scholarly journals Evaluation of the current therapeutic approaches for COVID-19: a meta-analysis

2020 ◽  
Author(s):  
Zeinab Abdelrahman ◽  
Qian Liu ◽  
Shanmei Jiang ◽  
Mengyuan Li ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Treatment Strategy ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Efficacy And Safety ◽  
Limited Data ◽  
Therapeutic Approaches ◽  
Comprehensive Search ◽  
The Impact ◽  
Length Of Icu Stay

Background and rationale: Limited data on the efficacy and safety of currently applied COVID-19 therapeutics and their impact on COVID-19 outcomes have raised additional concern. Aim and Methods: We estimated the impact of the current treatments on the efficacy and safety of COVID-19 by a meta-analysis. The comprehensive search included studies reporting clinical features and treatment strategies published from January 21, 2020, to May 15, 2020. Results: We included 52 studies that involved 13,966 COVID-19 patients. We found that the most prevalent treatments were antivirals (proportion: 0.74, 95% CI : [0.65, 0.83]) and antibiotics (proportion: 0.73, 95% CI: [0.62, 0.83]). The COVID-19 severity increased among patients taking glucocorticoids (risk ratio (RR) = 1.71, 95% CI: [1.06, 2.76]) or immunoglobulins (RR = 3.83, 95% CI: [1.27, 11.53]), and renal replacement therapy (RRT) and glucocorticoids increased the length of ICU stay (RRT : RR = 11.89, 95% CI: [3.26, 43.39]; glucocorticoids: RR = 3.10, 95% CI: [1.52, 6.29]). The COVID-19 severity and mortality increased among patients taking tocilizumab (severity: F = 25.53, P = 0.02; mortality: F = 19.37, P = 0.02). The most effective treatment was the combination of arbidol with lopinavir/ritonavir compared with placebo (mean difference = 0.5, 95% CI [-0.60, 1.66]), and the safest combination was remdesivir and lopinavir/ritonavir (RR= 0.78, 95% CI [0.32, 1.91]). Conclusion: glucocorticoids, immunoglobulins, RRT, and tocilizumab might worsen COVID-19 outcomes, and the most effective and safest treatment strategy for COVID-19 is the combination of different antivirals.

The Efficacy and Safety of Bisphosphonates for Osteoporosis in Women Older Than 65 Years: A Meta-Analysis

2020 ◽  
Vol 26 (32) ◽  
pp. 4022-4030
Author(s):  
Qin Fan ◽  
Junjie Wang
Keyword(s):  
Hip Fracture ◽  
Bone Turnover Marker ◽  
Mass Density ◽  
Meta Analysis ◽  
Bone Mass Density ◽  
Fracture Rate ◽  
Gastrointestinal Adverse Event ◽  
Efficacy And Safety ◽  
Lateral Spine ◽  
Comprehensive Search

Background: Osteoporosis presents a major threat to the health of women older than 65 years. Bisphosphonates (BPs) are now the principal class of medications for osteoporosis. Objective: To evaluate the efficacy and safety of BPs in women older than 65 years. Methods: A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane Central databases was undertaken for randomized controlled trials (RCTs) on the efficacy and safety of BPs in women older than 65 years. The primary outcome measures were the change in bone mass density (BMD), serum bone turnover marker levels, fracture rate and the adverse effect (AE) rate. The final search was performed in August 2019. Results: Seven RCTs were included. A total of 23287 patients met the inclusion criteria. BPs significantly increased the BMD of the posteroanterior (PA) spine, lateral spine and femoral neck, and reduced the fracture, vertebrate fracture and hip fracture rates in women older than 65 years. In addition, BPs increased the risks for pyrexia, myalgia, arthralgia, headache and influenza-like symptoms and had no statistical effect on any AEs, any serious AEs, discontinuation due to AEs, oesophagitis, any upper gastrointestinal adverse event, atrial fibrillation and myocardial infarction occurrence in women older than 65 years. Finally, intravenous BPs reduced hip fracture risk but increased AEs in women older than 65 years. Conclusion: Despite the fact that AEs significantly increased after drug delivery, BPs are highly effective and safe for managing osteoporosis in women older than 65 years. Zoledronic acid caused an increased rate of AEs in women older than 65 years, but these AEs seemed to be mild to moderate. In addition, the hip fracture rate in women older than 80 years old treated with BPs was different than that in the other included patients. Therefore, doctors may prescribe BPs for women older than 65 years in order to increase BMD, and AEs and hip fractures in women older than 80 years should be given attention.

