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Journal of Pharmaceutical and... May 2021A fast fabric phase sorptive extraction method is presented herein for the rapid isolation of selected beta-blocker drugs from human serum and urine. Among many high...
A fast fabric phase sorptive extraction method is presented herein for the rapid isolation of selected beta-blocker drugs from human serum and urine. Among many high efficiency sol-gel sorbent coated FPSE membranes, sol-gel CW20 M coated FPSE membrane was identified as the best FPSE membrane for the target beta-blocker drugs possessing logP values ranging from 0.1 (highly polar) to 3.1 (moderately polar). Due to the engineered affinity towards the analytes via complementary intermolecular interactions and high mass transfer rate of the analytes from the bulk sample solution to the FPSE membrane, the extraction is accomplished in relatively short time (15 min) while its high permeability permits the direct extraction of biological samples without any other pretreatment. The advantages of the fabricated extraction membrane were exploited for the determination of six beta-blockers (namely atenolol, nadolol, metoprolol, oxprenolol, labetalol and propranolol) in biological matrices in combination with UHPLC-ESI-MS/MS. Important parameters including extraction time, sample volume, sorbent size, elution solvent, etc. affecting the performance of the extraction were systematically investigated. The linearity of the method was evaluated in the range of 50-5000 ng mL by constructing weighted (1/X) matrix-matched calibration curves. The intra-day and inter-day trueness were ranged between - 17.2 to 13.3% and - 10.8 to 12.6%, respectively. The intra-day and inter-day precision were less than 11.5 and 14.5 %, respectively. The proposed analytical scheme was successfully applied to the determination of the target drugs in human serum and urine.
Topics: Chromatography, High Pressure Liquid; Humans; Tandem Mass Spectrometry
PubMed: 33819696
DOI: 10.1016/j.jpba.2021.114053 -
Scientific Reports Jan 2021Beta-adrenergic blocking agents (abbreviated as beta-blockers) have been used for treating various cardiovascular diseases. However, the potential for asthma... (Meta-Analysis)
Meta-Analysis
Beta-adrenergic blocking agents (abbreviated as beta-blockers) have been used for treating various cardiovascular diseases. However, the potential for asthma exacerbation is one of the major adverse effects of beta-blockers. This study aimed to compare the level of risk for an asthma attack in patients receiving various beta-blockers. We searched for randomized controlled trials (RCTs) of either placebo-controlled or active-controlled design. The current network meta-analysis (NMA) was conducted under a frequentist model. The primary outcome was the incidence of asthmatic attack. A total of 24 RCTs were included. Overall NMA revealed that only oral timolol [risk ratio (RR) = 3.35 (95% confidence interval (CI) 1.04-10.85)] and infusion of propranolol [RR = 10.19 (95% CI 1.29-80.41)] were associated with significantly higher incidences of asthma attack than the placebo, whereas oral celiprolol [RR = 0.39 (95% CI 0.04-4.11)], oral celiprolol and propranolol [RR = 0.46 (95% CI 0.02-11.65)], oral bisoprolol [RR = 0.46 (95% CI 0.02-11.65)], oral atenolol [RR = 0.51 (95% CI 0.20-1.28)], infusion of practolol [RR = 0.80 (95% CI 0.03-25.14)], and infusion of sotalol [RR = 0.91 (95% CI 0.08-10.65)] were associated with relatively lower incidences of asthma attack than the placebo. In participants with a baseline asthma history, in addition to oral timolol and infusion of propranolol, oral labetalol, oxprenolol, propranolol, and metoprolol exhibited significantly higher incidences of asthma attack than did the placebo. In conclusion, oral timolol and infusion of propranolol were associated with a significantly higher risk of developing an asthma attack in patients, especially in those with a baseline asthma history, and should be avoided in patients who present a risk of asthma.Trial registration: PROSPERO CRD42020190540.
