Patient-requested Neuraxial Analgesia for Labor

A systematic review, including a meta-analysis, on the timing effects of neuraxial analgesia (NA) on cesarean and instrumental vaginal deliveries in nulliparous women was conducted. Of 20 articles identified, 9 met the inclusion quality criteria (3,320 participants). Cesarean delivery (odds ratio, 1.00; 95% confidence interval, 0.82-1.23) and instrumental vaginal delivery (odds ratio, 1.00; 95% confidence interval, 0.83-1.21) rates were similar in the early NA and control groups. Neonates of women with early NA had a higher umbilical artery pH and received less naloxone. In the early NA group, fewer women were not compliant with assigned treatment and crossed over to the control group. Women receiving early NA for pain relief are not at increased risk of operative delivery, whereas those receiving early parenteral opioid and late epidural analgesia present a higher risk of instrumental vaginal delivery for nonreassuring fetal status, worse indices of neonatal wellness, and a lower quality of maternal analgesia.

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Do Children Who Experience Laryngospasm Have an Increased Risk of Upper Respiratory Tract Infection?

Anesthesiology ◽

10.1097/00000542-199609000-00005 ◽

1996 ◽

Vol 85 (3) ◽

pp. 475-480. ◽

Cited By ~ 107

Author(s):

Mark S. Schreiner ◽

Irene O'Hara ◽

Dorothea A. Markakis ◽

George D. Politis

Keyword(s):

Confidence Interval ◽

Respiratory Infection ◽

Odds Ratio ◽

Signs And Symptoms ◽

Control Group ◽

Upper Respiratory Tract ◽

Upper Respiratory Infection ◽

Airway Surgery ◽

Increased Risk ◽

Upper Respiratory

Background Laryngospasm is the most frequently reported respiratory complication associated with upper respiratory infection and general anesthesia in retrospective studies, but prospective studies have failed to demonstrate any increase in risk. Methods A case-control study was performed to examine whether children with laryngospasm were more likely to have an upper respiratory infection on the day of surgery. The parents of all patients (N = 15,183) who were admitted through the day surgery unit were asked if their child had an active or recent (within 2 weeks of surgery) upper respiratory infection and were questioned about specific signs and symptoms to determine if the child met Tait and Knight's definition of an upper respiratory infection. Control subjects were randomly selected from patients whose surgery had occurred within 1 day of the laryngospasm event. Results Patients who developed laryngospasm (N = 123) were 2.05 times (95% confidence interval 1.21-3.45) more likely to have an active upper respiratory infection as defined by their parents than the 492 patients in the control group (P < or = 0.01). The development of laryngospasm was not related to Tait and Knight's definition for an upper respiratory infection or to recent upper respiratory infection. Children with laryngospasm were more likely to be younger (odds ratio = 0.92, 95% confidence interval 0.87-0.99), to be scheduled for airway surgery (odds ratio = 2.08, 95% confidence interval 1.21-3.59), and to have their anesthesia supervised by a less experienced anesthesiologist (odds ratio = 1.69, 95% confidence interval 1.04-2.7) than children in the control group. Conclusion Laryngospasm was more likely to occur in children with an active upper respiratory infection, children who were younger, children who were undergoing airway surgery, and children whose anesthesia were supervised by less experienced anesthesiologists. Understanding the risk factors and the magnitude of the likely risk should help clinicians make the decision as to whether to anesthetize children with upper respiratory infection.

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Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867420954284 ◽

2020 ◽

pp. 000486742095428

Author(s):

Lei Sun ◽

Su Wang ◽

Xi-Qian Li

Keyword(s):

Postpartum Depression ◽

Confidence Interval ◽

Cesarean Section ◽

Vaginal Delivery ◽

Odds Ratio ◽

Meta Analysis ◽

Mode Of Delivery ◽

Spontaneous Vaginal Delivery ◽

Emergency Cesarean Section ◽

Emergency Cesarean

Background: Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery. Methods: We searched in three electronic databases: PubMed, EMBASE and Cochrane Library. Results: This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]). Conclusion: The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

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PROGNOSIS OF DIFFERENTIATED THYROID CARCINOMA IN PATIENTS WITH GRAVES DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Endocrine Practice ◽

10.4158/ep-2019-0201 ◽

2019 ◽

Vol 25 (12) ◽

pp. 1323-1337 ◽

Cited By ~ 3

Author(s):

Poemlarp Mekraksakit ◽

Pattara Rattanawong ◽

Rudruidee Karnchanasorn ◽

Chanavuth Kanitsoraphan ◽

Natnicha Leelaviwat ◽

...

