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Intensive Care Medicine Jan 2001To assess the current use of low-dose dopamine (< 5 microg/kg per minute) to improve renal function and urine volume (UV) in neonatal (NICU) and pediatric (PICU)... (Review)
Review
OBJECTIVES
To assess the current use of low-dose dopamine (< 5 microg/kg per minute) to improve renal function and urine volume (UV) in neonatal (NICU) and pediatric (PICU) intensive care units, and to assess the available evidence to support this practice.
DESIGN
A written survey was used to assess the current use of low-dose dopamine among all 19 NICUs and PICUs in the Netherlands. In addition, a review of the literature of clinical intervention studies in which low-dose dopamine was administered to improve renal function and UV was performed.
METHODS
The clinical intervention studies focused on preterm neonates, critically ill infants and children, and those who underwent cardiac surgery. Either creatinine clearance or glomerular filtration rate and increase in UV were used to measure renal function improvement.
RESULTS
Our survey showed that among the 19 NICUs and PICUs, dopamine is regularly used either to improve renal function (n = 7) or to enhance UV (n = 13). The literature review identified seven clinical studies. Of these only one was a randomized controlled trial in preterm neonates, and this showed no positive correlation between renal function and UV. The other studies were uncontrolled experiments in preterm infants that claimed positive effects on UV (n = 5) and creatinine clearance (n = 2).
CONCLUSIONS
The widespread use today of low-dose dopamine in Dutch NICUs and PICUs is not supported in the literature. Evidence from well performed clinical studies to support the use of low-dose dopamine for improving renal function and UV in critically ill neonates and children is largely insufficient. In view of adverse effects, the use of low-dose dopamine in neonatal and pediatric intensive care patients should be reconsidered.
Topics: Cardiac Surgical Procedures; Cardiotonic Agents; Child; Dopamine; Humans; Infant; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Intensive Care Units, Pediatric; Kidney Diseases; Netherlands; Postoperative Care; Treatment Outcome
PubMed: 11280636
DOI: 10.1007/s001340000775 -
Medicine Mar 2020The association of resting heart rate (RHR) and hypertension in adults is unclear. We aimed to perform a meta-analysis of cohort studies to clarify the association. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The association of resting heart rate (RHR) and hypertension in adults is unclear. We aimed to perform a meta-analysis of cohort studies to clarify the association.
METHODS
We searched PubMed and Embase from their inception to November 3, 2017, for published articles. We used a random effects model to combine study-specific relative risks (RRs) and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose-response relationship.
RESULTS
Nine cohort articles (12 independent studies) with 79,399 individuals and more than 26,380 incident cases of hypertension were included. The summary RR for hypertension was 1.09 (95% CI: 1.06-1.13) with each 10 bpm increment in RHR. The cubic spline model suggested that when compared with 55.5 beats per minute, the risk of hypertension significantly increased with increasing levels of RHR (Pnonlinearity = 0.059).
CONCLUSION
We found a linear dose-response association between RHR and incident hypertension in adults.
Topics: Adult; Cohort Studies; Dose-Response Relationship, Drug; Heart Rate; Heart Rate Determination; Humans; Hypertension; Risk Factors
PubMed: 32150086
DOI: 10.1097/MD.0000000000019401 -
Vaccine May 2020The prevalence of co-infection of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is high and increases risk of hepatitis B chronicity and mortality.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The prevalence of co-infection of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is high and increases risk of hepatitis B chronicity and mortality. Despite guidelines for HIV-infected patients to be immunized against HBV, the immunogenicity of the HBV vaccination in HIV-infected patients is lower than that in the HIV-seronegative population.
METHOD
In this study, we performed a systematic review of the literature and meta-analysis of randomized clinical trials to investigate the response rate to an increased dose of HBV vaccination in HIV-infected patients. A fixed-effects model, with heterogeneity and sensitivity analyses, was used. We identified nine studies involving 970 HIV-positive vaccine recipients.
