scholarly journals Anticoagulant treatment regimens in patients with Covid‐19: a meta‐analysis

2021 ◽  
Author(s):  
Anselm Jorda ◽  
Jolanta M. Siller‐Matula ◽  
Markus Zeitlinger ◽  
Bernd Jilma ◽  
Georg Gelbenegger
Keyword(s):  
Meta Analysis ◽  
Anticoagulant Treatment ◽  
Treatment Regimens

scholarly journals The effect of double-carbapenem therapy on mortality rates and microbiological cure rates in patients diagnosed with carbapenem-resistant Klebsiella pneumoniae infections in comparison to monotherapy and currently used combinations of antibiotics

2021 ◽  
Vol 5 (1) ◽  
pp. e000243
Author(s):  
Rhiannon Olivia Moody
Keyword(s):  
Mortality Rate ◽  
Klebsiella Pneumoniae ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Resistant Bacteria ◽  
Cure Rate ◽  
Treatment Regimens ◽  
Hospitalised Patients ◽  
Microbiological Cure

Introduction: Infection with the bacteria carpamenease-producing Klebsiella pneumoniae represents a significant cause of mortality in hospitalised patients. These multidrug resistant bacteria are resistant to currently used antibiotics as a result of carbapenemase production. Dual carbapenem therapy has been proposed as a valid therapeutic option, this therapy combines two carbapenem antibiotics, with one acting as a suicide inhibitor allowing the subsequent carbapenem to exert a bactericidal effect. Aim: The aim of this meta-analysis was to determine if dual carbapenem therapy had a significant effect on mortality rate and microbiological cure rate in patients diagnosed with carbapenemase-producing Klebsiella pneumoniae infections in comparison to standard antibiotic therapies. Methods: The search terms “(dual OR double) carbapenem (therapy OR treatment) AND klebsiella pneumoniae” were used to search databases and inclusion and exclusion criteria were applied to retrieved papers, a total of seven studies were identified for inclusion in the meta-analysis. The quality of included studies was assessed using the cochrane tool for risk of bias assessment and funnel plots were produced to determine the influence of publication bias. A random effects model was used to assess the outcomes; mortality rate and microbiological cure rate. Results and Conclusion: Dual carbapenem therapy had a time dependent effect on patient mortality rates. Dual carbapenem therapy significantly lowered  mortality rates in patients in comparison to standard antibiotic therapy, especially in comparison to monotherapy treatment regimens. Additionally, dual carbapenem therapy significantly improved microbiological cure rate in patients when compared to standard antibiotic treatment regimens demonstrating the possible clinical applications of a dual carbapenem antibiotic regimen in the treatment of carbapenemase-producing Klebsiella pneumoniae infections. 

scholarly journals The anticoagulant treatment for sepsis induced disseminated intravascular coagulation; network meta-analysis

2018 ◽  
Vol 171 ◽  
pp. 136-142 ◽  
Author(s):  
Tomoaki Yatabe ◽  
Shigeaki Inoue ◽  
So Sakamoto ◽  
Yuka Sumi ◽  
Osamu Nishida ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Meta Analysis ◽  
Anticoagulant Treatment ◽  
Intravascular Coagulation

Abstract 16653: Ventricular Arrhythmias With Ibrutinib Use: A Systematic Review and Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yaser Khallid ◽  
Neethi Dasu ◽  
Ankit Shah ◽  
Michael G Fradley ◽  
Kirti Dasu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ventricular Arrhythmias ◽  
Kinase Inhibitors ◽  
Meta Analysis ◽  
Lymphocytic Leukemia ◽  
Duration Of Treatment ◽  
Treatment Regimens ◽  
Mantle Cell ◽  
Meta Regression ◽  
Meta Regression Analysis

