-
Andes Pediatrica : Revista Chilena de... Jun 2021Second-line drugs for acute asthma, such as salbutamol, magnesium sulfate, and aminophylline, are generally intravenously administered. (Comparative Study)
Comparative Study Randomized Controlled Trial
INTRODUCTION
Second-line drugs for acute asthma, such as salbutamol, magnesium sulfate, and aminophylline, are generally intravenously administered.
OBJECTIVE
To compare the efficacy and safety of using mag nesium sulfate or aminophylline in children who did not respond to initial treatment.
PATIENTS AND METHOD
Randomized clinical trial. Children who did not improve the Modified Pulmonary Index Score (mPSI) receive at random magnesium sulfate (50 mg/kg/single dose) or aminophylline (5 mg/ kg/dose followed by continuous infusion at 1 mg/kg/hour for 3 hours). Primary endpoints were changes in mPSI and oxygen saturation; secondary endpoints: hospitalization rate, need for transfer to the intensive care unit, use of a third intervention, and adverse effects.
RESULTS
131 patients were studied (66 patients in the aminophylline group and 65 MgSO4). The mean age was 5 ± 2.3 years, the demographic and clinical parameters did not differ between the groups. In the group that received magnesium sulfate, the mPSI and oxygen saturation changed significantly in favor from 13.1 ± 1.3 to 4.9 ± 2.5 (p < 0.001) and from 3.3 ± 2.5; (p 0.021), respectively, and their risk of hospital admission (RR 0.68 95% CI [0.56, 0.82]) and of secondary failure (0.16 95% CI 95% [0 , 07; 0.38]) decreased. Only one adverse event (tachycardia) was recorded.
CONCLUSION
The administration of a single dose of magnesium sulfate proved to be more effective and safe than the use of aminophylline as a second- line drug.
Topics: Acute Disease; Aminophylline; Anti-Asthmatic Agents; Asthma; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Emergency Service, Hospital; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Magnesium Sulfate; Male; Severity of Illness Index; Treatment Outcome
PubMed: 34479242
DOI: 10.32641/andespediatr.v92i3.2969 -
Iranian Journal of Otorhinolaryngology Jul 2022Olfactory training is accounted as a significantly beneficial therapy for hyposmia or anosmia. There is some evidence about methylxanthine usage for this issue. In the...
INTRODUCTION
Olfactory training is accounted as a significantly beneficial therapy for hyposmia or anosmia. There is some evidence about methylxanthine usage for this issue. In the present study, we have investigated the effects of topical aminophylline in hyposmic and anosmic patients.
MATERIALS AND METHODS
In this clinical trial study, patients were randomly divided into two groups (n= 20/each), the case group was given aminophylline drops over a three-month period (using the contents of the vial aminophylline in the form of nasal drops, 250 micrograms daily) with olfactory training and the control group was given normal saline drops with olfactory training over a three-month period. The olfactory capacities were assessed before the start and after the completion of treatments using a valid and reliable smell identification test.
RESULTS
In the saline and aminophylline groups, the mean ± SD relative changes in SIT score were 0.55±0.31 and 0.85±0.56, respectively. As a result, the SIT score in the saline group climbed by 55 percent but increased by 85 percent in the aminophylline group. The difference in SIT score between pre- and post-test was meaningful in both groups (P< 0.001). The aminophylline group scored significantly higher according to the marginal longitudinal regression model, adjusting baseline parameters.
CONCLUSIONS
Intranasal aminophylline plus olfactory training significantly improved SIT scores in severe hyposmia or anosmia. Hypothetically, these effects are mediated through changes in cAMP and cGMP.
PubMed: 36035646
DOI: 10.22038/IJORL.2022.64064.3195 -
Clinical Journal of the American... Oct 2021AKI is a common complication after pediatric cardiac surgery and has been associated with higher morbidity and mortality. We aimed to compare the efficacy of available... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
AKI is a common complication after pediatric cardiac surgery and has been associated with higher morbidity and mortality. We aimed to compare the efficacy of available pharmacologic and nonpharmacologic strategies to prevent AKI after pediatric cardiac surgery.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
PubMed/MEDLINE, Embase, Cochrane Controlled Trials Register, and reference lists of relevant articles were searched for randomized controlled trials from inception until August 2020. Random effects traditional pairwise, Bayesian network meta-analyses, and trial sequential analyses were performed.
