Bleomycin-Induced Pneumonitis in the Treatment of Ovarian Sex Cord–Stromal Tumors: A Systematic Review and Meta-analysis

ObjectiveAdult ovarian sex cord–stromal tumors (SCSTs) are a rare histological subtype of ovarian cancer associated with a favorable prognosis. Bleomycin-containing regimens are standards of care, although pneumonitis may cause potentially fatal dose-limiting toxicity. We aimed to evaluate the safety of bleomycin in SCST treatment.MethodsWe performed a systematic literature review of all studies of bleomycin therapy for SCSTs that were referenced in MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials and published from 1986 to 2014.ResultsEight studies totaling 221 patients were included. Rates of pneumonitis (7.7%; 95% confidence interval, 4.2–11.2) and mortality (1.8%; 95% confidence interval, 0.1–3.6) related to bleomycin were significant. However, these results were very similar to those reported for men who were treated with bleomycin for a male germ cell tumor, suggesting that women with ovarian SCSTs are not particularly vulnerable to bleomycin lung toxicity. The main risk factors of bleomycin-induced pneumonitis are high cumulative bleomycin dose (>400 U or mg), age older than 40 years, and impaired renal function. Whether granulocyte colony-stimulating factor is a risk factor remains controversial.ConclusionsBleomycin-induced pneumonitis frequently occurs in patients with SCSTs and lacks effective treatment. Prevention lies in limiting cumulative bleomycin dose, monitoring pulmonary function during treatment, discontinuing bleomycin at the onset of pulmonary symptoms or if pulmonary function is impaired, and avoiding bleomycin in older patients.

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1183. Effect of Chlorhexidine Bath on the Prevention of Ventilator-associated Pneumonia: A Meta-Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1046 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S424-S424

Author(s):

Mark Jay M Robles

Keyword(s):

Confidence Interval ◽

Meta Analysis ◽

Cochrane Central Register ◽

Ventilator Associated Pneumonia ◽

Antiseptic Solution ◽

Central Register ◽

Before And After ◽

Effective Product ◽

Study Designs ◽

Before And After Study

Abstract Background Ventilator-associated pneumonia, defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation, represents one of the most important nosocomial infections in critically ill patients. Chlorhexidine, an antiseptic solution, is a safe and effective product with broad antiseptic activity. This meta-analysis would like to investigate if Chlorhexidine bathing significantly reduced the incidence of Ventilator-associated pneumonia. Methods We searched PubMed and Cochrane Central Register database to check for all published studies related to the reduction of VAP with the application of chlorhexidine bath vs. control. Various study designs such as randomized controlled trials, Before-and-After study were included in this meta-analysis. Results This meta-analysis analyzed eight studies. One hundred Thirty-nine (139) events developed in the chlorhexidine group over 33,030 patient-days which were significantly lower compared with 183 in the soap and water group over 35,213 patient-days. The overall incidence of Ventilator-associated Pneumonia (VAP) with the application of chlorhexidine was significantly reduced by 23% with a pooled Risk Ratio (RR) of 0.77 with 95% Confidence Interval (CI): 0.62–0.96; I2 = 52%. In the subgroup analysis, a more significant outcome was observed using Before-and-After study as the research design (pooled RR 0.63, 95% Confidence Interval (CI): 0.48–0.83, I2 = 31%). Daily chlorhexidine bath generated a more favorable outcome, compared with every other day application as evident on the pooled RR 0.78, 95% confidence interval (CI): 0.62–0.98, I2=59% Conclusion This meta-analysis clearly favors the use of daily chlorhexidine bath in the prevention of ventilator-associated pneumonia. Disclosures All authors: No reported disclosures.