Topics: Administration, Oral; Adrenergic beta-Antagonists; Atenolol; Bisoprolol; Cardiovascular Diseases; Celiprolol; Disease Progression; Female; Humans; Incidence; Infusions, Intravenous; Male; Practolol; Propranolol; Randomized Controlled Trials as Topic; Risk; Sotalol; Status Asthmaticus; Timolol
PubMed: 33432057
DOI: 10.1038/s41598-020-79837-3 -
Journal of Chromatography. A Dec 2020The capability of liquid chromatography with microemulsions (MEs) as mobile phases was studied for the analysis of four parabens (butylparaben, ethylparaben,...
The capability of liquid chromatography with microemulsions (MEs) as mobile phases was studied for the analysis of four parabens (butylparaben, ethylparaben, methylparaben, and propylparaben) and seven β-adrenoceptor antagonists (acebutolol, atenolol, carteolol, metoprolol, oxprenolol, propranolol, and timolol). MEs were formed by mixing aqueous solutions of the anionic surfactant sodium dodecyl sulphate, the alcohol 1-butanol that played the role of co-surfactant, and octane as oil. In order to guarantee the formation of stable MEs, a preliminary study was carried out to determine the appropriate ranges of concentrations of the three components. For this purpose, mixtures of variable composition were prepared, and the possible separation of two phases (formation of an emulsion) was visually detected. The advantage offered by the addition of octane to micellar mobile phases, inside the concentration range that allows the formation of stable MEs, was evaluated by comparing the retention behaviour, peak profile and resolution of mixtures of the probe compounds, in the presence and absence of octane. The final aim of this work was the proposal of a mathematical equation to model the retention behaviour in microemulsion liquid chromatography. The derived global model that considered the three factors (surfactant, alcohol and oil) allowed the prediction of retention times at diverse mobile phase compositions with satisfactory accuracy (in the 1.1‒2.5% range). The behaviour was compared with that found with mobile phases without octane. The model also yielded information about the retention mechanism and revealed that octane, when inserted inside the micelle, modifies the interaction between solutes and micelles.
Topics: Butanols; Chromatography, Liquid; Emulsions; Micelles; Models, Chemical; Parabens; Sodium Dodecyl Sulfate; Surface-Active Agents; Water
PubMed: 33166895
DOI: 10.1016/j.chroma.2020.461651 -
The Cochrane Database of Systematic... Sep 2019Randomized controlled trials (RCTs) have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and...
BACKGROUND
Randomized controlled trials (RCTs) have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in an unselected population remains a controversial issue. A previous version of this review assessing the effectiveness of perioperative beta-blockers in cardiac and non-cardiac surgery was last published in 2018. The previous review has now been split into two reviews according to type of surgery. This is an update, and assesses the evidence in non-cardiac surgery only.
OBJECTIVES
To assess the effectiveness of perioperatively administered beta-blockers for the prevention of surgery-related mortality and morbidity in adults undergoing non-cardiac surgery.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, CINAHL, Biosis Previews and Conference Proceedings Citation Index-Science on 28 June 2019. We searched clinical trials registers and grey literature, and conducted backward- and forward-citation searching of relevant articles.
SELECTION CRITERIA
We included RCTs and quasi-randomized studies comparing beta-blockers with a control (placebo or standard care) administered during the perioperative period to adults undergoing non-cardiac surgery. If studies included surgery with different types of anaesthesia, we included them if 70% participants, or at least 100 participants, received general anaesthesia. We excluded studies in which all participants in the standard care control group were given a pharmacological agent that was not given to participants in the intervention group, studies in which all participants in the control group were given a beta-blocker, and studies in which beta-blockers were given with an additional agent (e.g. magnesium). We excluded studies that did not measure or report review outcomes.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion, extracted data, and assessed risks of bias. We assessed the certainty of evidence with GRADE.