RESULTS
Twenty randomized controlled trials including 2339 patients and 11 preventive strategies met the eligibility criteria. No overall significant differences were observed compared with control for corticosteroids, fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning in traditional pairwise meta-analysis. In contrast, trial sequential analysis suggested a 80% relative risk reduction with dexmedetomidine and evidence of <57% relative risk reduction with remote ischemic preconditioning. Nonetheless, the network meta-analysis was unable to demonstrate any significant differences among the examined treatments, including also acetaminophen, aminophylline, levosimendan, milrinone, and normothermic cardiopulmonary bypass. Surface under the cumulative ranking curve probabilities showed that milrinone (76%) was most likely to result in the lowest risk of AKI, followed by dexmedetomidine (70%), levosimendan (70%), aminophylline (59%), normothermic cardiopulmonary bypass (57%), and remote ischemic preconditioning (55%), although all showing important overlap.
CONCLUSIONS
Current evidence from randomized controlled trials does not support the efficacy of most strategies to prevent AKI in the pediatric population, apart from limited evidence for dexmedetomidine and remote ischemic preconditioning.
Topics: Acute Kidney Injury; Adrenergic alpha-2 Receptor Agonists; Age Factors; Bayes Theorem; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child, Preschool; Dexmedetomidine; Female; Humans; Infant; Infant, Newborn; Ischemic Preconditioning; Male; Network Meta-Analysis; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 34620647
DOI: 10.2215/CJN.05800421 -
Skin Research and Technology : Official... Feb 2024The review delves into the realm of reducing submental fat, presenting a comprehensive analysis of various lipolytic agents used in plastic surgery and dermatology. The... (Review)
Review
The review delves into the realm of reducing submental fat, presenting a comprehensive analysis of various lipolytic agents used in plastic surgery and dermatology. The introduction establishes the context by defining the key indicators of a youthful neck and emphasizing the significant influence of fat in the aging process, particularly in the submental area. The usage of aminophylline involves subcutaneous injections, facilitating fat breakdown by increasing cyclic adenosine monophosphate and inhibiting adenosine receptors. Hypotonic pharmacologic lipo-dissolution induces fat dissolution via injected compounds under pressure, while lipolytic lymphatic drainage employs hyaluronidase to reduce tissue viscosity, aiding fat circulation. Glycerophosphorylcholine containing choline alfoscerate claims to activate fat metabolism, whereas the utilization of phosphatidylcholine combined with deoxycholate lacks cosmetic approval due to safety concerns. Deoxycholic acid has FDA approval for submental fat reduction, yet its mechanisms remain incompletely understood. Understanding the complex anatomy and mechanisms of lipolytic agents is essential for safe and effective submental fat reduction, despite evolving practices and off-label utilization. Clinical guidelines and references support this discussion, offering insights for safer applications.
Topics: Humans; Adipose Tissue; Deoxycholic Acid; Cosmetic Techniques; Injections, Subcutaneous; Aminophylline; Subcutaneous Fat
PubMed: 38297988
DOI: 10.1111/srt.13601 -
Indian Journal of Critical Care... Oct 2017Capillary leak syndrome is a unique complication that follows Russell's viper envenomation. This syndrome has a very high fatality rate and is characterized by parotid... (Review)
Review
Capillary leak syndrome is a unique complication that follows Russell's viper envenomation. This syndrome has a very high fatality rate and is characterized by parotid swelling, chemosis, periorbital edema, hypotension, albuminuria, hypoalbuminemia, and hemoconcentration. This syndrome is frequently recognized from the southern parts of India, especially from the state of Kerala. It has been postulated that a vascular apoptosis inducing component of Russell's viper venom that is not neutralized by the commercially available anti-snake venom (ASV) is responsible for this complication as it occurs even after adequate doses of ASV administration in most cases. Acute kidney injury often requiring dialysis is invariably present in all patients because of reduced renal perfusion and ischemic acute tubular necrosis as a result of hypotension. Management mainly involves aggressive fluid resuscitation to maintain adequate tissue perfusion. There are no other proven effective treatment modalities, except a few reports of successful treatment with plasmapheresis. Methylprednisolone pulse therapy, terbutaline, aminophylline, and intravenous immunoglobulin are other treatment modalities tried.