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Effect of Obesity on Survival of Women With Epithelial Ovarian Cancer: A Systematic Review and Meta-Analysis of Observational Studies

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31822eb5f8 ◽

2011 ◽

Vol 21 (9) ◽

pp. 1525-1532 ◽

Cited By ~ 45

Author(s):

Hyun-Sik Yang ◽

Chan Yoon ◽

Seung-Kwon Myung ◽

Sang Min Park

Keyword(s):

Ovarian Cancer ◽

Confidence Interval ◽

Epithelial Ovarian Cancer ◽

Meta Analysis ◽

Early Adulthood ◽

Harmful Effect ◽

Advanced Ovarian Cancer ◽

Final Analysis ◽

Cochrane Central Register ◽

Central Register

ObjectiveAlthough obesity is shown to be a risk factor for epithelial ovarian cancer, its role as a prognostic factor has been remained inconclusive. In this study, available evidences on this matter to date have been assembled for a meta-analysis to determine the effect of obesity on the survival of patients with epithelial ovarian cancer.Materials and MethodsEligible studies published up to December 2010 were searched using MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials, and manual review of relevant bibliography to look for additional studies was done. Adjusted hazard ratios (HRs) from individual studies were pooled using a random-effects model.ResultsTen cohort studies of 331 screened articles were included in the final analysis. The meta-analysis showed overweight or obesity at early adulthood to be associated with higher mortality among patients with ovarian cancer (HR, 1.60; 95% confidence interval, 1.10–2.34). Among patients with advanced ovarian cancer, premorbid obesity was associated with worse prognosis (HR, 1.45; 95% confidence interval, 1.09–1.93). However, there was no significant relationship between prognosis and obesity around the time of diagnosis.ConclusionsThis study suggests a possible relationship between obesity at early adulthood and higher mortality among patients with ovarian cancer. Further studies are needed to elucidate the harmful effect of obesity on the survival of patients with ovarian cancer.

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Convalescent plasma therapy for COVID-19 patients: a protocol of a prospective meta-analysis of randomized controlled trials

Trials ◽

10.1186/s13063-021-05066-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Lajos Szakó ◽

Nelli Farkas ◽

Szabolcs Kiss ◽

Szilárd Váncsa ◽

Noémi Zádori ◽

...

Keyword(s):

Confidence Interval ◽

Randomized Controlled Trials ◽

Organ Failure ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Plasma Therapy ◽

Monthly Basis ◽

Randomized Controlled

Abstract Background Coronavirus disease 2019 (COVID-19) is an infection with possible serious consequences. The plasma of recovered patients might serve as treatment, which we aim to assess in the form of a prospective meta-analysis focusing on mortality, multi-organ failure, duration of intensive care unit stay, and adverse events. Methods A systematic search was conducted to find relevant registered randomized controlled trials in five trial registries. A comprehensive search will be done continuously on a monthly basis in MEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science to find the results of previously registered randomized controlled trials. The selection will be done by two independent authors. Data extraction will be carried out by two other independent reviewers. Disagreements will be resolved by a third investigator. An update of the search of the registries and the first search of the databases will be done on the 21st of July. Data synthesis will be performed following the recommendations of the Cochrane Collaboration. In the case of dichotomous outcomes (mortality and organ failure), we will calculate pooled risk ratios with a 95% confidence interval (CI) from two-by-two tables (treatment Y/N, outcome Y/N). Data from models with multivariate adjustment (hazard ratios, odds ratio, risk ratio) will be preferred for the analysis. P less than 0.05 will be considered statistically significant. In the case of ICU stay, weighted mean difference with a 95% confidence interval will be calculated. Heterogeneity will be tested with I2, and χ2 tests. Meta-analysis will be performed if at least 3 studies report on the same outcome and population. Discussion Convalescent plasma therapy is a considerable alternative in COVID-19, which we aim to investigate in a prospective meta-analysis.