Introduction: Ibrutinib is a widely used treatment option for patients with chronic lymphocytic leukemia, mantle cell lymphoma, and Waldenstrom’s macroglobulinemia. There is limited investigation on the relationship between ibrutinib and the development of ventricular arrhythmias. Hypothesis: We hypothesized that the incidence of ventricular arrhythmias in patients taking ibrutinib compared to the patients on other treatment regimens would be higher. Methods: We performed an aggregate data meta-analysis on nine studies to examine the incidence of ventricular arrhythmias. We further assessed a meta-regression analysis to evaluate the effect of duration of therapy on incidence of ventricular arrhythmias. Relative risk (RR) and 95% confidence intervals (CI) were estimated using a random-effects model. Results: Of 3809 patients being treated with ibrutinib, the incidence of ventricular arrhythmias was almost 8-fold higher in patients being treated with ibrutinib compared to other tyrosine kinase inhibitors (TKIs), other chemotherapies, or immunotherapy. (RR 8.13, 95% CI 4.37-15.10, p <0.0001). On meta-regression analysis, the incidence increased further with longer duration of treatment (coefficient = 0.0206, p=0.049); patient populations greater than 60 years have a higher incidence of ventricular arrhythmias (coefficient = 0.0237, p=0.044). Over 50% of patients diagnosed with ventricular arrhythmias on ibrutinib died of sudden death. Conclusions: For patients treated with ibrutinib, there was a markedly higher rate of ventricular arrhythmias and an increased incidence with longer duration of treatment. These data highlight the need for guidelines on surveillance and management for ventricular arrhythmias for patients taking ibrutinib.

The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 414-415
Author(s):  
KENNETH L. HARKAVY
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Meta Analysis ◽  
Cautionary Note ◽  
Short Treatment ◽  
Treatment Regimens ◽  
Length Of Treatment ◽  
Term Benefit ◽  
Combined Data

In Reply.— The letter-to-the-editor from Dr Frank is a cautionary note about the risks of glucocorticoid therapy for chronic lung disease in infants. These concerns are real and have been enumerated in most papers on the subject. Only one study to date has suggested a long-term benefit (decreased mortality); yet consistently respiratory therapy support is decreased by steroid use. I have performed a limited meta-analysis because all studies have had similar enrollment criteria and treatment regimens. Two lengths of treatment have been compared and the combined data compared with the controls (Table 1). [See table in the PDF file] This analysis suggests that there is no major difference in outcome by length of treatment, although short treatment was associated with less hyperglycemia and longer duration of intubation. Comparison of all steroid-treated patients with placebo-treated babies showed treated infants had more hyperglycemia (P &lt; .01 χ2) but an average of 11 fewer days of mechanical ventilation (intermittent mandatory ventilation, ImV). (t test was not done due to lack of raw data; however, difference was significant in each subgroup.)

scholarly journals Accelerated Hyperfractionated Radiotherapy versus Conventional Fractionation Radiotherapy for Head and Neck Cancer: A Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Bo Zhu ◽  
Changgui Kou ◽  
Wei Bai ◽  
Weiying Yu ◽  
Lili Zhang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Therapeutic Effects ◽  
Cochrane Central Register ◽  
Hyperfractionated Radiotherapy ◽  
Conventional Fractionation ◽  
Treatment Regimens

Objective. The benefits of accelerated hyperfractionated radiotherapy (HART) and conventional fractionation radiotherapy (CFRT) in the treatment of head and neck cancer (HNC) remain controversial. In this study, we analyzed the therapeutic effects of these two treatment regimens to explore whether HART can improve the overall survival (OS) rate and locoregional control (LRC) rate in patients with HNC. Methods. The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for eligible studies. The OS rate and LRC rate were considered as the efficacy outcomes. I2 was used to test the heterogeneity among studies with a cutoff value of 50%. Potential publication bias was assessed by funnel plots and Egger’s test. We also performed a sensitivity analysis to assess the stability of the results. In this meta-analysis, all analyses were performed using R 3.5.3 software. Results. Twelve qualified articles including a total of 2,935 patients were identified. HART had a significant beneficial effect on OS rate (HR = 0.80, 95% CI: 0.65–0.98). Compared with CFRT, HART demonstrated a significantly higher LRC rate (HR = 0.82, 95% CI: 0.71–0.96). Conclusion. Our meta-analysis showed that HART can significantly improve OS and LRC compared with CFRT in patients with HNC.

scholarly journals Prevalence of Diabetes Mellitus and Its Associated Unfavorable Outcomes in Patients With Acute Respiratory Syndromes Due to Coronaviruses Infection: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 13 ◽  
pp. 117955142096249
Author(s):  
Isabel Pinedo-Torres ◽  
Magaly Flores-Fernández ◽  
Marlon Yovera-Aldana ◽  
Claudia Gutierrez-Ortiz ◽  
Paolo Zegarra-Lizana ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Health Outcomes ◽  
Meta Analysis ◽  
Population Based ◽  
Pooled Analysis ◽  
Sensitivity Analyses ◽  
Cross Sectional ◽  
Treatment Regimens ◽  
Prevalence Of Diabetes Mellitus

