Treatment,outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study

Objective

To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures.

Theophylline in acute childhood asthma: A meta-analysis of its efficacy

Although theophylline is a widely used drug for the treatment of acute childhood asthma, its efficacy has not been clearly established. This study constitutes a meta-analysis of published randomized clinical trials of theophylline in children hospitalized with acute asthma. We conducted a search of English language MEDLINE citations from 1966 to 1995 and analyzed the methods of each report meeting study criteria. We pooled similar clinical measures across studies if a test for homogeneity of effect size was non-significant. The six methodologically acceptable randomized clinical trials included a total of 164 children less than 18 years of age. Incomplete reporting of measures and variances was common. No study included children in intensive care settings. Using pooled results, pulmonary function parameters [forced expired volume in 1 second (FEV₁), forced expired flow (FEF)] appeared better at 24 hours in the theophylline group, but the results did not reach statistical significance (mean effect difference, +3.9% predicted values; pooled effect size, +1.6 SDS; P = 0.25). A mean of 2.1 more albuterol treatments were administered in the theophylline group (pooled effect size, −0.18 SDS; P = 0.02), and the mean hospital stay was slightly longer (mean effect difference, −0.31 days; pooled effect size, −0.18 SDS; P = 0.03). We conclude that currently available data do not indicate a significant beneficial effect of theophylline in children hospitalized with acute asthma. There is evidence for weak detrimental effects. Theophylline efficacy in intensive care unit settings remains unstudied. Pediatr Pulmonol. 1996; 21:211–218. © 1996 Wiley-Liss, Inc.     

Effects of omalizumab in children with asthma: A protocol for systematic review and meta-analysis

Background:It is still controversial in the current literature whether omalizumab is beneficial for children with asthma. Given that there is no high-quality meta-analysis to incorporate existing evidence, the purpose of this protocol is to design a systematic review and meta-analysis of the level I evidence to ascertain whether omalizumab is beneficial and safe for children with asthma.Methods:The systematic literature review is structured to adhere to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The following search terms will be used in PUBMED, Scopus, EMBASE, and Cochrane Library databases on June, 2021, as the search algorithm: (omalizumab) AND (asthma) AND (children). The primary outcome is the long-term safety and tolerability of omalizumab. The other outcomes include asthma control, quality of life, use of asthma controller medications, and spirometry measurements and emergency room visits due to asthma, and serum trough concentrations of omalizumab, free and total immunoglobulin E measured. Review Manager software (v 5.3; Cochrane Collaboration) will be used for the meta-analysis.Results:The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.Registration number:10.17605/OSF.IO/G6N3P.     

Evaluation of exhaled breath temperature (EBT) as a marker and predictor of asthma exacerbation in children and adolescents

Introduction: Noninvasive and easy-to-use tools to monitor airway inflammation in asthma are needed to maintain disease control, particularly in pediatric population. The aim of the study was to evaluate exhaled breath temperature (EBT) in pediatric respiratory clinic setting. Methods: We evaluated 37 children and adolescents with asthma (5–17 years; median: 11 years). The patients were followed up in stable condition and during exacerbations (paired observations in n = 19 subjects). We evaluated medication use, EBT, fractional exhaled nitric oxide (FeNO), spirometry and atopic status of patients. Results: EBT was significantly higher in children with asthma exacerbation {entire group: median [interquartile range (IQR)]: 32.3 [1.1]°C vs. 33.8 [1.7]°C; p < 0.001 and mean ± SD: 33.1 ± 1.0°C vs. 33.6 ± 1.1°C; p = 0.038 for paired observations}. Significant correlation was observed between EBT and FeNO in the entire group (r = 0.22; p = 0.03). No difference was observed in EBT median values in atopic and non-atopic subjects in the entire group (median [IQR]: 32.6 [1.6] vs. 32.7 [2.0]; p = 0.88) and in subgroups. There was no difference in EBT values in patients receiving systemic or inhaled glucocorticosteroids (p = 0.45 and 0.83). There was no significant correlation between EBT and body or room temperature. The only significant predictor of exacerbation in logistic regression model was EBT {aOR = 2.4; 95% [confidence interval (CI)]: 1.4–4.1}. ROC analysis demonstrated applicability of EBT as a marker of asthma exacerbation in children (AUC = 0.748; p < 0.001; cut-off = 33.3°C; sensitivity: 64.3%; specificity: 82.1%). Conclusions: We suggest that EBT may serve as marker and predictor of asthma exacerbation in children. EBT follow-up may be useful in asthma monitoring in children and adolescents.     