PubMed: 29142382
DOI: 10.4103/ijccm.IJCCM_41_17 -
European Journal of Clinical... Oct 2022Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring... (Review)
Review
PURPOSE
Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring emergency department visits. In addition to conventional strategies for SAEs (inhaled β-agonists, anticholinergics, and systemic corticosteroids), another pharmacological option is represented by ketamine. We performed a systematic review to explore the role of ketamine in refractory SAEs.
METHODS
We performed a systematic search on PubMed and EMBASE up to August 12th, 2021. We selected prospective studies only, and outcomes of interest were oxygenation/respiratory parameters, clinical status, need for invasive ventilation and effects on weaning.
RESULTS
We included a total of seven studies, five being randomized controlled trials (RCTs, population range 44-92 patients). The two small prospective studies (n = 10 and n = 11) did not have a control group. Four studies focused on adults, and three enrolled a pediatric population. We found a large heterogeneity regarding sample size, age and gender distribution, inclusion criteria (different severity scores, if any) and ketamine dosing (bolus and/or continuous infusion). Of the five RCTs, three compared ketamine to placebo, while one used fentanyl and the other aminophylline. The outcomes evaluated by the included studies were highly variable. Despite paucity of data and large heterogeneity, an overview of the included studies suggests absence of clear benefit produced by ketamine in patients with refractory SAE, and some signals towards side effects.
CONCLUSION
Our systematic review does not support the use of ketamine in refractory SAE. A limited number of prospective studies with large heterogeneity was found. Well-designed multicenter RCTs are desirable.
Topics: Adrenal Cortex Hormones; Adult; Aminophylline; Anti-Asthmatic Agents; Asthma; Child; Cholinergic Antagonists; Fentanyl; Humans; Ketamine; Multicenter Studies as Topic; Prospective Studies
PubMed: 36008492
DOI: 10.1007/s00228-022-03374-3 -
Revista Brasileira de Terapia Intensiva 2017Patients admitted to an intensive care unit are prone to cumulated fluid overload and receive intravenous volumes through the aggressive resuscitation recommended for... (Review)
Review
Patients admitted to an intensive care unit are prone to cumulated fluid overload and receive intravenous volumes through the aggressive resuscitation recommended for septic shock treatment, as well as other fluid sources related to medications and nutritional support. The liberal liquid supply strategy has been associated with higher morbidity and mortality. Although there are few prospective pediatric studies, new strategies are being proposed. This non-systematic review discusses the pathophysiology of fluid overload, its consequences, and the available therapeutic strategies. During systemic inflammatory response syndrome, the endothelial glycocalyx is damaged, favoring fluid extravasation and resulting in interstitial edema. Extravasation to the third space results in longer mechanical ventilation, a greater need for renal replacement therapy, and longer intensive care unit and hospital stays, among other changes. Proper hemodynamic monitoring, as well as cautious infusion of fluids, can minimize these damages. Once cumulative fluid overload is established, treatment with long-term use of loop diuretics may lead to resistance to these medications. Strategies that can reduce intensive care unit morbidity and mortality include the early use of vasopressors (norepinephrine) to improve cardiac output and renal perfusion, the use of a combination of diuretics and aminophylline to induce diuresis, and the use of sedation and early mobilization protocols.
Topics: Cardiac Output; Child; Diuretics; Fluid Therapy; Humans; Length of Stay; Respiration, Artificial; Resuscitation; Shock, Septic; Vasoconstrictor Agents
PubMed: 28977099
DOI: 10.5935/0103-507X.20170045 -
Renal Failure Dec 2023To investigate the effects of low-dose furosemide and aminophylline on the renal function in patients with septic shock. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To investigate the effects of low-dose furosemide and aminophylline on the renal function in patients with septic shock.