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Thyroid Carcinoma ◽

Cancer Diagnosis ◽

Distant Metastasis ◽

Odds Ratio ◽

Meta Analysis ◽

Differentiated Thyroid Carcinoma ◽

Graves Disease ◽

Increased Risk

Objective: It is still controversial whether differentiated thyroid carcinoma (DTC) in patients with Graves disease (GD) can be more aggressive than non-Graves DTC. We conducted a systematic review and meta-analysis to examine the association between GD and prognosis in patients with DTC. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2019. We included published studies that compared the risk of mortality and prognosis between DTC patients with GD and those with non-GD. Data from each study were combined using the random-effects model. Results: Twenty-five studies from February 1988 to May 2018 were included (987 DTC patients with GD and 2,064 non-Graves DTC patients). The DTC patients with GD had a significantly higher risk of associated multifocality/multicentricity (odds ratio, 1.45; 95% confidence interval, 1.04 to 2.02; I 2, 6.5%; P = .381) and distant metastasis at the time of cancer diagnosis (odds ratio, 2.19; 95% confidence interval, 1.08 to 4.47; I 2, 0.0%; P = .497), but this was not associated with DTC-related mortality and recurrence/persistence during follow-up. Conclusion: Our meta-analysis demonstrates a statistically significant increased risk of multifocality/multicentricity and distant metastasis at the time of cancer diagnosis in DTC patients with GD than those without GD. Abbreviations: CI = confidence interval; DTC = differentiated thyroid carcinoma; GD = Graves disease; LN = lymph node; OR = odds ratio; PTC = papillary thyroid carcinoma; TC = thyroid carcinoma; TSAb = thyroid-stimulating antibody; TSH = thyroid-stimulating hormone

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Glutathione S-transferase T1 and M1 polymorphisms and risk of thyroid neoplasms

Archive of oncology ◽

10.2298/aoo0303185l ◽

2003 ◽

Vol 11 (3) ◽

pp. 185-185

Author(s):

Karmen Stankov ◽

Stefano Landi ◽

Marco Volante ◽

Mauro Papotti

Keyword(s):

Confidence Interval ◽

Thyroid Carcinoma ◽

Odds Ratio ◽

Follicular Adenoma ◽

Follicular Carcinoma ◽

Thyroid Neoplasms ◽

Control Group ◽

Glutathione S Transferase ◽

Gstt1 Null Genotype ◽

Increased Risk

Background: In order to test the possibility of association between GSTT1 and M1 (glutathione S-transferase) null allele variant, in which the entire gene is absent, and the risk of TCO (thyroid carcinoma with cell oxyphilia), the case-control study was carried out. Methods: Genotypes for GSTT1 and GSTM1 were determined by multiplex PCR in the DNA from 108 healthy individuals and in DNA from samples of thyroid tumors from 130 patients of the same race and origin as the control group (Caucasian, Italian). The following types of NMTC were analyzed: oxyphilic adenoma (OA), oxyphilic carcinoma (OC) papillary thyroid carcinoma with oxyphilic features (PTCof), follicular adenoma (FA), follicular carcinoma (FC), follicular variant of PTC (fvPTC) and classical PTC. Associations between prevalence of particular genotypes and the occurrence of TCO (versus controls) and other subtypes of NMTC were tested. Associations were quantified by calculating OR (odds ratio) with 95% confidence interval. StatGraphics Plus v. 5 software (Manugistics) was used for statistical analysis. Results: In this study of the association between the GSTT1 and M1 null genotype and the increased risk of TCO, the frequency of GSTT1 null genotype of 19.2% in cases and 15.7% in controls was found with an adjusted odds ratio (OR) of 1.4 (95% confidence interval (CI) 0.70-2.81), and the frequency of GSTM1 null genotype of 59% in cases with oxyphilic tumors and of 55.6% in controls (OR 1.24; 95% CI, 0.62-2.48). Conclusion: These results indicate that the GSTT1 and M1 null genotypes do not increase the risk of development of oxyphilic tumors, as well as other types of NMTC that have been included in this study.