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A Meta-Analysis of the Efficacy of Hyaluronic Acid Eye Drops for the Treatment of Dry Eye Syndrome

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052383 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2383

Author(s):

Yun-Jung Yang ◽

Won-Young Lee ◽

Young-jin Kim ◽

Yeon-pyo Hong

Keyword(s):

Hyaluronic Acid ◽

Confidence Interval ◽

Dry Eye ◽

Test Scores ◽

Meta Analysis ◽

Mean Difference ◽

Dry Eye Syndrome ◽

Eye Drops ◽

Cochrane Central Register ◽

Standard Mean Difference

Hyaluronic acid (HA) is commonly used for treating dry eye syndrome (DES). This meta-analysis was performed to compare the efficacies of HA- and non-HA-based eye drops, including saline and conventional artificial tears (ATs), for the treatment of dry eye disease. Eight databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, DBpia, KoreaMed, KMBASE, RISS, KISS) were searched for studies comparing the efficacies of HA- and non-HA-based ATs in patients with DES published up to September 2020. Two independent reviewers assessed the quality and extracted the relevant data. The mean differences of Schirmer’s (SH) test scores, tear breakup times (TBUT), corneal fluorescein staining scores (Oxford scale, 0–4), and ocular surface disease indexes were calculated. The standard mean difference and 95% confidence interval were calculated using a random effect model. Nineteen studies, including 2078 cases, were included. HA eye drops significantly improved tear production compared with non-HA-based eye drops (standard mean difference (SMD) 0.18; 95% confidence interval (CI) 0.03, 0.33). In a subgroup analysis, the SH test scores and TBUT values after using HA significantly increased compared to those measured after using saline (SMD 0.27; 95% CI 0.05, 0.49 and SMD 0.28; 95% CI 0.03, 0.52, respectively). Based on these results, HA eye drops may be superior to non-HA eye drops including normal saline and ATs. Further research is needed to assess the efficacies stratified by age, treatment duration, the severity of dry eye, and optimal dosages.

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Use of opioids in patients with cancer with hepatic impairment—a systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003065 ◽

2021 ◽

pp. bmjspcare-2021-003065

Author(s):

Lewis Thomas Hughes ◽

David Raftery ◽

Paul Coulter ◽

Barry Laird ◽

Marie Fallon

Keyword(s):

Systematic Review ◽

Cancer Pain ◽

Hepatic Impairment ◽

Evaluation System ◽

Meta Analysis ◽

Hepatic Function ◽

Cochrane Central Register ◽

Assessment Development ◽

Patients With Cancer ◽

Central Register

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

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Meta-Analysis: Randomized Trials of Lactobacillus plantarum on Immune Regulation Over the Last Decades

Frontiers in Immunology ◽

10.3389/fimmu.2021.643420 ◽

2021 ◽

Vol 12 ◽

Author(s):

Wei Zhao ◽

Chuantao Peng ◽

Hafiz Arbab Sakandar ◽

Lai-Yu Kwok ◽

Wenyi Zhang

Keyword(s):

Meta Analysis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Central Register ◽

Tnf Α ◽

Ifn Γ ◽

The Mean ◽

Regulatory Effects ◽

Mean Differences ◽

Necrosis Factor

Lactobacillus (L.) plantarum strains, belong to lactic acid bacteria group, are considered indispensable probiotics. Here, we performed meta-analysis to evaluate the regulatory effects of L. plantarum on the immunity during clinical trials. This meta-analysis was conducted by searching across four most common literature databases, namely, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PubMed. Clinical trial articles that met the inclusion and exclusion criteria were analyzed by Review Manager (version 5.3). p-value < 0.05 of the total effect was considered statistically significant. Finally, total of 677 references were retrieved, among which six references and 18 randomized controlled trials were included in the meta-analysis. The mean differences observed at 95% confidence interval: interleukin (IL)-4, −0.48 pg/mL (−0.79 to −0.17; p < 0.05); IL-10, 9.88 pg/mL (6.52 to 13.2; p < 0.05); tumor necrosis factor (TNF)-α, −2.34 pg/mL (−3.5 to −1.19; p < 0.05); interferon (IFN)-γ, −0.99 pg/mL (−1.56 to −0.41; p < 0.05). Therefore, meta-analysis results suggested that L. plantarum could promote host immunity by regulating pro-inflammatory and anti-inflammatory cytokines.

