Low-dose or no aspirin administration in acute-phase Kawasaki disease: a meta-analysis and systematic review

2020 ◽  
pp. archdischild-2019-318245
Author(s):  
Ming-Hsiu Chiang ◽  
Hsingjin Eugene Liu ◽  
Jinn-Li Wang
Keyword(s):  
Systematic Review ◽  
Kawasaki Disease ◽  
Acute Phase ◽  
Low Dose ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
High Dose ◽  
Cochrane Central Register ◽  
Factors Affecting ◽  
Standard Mean Difference

ObjectiveTo compare the efficacy of low-dose or no aspirin with conventional high-dose aspirin for the initial treatment in the acute-phase of Kawasaki disease (KD).DesignA meta-analysis and systematic review of randomised control trials and cohort studies.MethodsAll available articles that compared different dosage of aspirin in the acute-phase of KD published until 20 September 2019 were included from the databases of PubMed, Embase and Cochrane Central Register of Controlled Trials Central without language restrictions. Extracted data from eligible studies were reviewed by two authors independently and analysed by using RStudio software.ResultsNine cohorts with a total of 12 182 children were enrolled. We found that low-dose (3–5 mg/kg/day) or no aspirin in the acute-phase KD was associated with reducing the risk of coronary artery lesions (CALs, OR=0.81, 95% CI 0.69 to 0.95). No differences were observed in intravenous immunoglobulin resistance, length of hospital stay and fever days after admission (OR=1.35, 95% CI 0.91 to 1.98; standard mean difference (SMD)=0.17, 95% CI −1.07 to 1.4; SMD=0.3, 95% CI −1.51 to 2.11) in the low-dose/no aspirin subgroup compared with the high-dose (≥30 mg/kg/day) aspirin subgroup. We did not identify any potential factors affecting the homogeneity of CAL risk as well as clinical important effects in all included studies.ConclusionsPrescribing low-dose or no aspirin in the acute-phase of KD might be associated with a decreased incidence of CAL. However, additional well-designed prospective trials are required to support the theory.

scholarly journals Effectiveness and safety of steady versus intermittent high dose vitamin D supplementation for the prevention of falls and fractures among adults: a protocol for systematic review and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027349
Author(s):  
Banaz Al-khalidi ◽  
Joycelyne Efua Ewusie ◽  
Jemila Hamid ◽  
Samantha Kimball
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Institutional Care ◽  
Vitamin D Supplementation ◽  
Controlled Trials ◽  
High Dose ◽  
Cochrane Central Register ◽  
Dosing Schedule

IntroductionClinical trials and systematic reviews of trials involving vitamin D supplementation have mainly focused on defining the optimal amount of vitamin D dosage. However, the comparative effectiveness of different dosing schedules (ie, daily vs bolus dosing schedule) has been largely unexplored; and currently, there is no consensus regarding the optimal vitamin D dosing schedule. Our objective is to conduct a systematic review and network meta-analysis (NMA) to evaluate the comparative effectiveness and safety of steady (eg, daily, weekly) and intermittent high-dose (eg, monthly, yearly) vitamin D dosing schedules; and to determine the effectiveness of the various dosing schedules and combinations of treatments.Methods and analysisWe will conduct a systematic search and review of literature from major medical databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov) involving studies that compare vitamin D supplementation alone or in combination with calcium. Only randomised controlled trials (RCTs) will be considered. We will, however, consider various settings (eg, community, institutional care) and study designs (eg, cluster RCTs, cross-over trials). Our primary outcomes include falls and fractures including hip-fracture and non-vertebral fractures. Secondary outcomes will include muscle strength, physical performance, gait and mobility limitation. A Bayesian NMA will be conducted, and the results will be presented in the form of treatment effect estimates and ranking probabilities, with corresponding CIs. Pairwise meta-analysis will also be conducted for studies reporting head-to-head comparisons. Subgroup analysis will be performed with respect to pre-determined subgroups; including vitamin D status as measured by serum 25-hydroxyvitamin D levels, age and follow-up time. Sensitivity analysis will also be performed with respect to risk of bias.Ethics and disseminationThis study is a systematic review and meta-analysis of published RCTs; therefore, no ethical approval is required. Results will be disseminated through open access peer-reviewed publications.Systematic review registrationPROSPERO CRD42018112662.