METHODS AND RESULTS
A total of 109 eligible septic shock patients in the intensive care unit were randomly divided into a control group ( = 55) and an intervention group ( = 54). The control group received normal saline, and the intervention group received low-dose furosemide (0.048 mg/kg.h) with aminophylline (0.3 mg/kg.h). The primary outcomes included the levels of serum creatinine (Scr), creatinine clearance rate (Ccr), blood urea nitrogen (BUN), glomerular filtration rate (GFR), and urine output on admission and on days 3, 7 and 14. The secondary outcomes were the sequential organ failure assessment (SOFA) scores, continuous renal replacement therapy (CRRT) time and intensive care unit (ICU) mortality, hospital mortality and 28-day mortality. There were no significant differences in the levels of Scr, Ccr, BUN, or GFR between the two groups, while the urine output was higher in the intervention group on days 3, 7, and 14. Compared with the control group, the SOFA scores, ICU mortality, hospital mortality and 28-day mortality were significantly lower in the intervention group on days 3, 7, and 14, the CRRT time was shorter, and the cumulative fluid balance was lower on days 3 and 7 in the intervention group.
CONCLUSIONS
Although low-dose furosemide and aminophylline have fewer protective effects on the renal function in septic shock patients, they could reduce the CRRT time and improve the prognosis.
Topics: Humans; Aminophylline; Furosemide; Shock, Septic; Glomerular Filtration Rate; Kidney
PubMed: 36856313
DOI: 10.1080/0886022X.2023.2185084 -
Journal of Microscopy and Ultrastructure 2022Electroconvulsive therapy (ECT) is a highly efficacious treatment modality used to produce seizures in patients diagnosed with major depressive disorders and psychotic... (Review)
Review
BACKGROUND
Electroconvulsive therapy (ECT) is a highly efficacious treatment modality used to produce seizures in patients diagnosed with major depressive disorders and psychotic episodes. In general, ECT treatment is successful in most patients; however, in some populations, ECT fails to produce adequate response. Caffeine, theophylline, and aminophylline are documented to augment seizure activity in ECT. By inhibiting adenosine, these medications can improve ECT response rate in a certain patient population. Caffeine and aminophylline have been documented to prolong seizure duration. Theophylline has been shown to improve seizure duration along with decreasing seizure threshold. All of these medications have very minimal side effect profiles. This review will discuss up-to-date evidence on the effects of xanthine derivatives in patients receiving ECT treatment.
METHODS
A literature review of PubMed and EMBASE was performed for related studies.
RESULTS
Eight studies were included in our review. Premedication with caffeine, theophylline, or aminophylline was associated with increased seizure duration in patients suffering from mental disorders and were indicated to manage ECT.
CONCLUSION
Xanthine derivatives prolong seizure duration in patients treated with ECT.
PubMed: 36504593
DOI: 10.4103/jmau.jmau_19_21 -
Drugs in Context 2021Asthma is the most common chronic disease of childhood and a major source of childhood health burden worldwide. These burdens are particularly marked when children... (Review)
Review
BACKGROUND
Asthma is the most common chronic disease of childhood and a major source of childhood health burden worldwide. These burdens are particularly marked when children experience characteristic 'symptom flare-ups' or acute asthma exacerbations (AAEs). AAE are associated with significant health and economic impacts, including acute Emergency Department visits, occasional hospitalizations, and rarely, death. To treat children with AAE, several medications have been studied and used.
METHODS
We conducted a narrative review of the literature with the primary objective of understanding the evidence of their efficacy. We present this efficacy evidence in the context of a general stepwise management pathway for paediatric AAEs. This framework is developed from the combined recommendations of eight established (inter)national paediatric guidelines.
DISCUSSION
Management of paediatric AAE centres around four major care goals: (1) immediate and objective assessment of AAE severity; (2) prompt and effective medical interventions to decrease respiratory distress and improve oxygenation; (3) appropriate disposition of patient; and (4) safe discharge plans. Several medications are currently recommended with varying efficacies, including heliox, systemic corticosteroids, first-line bronchodilators (salbutamol/albuterol), adjunctive bronchodilators (ipratropium bromide, magnesium sulfate) and second-line bronchodilators (aminophylline, i.v. salbutamol, i.v. terbutaline, epinephrine, ketamine). Care of children with AAE is further enhanced using clinical severity scoring, pathway-driven care and after-event discharge planning.
CONCLUSIONS
AAEs in children are primarily managed by medications supported by a growing body of literature. Continued efforts to study the efficacy of second-line bronchodilators, integrate AAE management with long-term asthma control and provide fair/equitable care are required.
PubMed: 34113386
DOI: 10.7573/dic.2020-12-7