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Systematic review and meta-analysis of outcomes in patients with suspected pulmonary embolism

Blood Advances ◽

10.1182/bloodadvances.2020002398 ◽

2021 ◽

Vol 5 (8) ◽

pp. 2237-2244

Author(s):

Parth Patel ◽

Payal Patel ◽

Meha Bhatt ◽

Cody Braun ◽

Housne Begum ◽

...

Keyword(s):

Pulmonary Embolism ◽

Ct Scan ◽

Major Bleeding ◽

Meta Analysis ◽

Cochrane Central Register ◽

Suspected Pulmonary Embolism ◽

Central Register ◽

Mortality Incidence ◽

D Dimer

Abstract Prompt evaluation and therapeutic intervention of suspected pulmonary embolism (PE) are of paramount importance for improvement in outcomes. We systematically reviewed outcomes in patients with suspected PE, including mortality, incidence of recurrent PE, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included 22 studies with 15 865 patients. Among patients who were diagnosed with PE and discharged with anticoagulation, 3-month follow-up revealed that all-cause mortality was 5.69% (91/1599; 95% confidence interval [CI], 4.56-6.83), mortality from PE was 1.19% (19/1597; 95% CI, 0.66-1.72), recurrent venous thromboembolism (VTE) occurred in 1.38% (22/1597; 95% CI: 0.81-1.95), and major bleeding occurred in 0.90% (2/221%; 95% CI, 0-2.15). In patients with a low pretest probability (PTP) and negative D-dimer, 3-month follow-up revealed mortality from PE was 0% (0/808) and incidence of VTE was 0.37% (4/1094; 95% CI: 0.007-0.72). In patients with intermediate PTP and negative D-dimer, 3-month follow-up revealed that mortality from PE was 0% (0/2747) and incidence of VTE was 0.46% (14/3015; 95% CI: 0.22-0.71). In patients with high PTP and negative computed tomography (CT) scan, 3-month follow-up revealed mortality from PE was 0% (0/651) and incidence of VTE was 0.84% (11/1302; 95% CI: 0.35-1.34). We further summarize outcomes evaluated by various diagnostic tests and diagnostic pathways (ie, D-dimer followed by CT scan).

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Cognitive Behavioral Therapy combined with physical exercise for depression, anxiety, fatigue and pain in adults with chronic diseases: systematic review and meta-analysis

10.31236/osf.io/as6c7 ◽

2018 ◽

Author(s):

Paquito Bernard ◽

Romain Ahmed Jérôme ◽

Johan Caudroit ◽

Guillaume Chevance ◽

Carayol Marion ◽

...

Keyword(s):

Physical Exercise ◽

Methodological Quality ◽

Randomized Clinical Trials ◽

Behavioral Therapy ◽

Meta Analysis ◽

Effect Sizes ◽

Cognitive Behavior ◽

Cochrane Central Register ◽

Depression And Anxiety ◽

Central Register

Objective. The present meta-analysis aimed to determine the overall effect of cognitive behavior therapy combined with physical exercise (CBTEx) interventions on depression, anxiety, fatigue, and pain in adults with chronic illness; to identify the potential moderators of efficacy; and to compare the efficacy of CBTEx versus each condition alone (CBT and physical exercise). Methods. Relevant randomized clinical trials, published before July 2017, were identified through database searches in Pubmed, PsycArticles, CINAHL, SportDiscus and the Cochrane Central Register for Controlled Trials.Results. A total of 30 studies were identified. CBTEx interventions yielded small-to-large effect sizes for depression (SMC = -0.34, 95% CI [-0.53; -0.14]), anxiety (SMC = -0.18, 95% CI [-0.34; -0.03]) and fatigue (SMC = -0.96, 95% CI [-1.43; -0.49]). Moderation analyses revealed that longer intervention was associated with greater effect sizes for depression and anxiety outcomes. Low methodological quality was also associated with increased CBTEx efficacy for depression. When compared directly, CBTEx interventions did not show greater efficacy than CBT alone or physical exercise alone for any of the outcomes. Conclusion. The current literature suggests that CBTEx interventions are effective for decreasing depression, anxiety, and fatigue symptoms, but not pain. However, the findings do not support an additive effect of CBT and exercise on any of the four outcomes compared to each condition alone.