Efficacy, tolerability, and safety of low-dose and high-dose baclofen in the treatment of alcohol dependence: A systematic review and meta-analysis

2018 ◽  
Vol 28 (7) ◽  
pp. 795-806 ◽  
Author(s):  
Mimi Pierce ◽  
Arjen Sutterland ◽  
Esther M. Beraha ◽  
Kirsten Morley ◽  
Wim van den Brink
Keyword(s):  
Systematic Review ◽  
Alcohol Dependence ◽  
Low Dose ◽  
Meta Analysis ◽  
High Dose

scholarly journals High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e014171 ◽  
Author(s):  
Peng Li ◽  
Li-ping Qu ◽  
Dong Qi ◽  
Bo Shen ◽  
Yi-mei Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Meta Analysis ◽  
Kidney Injury ◽  
High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

scholarly journals 2225. Are Fluoroquinolones or Macrolides Better for Treating Legionella Pneumonia? A Systematic Review and Meta-Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S759-S760
Author(s):  
Annie S Jasper ◽  
Jackson S Musuuza ◽  
Vanessa W Stevens ◽  
Shantini D Gamage ◽  
Nasia Safdar
Keyword(s):  
Systematic Review ◽  
Clinical Cure ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Legionella Pneumonia ◽  
Standard Mean Difference ◽  
Risk Of Mortality ◽  
Cure Time ◽  
Secondary Outcomes

Abstract Background Reported cases of Legionella pneumonia continue to rise in the United States; with mortality rates of 9–25%. The Infectious Disease Society of America recommends either a fluoroquinolone or azithromycin as the first-line treatment for legionellosis. While treatment of Legionella pneumonia improves outcome, it is uncertain as to which antibiotic offers optimal clinical outcomes. We undertook a systematic review and meta-analysis to compare the effectiveness of fluoroquinolone vs. macrolide monotherapy in Legionella pneumonia. Methods We conducted a systematic search of literature in multiple databases through April 2019. Studies on patients diagnosed with Legionella pneumonia and treated with either antibiotic of interest were included. Mortality was used as the primary outcome to compare fluoroquinolones and macrolides. Secondary outcomes were clinical cure, time to apyrexia, length of hospital stay (LOS), and the occurrence of complications. We estimated pooled odd ratios to compare the odds of death, clinical cure, and complications. The standard mean difference was estimated for LOS and time to apyrexia. We used a random-effects model and estimated heterogeneity using the I2 statistic. We also analyzed the risk of mortality by setting, i.e., intensive care unit (ICU) vs. non-ICU studies. Results Of the 1,583 abstracts reviewed, 20 studies with a total of 3,656 patients met inclusion criteria. The mean age of the population was 60.9 years and 68.5% were men. The mortality rate for patients treated with fluoroquinolones was 7% (102/1454) and 7.7% (125/1615) among those treated with macrolides. The overall pooled odds ratio (OR) assessing mortality risk for patients treated with fluoroquinolones vs. macrolides was 0.95 (95% CI 0.71–1.27, I2 = 0%, p = 0.54). Odds ratios for subgroup analyses were: ICU studies (OR = 1.27, 95% CI: 0.18–9.08, I2 = 45%, p = 0.158); non-ICU studies (OR = 0.96, 95% CI: 0.71–1.32, I2 = 0%, p = 0.616) (figure). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ between fluoroquinolones and macrolides. Conclusion Fluoroquinolones and macrolides were found to have similar effectiveness in treatment of Legionella pneumonia for mortality outcomes. However, insufficient data for secondary outcomes was a limitation of this analysis. Disclosures All authors: No reported disclosures.

scholarly journals High dose vs low dose irradiation of the subventricular zone in patients with glioblastoma—a systematic review and meta-analysis

2019 ◽  
Vol Volume 11 ◽  
pp. 6741-6753
Author(s):  
Sergiu Şuşman ◽  
Daniel-Corneliu Leucuţa ◽  
Gabriel Kacso ◽  
Ştefan loan Florian
Keyword(s):  
Systematic Review ◽  
Subventricular Zone ◽  
Low Dose ◽  
Meta Analysis ◽  
High Dose ◽  
Dose Irradiation

scholarly journals Risk of hypertension with bevacizumab, an antibody against vascular endothelial growth factor A: a systematic review and meta-analysis