Introduction: Only 3 types of coronavirus cause aggressive respiratory disease in humans (MERS-Cov, SARS-Cov-1, and SARS-Cov-2). It has been reported higher infection rates and severe manifestations (ICU admission, need for mechanical ventilation, and death) in patients with comorbidities such as diabetes mellitus (DM). For this reason, this study aimed to determine the prevalence of diabetes comorbidity and its associated unfavorable health outcomes in patients with acute respiratory syndromes for coronavirus disease according to virus types. Methods: Systematic review of literature in Pubmed/Medline, Scopus, Web of Science, Cochrane, and Scielo until April of 2020. We included cohort and cross-sectional studies with no restriction by language or geographical zone. The selection and extraction were undertaken by 2 reviewers, independently. The study quality was evaluated with Loney’s instrument and data were synthesized by random effects model meta-analysis. The heterogeneity was quantified using an I2 statistic. Funnel plot, Egger, and Begg tests were used to evaluate publication biases, and subgroups and sensitivity analyses were performed. Finally, we used the GRADE approach to assess the evidence certainty (PROSPERO: CRD42020178049). Results: We conducted the pooled analysis of 28 studies (n = 5960). The prevalence analysis according to virus type were 451.9 diabetes cases per 1000 infected patients (95% CI: 356.74-548.78; I2 = 89.71%) in MERS-Cov; 90.38 per 1000 (95% CI: 67.17-118.38) in SARS-Cov-1; and 100.42 per 1000 (95% CI: 77.85, 125.26 I2 = 67.94%) in SARS-Cov-2. The mortality rate were 36%, 6%, 10% and for MERS-Cov, SARS-Cov-1, and SARS-Cov-2, respectively. Due to the high risk of bias (75% of studies had very low quality), high heterogeneity ( I2 higher than 60%), and publication bias (for MERS-Cov studies), we down rate the certainty to very low. Conclusion: The prevalence of DM in patients with acute respiratory syndrome due to coronaviruses is high, predominantly with MERS-Cov infection. The unfavorable health outcomes are frequent in this subset of patients. Well-powered and population-based studies are needed, including detailed DM clinical profile (such as glycemic control, DM complications, and treatment regimens), comorbidities, and SARS-Cov-2 evolution to reevaluate the worldwide prevalence of this comorbidity and to typify clinical phenotypes with differential risk within the subpopulation of DM patients.

Determining the Benefits of Rituximab + Chemotherapy for Patients with Untreated Follicular Lymphoma: A Comprehensive Meta-Analysis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3330-3330 ◽  
Author(s):  
Josiah N. Orina ◽  
Christopher R. Flowers
Keyword(s):  
Follicular Lymphoma ◽  
Watchful Waiting ◽  
Meta Analysis ◽  
Single Agent ◽  
Inclusion Criteria ◽  
First Line ◽  
Treatment Regimens ◽  
First Line Therapy ◽  
American Society ◽  
Meta Analyses