scholarly journals Intraoperative Applications of Topical Corticosteroid Therapy for Chronic Rhinosinusitis

2020 ◽  
pp. 014556132097010
Author(s):  
Matthew J. Lelegren ◽  
Randall A. Bloch ◽  
Kent K. Lam
Keyword(s):  
Topical Corticosteroid ◽  
Chronic Rhinosinusitis ◽  
Corticosteroid Therapy ◽  
Calcium Alginate ◽  
Sinus Surgery ◽  
Efficacy And Safety ◽  
Limited Data ◽  
Wide Range ◽  
Comprehensive Search ◽  
Ocular Safety

Objectives: To provide an overview of recent techniques and technologies for the application of topical corticosteroid therapy immediately following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods: A comprehensive search in the PubMed and Google Scholar databases was conducted to identify publications between January 2000 and December 2019 detailing clinical trials that have evaluated the efficacy and safety of intraoperative applications of topical corticosteroids for CRS. Results: A total of 21 articles, all of which highlight a variety of corticosteroid-infused products, including Propel corticosteroid-eluting stents, NasoPore, Merocel, SinuBand, calcium alginate, and bioresorbable gel-type products, are included for review. Propel stents are the only devices that have achieved level 1A evidence in terms of efficacy and have data to support their safety. The remaining products have shown mixed results in terms of efficacy and safety. Conclusion: A wide range of techniques and technologies have been introduced to enhance the topical delivery of corticosteroids into the neosinuses after ESS for CRS. Regarding efficacy, there is level 1A evidence to support the use of Propel stents. Most of the remaining strategies show some degree of efficacy. Direct comparisons across the different strategies are limited owing to the varied uses of delivery vectors, corticosteroid choices, and doses of corticosteroids. Propel stents and SinuBand have sufficient data to support systemic and ocular safety, whereas the remaining products have limited data to support their safety.

scholarly journals The Influence of Inflammation on Anemia in CKD Patients

2020 ◽  
Vol 21 (3) ◽  
pp. 725 ◽  
Author(s):  
Anna Gluba-Brzózka ◽  
Beata Franczyk ◽  
Robert Olszewski ◽  
Jacek Rysz
Keyword(s):  
Treatment Strategies ◽  
Progression Rate ◽  
Therapeutic Approaches ◽  
Pharmacological Interventions ◽  
Anemia Of Chronic Disease ◽  
New Therapeutic Approaches ◽  
Persistent Inflammation ◽  
Inflammatory State ◽  
The Impact

Anemia is frequently observed in the course of chronic kidney disease (CKD) and it is associated with diminishing the quality of a patient’s life. It also enhances morbidity and mortality and hastens the CKD progression rate. Patients with CKD frequently suffer from a chronic inflammatory state which is related to a vast range of underlying factors. The results of studies have demonstrated that persistent inflammation may contribute to the variability in Hb levels and hyporesponsiveness to erythropoietin stimulating agents (ESA), which are frequently observed in CKD patients. The understanding of the impact of inflammatory cytokines on erythropoietin production and hepcidin synthesis will enable one to unravel the net of interactions of multiple factors involved in the pathogenesis of the anemia of chronic disease. It seems that anti-cytokine and anti-oxidative treatment strategies may be the future of pharmacological interventions aiming at the treatment of inflammation-associated hyporesponsiveness to ESA. The discovery of new therapeutic approaches towards the treatment of anemia in CKD patients has become highly awaited. The treatment of anemia with erythropoietin (EPO) was associated with great benefits for some patients but not all.