2019 ◽  
Vol 8 (10) ◽  
pp. 2354
Author(s):  
Mandar K. Shah ◽  
Mihika A. Shah ◽  
Sharan D. Shah
Keyword(s):  
Systematic Review ◽  
Low Dose ◽  
Meta Analysis ◽  
Concurrent Chemotherapy ◽  
High Dose ◽  
Vascular Endothelial ◽  
Exclusion Criteria ◽  
Increased Risk ◽  
Grade 3 ◽  
Endothelial Growth Factor

Bevacizumab, a humanized antibody against VEGF, is effective in the treatment of patients with many cancers. However, as with many therapeutic agents, significant side effects are associated with bevacizumab, Hypertension is one of the predominant toxicity. We performed a systematic review and meta-analysis of published clinical trials of bevacizumab to quantify the risk of hypertension. 15 studies following PRISMA guidelines and matching inclusion and exclusion criteria were collected in which a group of patients were either treated with Bevacizumab and a concurrent chemotherapy and another group treated with Placebo and the same chemotherapy. Relative risk (RR) was calculated. P<0.05 was considered statistically significant. RevMan 5.3 software was used for the analysis. A total of 13,070 patients were included. Bevacizumab was associated with a significant increased risk of overall hypertension (RR=3.509; 95% C.I:2.451 to 5.023). 11 trials are included for determining the risk of Grade 3 hypertension including 8799 patients with a significant increased risk (RR=3.909; 95%C.I:1.983 to 7.707). 7 trials are included for determining the risk of hypertension at low dose (2.5 mg/kg/cycle) including 3691 patients associated with a significant increased (RR=2.640; 95%C.I: 1.408 to 4.950). 10 trials are included for determining the risk of hypertension at high dose (5 mg/kg/cycle) including 9379 patients associated with a significant (RR=4.036; 95%C.I: 2.948 to 5.525). Our meta-analysis has demonstrated that bevacizumab may be associated with a significantly increased risk of hypertension in patient with a variety of metastatic solid tumors irrespective of dosing.

scholarly journals Efficacy and safety of low-dose versus high-dose hydrocortisone to treat hypotension in neonates: a protocol for a systematic review and meta-analysis

2021 ◽  
Vol 5 (1) ◽  
pp. e001200
Author(s):  
Katelyn Sushko ◽  
Nada Al-Rawahi ◽  
Kristi Watterberg ◽  
John Van Den Anker ◽  
Catherine Litalien ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Critically Ill ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Adrenal Function ◽  
High Dose ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Registration Number

BackgroundImpaired adrenal function is a well-described entity in critically ill term and preterm neonates with systemic hypotension. The standard treatment for neonatal hypotension includes volume expanders and vasopressors. Recent evidence supports the use of glucocorticoids for the primary or rescue treatment of neonatal hypotension associated with impaired adrenal function. However, inconsistency regarding the prescribed dosing regimen to provide the best balance between efficacy and safety in this vulnerable population remains an area of concern.MethodsWe will conduct a systematic review and meta-analysis to evaluate low-dosing compared with high-dosing regimens of hydrocortisone for the treatment of hypotension in critically ill term, preterm and very low birth weight neonates. Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and Web of Science will be searched from inception to November 2021. Study screening and selection will be completed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Our primary outcomes will be (1) an improvement in end-organ perfusion, defined as an increase in blood pressure along with an increase in urine output or a reduction in serum lactate and (2) mortality prior to discharge. Our secondary outcomes will be the development of (1) major neurosensory abnormality, (2) bronchopulmonary dysplasia and (3) the occurrence of adverse events.DiscussionHydrocortisone may be beneficial in the treatment of hypotension associated with impaired adrenal function among critically ill neonates. However, its optimal dosing to balance desired efficacy with the risk of adverse events is yet to be determined. Our systematic review and meta-analysis aims to address this evidence gap, providing valuable knowledge for a large audience, including guideline developers, policy-makers and clinicians.PROSPERO registration numberThis protocol is submitted for registration to the international database of prospectively registered systematic reviews (PROSPERO, awaiting registration number).

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