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TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.641268 ◽

2021 ◽

Vol 8 ◽

Author(s):

Konstantinos Marmagkiolis ◽

Dominique J. Monlezun ◽

Mehmet Cilingiroglu ◽

Cindy Grines ◽

Joerg Herrmann ◽

...

Keyword(s):

Aortic Stenosis ◽

Confidence Interval ◽

Cancer Patients ◽

Odds Ratio ◽

Meta Analysis ◽

Pacemaker Implantation ◽

Control Group ◽

Cochrane Central Register ◽

Cancer Group ◽

Meta Regression

Objectives: This study sought to systematically analyze the available clinical evidence on TAVR therapy in cancer patients with symptomatic severe AS.Background: Aortic stenosis is the most common valvular heart disease in the world. TAVR has expanded the treatment options for this lethal disease process. The safety and efficacy of TAVR in cancer patients has not yet been reliably established. We thus conducted the largest known multi-center meta-analysis on TAVR and cancer status.Methods: We performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from January 2015 to 2020. Studies that compared the use of TAVR in patients with severe symptomatic aortic stenosis and cancer against patients without cancer were included. Meta-regression was also conducted to determine if common clinical factors modified the possible association between cancer status and TAVR mortality.Results: Five studies with 11,129 patients in the cancer group and 41,706 patients in the control group met inclusion criteria. The short-term mortality in the cancer group was 2.4% compared with 3.3% in the control group (odds ratio: 0.72, 95% confidence interval: 0.63–0.82; p < 0.0001). The frequency of stroke was 2.4% compared with 2.7% (odds ratio of 0.87, 95% confidence interval: 0.76–0.99; p < 0.04). The frequency of AKI was 14.2% in cancer patients vs. 16.4% (odds ratio of 0.81, 95% confidence interval: 0.76–0.85; p < 0.04). The rates of bleeding and need for new pacemaker implantation were not significantly different. Meta-regression demonstrated there was no significant association modifying.Conclusions: On the basis of the results of this meta-analysis TAVR may be a safe and effective therapeutic option for patients with cancer and symptomatic severe aortic stenosis. Larger, longer, and randomized trials are required to adequately test this above hypothesis.

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Correlation between NAD(P)H: quinone oxidoreductase 1 C609T polymorphism and increased risk of esophageal cancer: evidence from a meta-analysis

Therapeutic Advances in Medical Oncology ◽

10.1177/1758834016668682 ◽

2016 ◽

Vol 9 (1) ◽

pp. 13-21 ◽

Cited By ~ 2

Author(s):

Jingfang Diao ◽

Jie Bao ◽

Jianxin Peng ◽

Jiaqiang Mo ◽

Qing Ye ◽

...

Keyword(s):

Sensitivity Analysis ◽

Esophageal Cancer ◽

Confidence Interval ◽

Odds Ratio ◽

Gene Polymorphisms ◽

Meta Analysis ◽

Variant Allele ◽

Quinone Oxidoreductase ◽

Increased Risk ◽

Nqo1 C609t Polymorphism

NAD(P)H: quinone oxidoreductase 1 (NQO1) C609T gene polymorphisms have been reported to influence the risk for esophageal cancer (EC) in many studies. However, the results remain controversial and ambiguous. We performed a meta-analysis, which included 13 independent studies with a total of 2357 subjects, to examine the association between NQO1 C609T polymorphism and EC. The association was assessed by five different gene models. The overall analysis suggested that the variant allele and genotypes were significantly related to increased risk of EC (odds ratio [OR] T versus C = 1.15, 95% confidence interval [CI] 0.95–1.40, probability of rejection [POR] = 0.014; OR TT versus CC = 1.32, 95% CI 1.01–1.73, POR = 0.045; OR TC versus CC = 1.32, 95% CI 0.98–1.21, POR = 0.128; OR TT + TC versus CC = 1.10, 95% CI 1.00–1.20, POR = 0.05; OR TT versus CC + TC = 1.26, 95% CI 0.95–1.57, POR = 0.103). Sensitivity analysis confirmed the reliability of these findings. Our study shows that individuals carrying the NQO1 C609T variant allele and genotypes are more susceptible to EC.