Comparison of efficacy and safety of traditional Chinese patent medicine in the treatment of vitiligo in children or adults: A protocol for systematic review and network meta-analysis

Background:Vitiligo is a common depigmented skin disease in children or adults, which usually causes considerable psychological burden to life and work for the reason that it affects appearance. The conventional therapies, including external 308 nm excimer laser therapy along with oral administration of western medicine, are associated with distinct disadvantages. Notably, traditional Chinese patent medicine (TCPM) exerts a vital part in treating vitiligo. Currently, no existing research has examined the effectiveness and safety of different TCPMs in treating vitiligo among either child or adult patients. As a result, the present network meta-analysis was carried out for the systematic comparison of the effectiveness of different TCPMs in treating vitiligo.Methods:The electronic databases, like PubMed, Web of Science, EMBASE, The Cochrane Library, Chinese Scientific Journals Database, China National Knowledge Infrastructure, Wanfang database and China BioMedical Literature, were searched systemically by 2 reviewers independently from inception to August 2020 to identify relevant randomized controlled trial (RCTs) according to our study inclusion criteria. In data extraction, risk of bias among those enrolled articles was also detected. Besides, the Bayesian network meta-analysis method was utilized to evaluate the evidence and data collected. This adopted the STATA and Win BUGS software for analysis.Results:The present work assessed the safety and efficacy of different TCPMs in treating vitiligo among child or adult patients.Conclusion:Our findings can shed precious lights on applying TCPMs in clinic and help the clinicians to formulate the efficient diagnostic and therapeutic strategies.Ethics and dissemination:No ethical approval was needed in this study.INPLASY registration number:INPLASY2020120050.     

Efficacy of probiotic use in acute diarrhea in children: a meta-analysis

Our objective was to determine the efficacy of probiotic use in reducing the duration of increased stool output in children with acute diarrheal illness. Eligible studies were limited to trials of probiotic therapy in otherwise healthy children <5 years old with acute-onset diarrhea. The main outcome variable was difference in diarrhea duration between treatment and control groups. Our meta-analysis of 18 eligible studies suggests that coadministration of probiotics with standard rehydration therapy reduces the duration of acute diarrhea by 1 day [random-effects pooled estimate = –0.8 days (–1.1, –0.6), P < 0.001]. Differences in treatment effect between studies was assessed by calculating the Q statistic (Q = 204.1, P < 0.001). In subsequent analyses limited to studies of hospitalized children, to double-blinded trials, and to studies evaluating lactobacilli, the pooled estimates were similar (–0.6 to –1.2 days, P < 0.001). In conclusion, bacterial probiotic therapy shortens the duration of acute diarrheal illness in children by approximately one day.     

Effectiveness and safety of different dressings therapy for pressure injuries: A protocol for systematic reviews and network meta-analysis

Background:Pressure injuries, also known as pressure ulcers, are local skin injuries. Once a pressure injury occurs, clinical treatment is relatively difficult, the treatment cycle is long, and the treatment cost is high, which brings heavy burdens to patients and society. Therefore, look for a reliable pressure injuries treatment method is 1 of the focus of clinical nursing workers.Objective:At present, there are many kinds of dressings to treat pressure injuries, and there is no uniform conclusion about which dressing is the most effective. Therefore, we systematically evaluate the effects of different dressings on the treatment of pressure injuries.Methods:We systematically searched the Chinese and English databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, CNKI, CBM, VIP, Wan Fang. Literature screening, data extraction, and quality evaluation were carried out by 2 researchers, and finally, use R software to carry out network meta-analysis.Results:This study is ongoing and the results will be submitted to a peer-reviewed journal for publication.Ethics and dissemination:Ethical approval is not applicable, since this is an overview based on published articles.Protocol registration number:INPLASY2020100087.     

