Adolescent obesity is difficult to assess in multi‐ethnic populations using BMI, due to variability in the BMI–fatness relationship. We aimed to describe body composition (BC), and to validate leg–leg bioelectrical impedance analysis (BIA), in adolescents from different ethnic groups using deuterium (D2O) as the reference method. Measurements were made of weight, height, total body water (TBW), and BIA (TANITA TBF‐300) in 110 white, 170 Asian, and 102 black adolescents aged 11–15 years. TBW was converted to lean mass (LM) using assumed hydration of lean tissue. General linear models were used to compare BC by D2O between the ethnic groups. BC values from D2O were compared with TANITA values, and used to generate ethnic‐specific prediction equations in the whole sample, and also in equation‐generation (group 1) and cross‐validation (group 2) subsamples. Ethnic variability in BMI did not reflect variability in adiposity. Asians had less LM than white and black adolescents, and less fat mass (FM) than white girls. TANITA in‐built equations did not predict BC accurately across ethnic groups, with significant bias in white and Asian males, and Asian and black females. The new equation generated from the entire sample removes ethnic‐specific mean biases. The group 1 equation showed no significant bias in any ethnic group when tested in group 2. We found significant variability in BC between ethnic groups that was not reflected by BMI. Manufacturers' equations are unsuitable for predicting BC in multi‐ethnic populations, and our new equations are recommended.

RESULTSIn total, 15 522 records were identified. After removal of duplicates, screening of title/abstracts for relevance and independent selection of full texts by two reviewers, 36 studies were included. Across all the included studies, 24 107 participants received a single one-off dose of gentamicin (doses ranged from 1 mg kg -1 to 480 mg per dose). Acute kidney injury was described in 2520 participants receiving gentamicin. The large majority of cases were reversible. There were no cases of ototoxicity reported in patients receiving gentamicin. A meta-analysis was not performed due to study heterogeneity. CONCLUSIONSA significant number of patients saw a transient rise in creatinine after a single dose of gentamicin at doses up to 480 mg. Persistent renal impairment and other adverse events were relatively rare.British Journal of Clinical Pharmacology Br J Clin Pharmacol (2018) 84 223-238 223

Aim To review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults. Methods The review protocol was registered on PROSPERO (CRD42019136097). MEDLINE, EMBASE, British Nursing Index and CINAHL were searched up to June 2020. Included studies were appraised and a meta-analysis, where appropriate, was conducted with a random effects model and test for heterogeneity. Standardised mean difference (SMD) with a 95% confidence interval in reported injection pain (intervention cf. control) was reported. Results 29 studies were included in the systematic review and 20 studies in the meta-analysis. 13 IMI techniques were identified. 10 studies applied local pressure to the injection site. Of these, applying manual pressure (4 studies, SMD = -0.85[-1.36,-0.33]) and Helfer (rhythmic) tapping (3 studies, SMD = -2.95[-5.51,-0.39]) to the injection site reduced injection pain, whereas the use of a plastic device to apply local pressure to the skin (ShotBlocker) did not significantly reduce pain (2 studies, SMD = -0.51[-1.58,0.56]). Acupressure techniques which mostly involved applying sustained pressure followed by intermittent pressure (tapping) to acupressure points local to the injection site reduced pain (4 studies: SMD = -1.62[-2.80,-0.44]), as did injections to the ventrogluteal site compared to the dorsogluteal site (2 studies, SMD = -0.43[-0.81,-0.06]). There was insufficient evidence on the benefits of the ‘Z track technique’ (2 studies, SMD = -0.20[-0.41,0.01]) and the cold needle technique (2 studies, SMD = -0.73[-1.83,0.37]) on injection pain. The effect of changing the needle after drawing up the injectate on injection pain was conflicting and warming the injectate did not reduce pain. Limitations included considerable heterogeneity, poor reporting of randomisation, and possible bias in outcome measures from unblinding of assessors or participants. Conclusions Manual pressure or rhythmic tapping over the injection site and applying local pressure around the injection site reduced IMI pain. However, there was very high unexplained heterogeneity between studies and risk of significant bias within small studies.

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BackgroundTraditionally, gentamicin is given eight hourly, guided by drug levels. Several studies have shown that single-daily dosing of gentamicin offers an equal, if not improved, toxicity profile compared to traditional dosing. Single one-off dose gentamicin has been suggested as treatment for gonorrhoea, but its safety has not been reviewed.AimSystematically review the frequency and type of adverse events associated with a single dose of intravenous or intramuscular gentamicin in adults, for any indication, in studies where a comparator was available.MethodsA review protocol was developed and registered (PROSPERO: CRD42013003229). Studies were eligible for review if they; recruited participants ≥16 years old, used gentamicin intramuscularly or intravenously as a single one-off dose, compared gentamicin to another medication or placebo, and if adverse events were monitored. We searched MEDLINE, EMBASE and other relevant databases. Risk of bias was assessed in included studies.Results12,116 records were identified. After removal of duplicates, screening of title/abstracts for relevance and independent selection of full texts by two reviewers, 20 studies were included. 3589 participants were analysed across all studies, 2042 received a single one-off dose of gentamicin (doses ranged from 1 mg/kg - 280 mg). Reversible nephrotoxicity/creatinine rise was reported in 37 cases, with one case of irreversible renal impairment. There were three cases of ototoxicity, with similar frequency reported in the comparator group. A meta-analysis was not possible due to heterogeneity. Reporting of adverse events was poor in the majority of studies.DiscussionAdverse events with single dose gentamicin are infrequent.