MAIN RESULTS
We included 83 RCTs with 14,967 participants; we found no quasi-randomized studies. All participants were undergoing non-cardiac surgery, and types of surgery ranged from low to high risk. Types of beta-blockers were: propranolol, metoprolol, esmolol, landiolol, nadolol, atenolol, labetalol, oxprenolol, and pindolol. In nine studies, beta-blockers were titrated according to heart rate or blood pressure. Duration of administration varied between studies, as did the time at which drugs were administered; in most studies, it was intraoperatively, but in 18 studies it was before surgery, in six postoperatively, one multi-arm study included groups of different timings, and one study did not report timing of drug administration. Overall, we found that more than half of the studies did not sufficiently report methods used for randomization. All studies in which the control was standard care were at high risk of performance bias because of the open-label study design. Only two studies were prospectively registered with clinical trials registers, which limited the assessment of reporting bias. In six studies, participants in the control group were given beta-blockers as rescue therapy during the study period.The evidence for all-cause mortality at 30 days was uncertain; based on the risk of death in the control group of 25 per 1000, the effect with beta-blockers was between two fewer and 13 more per 1000 (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.89 to 1.54; 16 studies, 11,446 participants; low-certainty evidence). Beta-blockers may reduce the incidence of myocardial infarction by 13 fewer incidences per 1000 (RR 0.72, 95% CI 0.60 to 0.87; 12 studies, 10,520 participants; low-certainty evidence). We found no evidence of a difference in cerebrovascular events (RR 1.65, 95% CI 0.97 to 2.81; 6 studies, 9460 participants; low-certainty evidence), or in ventricular arrhythmias (RR 0.72, 95% CI 0.35 to 1.47; 5 studies, 476 participants; very low-certainty evidence). Beta-blockers may reduce atrial fibrillation or flutter by 26 fewer incidences per 1000 (RR 0.41, 95% CI 0.21 to 0.79; 9 studies, 9080 participants; low-certainty evidence). However, beta-blockers may increase bradycardia by 55 more incidences per 1000 (RR 2.49, 95% CI 1.74 to 3.56; 49 studies, 12,239 participants; low-certainty evidence), and hypotension by 44 more per 1000 (RR 1.40, 95% CI 1.29 to 1.51; 49 studies, 12,304 participants; moderate-certainty evidence).We downgraded the certainty of the evidence owing to study limitations; some studies had high risks of bias, and the effects were sometimes altered when we excluded studies with a standard care control group (including only placebo-controlled trials showed an increase in early mortality and cerebrovascular events with beta-blockers). We also downgraded for inconsistency; one large, well-conducted, international study found a reduction in myocardial infarction, and an increase in cerebrovascular events and all-cause mortality, when beta-blockers were used, but other studies showed no evidence of a difference. We could not explain the reason for the inconsistency in the evidence for ventricular arrhythmias, and we also downgraded this outcome for imprecision because we found few studies with few participants.
AUTHORS' CONCLUSIONS
The evidence for early all-cause mortality with perioperative beta-blockers was uncertain. We found no evidence of a difference in cerebrovascular events or ventricular arrhythmias, and the certainty of the evidence for these outcomes was low and very low. We found low-certainty evidence that beta-blockers may reduce atrial fibrillation and myocardial infarctions. However, beta-blockers may increase bradycardia (low-certainty evidence) and probably increase hypotension (moderate-certainty evidence). Further evidence from large placebo-controlled trials is likely to increase the certainty of these findings, and we recommend the assessment of impact on quality of life. We found 18 studies awaiting classification; inclusion of these studies in future updates may also increase the certainty of the evidence.
Topics: Adrenergic beta-Antagonists; Anesthesia, General; Arrhythmias, Cardiac; Bradycardia; Cause of Death; Humans; Hypotension; Morbidity; Myocardial Infarction; Perioperative Care; Postoperative Complications; Quality of Life; Randomized Controlled Trials as Topic; Surgical Procedures, Operative
PubMed: 31556094
DOI: 10.1002/14651858.CD013438