雾化吸人高剂量糖皮质激素对儿童中重度支气管哮喘急性发作的疗效

目的 观察吸入糖皮质激素(ICS)对儿童中～重度哮喘急性发作的疗效,探讨更有效、安全的儿童哮喘急性发作治疗方案.方法 采用前瞻性、随机、双盲、安慰剂平行对照研究方法,将40例5～15岁(男30例,女10例)因哮喘急性发作急诊的儿童按随机数字表法随机分为吸入激素组(21例)和常规治疗组(19例),分别以氧动雾化吸入法吸人0.5％沙丁胺醇(150 μg/kg)+0.025％溴化异丙托品(1 ml) +0.05％布地奈德(2 ml)或0.5％沙丁胺醇(150 μg/kg) +0.025％溴化异丙托品(1 ml)+生理盐水(2 ml),每30分钟雾化吸人1次,连用3次.治疗前、刚完成3次雾化吸人后(治疗后0h)、完成后1h(治疗后1h)、完成后2h(治疗后2h)分别测定肺通气功能、心率(HR)、呼吸频率(RR)、经皮测SaO2,进行临床计分(CS).结果 吸入激素组和常规治疗组治疗后CS、RR、SaO2、FEV1、FEV1占预计值％(FEV1％)均较治疗前明显改善(均P＜0.05),HR治疗前后比较差异无统计学意义(均P＞0.05).治疗后2 h吸入激素组和常规治疗组CS[中位数(四分位间距)]分别为0(0)分和0(1)分,吸入激素组明显低于常规治疗组(Z =2.522,P=0.012).两组间治疗前后RR、HR和SaO2比较差异均无统计学意义(均P＞0.05).吸人激素组治疗后第1小时和第2小时FEV1占预计值％分别改善8.0％(6.8％)和5.5％(6.5％),常规治疗组分别改善6.0％(8.5％)和1.0％(6.5％),吸入激素组治疗后第2小时FEV1改善0.07(0.12)L,常规治疗组为0.01(0.10)L.两组间比较差异均有统计学意义(Z值分别为2.270、2.686和2.455,均P＜0.05).吸人激素组治疗后2h完全缓解率为85.0％(17/20),明显高于常规治疗组的50.0％ (9/18),差异有统计学意义(x2=5.371, P=0.024).吸入激素组和常规治疗组需要全身用糖皮质激素的比率分别为15.0％( 3/20)和44.4％(8/18),两组间比较差异有统计学意义(x2=3.993,P=0.046).吸入激素组仅5％(1/20)患儿需住院治疗,而常规治疗组17％ (3/18)患儿需住院治疗.结论 中～重度哮喘急性发作时,高剂量、短时间间隔雾化吸入布地奈德能与吸人速效支气管舒张剂发挥协同作用,快速有效缓解哮喘急性发作症状,改善肺功能,减少全身用糖皮质激素使用,降低住院率,在非危及生命哮喘急性发作可替代或部分替代全身用糖皮质激素.     

IL-17 polymorphisms and asthma risk: a meta-analysis of 11 single nucleotide polymorphisms

