Medium Cumulative Dose Research Articles

Systemic steroids and bronchopulmonary dysplasia: a systematic review and meta-analysis.

It is unclear if systemic steroids decrease the risk of Bronchopulmonary Dysplasia (BPD) while increasing the risk of neurodevelopmental impairment (NDI). Conduct a systematic review of randomized controlled trials of systemic steroids to evaluate the risk of BPD, mortality, and NDI in premature infants ≤30 weeks. MEDLINE, EBSCOhost, Web of Science, Cochrane Library, Embase, and CINAHL. Randomized clinical trials of Dexamethasone (DEX) or Hydrocortisone (HC) to prevent BPD in premature infants ≤ 30 weeks. Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Random-effects meta-analyses and multivariable meta-regression were conducted. Primary outcomes were BPD, mortality, and NDI. Secondary outcomes were hypertension, hyperglycemia, sepsis, intestinal perforation, necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). The a priori hypothesis was that steroids would reduce the risk of BPD without increasing NDI. There were 6377 preterm infants in the 44 (32 DEX, 13 HC) selected studies. DEX significantly reduced the risk of BPD, RR = 0.66, (95% CI, 0.56-0.78). The most effective DEX regimen was medium cumulative dose (2 to 3 mg/kg), RR = 0.43 (95% CI, 0.29-0.65); day of initiation <8 days: RR = 0.68, (95% CI, 0.59-0.79); and treatment for ≥14 days: RR = 0.67 (95% CI, 0.55-0.80). HC did not significantly decrease the risk of BPD, RR = 0.98, (95% CI, 0.87-1.10). Neither DEX, (RR = 0.92, 95% CI, 0.78-1.09) nor HC (RR = 0.83, 95% CI, 0.68-1.01) decrease the risk of mortality. The risk of CP was not increased by either DEX (RR = 1.09, 95% CI, 0.55-2.17) or HC (RR = 1.18, 95% CI, 0.75-1.87). There were no significant differences between steroids and placebo for MDI/PDI scores. Multivariable meta-regression models showed that DEX significantly reduced the risk of BPD without increased risk of CP. DEX increased the risk of hypertension and hyperglycemia. Studies showed high heterogeneity, differing treatment regimen, missing data and different rates of follow-up. DEX, but not HC, significantly decreased the risk of BPD. Neither steroid showed an increased risk of NDI or mortality.

Association between Use of Hydrochlorothiazide and Nonmelanoma Skin Cancer: Common Data Model Cohort Study in Asian Population.

Although hydrochlorothiazide (HCTZ) has been suggested to increase skin cancer risk in white Westerners, there is scant evidence for the same in Asians. We analyzed the association between the use of hydrochlorothiazide and non-melanoma in the Asian population using the common data model. Methods: A retrospective multicenter observational study was conducted using a distributed research network to analyze the effect of HCTZ on skin cancer from 2004 to 2018. We performed Cox regression to evaluate the effects by comparing the use of HCTZ with other antihypertensive drugs. All analyses were re-evaluated using matched data using the propensity score matching (PSM). Then, the overall effects were evaluated by combining results with the meta-analysis. Results: Positive associations were observed in the use of HCTZ with high cumulative dose for non-melanoma skin cancer (NMSC) in univariate analysis prior to the use of PSM. Some negative associations were observed in the use of low and medium cumulative doses. Conclusion: Although many findings in our study were inconclusive, there was a non-significant association of a dose-response pattern with estimates increasing in cumulative dose of HCTZ. In particular, a trend with a non-significant positive association was observed with the high cumulative dose of HCTZ.

Effect of low-dose ionizing radiation on platelet and leukocytes of radiation workers

Objective: To explore the effect of low-dose ionizing radiation on the platelets and leukocytes of the radiation workers. Methods: We collected data from a total number of 2 055 radiation related workers and with their cumulative doses. Data on platelets and leukocytes was gathered from physical examination of the staff members, from 2013 to 2015 in Chengdu. T test, variance analysis, χ2 test, linear correlation, covariance analysis and multivariate logistic regression analysis were used to analyze the data. Results: Results from the covariance analysis showed that with the increase of cumulative doses, the quantity of platelet and leukocyte appeared a decreasing trend. Multivariate logistic regression analysis showed that, with the increase of BMI levels and the medium cumulative dose and above (>4.333 mSv), the risk of thrombocytopenia became more obvious (trend test as P<0.05). In the group with high-dose exposure radiation (>15.639 mSv) and combined factor as smoking, the risk of developing thrombocytopenia would increase (OR=2.33, 95% CI: 1.23-4.44). Staff with cumulative dose of less than 4.332 mSv and exercised more than 1 time per week, the risk of developing low leukocyte would decrease (OR=0.26, 95% CI: 0.09-0.70). Conclusions: Along with the increase of cumulative doses on exposure to radiation related workers. The quantity of platelet and leukocyte showed a decreasing trend among them. When this high-dose exposure radiation combined with overweight/obesity or cigarette smoking, the risk of developing thrombocytopenia was high. However, physical exercise might have served as protective factor on leukopenia.

Levothyroxine dose and risk of fractures in older adults: nested case-control study

Objective To quantify the effect of levothyroxine dose on risk of fractures in older adults.Design Nested case-control study.Setting Population based health databases, Ontario, Canada.Participants Adults aged 70 or more prescribed...