Abstract Background: Current guidelines offer numerous options for initiating therapy in patients with untreated, advanced stage follicular lymphoma (FL). Selecting among these options that include watchful waiting, single-agent and combination chemotherapy, monoclonal antibodies, and radioimmunotherapy, remains challenging. Recent data suggest that chemotherapy combined with a monoclonal antibody may alter patterns of relapse and overall survival for pts with FL (Fisher, Blood 2004). While rituximab (R) chemotherapy combinations have become commonly used for untreated pts with FL, to date, the optimal first-line therapy remains undefined. To address this issue, we updated a systematic literature review and performed a meta-analysis of first-line therapy for untreated FL that examined the effect of various chemotherapy regimens combined with R on response rates and survival in patients with untreated FL. Methods: The comprehensive systematic review included searches the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 1, 2003), MEDLINE (1/1996–6/2006), EMBASE (1/1980–7/2006), American Society of Hematology Annual Meeting abstracts (2002–2005), and American Society of Clinical Oncology Annual Meeting abstracts (1995–2006). Each database was searched using combinations of the term follicular lymphoma and the terms for medications and treatment regimens. Inclusion criteria for studies were as follows: 1) Inclusion of patients with untreated stage III/IV FL grades 1, 2, or 3; 2) Intervention with chemotherapy and/or immunotherapy, radioimmunotherapy, or watchful waiting; 3) Reporting in English of the following treatment outcome measures specifically for patients with FL: CR/CR-unconfirmed, overall response rate (OR), and at least one form of survival data. Abstracts subsequently published as papers were excluded. Extracted data included pre-treatment disease status, treatment regimen, median follow-up time, progression free survival, overall survival, CR and OR. The following treatment strategies from peer-review publications were analyzed: single agent R, R-CVP, R-CHOP, and fludarabine-combinations with R (R-Fcom). In meta-analyses of selected studies, we utilized the Mantel-Haenszel (fixed effects model) and DerSimonain and Laird (random effects) methods to calculate the risk difference comparing treatment regimens’ CR/CRu to the spontaneous CR in patients undergoing watchful waiting (4.6%; Ardeshna et al. Lancet, 2003). Results: In total, over 3135 abstracts were reviewed to identify 11 studies meeting the inclusion criteria for this analysis. These studies included data from 3144 patients. Only one study presenting CR data for R-CVP (36%, 95% confidence interval: 28%–44%) met inclusion criteria. The meta-analyses estimated the CR rate associated with single-agent R to be 30% (95% CI: 20%–40%), R-CHOP to be 62% (30%–94%), and R-Fcom to be 85% (76%–94%) (random effects; see Figure). Conclusions: R-CHOP and R-fludarabine combinations appear to produce the highest CR rates for untreated pts with FL. Meta-analysis can aid clinicians in therapeutic decision making as they weight the risks and benefits of various regimens for newly diagnosed pts. Figure Figure

scholarly journals A systematic review and meta-analysis of technical aspects and clinical outcomes of botulinum toxin prior to abdominal wall reconstruction

Hernia ◽  
2021 ◽  
Author(s):  
A. S. Timmer ◽  
J. J. M. Claessen ◽  
J. J. Atema ◽  
M. V. H. Rutten ◽  
R. Hompes ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Abdominal Wall ◽  
Clinical Outcomes ◽  
Botulinum Toxin A ◽  
Meta Analysis ◽  
Fascial Closure ◽  
Technical Aspects ◽  
Lateral Abdominal Wall ◽  
Treatment Regimens ◽  
Meta Analyses

Abstract Purpose To systematically review technical aspects and treatment regimens of botulinum toxin A (BTA) injections in the lateral abdominal wall musculature. We also investigated the effect of BTA on abdominal muscle- and hernia dimensions, and clinical outcome. Methods PubMed, EMBASE, CENTRAL, and CINAHL were searched for studies that investigate the injection of BTA in the lateral abdominal wall muscles. Study characteristics, BTA treatment regimens, surgical procedures, and clinical outcomes are presented descriptively. The effect of BTA on muscle- and hernia dimensions is analyzed using random-effects meta-analyses, and exclusively for studies that investigate ventral incisional hernia patients. Results We identified 23 studies, comprising 995 patients. Generally, either 500 units of Dysport® or 200–300 units of Botox® are injected at 3–5 locations bilaterally in all three muscles of the lateral abdominal wall, about 4 weeks prior to surgery. No major procedural complications are reported. Meta-analyses show that BTA provides significant elongation of the lateral abdominal wall of 3.2 cm per side (95% CI 2.0–4.3, I2 = 0%, p < 0.001); 6.3 cm total elongation, and a significant but heterogeneous decrease in transverse hernia width (95% CI 0.2–6.8, I2 = 94%, p = 0.04). Furthermore, meta-analysis shows that BTA pretreatment in ventral hernia patients significantly increases the fascial closure rate [RR 1.08 (95% CI 1.02–1.16, I2 = 0%, p = 0.02)]. Conclusion The injection technique and treatment regimens of botulinum toxin A as well as patient selection require standardization. Bilateral pretreatment in hernia patients significantly elongates the lateral abdominal wall muscles, making fascial closure during surgical hernia repair more likely. Study registration A review protocol for this meta-analysis was registered at PROSPERO (CRD42020198246).

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