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        Comparison of normal saline solution with low-chloride solutions in renal transplants: a meta-analysis

        ( Abdullah Jahangir ),( Syeda Sahra ),( Muhammad Rafay Khan Niazi ),( Fasih Sami Siddiqui ),( Muhammad Yasir Anwar ),( Ahmad Jahangir ),( Elie J. El-charabaty ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.3

        Background: Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients. Methods: We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical tri-als (RCTs) and matched cohort studies involving NSS as the control arm and low-chloride solutions as an intervention arm were cho-sen. The standardized mean difference for continuous variables, the odds ratio (OR) for discrete variables, and a 95% confidence in-terval (CI) for effect sizes were used. A p-value of <0.05 was considered statistically significant. Analysis was performed using a ran-dom-effects model irrespective of heterogeneity, which was evaluated using I<sup>2</sup> statistics. Results: Nine RCTs and one cohort study with a total of 726 patients were included. After transplantation, serum potassium was sig-nificantly lower in the low-chloride group (standardized mean difference compared to NSS group, -0.38 mEq/L; 95% CI, -0.66 to -0.11; p = 0.007). Similarly, postoperative chloride was lower in the low-chloride group (-2.41 mEq/L [-3.34 to -1.48], p < 0.001). No statistically significance was observed in delayed graft function (OR, 0.98 [0.56-1.69], p = 0.93), day 3 creatinine (-0.14 mg/dL [-0.46 to 0.18], p = 0.38), or day 7 urine output (-0.08 L [-0.29 to 0.12], p = 0.43). onclusion: Use of NSS during renal transplant leads to increased incidence of hyperchloremic acidosis with subsequent hyperkale-mia, but clinical significance in the form of delayed graft function or postoperative creatinine remains comparable to that of low-chlo-ride solutions.

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        Clinical and Microbiologic Efficacy and Safety of Imipenem/Cilastatin/Relebactam in Complicated Infections: A Meta-analysis

        Syeda Sahra,Abdullah Jahangir,Rachelle Hamadi,Ahmad Jahangir,Allison Glaser 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.2

        Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for Gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (HABP), and ventilator-associated bacterial pneumonia (VABP). Materials and Methods: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. We included randomized clinical trials-with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A P-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, HABP, VABP).

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