Objective: There has been significant interest in the association between asthma and the polymorphisms of IL-17A and IL-17F for a period of time. This work aims to present a clearer relationship between asthma and the polymorphisms of IL-17A and IL-17F. Method: Searches were performed in Medline, EMBASE, and the Chinese National Knowledge Infrastructure (CNKI) databases. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the relationship between polymorphisms of IL-17A and IL-17F and asthma. Results: Nine studies comprising 3650 asthmatics and 3370 controls were included in this meta-analysis for all single nucleotide polymorphisms (SNPs) (2–6 per SNP). Our study examined the polymorphisms of IL-17F rs1889570 (C/T) (CC versus TT: OR?=?0.55, 95%CI?=?0.41–0.75; CT versus TT: OR?=?0.54, 95%CI?=?0.40–0.72; CC/CT versus TT: OR?=?0.55, 95%CI?=?0.42–0.72; CC versus CT/TT, OR?=?1.83, 95%CI?=?1.39–2.41), IL-17A rs4711998(A/G) (AA/AG versus GG: OR?=?0.67, 95%CI?=?0.46–0.98), and IL-17A rs3819024(A/G) (AA versus GG: OR?=?1.77, 95%CI?=?1.39–2.25) and found they were significantly related to the risk of asthma. Conclusion: Our systematic review showed that IL-17F rs1889570(C/T), IL-17A rs4711998(A/G) and IL-17A rs3819024(A/G) may be potential risk factors for asthma susceptibility.     

Effectiveness comparisons of acupuncture treatments for vascular dementia: A protocol for systematic review and network meta-analysis

Background:Vascular dementia (VD) is the second most common form of dementia in the world. Acupuncture therapy has been widely used in clinical treatment. Based on the available evidence, we will rank different acupuncture therapy to determine the most effective acupuncture therapy.Methods:We will search the following database, including PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and Chinese Scientific Journals Database database, in order to collect randomized controlled trials on acupuncture in the treatment of VD. We will use Stata 14.2 and WinBUGS 1.4.3 software for Bayesian network meta-analysis and finally evaluated the level of evidence of the results.Results:This study will compare and rank the effectiveness of acupuncture in the treatment of vascular dementia. Outcome indicators included Alzheimer Disease Assessment Scale-Cognitive section and Mini-mental State Examination, Activity of Daily Living, Blessed dementia scale, Hastgawa Dementia Scale, and adverse events.Conclusion:Our study will provide support for clinical practice.INPLASY registration number:INPLASY2020110088.     

Efficacy of high-dose vitamin D in pediatric asthma: a systematic review and meta-analysis

Context: Observational studies have suggested a relationship between vitamin D status and asthma-related respiratory outcomes. The benefit of vitamin D supplementation for pulmonary function, symptoms and exacerbations is not well established. Objective: To systematically review paediatric clinical trials investigating the role of vitamin D on asthma-related respiratory outcomes. Data sources: MEDLINE, EMBASE and CENTRAL were searched until January 2014. No date or language restrictions. Study selection: Clinical trials reporting asthma-related respiratory outcomes following vitamin D administration at a dose equal or greater than 500 IU per day were included and reviewed independently by two authors for full systematic review eligibility. Data extraction: Two reviewers independently extracted and verified pre-defined data fields. Results: We identified five studies that met study eligibility and assessed final data synthesis. The median trial size was 48 participants (range 17–430) and the average daily dose of cholecalciferol ranged from 500 to 2000?IU/day. Overall study methodological quality was high, but some heterogeneity in population and vitamin D dosing regimen was evident. Meta-analysis suggested a statistically significant reduction (RR 0.41, CI 0.27–0.63) in asthma exacerbation with vitamin D therapy. Limitations: Due to variability in outcome selection and missing data, it was not possible to perform meta-analysis for pulmonary function testing and asthma symptom scores. Vitamin D-related adverse events were not considered in four of five papers. Conclusions: Available evidence from this systematic review suggests that high dose vitamin D may prevent asthma exacerbation. This should be confirmed through larger well-designed randomised controlled trials.     