RESULTS
The study results were divided into two groups, depending on the time when antibody against hepatitis surface antigen was measured. Results showed a significant increase in response rates among patients who received a double dose of the vaccine versus the standard dose in both subgroups; the pooled odds ratio (OR) was 1.76 (95% confidence interval [CI]: 1.36-2.29) and 2.28 (95% CI: 1.73-3.01) for the rate that was measured 4-6 weeks and >12 months after completion of vaccination, respectively. The total OR was 1.99 (95% CI: 1.64-2.41). No heterogeneity was found.
DISCUSSION
Our meta-analysis shows that a double dose of the HBV vaccine may significantly improve the immune response in HIV-infected patients. Higher immunogenicity was observed, when it was measured 4-6 weeks and >12 months after completion of the vaccination.
Topics: Coinfection; Dose-Response Relationship, Immunologic; HIV Infections; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Vaccines; Humans; Immunity; Immunogenicity, Vaccine
PubMed: 32334887
DOI: 10.1016/j.vaccine.2020.04.022 -
Tidsskrift For Den Norske Laegeforening... Mar 2015Prostate cancer is a radiosensitive type of cancer for which radiotherapy is used for both curative and palliative purposes. Low-dose-rate brachytherapy is an internal... (Review)
Review
BACKGROUND
Prostate cancer is a radiosensitive type of cancer for which radiotherapy is used for both curative and palliative purposes. Low-dose-rate brachytherapy is an internal radiotherapy technique which allows high doses of radiation to be delivered to a tumour at short range and with a high degree of precision. We have conducted a systematic review of the evidence base for this treatment. The method is not established in Norway.
METHOD
This review is based on systematic review articles and publications on treatment, outcomes, adverse effects and health economics considerations found by searching the databases Cochrane Library, Current Controlled Trials, Medline, Embase and NICE (National Institute of Clinical Excellence).
RESULTS
Subsequent to long-term observations of the efficacy, adverse effects and costs presented in 43 selected studies, including one randomised, controlled trial, there is still uncertainty as to which of the three methods low-dose brachytherapy, external radiotherapy and radical prostatectomy is optimal. The reason for this is the methodological differences in patient selection and in endpoints such as biochemical disease-free interval and cause-specific survival. The evidence base appears to suggest that low-dose-rate brachytherapy causes more frequent grade 2 and 3 doctor-reported urogenital adverse effects than prostatectomy, but better patient-reported sexual functions and fewer patients with urinary incontinence than after surgery. Low-dose-rate brachytherapy appears to be socioeconomically cost-effective.
INTERPRETATION
The evidence base with respect to therapeutic effect and toxicity in men with low-risk prostate cancer treated with low-dose brachytherapy is regarded as solidly documented. However, there are no good prospective randomised multi-centre trials with overall survival as an endpoint.
Topics: Brachytherapy; Cost-Benefit Analysis; Disease-Free Survival; Erectile Dysfunction; Humans; Male; Prostatic Neoplasms; Treatment Outcome; Urinary Incontinence
PubMed: 25806763
DOI: 10.4045/tidsskr.13.1404 -
Pediatric Pulmonology Dec 2020The benefits of metered-dose inhalers with a spacer (MDI+S) have increasingly been recognized as an alternative method of albuterol administration for treating pediatric... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVES
The benefits of metered-dose inhalers with a spacer (MDI+S) have increasingly been recognized as an alternative method of albuterol administration for treating pediatric asthma exacerbations. The aim of this systematic review was to compare the response to albuterol delivered through nebulization (NEB) with albuterol delivered through MDI+S in pediatric patients with asthma exacerbations.
METHODS
We conducted an electronic search in MEDLINE/PubMed, EMBASE, Ovid, and ClinicalTrials. To be included in the review, a study had to a randomized clinical trial comparing albuterol delivered via NEB versus MDI+S; and had to report the rate of hospital admission (primary outcome), or any of the following secondary outcomes: oxygen arterial saturation, heart rate (HR), respiratory rate (RR), the pulmonary index score (PIS), adverse effects, and need for additional treatment.