scholarly journals A systematic review and critical evaluation of inflammatory cytokine associations in hidradenitis suppurativa

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1930 ◽  
Author(s):  
John W. Frew ◽  
Jason E. Hawkes ◽  
James G. Krueger
Keyword(s):  
Systematic Review ◽  
Hidradenitis Suppurativa ◽  
Meta Analysis ◽  
Critical Evaluation ◽  
Treatment Strategies ◽  
Large Degree ◽  
Inflammatory Conditions ◽  
Longitudinal Measurements ◽  
Chi Squared ◽  
The Impact

Background: The pathogenesis of hidradenitis suppurativa (HS) remains unclear. In order to develop effective treatment strategies, a deeper understanding of pathophysiology is needed. This is impaired by multiple small studies with inconsistent methodologies and the impact of co-occurring pro-inflammatory conditions such as smoking and obesity. Methods: This systematic review aimed to collate all published reports of cytokine studies in tissue, blood, serum and exudate. It was registered with PROSPERO (Registration number CRD42018104664) performed in line with the PRISMA checklist. Results: 19 studies were identified comprising 564 individual HS patients and 198 control patients examining 81 discrete cytokines. Methodology was highly varied and the quality of studies was generally low. There was a large degree of variance between the measured levels of cytokines. 78.2% of cytokines demonstrated heterogeneity by the chi-squared test for homogeneity and hence meta-analysis was not deemed appropriate. However, a strong and significant IL-17 signalling component was identified. Conclusions: Cytokines consistently elevated in lesional, peri-lesional and unaffected tissue are identified and discussed. Areas for further investigation include the role of dendritic cells in HS; the contribution of obesity, smoking, diabetes and the microbiome to cytokine profiles in HS; and examining the natural history of this disease through longitudinal measurements of cytokines over time.

Effect of rosiglitazone on circulating malondialdehyde (MDA) level in diabetes based on a systematic review and meta-analysis of eight clinical trials

2020 ◽  
pp. jim-2020-001588
Author(s):  
Ziba Majidi ◽  
Shaghayegh Hosseinkhani ◽  
Nasrin Amiri-Dashatan ◽  
Solaleh Emamgholipour ◽  
Sara Tutunchi ◽  
...  
Keyword(s):  
Random Effects ◽  
Meta Analysis ◽  
Scientific Information ◽  
Rank Correlation ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Serum Samples ◽  
Subgroup Analyses ◽  
Comprehensive Search ◽  
The Impact

Patients with type 2 diabetes have high levels of malondialdehyde (MDA), and clinical data suggest a reducing effect of rosiglitazone (RSG) on the level of MDA in these patients. However, the results of available studies on the level of MDA in RSG-treated patients are not univocal. This meta-analysis aimed to assess the impact of RSG on the level of MDA. We performed a comprehensive search of PubMed, the Institute for Scientific Information Web of Science, Embase, Scopus, and Cochrane Library for related controlled trials until July 2020. Eligible studies were selected based on the inclusion criteria. Extracted data from each study were combined using a random-effects model. Sensitivity and subgroup analyses were conducted to explore potential heterogeneity. Eight trials with 456 subjects met the inclusion criteria. The results significantly showed the reducing effect of RSG on circulating MDA level (−0.47 μmol/mL; 95% CI −0.93 to −0.01; p=0.04; I2=82.1%; p heterogeneity=0.00) in individuals with T2D. No publication bias was observed with Begg’s rank correlation (p=0.71) and Egger’s linear regression (p=0.52) tests. Subgroup analyses showed that an intervention dose of 8 mg/day in serum samples was found to have a reducing effect on the level of MDA (−0.56 μmol/mL; 95% CI −0.98 to −0.14; p=0.008; I2=11.4%; p heterogeneity=0.32). Random-effects meta-regression did not show any significant association between the level of MDA and potential confounders including RSG dose, treatment duration, and sex. In conclusion, we found a significant reduction in MDA concentration in subjects with T2D who received a dose of 8 mg of RSG daily.

