reconsidered.PROSPERO registration numberCRD42019130459.

scholarly journals M89. PHARMACOLOGICAL INTERVENTIONS FOR SMOKING CESSATION AMONG PEOPLE WITH SCHIZOPHRENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S168-S168
Author(s):  
Dan Siskind ◽  
Brian Wu ◽  
Tommy Wong ◽  
Steve Kisely
Keyword(s):  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Evidence Based ◽  
Smoking Abstinence ◽  
Pharmacological Interventions ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Meta Analyses

Abstract Background People living with schizophrenia are 3 times more likely to smoke than the general population, and have fewer and less successful quitting attempts. In concert with psychosocial quit interventions, there is a need for evidence based pharmacological interventions to assist people living with schizophrenia achieve smoking abstinence. Methods We systematically searched PubMed, PsycInfo, EMBASE and Cochrane for randomised controlled trials of pharmacological interventions for reducing smoking among people living with schizophrenia. We conducted pairwise and network meta-analyses of effectiveness of interventions for achieving abstinence and reduction in smoking. We also examined psychiatric and physical adverse events of interventions. Results Nineteen studies were included in the systematic review. Data was available for buproprion, varenicline and nicotine replacement therapy (NRT). Buproprion (RR 3.4, 95%CI 1.6–7.3, p=0.002), varenicline (RR 3.8, 95%CI 2.0–7.2, p&lt;0.001) and NRT (RR 4.3, 95%CI 1.7–10.7, p=0.002) were all associated with increased rates of abstinence in pairwise meta-analyses. In a network meta-analysis varenicline was superior to buproprion (RR 2.0, 95%CI 1.0–3.9), however there was no statistically significant difference between varenicline and NRT or buproprion and NRT. Varenicline was associated with higher rates of nausea than placebo. Discussion Buproprion, varenicline and NRT were all superior to placebo for achieving abstinence. Varenicline appears to be superior to buproprion for achieving abstinence, however varenicline is associated with higher rates of nausea.

scholarly journals Effect of ranolazine on glycaemia in adults with and without diabetes: a meta-analysis of randomised controlled trials

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000706
Author(s):  
Ik Hur Teoh ◽  
Moulinath Banerjee
Keyword(s):  
Glycaemic Control ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Chronic Stable Angina ◽  
Controlled Trials ◽  
Haemoglobin A1c ◽  
Significant Difference ◽  
Mean Differences ◽  
Randomised Controlled ◽  
Meta Analyses

BackgroundRanolazine is an antianginal drug reported to have hypoglycaemic effects.ObjectivesTo assess the effect of ranolazine versus placebo on glycaemic control for adults with and without diabetes.MethodsA systematic search of seven databases was conducted to identify all randomised controlled trials that compared the effect of ranolazine versus placebo on haemoglobin A1c (HbA1c) and/or fasting plasma glucose (FPG) and/or incidence of hypoglycaemia. We used mean differences in HbA1c and FPG to express intervention effect estimates and analysed the data with random-effects model for meta-analyses using Revman 5.3.ResultsWe identified seven trials including 6543 subjects to assess the effect of ranolazine on HbA1c and/or FPG. A separate trial that included 944 subjects was included to assess the effect of ranolazine on hypoglycaemia. The change in HbA1c for all patients was −0.36% (95% CI −0.57% to −0.15%; p=0.0004, I2=78%). In patients with diabetes, the change in HbA1c was −0.41% (95% CI −0.58% to −0.25%; p<0.00001, I2=65%). There was no significant difference in FPG between ranolazine and placebo groups (−2.58 mmol/L, 95% CI −7.02 to 1.85; p=0.25; I2=49%) or incidence of hypoglycaemia between ranolazine and placebo groups (OR 1.70, 95% CI 0.89 to 3.26; p=0.61, I2=0%).ConclusionsOur meta-analytic findings support the fact that ranolazine improves HbA1c without increasing the risk of hypoglycaemia. It therefore has a potential of having an additional benefit of improving glycaemic control in patients with chronic stable angina and diabetes.

scholarly journals Efficacy and Safety of Oral Herbal Drugs Used as Adjunctive Therapy for Melasma: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Qingti Tang ◽  
Hongjie Yang ◽  
Xiarong Liu ◽  
Yu Zou ◽  
Xintong Lv ◽  
...  
Keyword(s):  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Complementary Therapy ◽  
Controlled Trials ◽  
Herbal Drugs ◽  
Efficacy And Safety ◽  
Female Patients ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Routine Therapy

Background. Melasma is an acquired disorder of facial pigmentation. Its etiology is multifactorial; thus, the management is usually challenging. As a complementary therapy, herbal drugs are often used in the management of melasma. This work was aimed to investigate the efficacy and safety of herbal drugs on melasma in female patients. Methods. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted, and all randomised controlled trials (RCTs) on the use of oral herbal drugs as complementary therapy for melasma in female patients were included. A meta-analysis was conducted according to the guidelines of the Cochrane Collaboration using Review Manager 5.4. Results. Ten eligible trials, with 1015 female melasma patients, were included. All of the included RCTs had some concerns for risk of bias for different reasons, especially for that most of included trials were unblinded. Pooled data suggested phytotherapy plus routine therapy had significantly better efficacy on melasma than routine therapy, in terms of response rate (OR: 4.49, 95% CI: 3.25 to 6.20, p < 0.00001 ), reduction of skin lesion score (SMD: −0.56, 95% CI: −0.79 to −0.33, p < 0.00001 ), and improvement of serum E2 levels (SMD: −1.58, 95% CI: −2.62 to −0.55, p 0.003). In addition, there was no significant difference in the incidence of AEs between phytotherapy plus routine therapy and routine therapy (OR: 0.92, 95% CI: 0.53 to 1.58; p 0.76). Overall, herbal drugs used as an adjunct to routine therapy significantly enhanced the efficacy for the treatment of melasma but with a comparable safety profile. Conclusion. These findings have implications for recommending herbal drugs as a viable complementary treatment option for melasma.