RESULTS
Fifteen studies (n = 2057) met inclusion criteria. No significant differences were found between the two albuterol delivery methods in terms of hospital admission (relative risk, 0.89; 95% confidence interval [CI], 0.55-1.46; I = 32%; p = .65). There was a significant reduction in the PIS score (mean difference [MD], -0.63; 95% CI, -0.91 to -0.35; I = 0%; p < .00001), and a significantly smaller increase in HR (better; MD -6.47; 95% CI, -11.69 to -1.25; I = 0%; p = .02) when albuterol was delivered through MDI+S than when it was delivered through NEB.
CONCLUSIONS
This review, an update of a previously-published meta-analysis, showed a significant reduction in the PIS and a significantly smaller increase in HR when albuterol was delivered through MDI+S than when it was delivered through NEB.
Topics: Acute Disease; Administration, Inhalation; Albuterol; Asthma; Bronchodilator Agents; Child; Disease Progression; Humans; Nebulizers and Vaporizers; Randomized Controlled Trials as Topic; Respiratory Sounds
PubMed: 32940961
DOI: 10.1002/ppul.25077 -
Vaccines Dec 2022Considering the indeterminate effects following the administration of three doses of the SARS-CoV-2 vaccine to patients under dialysis, the present study aimed to... (Review)
Review
BACKGROUND
Considering the indeterminate effects following the administration of three doses of the SARS-CoV-2 vaccine to patients under dialysis, the present study aimed to evaluate the immunogenicity rates of patients who received the three-dose vaccine.
METHODS
MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Controlled Trials were searched to select the relevant literature to perform the present review. We included randomized controlled trials, non-randomized trials, prospective, observational cohort, and case-control studies to assess the humoral and cellular immune responses following the administration of the three-dose SARS-CoV-2 vaccine to patients receiving dialysis.
RESULTS
Overall, 38 studies are included in the meta-analysis presented in this paper. For patients on dialysis, the overall humoral antibody response rate is 97% following three doses of mRNA or viral vector vaccines and 100% following four doses of the SARS-CoV-2 vaccine. A subgroup analysis shows that the antibody response rate is 96% for patients on hemodialysis (HD) and 100% for those receiving peritoneal dialysis (PD). The antibody response rate in the different immunogen-vaccinated groups tends to be higher than that in the same immunogen-vaccinated group (99% vs. 96%). For those who exhibit no response following two doses of the vaccine, the third and fourth doses can elevate the antibody response rate to 81%, and that number for low responders increases to 96%. However, the pooled results obtained from the relatively few trials conducted indicate that the positive T-cell response rate only increases to 59% following three doses of the vaccine. The antibody response rate is not different between dialysis and non-dialysis groups (relative risk = 0.95, 95% CI 0.90-1.02) following three doses of the vaccine. The relative risks for a SARS-CoV-2 breakthrough infection, all-cause mortality, and hospital admissions are 0.59 (95% CI 0.30-1.04), 0.63 (95% CI 0.35-1.12), and 0.53 (95% CI 0.37-0.74), respectively, when comparing three doses with two doses of the vaccine administered to the dialysis population.
CONCLUSIONS
The third or fourth dose of the SARS-CoV-2 vaccine significantly increases the immunogenicity rates in dialysis patients, and this beneficial effect does not vary with the type of vaccine (the same or different immunogen vaccination), dialysis modality (HD or PD), or previous low response following the administration two doses of the vaccine. We believe that healthcare workers should encourage patients receiving dialysis to receive a third or fourth vaccine dose to strengthen their immunity against SARS-CoV-2.
