Overcoming beta-agonist tolerance: high dose salbutamol and ipratropium bromide. Two randomised controlled trials

Objectives. To explore the rebound effects and safety of atropine on accommodation amplitude in slowing myopia progression. Methods. We conducted a meta-analysis to testify proper dosage of atropine in children with myopia. We searched in PubMed, EMBASE, Ovid, and the Cochrane Library up to March 30, 2021. We selected randomised controlled trials (RCTs) that evaluated the efficacy of atropine for controlling myopia progression in children. We performed the inverse variance random-effects model to pool the data using mean difference (MD) for continuous variables. Statistical heterogeneity was assessed using the I2 test. Additionally, we conducted subgroup analyses and sensitivity analyses. Results. Seventeen RCTs involving 2955 participants were included. Myopia progression was significantly less in the atropine group than that of the control group, with MD = 0.38 D per year (95% confidence interval, 0.20 to 0.56). Less axial elongation was shown with MD = −0.19 mm per year (95% CI, −0.25 to −0.12). There was a statistically difference among various doses ( p = 0.00001 ). In addition, 1.0% atropine showed the rebound effect with MD = −0.54 D per year (95% CI, −0.81 to −0.26) and was more effective in the latter six months than in the former one. Less accommodation amplitude was shown in 0.01% atropine. Conclusion. The efficacy of atropine is dose dependent, and 0.01% atropine may be the optimal dose in slowing myopia progression in children with no accommodation dysfunction. A rebound effect is more prominent in high-dose atropine in the former cessation after discontinuation.

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Faculty Opinions recommendation of Pharmacogenetic studies of long-acting beta agonist and inhaled corticosteroid responsiveness in randomised controlled trials of individuals of African descent with asthma.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.741164286.793590339 ◽

2021 ◽

Author(s):

Gerard H Koppelman ◽

Elin Kersten

Keyword(s):

Randomised Controlled Trials ◽

African Descent ◽

Beta Agonist ◽

Controlled Trials ◽

Inhaled Corticosteroid ◽

Long Acting ◽

Randomised Controlled

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Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

Open Heart ◽

10.1136/openhrt-2018-000864 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000864 ◽

Cited By ~ 4

Author(s):

Alexander J Sharp ◽

Nishith Patel ◽

Barney C Reeves ◽

Gianni D Angelini ◽

Francesca Fiorentino

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

High Risk ◽

Coronary Angiography ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Kidney Injury ◽

Controlled Trials ◽

High Dose ◽

Randomised Controlled

ObjectiveQuantify the efficacy of strategies to prevent contrast-induced acute kidney injury (CI-AKI) in high-risk patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI).BackgroundCI-AKI remains a common problem. The renoprotective efficacy of existing pharmacological agents remains uncertain in high-risk populations.MethodsSystematic review and meta-analysis of randomised controlled trials (RCTs) to compare different strategies versus hydration in patients with chronic kidney disease (CKD) undergoing CAG±PCI. Primary outcome was incident CI-AKI. Fixed-effects meta-analyses estimated ORs, 95% CIs and heterogeneity.ResultsForty-eight RCTs were included. Seven pharmacological strategies were evaluated by multiple RCTs and 10 by one RCT each. These had varying risk of bias; >25% of trials were at high risk of performance bias. Five strategies significantly reduced the odds of CI-AKI: N-acetylcysteine (NAC) (27 trials, 5694 participants; OR=0.77, 95% CI 0.65 to 0.91, p=0.002, I2=36%), ascorbic acid (four trials, 759 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.01, I2=0%), statin (two trials, 3234 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.75, I2=0%), trimetazidine (two trials, 214 participants; OR=0.27, 95% CI 0.10 to 0.71, p=0.01, I2=0%) and nicorandil (two trials, 389 participants; OR=0.47, 95% CI 0.23 to 0.94, p=0.03, I2=52%). Theophylline had a similar, but non-significant, effect. A subgroup analysis found that the benefit of NAC was highest in patients requiring a high-contrast dose.ConclusionsSeveral drugs are renoprotective in patients with CKD undergoing CAG±PCI. The evidence is strongest for NAC. We recommend that NAC should be used when a high dose of contrast is anticipated.Trial registration numberPROSPERO registration CRD42014014704.Open Science Framework link: https://osf.io/vxg7d/?view_only=62bad0404b18405abd39ff2ead2575a8

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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

Southern African Journal of Infectious Diseases ◽

10.4102/sajid.v31i3.80 ◽

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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