Neck circumference and blood pressure among children: a systematic review and meta-analysis

Emerging evidence suggested that large neck circumference (NC) in children and adolescents may be an indicator of increased blood pressure. We sought to conduct a systematic review and meta-analysis regarding the association between NC and blood pressure in children. Pertinent studies were identified by searching PubMed and Scopus databases, up to January 2018. Studies which reported the correlation coefficient between NC, systolic blood pressure and diastolic blood pressure in children (aged <18 years) were selected. Fifteen studies met eligibility criteria for the quantitative synthesis. Overall, NC was significantly correlated with systolic blood pressure (effect size (z) = 0.39; 95% confidence interval [CI] = 0.29–0.49; P < .001; meta r = 0.371; r² = 0.13) and diastolic blood pressure (effect size (z) = 0.25; 95% CI = 0.19–0.32; P < .001; meta r = 0.0.245; r² = 0.06). NC had a positive relationship with the risk of hypertension (odds ratio [OR] = 1.35; 95% CI: 1.05–1.75). Furthermore, studies conducted in Western regions (OR = 1.55; 95% CI: 1.12–2.14) reported higher risk of hypertension in association with NC than those conducted in the Eastern regions (OR = 1.14; 95% CI: 1.03–1.25).NC seems to be a novel anthropometric measurement in children and adolescents. It can be a good predictor of elevated blood pressure, especially in the Western population.     

Pharmacological and non-pharmacological treatments for insomnia: A protocol for a systematic review and network meta-analysis

Background:Although nonpharmacological therapies are recommended as first-line treatments for insomnia, they do not widely implement in practice owing to costly or time-consuming. As a result, pharmacotherapy remains to be commonly prescribed for patients with the sleep disorder. Pharmacotherapy for insomnia consists of different types of drugs. Few studies focused on comprehensively evaluating all available drugs for insomnia. Our review aims to compare efficacy and safety of pharmacological and nonpharmacological treatments by synthesizing direct evidence and indirect evidence to help clinicians and patients make informed decisions for insomnia.Methods:We will search the MEDLINE, EMBASE, and Cochrane Register of Controlled Trials between January 2000 and June 12, 2021. Randomized controlled trials of pharmacological and nonpharmacological interventions for insomnia will be included. Study quality will be assessed on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Eight network meta-analyses were conducted. A Bayesian network meta-analysis would be performed, and relative ranking of agents would be assessed. A node splitting method will be used to examine the inconsistency between direct and indirect comparisons when a loop connecting 3 arms exists.Results:The results of this paper will be submitted to a peer-reviewed journal for publication.Conclusion:The conclusion of our study will provide updated evidence to rank the effectiveness and safety of pharmacological and nonpharmacological interventions for insomnia.Ethics and dissemination:Ethical approval is not applicable, as this study is a network meta-analysis based on published trials.INPLASY registration number:INPLASY202160031     

Music-based intervention to reduce aggressive behavior in children and adolescents: A meta-analysis

Background:We aimed to evaluate the effect of music-based intervention on the aggressive behavior in children and adolescents, and made a comparison of music medicine and music therapy.Methods:We searched PubMed (MEDLINE), Ovid-Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify relevant studies. Standardized mean differences (SMDs) were estimated with random-effect model.Results:We included 10 studies and found a significant decrease of aggressive behavior (SMD = −0.99; 95% CI = −1.42 to −0.56) and a significant increase of self-control (SMD = 0.56; 95% CI: 0.19 to 0.93) in the music-based intervention group compared with the control group. The aggressive behavior was significantly decreased in the music therapy group compared with the control group (SMD = −1.79; 95% CI = −3.23 to −0.35); while, no difference was observed between music medicine group and control group. Sub-group analyses exhibited a more efficacious in reducing aggressive behavior in the children received ≥2 sessions per week, the children with a mean age > 10 years, the children whose behavior were reported by teachers, and the children with aggressive behavior before intervention. Sensitivity analyses yielded similar results.Conclusion:Music-based intervention seemed to be more efficacious for reducing aggression and increasing self-control in children and adolescents, especially music therapy.     