scholarly journals Efficacy and Safety of Isotonic and Hypotonic Intravenous Maintenance Fluids in Hospitalised Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 785
Author(s):  
Norfarahin Hasim ◽  
Mimi Azliha Abu Bakar ◽  
Md Asiful Islam
Keyword(s):  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Hypotonic Solution ◽  
Medical Patients ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Randomised Controlled

Hyponatraemia is a known complication in hospitalised children receiving maintenance intravenous fluid. Several studies have been published to investigate the efficacy and safety of intravenous fluids in children. However, there is still an ongoing debate regarding the ideal solution to be used in the paediatric population. Therefore, the aim of this meta-analysis was to investigate the safety and efficacy of administering isotonic versus hypotonic intravenous maintenance fluid in hospitalised children. An extensive search was undertaken on PubMed, Web of Science, Scopus, ScienceDirect, Google Scholar and Cochrane Library on 28 December 2020. Only randomised controlled trials (RCTs) were included. We used the random-effects model for all analyses. Risk ratio (RR) and mean difference with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. The quality of each study was assessed using the Joanna Briggs Institute critical appraisal tool for RCTs. This study is registered with PROSPERO (CRD42021229067). Twenty-two RCTs with a total of 3795 participants were included. The studies encompassed surgical and medical patients admitted to intensive care unit as well as to general wards. We found that hypotonic fluid significantly increases the risk of hyponatremia at both ≤24 h (RR 0.34; 95% CI: 0.26–0.43, p < 0.00001) and >24 h (RR 0.48; 95% CI: 0.36–0.64, p < 0.00001). Isotonic fluid increases the risk of hypernatraemia at ≤24 h (RR 2.15; 95% CI: 1.24–3.73, p = 0.006). The prevalence of hyponatraemia was also higher in the hypotonic group at both ≤24 h (5.7% vs. 23.3%) and >24 h (6.0% vs. 26.3%). There was no statistically significant difference in the risk of developing adverse outcomes between the two groups. Mean serum and urine sodium as well as serum osmolality/osmolarity was lower in the hypotonic group. Isotonic solution is protective against the development of hyponatraemia while hypotonic solution increases the risk of hyponatraemia.

scholarly journals Efficacy of antimicrobial lock solutions in preventing catheter-related blood stream infection in haemodialysis patients: a systematic review and meta-analysis of prospective randomised controlled trials

2016 ◽  
Vol 31 (3) ◽  
pp. 95-102
Author(s):  
Ahmad M. Yakasai ◽  
Hamza Muhammad ◽  
Garba Iliyasu ◽  
Aisha M. Nalado ◽  
Mahmood M. Dalhat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Low Dose ◽  
Blood Stream Infection ◽  
Meta Analysis ◽  
Blood Stream ◽  
Controlled Trials ◽  
High Dose ◽  
Significant Difference ◽  
Randomised Controlled

Background: Catheter-related blood stream infection (CRBSI) contributes to morbidity and mortality among patients on haemodialysis (HD). We carried out a systematic review and meta-analysis to assess the efficacy of antimicrobial lock solutions (ALS) in preventing CRBSI.Method: Electronic search of randomised controlled trials (RCTs) comparing ALS with other agents was performed up to January 2013. DerSimonian and Laird meta-analysis was performed to obtain pooled relative risk (RR) from which efficacy of ALS and numbers needed to treat (NNT) were calculated. In a restricted analysis, pooled RRs where compared using a test of interaction to calculate ratio of relative risks (RRR). Meta-regression analysis was employed to explore sources of heterogeneity.Results: Sixteen RCTs involving 2016 individuals met the inclusion criteria. The efficacy of ALS in preventing CRBSI was 80% with NNT of 3 patients to prevent one CRBSI. The RR of CRBSI was significantly lower with ALS compared with heparin-only lock solution [RR {95% confidence interval (CI)} = 0.20 (0.13-0.31)]. With low dose (≤ 5 mg/ml) and high dose (40 mg/ ml) gentamicin-containing ALS, the RR (95% CI) of developing CRBSI was 0.03 (0.01-0.13) and 0.18 (0.03-0.98), respectively, with no significant difference [RRR (95% CI) = 0.2 (0.02-1.61), p = 0.126]. Heterogeneity was explained by a statistically significant association between rate of CRBSI and catheter days (p = 0.037). Conclusion: ALS are effective in preventing CRBSI. Low dose gentamicin should be preferred over high dose gentamicin as an ALS because it offers similar benefit in preventing CRBSI with lesser risk of toxicity from systemic leakage and subsequent development of drug resistance.

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