PubMed: 36560480
DOI: 10.3390/vaccines10122070 -
BMC Urology Mar 2024The effectiveness of immunosuppressive and corticosteroid treatments for Immunoglobulin A (IgA) nephropathy (IgAN) remains thoroughly evaluated. We undertook a... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
The effectiveness of immunosuppressive and corticosteroid treatments for Immunoglobulin A (IgA) nephropathy (IgAN) remains thoroughly evaluated. We undertook a meta-analysis to investigate the efficacy and safety of low-dose corticosteroids plus leflunomide for progressive IgA nephropathy.
METHODS
Eligible studies were obtained from PubMed, Embase, and Cochrane Library databases. We also searched the references of the included studies. Our protocol followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Eligibility criteria were defined using a PICOS framework.
RESULTS
Our study included three articles presenting 342 patient cases. Findings revealed that low-dose corticosteroids combined with the leflunomide group were effective in relieving urine protein excretion (UPE) [mean difference (MD) = -0.35, 95% confidence interval (CI): -0.41 to -0.30, P < 0.00001] compared with the full-dose corticosteroids group. Regarding serum creatinine (SCr), estimated glomerular filtration rate (eGFR), complete remission rate, and overall response rate, there was no difference between the groups (p > 0.05). Regarding safety, low-dose corticosteroids combined with leflunomide significantly reduced the risk of serious adverse events [odds ratio (OR): 0.11, 95% CI: 0.01 to 0.91, P = 0.04]. Besides, no significant differences were observed between the two groups in the incidence of respiratory infection, abnormal liver function, diarrhea, herpes zoster, alopecia, pruritus, insomnia, pneumonia, diabetes, and urinary tract infection (P > 0.05).
CONCLUSIONS
Low-dose corticosteroids combined with leflunomide are a safe and effective treatment for progressive IgA nephropathy.
TRIAL REGISTRATION
The PROSPERO registration number is CRD42022361883.
Topics: Humans; Leflunomide; Glomerulonephritis, IGA; Immunosuppressive Agents; Adrenal Cortex Hormones; Glomerular Filtration Rate
PubMed: 38468247
DOI: 10.1186/s12894-024-01438-3 -
Prostate Cancer and Prostatic Diseases Mar 2024This study supports a value-based approach to prostate cancer (PCa) treatment by systematically reviewing economic evaluations that compare the cost and... (Review)
Review
BACKGROUND
This study supports a value-based approach to prostate cancer (PCa) treatment by systematically reviewing economic evaluations that compare the cost and cost-effectiveness of low-dose-rate brachytherapy (LDR-BT) with that of other treatment options for localised and locally advanced PCa.
METHODS
Studies published between 2008 and 2023 were searched for in MEDLINE, EMBASE and Tufts Medical Center's Cost-Effectiveness Analysis (CEA) Registry (Prospero protocol CRD42023-442027). Two reviewers independently screened the title and abstracts based on agreed inclusion and exclusion criteria, followed by full-text screening. The Drummond checklist was used to critically appraise the quality of the included studies.
RESULTS
After screening 453 records, 36 were sought for retrieval and 14 eligible studies included. Of them, 11 compared treatments for low- and/or favourable intermediate-risk PCa, 2 compared options for unfavourable intermediate- and/or high-risk disease and 1 analysed treatments for both risk groups. Considerable heterogeneity was seen in the populations, perspectives, time horizons, costs and outcomes data used. If the oncological outcomes of standard treatment approaches are considered equivalent, LDR-BT was the most cost-effective type of radiation therapy (RT) in 9 (75%) of 12 studies, was more cost-effective than radical prostatectomy (RP) in 6 (67%) of 9 studies and, depending on the time horizon, was more cost-effective than active surveillance (AS) in 3 (60%) of 5 studies. LDR-BT was more cost-effective than high-dose-rate brachytherapy (HDR-BT) in all 4 (100%) of the studies that made this comparison and, overall, LDR-BT was the least costly of all active treatment options in 7 (50%) of the 14 studies.