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Efficacy of parecoxib sodium on postoperative shivering: meta-analysis of clinical trials

Journal of International Medical Research ◽

10.1177/0300060517717359 ◽

2017 ◽

Vol 46 (1) ◽

pp. 3-10 ◽

Cited By ~ 1

Author(s):

Yu Zhu ◽

Chengmao Zhou ◽

Yuting Yang ◽

Yijian Chen

Keyword(s):

Clinical Trials ◽

Relative Risk ◽

Confidence Interval ◽

Odds Ratio ◽

Meta Analysis ◽

Control Group ◽

Effective Strategy

Objective To evaluate the effect of parecoxib on preventing postoperative shivering. Methods Main outcomes were the relative risk (odds ratio, OR) and 95% confidence interval (CI) relative to the incidence of shivering. Results Fourteen trials with 1,175 patients were analyzed. The pooled evidence suggested that parecoxib sodium, given before anesthesia or postoperatively (only 4 cases), had the potential to prevent postoperative shivering (OR = 0.21, 95% CI, 0.16, 0.29). Compared with the placebo, parecoxib sodium significantly lowered the incidence of postoperative shivering as follows: mild shivering [OR = 0.51, 95% CI (0.35, 0.74)]; moderate shivering [OR = 0.28, 95% CI (0.18, 0.45)]; severe shivering [OR = 0.18, 95% CI (0.10, 0.33)]. Compared with placebo, there was no significant association of parecoxib sodium with restlessness [OR = 0.95, 95% CI (0.59, 1.52)] or nausea/vomiting [OR = 0.24, 95% CI (0.09, 0.66)]. In addition, pethidine rescue was used significantly more often in the control group than in the parecoxib sodium group [OR = 0.22, 95% CI (0.09, 0.53)]. Conclusions Parecoxib sodium may be an effective strategy for preventing postoperative shivering.

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Helicobacter pyloriEradication in Idiopathic Thrombocytopenic Purpura: A Meta-Analysis of Randomized Trials

Gastroenterology Research and Practice ◽

10.1155/2018/6090878 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Bum Jun Kim ◽

Hyeong Su Kim ◽

Hyun Joo Jang ◽

Jung Han Kim

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Randomized Trials ◽

Response Rate ◽

Meta Analysis ◽

Case Series ◽

Cochrane Library ◽

Control Group ◽

Platelet Response ◽

H Pylori

Objective.Several recent reviews of published studies have shown that the eradication ofH. pyloriinfection in patients with ITP improved thrombocytopenia in about half of the cases. However, most included studies were observational case series. We performed the first meta-analysis of randomized trials to gain a better insight into the effect ofH. pylorieradication in ITP patients.Methods.A systematic computerized search of the electronic databases including PubMed, EMBASE, Google Scholar, and Cochrane Library (up to December 2017) was conducted.Results.From six studies, a total of 241 patients (125 in eradication group and 116 in control group) were included in the meta-analysis. Patients in the eradication group showed significantly higher overall platelet response rate than those in the control group (odds ratio = 1.93, 95% confidence interval: 1.01–3.71,P=0.05). In the subgroup analysis, however, children in the eradication group failed to show statistically better response rate than those in the noneradication group (odds ratio = 1.80, 95% confidence interval: 0.88–3.65,P=0.11).Conclusions.This meta-analysis indicates thatH. pylorieradication has a significant therapeutic effect in patients with ITP. Considering the intrinsic limits in the design and sample size of the included studies, however, large randomized controlled trials are warranted to validate the therapeutic impact ofH. pylorieradication in adults as well as children with ITP.

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The effectiveness of nonsteroidal anti-inflammatory drugs and acetaminophen in reduce the risk of amyotrophic lateral sclerosis? A meta-analysis

Scientific Reports ◽

10.1038/s41598-020-71813-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Min Cheol Chang ◽