Effectiveness comparisons of Chinese patent medicine on sciatica: A protocol for systematic review and Bayesian network meta-analysis

Background:Sciatica is one of the common clinical diseases. Studies have proved the efficacy of Chinese patent medicine (CPM) in the treatment of sciatica, so far, there has not been a complete systematic review of its effectiveness and safety, and the comparative efficacy and safety of CPM have not been ranked. Therefore, it is necessary to evaluate the efficacy and safety of these CPM by means of systematic review and network meta-analysis (NMA), and to compare them in order.Methods:We will search PubMed, Cochrane Library, EMbase, Web of Science, CNKI, Wanfang, VIP, CBM and other databases for RCTs of CPM in the treatment of sciatica, (database established until December 30, 2020). In addition, we will manually search the “Pharmaceutical Information”, “National Essential Drug List”, “Chinese Pharmacopoeia”, etc. to inquire about drug instructions, and screen the market circulation and clinically commonly used CPM. We will use RevMan software, gemtc package, GeMTC software for statistical analysis, and draw the surface under cumulative ranking area (SUCRA) to predict the order of curative effect of treatment measures.Results:Our study will compare and evaluate the effectiveness of CPM in the treatment of sciatica, and rank different CPM. The outcome indicators will include clinical efficacy, pain degree, lumbar spine function and adverse events.Conclusion:Our research will provide support for clinical practice.INPLASY registration number:INPLASY2020110073.     

Burden of asthma among children in a developing megacity: childhood asthma study,Pakistan

Objectives: Global burden of childhood asthma has increased in the past few decades, particularly in low-income countries. In Pakistan, there is a lack of community-based epidemiological studies estimating the burden of asthma among children. This study determined the prevalence and predictors of asthma among children 3–17 years of age in Karachi, Pakistan. Methods: A two-stage community-based representative cross-sectional survey was conducted in Karachi from March 2012 to April 2013 comprising 1046 children aged 3–17 years. Of 7500 clusters, 80 were randomly selected, and of these, 15 children per cluster were enrolled randomly. A translated and pre-tested version of International Study of Asthma and Allergies in Children questionnaire was administered. Results: The overall prevalence of asthma among study participants was 10.2% (95% CI: 8.4–12.0). Asthma was more likely to occur among boys (adj. OR: 2.5, 95% CI: 1.6–4.0), children in the younger age group (3–7 years) (adj. OR: 2.9, 95% CI: 1.7–4.8), those living in households with ill-ventilated kitchens (adj. OR: 1.8, 95% CI: 1.1–3.1), having family history of asthma (adj. OR: 2.3, 95% CI: 1.3–3.9) and those of the Sindhi ethnicity (adj. OR: 2.2, 95% CI: 1.1–4.4). Conclusion: This study is the first robust evidence regarding asthma among children in Pakistan, reporting a high burden in this group. Family history, male gender, Sindhi ethnicity and ill-ventilated kitchen were identified as important predictors of asthma. Targeted preventive measures and intervention studies are required to better understand and reduce the burden of asthma among children in Pakistan.     

Asthma control and need for future asthma controller therapy among inner-city Hispanic asthmatic children engaged in a pediatric asthma disease management program (the Breathmobile program,Mobile Asthma Care for Kids Network)

Objective: To determine whether significant numbers of asthmatic children with initially rated intermittent asthma later suffer poor asthma control and require the addition of controller medications. Methods: Inner-city Hispanic children were followed prospectively in an asthma-specific disease management system (Breathmobile) for a period of 2 years. Clinical asthma symptoms, morbidity treatment, and demographic data were collected at each visit. Treatment was based upon National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report 3 asthma guidelines. Primary outcome was percentage of patients with intermittent asthma who had not well or poorly controlled asthma during subsequent visits and required controller agents. Secondary outcomes were factors associated with the maintenance of asthma control. Results: About 30.9% of the patients with initial rating of intermittent asthma had not well controlled and poorly controlled asthma during subsequent visits and required the addition of controller agents. Factors associated with good asthma control were compliance, no previous emergency room visits and previous visit during spring season. Conclusion: Asthmatic children with intermittent asthma often lose asthma control and require controller therapy. This justifies asthma guideline recommendations to assess asthma control at follow-up visits and adjust therapy accordingly.