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A Meta-analysis of Major Complications between Traditional Pacemakers and Leadless Pacemakers

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2019.0596 ◽

2020 ◽

Author(s):

Yun-Qing Chen

Keyword(s):

Pericardial Effusion ◽

Risk Ratio ◽

Clinical Effect ◽

Meta Analysis ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Cardiac Perforation ◽

Major Complications ◽

Central Register ◽

Reported Data

Objectives: We aim to compare the major complications between leadless pacemakers and traditional pacemakers.Background: Leadless pacemakers, which are increasingly used in clinical practice, have several advantages compared with traditional pacemakers in avoiding pocket- and lead-related complications. However, the clinical effect of leadless pacemakers remains controversial.Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the CNKI database, and the Wanfang database were searched from July 2013 to December 2019. Studies comparing leadless pacemakers and traditional pacemakers were included. The primary end point was major complications. The secondary end points were cardiac perforation/pericardial effusion, device revision or extraction, loss of device function, and death.Results: Six studies fulfilled the inclusion criteria. Only four of the six studies reported data on major complications.Leadless pacemakers were associated with a lower incidence of major complications (risk ratio 0.33, 95% confidenceinterval 0.25–0.44, P < 0.00001, I² = 49%). We extracted data on cardiac perforation/pericardial effusion, device revisionor extraction, loss of device function, and death from six studies. Our meta-analysis showed that leadless pacemakershave a higher risk of cardiac perforation or pericardial effusion (risk ratio 4.28, 95% confidence interval 1.66–11.08,P = 0.003, I² = 0%). No statistically significant differences were found for mortality, device revision or extraction, andloss of device function.Conclusion: Compared with traditional pacemakers, leadless pacemakers have a significantly decreased risk of majorcomplications, but have a higher risk of cardiac perforation or pericardial effusion.

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Systematic Review and Meta-analysis of Eculizumab, Inebilizumab, Tocilizumab, and Satralizumab for Neuromyelitis Optica

10.1101/2021.07.22.21261005 ◽

2021 ◽

Author(s):

Rajan Chamlagain ◽

Sangam shah ◽

Suman Gaire ◽

Anuj Krishna Paudel ◽

Krishna Dahal ◽

...

Keyword(s):

Monoclonal Antibody ◽

Monoclonal Antibodies ◽

Neuromyelitis Optica ◽

Treatment Guidelines ◽

Meta Analysis ◽

Cochrane Central Register ◽

Central Register ◽

Significant Difference ◽

Quantitative Synthesis ◽

The Central Nervous System

Neuromyelitis optica is rare, autoimmune-mediated inflammation and demyelination of the central nervous system with a prevalence of 1-2 persons per 100,000 populations. We aim to generate a head-to-head comparison of these drugs with appropriate evidence to guide future trials and treatment guidelines in a patient with recurrent attacks of NMO. We searched the databases like PubMed, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase for studies published prior to April 2021 using the keywords. Over all 929 patients from 11 different publications were included in the study. Five studies were included for quantitative synthesis. Pooling of studies showed significant mean reduction of ARR in the monoclonal antibody group (-0.26 [-0.35, -0.17], P <0.00001, I2=0%) and the mean difference in EDSS score from baseline in monoclonal antibodies was -0.23(95% CI [-0.43, -0.03], P=0.02, I2=0%). There was no significant difference in frequency of total reported adverse events between monoclonal antibody and the comparator arm (RR: 1.01 [0.95, 1.07], P=0.74, I2=14%). Our findings, particularly seen from the context of a few RCTs, support the pursuit of larger, multi-center RCTs that evaluate the effectiveness of each of the currently available monoclonal antibodies and better describe their adverse risk profile.

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