Sang Gyu Kwak ◽

Jin-Sung Park ◽

Donghwi Park

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Meta Analysis ◽

Convincing Evidence ◽

Cochrane Library ◽

Control Group ◽

Inclusion Criteria ◽

Control Groups ◽

Significant Difference ◽

And Control

Abstract To test the hypothesis that aspirin, non-aspirin nonsteroidal anti-infammatory drugs (NA-NSAIDs), or acetaminophen can reduce the risk of ALS, we conducted a systematic review and meta-analysis of related previous studies. A comprehensive search was conducted on the PubMed, Embase, Cochrane Library and SCOPUS databases. It included studies published up to 29 February 2020 that fulfilled our inclusion criteria. Aspirin, acetaminophen and NA-NSAIDs use information, between the ALS and control groups, was collected for the meta-analysis. Rates of aspirin, NA-NSAID, and acetaminophen use in ALS group, compared with control group were investigated. In the results, only three studies that relate the risk of ALS to aspirin, NA-NSAIDs and acetaminophen use satisfied the inclusion criteria for the meta-analysis. Regarding aspirin, the studies did not show any statistically significant difference in aspirin use between the ALS and control groups (Odds ratio, 1.04 [95% confidence interval, 0.90–1.21]). NA-NSAIDs and acetaminophen use, however, did show up statistically significant differences in between the ALS and control groups. (Odds ratio, 0.82 [95% confidence interval, 0.73–0.91]) and (Odds ratio, 0.80 [95% confidence interval, 0.69–0.93]). However, our study has some limitations. Firstly, we only included a small number of studies. Secondly, the included studies did not control for past medical history, which may have confounded their results, and in turn, could have caused bias in our study. Thirdly, in this meta-analysis, the ALS patients were not subdivided into sporadic or familial type. Lastly, the studies also did not consider the types of NSAIDs and dosages used of each drug. For more convincing evidence regarding the effectiveness of aspirin, NA-NSAIDs and acetaminophen to reduce the risk of ALS occurrence, more qualified prospective studies are required. In conclusion, the use of NA-NSAIDs and acetaminophen is associated with a decreased risk for the development of ALS. In contrast, aspirin did not have any effect on the reduction of the risk of ALS occurrence.

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Labor Analgesia and Cesarean Delivery

Anesthesiology ◽

10.1097/00000542-200401000-00023 ◽

2004 ◽

Vol 100 (1) ◽

pp. 142-148 ◽

Cited By ~ 95

Author(s):

Shiv K. Sharma ◽

Donald D. McIntire ◽

Jackie Wiley ◽

Kenneth J. Leveno

Keyword(s):

Confidence Interval ◽

Epidural Analgesia ◽

Cesarean Delivery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Meta Analysis ◽

Opioid Analgesia ◽

Cesarean Deliveries ◽

Nulliparous Women ◽

To Receive

Background The authors performed an individual patient meta-analysis of 2,703 nulliparous women who were randomized to either epidural analgesia or intravenous opioids for pain relief during labor from five trials conducted at their hospital. The primary purpose in this meta-analysis was to evaluate the effects of epidural analgesia during labor on the rate of cesarean delivery. Methods Between November 1, 1993, and November 3, 2000, 2,703 nulliparous women (2,188 healthy parturients and 515 women with pregnancy-induced hypertension) in spontaneous labor at term were randomized to receive either epidural analgesia or intravenous opioid analgesia in the five studies. Epidural analgesia was initiated with either epidural bupivacaine or intrathecal sufentanil and was maintained with a low-dose (0.0625% or 0.125%) mixture of bupivacaine with fentanyl. Intravenous opioid analgesia was initiated with 50 mg meperidine and 25 mg promethazine hydrochloride and was maintained with intravenous boluses of meperidine as needed. Results A total of 1,339 nulliparous women were randomized to receive epidural analgesia, and 1,364 women were randomized to receive intravenous meperidine analgesia. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 10.5% [140 of 1,339] vs. intravenous meperidine analgesia, 10.3% [141 of 1,364]; adjusted odds ratio, 1.04; 95% confidence interval, 0.81-1.34; P = 0.920). Significantly more women randomized to epidural analgesia had forceps deliveries compared to meperidine analgesia (13% [172 of 1,339] vs. 7% [101 of 1,364]; adjusted odds ratio, 1.86; 95% confidence interval, 1.43-2.40; P < 0.001). Epidural women had longer first and second stages of labor. Women who received epidural analgesia reported lower pain scores during labor and delivery compared to women who received intravenous meperidine analgesia. Conclusion Epidural analgesia compared to intravenous meperidine analgesia during labor does not increase the number of cesarean deliveries.

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