CONCLUSION
The available health economic evidence suggests that LDR-BT has significant cost advantages and an important role to play in the delivery of value-based PCa care. In the future these advantages could be challenged if radiotherapy favours ultrahypofractionated strategies such as stereotactic body radiation therapy (SBRT) and reduced fractionation in HDR-BT.
PubMed: 38480973
DOI: 10.1038/s41391-024-00817-z -
Physica Medica : PM : An International... Apr 2022High dose rate (HDR) brachytherapy is a widely accepted cancer treatment method which provides high cure rates. In a HDR brachytherapy treatment, high radiation doses... (Review)
Review
High dose rate (HDR) brachytherapy is a widely accepted cancer treatment method which provides high cure rates. In a HDR brachytherapy treatment, high radiation doses are delivered to the tumor area by placing the radioactive sources in the close proximity to the region of interest. The brachytherapy dose delivery follows the inverse square law with rapid dose fall of leading to minimal damage to the surrounding normal tissue. The safe direct delivery of the radiation dose to the tumour leads to good treatment outcomes comparable to other modalities of treatment. Hence, it is crucial to maintain a sharp drop in the radiation dose distribution within very short distances. Treatment planning system (TPS) which is controlled by a computer algorithm plays a significant role in calculating the optimum doses to the tumour area during a typical HDR brachytherapy treatment. However, the optimum dose calculated by the TPS must be verified by using an independent testing method in order to eliminate under/over irradiation of the tumor region and as quality assurance. In general, two types of independent dose verification methods(experimental and computational) are used to crosscheck the doses calculated by TPS. This systematic review aims to summarize the studies done in the past ten years on HDR brachytherapy treatment planning verification and to analyze the reliability and limitations.
Topics: Brachytherapy; Humans; Monte Carlo Method; Neoplasms; Radiometry; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Reproducibility of Results
PubMed: 35240479
DOI: 10.1016/j.ejmp.2022.02.022 -
Journal of Clinical Medicine May 2021Loss of response to antitumor necrosis factor (anti-TNF) therapies in inflammatory bowel disease occurs in a high proportion of patients. Our aim was to evaluate the... (Review)
Review
UNLABELLED
Loss of response to antitumor necrosis factor (anti-TNF) therapies in inflammatory bowel disease occurs in a high proportion of patients. Our aim was to evaluate the loss of response to anti-TNF therapy, considered as the need for dose intensification (DI), DI effectiveness and the possible variables influencing its requirements. Bibliographical searches were performed.
SELECTION
prospective and retrospective studies assessing DI in Crohn's disease and ulcerative colitis patients treated for at least 12 weeks with an anti-TNF drug.
EXCLUSION CRITERIA
studies using anti-TNF as a prophylaxis for the postoperative recurrence in Crohn's disease or those where DI was based on therapeutic drug monitoring.
DATA SYNTHESIS
effectiveness by intention-to-treat (random effects model). Data were stratified by medical condition (ulcerative colitis vs. Crohn's disease), anti-TNF drug and follow-up.
RESULTS
One hundred and seventy-three studies (33,241 patients) were included. Overall rate of the DI requirement after 12 months was 28% (95% CI 24-32, = 96%, 41 studies) in naïve patients and 39% (95% CI 31-47, = 86%, 18 studies) in non-naïve patients. The DI requirement rate was higher both in those with prior anti-TNF exposure ( = 0.01) and with ulcerative colitis ( = 0.02). The DI requirement rate in naïve patients after 36 months was 35% (95% CI 28-43%; = 98%; 18 studies). The overall short-term response and remission rates of empirical DI in naïve patients were 63% (95% CI 48-78%; = 99%; 32 studies) and 48% (95% CI: 39-58%; = 92%; 25 studies), respectively. The loss of response to anti-TNF agents-and, consequently, DI-occurred frequently in inflammatory bowel disease (approximately in one-fourth at one year and in one-third at 3 years). Empirical DI was a relatively effective therapeutic option.
PubMed: 34069295
DOI: 10.3390/jcm10102132