scholarly journals Phosphodiesterase-5 Inhibitors for Premature Ejaculation: Systematic Review and Meta-Analysis of Placebo-Controlled Trials

2020 ◽  
Vol 14 (3) ◽  
pp. 155798832091640
Author(s):  
Xuebao Zhang ◽  
Nan Chi ◽  
Miao Sun ◽  
Zhengfei Shan ◽  
Yulian Zhang ◽  
...  
Keyword(s):  
Side Effects ◽  
Sexual Satisfaction ◽  
Premature Ejaculation ◽  
Nasal Congestion ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Satisfaction Scale ◽  
Phosphodiesterase 5 Inhibitors ◽  
Comprehensive Search ◽  
Phosphodiesterase 5

The purpose of this analysis is to assess the efficacy and safety of phosphodiesterase-5 inhibitors (PDE5Is) for the treatment of premature ejaculation (PE). A comprehensive search was performed to ascertain from trials about PDE5Is for the treatment of PE and compare the results, including intravaginal ejaculatory latency time (IVELT), score of sexual satisfaction scale, and side effects, between the group treated with PDE5Is and that treated with placebo. Seven studies involving a total of 471 patients were included in this meta-analysis. This analysis showed that patients who were treated with PDE5Is had significantly increased IVELT (mean difference [MD] 2.60; 95% CI [1.85, 3.36]; p < .00001) and score of sexual satisfaction scale (MD 2.04; 95% CI [0.78, 3.30]; p = .002) compared with the group on placebo. More patients had side effects while taking PDE5Is, such as headache, dizziness, flushing, and nasal congestion. PDE5Is were significantly more effective than placebo in the treatment of PE. Side effects were more common among patients who were treated with PDE5Is.

The Potential Effects of Burn Pit Exposure on the Respiratory Tract: A Systematic Review

2021 ◽  
Author(s):  
James McLean ◽  
Danielle Anderson ◽  
Gregory Capra ◽  
Charles A Riley
Keyword(s):  
Systematic Review ◽  
Respiratory Tract ◽  
Meta Analysis ◽  
Service Members ◽  
Objective Measures ◽  
Upper Respiratory Tract ◽  
Limited Data ◽  
Patient Reports ◽  
Patient Reported ◽  
The Impact

ABSTRACT Introduction Burn pits (BPs) have been widely used by the U.S. military for waste disposal while in conflicts abroad. Significant adverse health effects are thought to be linked to BPs, but limited data exist examining the impact on the respiratory tract. The purpose of this systematic review is to characterize these effects on both the upper respiratory tract (URT) and lower respiratory tract (LRT). Materials and Methods A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines on articles published from January 1, 2001, through November 2020. PubMed, EMBASE, and Ovid MEDLINE databases were queried for studies examining the effect of BPs on the URT and LRT of service members. Results A total of 288 articles were identified, with nine meeting inclusion criteria. Eight of the nine articles assessed the LRT, one examined the URT alone, and two examined both the URT and LRT. Outcome measures were heterogeneous across all studies, precluding meta-analysis. Patient-reported LRT diagnoses appeared to increase as exposure to BPs increased. There are very limited data assessing the impact of BP exposure on the URT. No association between BP exposure and objective measures of LRT or URT disease was identified. Conclusion Service members deployed to combat zones seem to report a significant increase in respiratory diseases following exposure to BPs, although definitive conclusions are limited by multiple airborne exposures and varied reporting methods. Self-reported LRT diagnoses appear to be more prevalent. There is a paucity of data on the effects of BPs on the URT. Objective measures of disease do not appear to correlate with patient reports. Prospective, long-term, and outcome-based studies are necessary to examine the effects of BPs, and other airborne hazards related to deployment, on the URT and LRT of service members.

scholarly journals Efficacy and safety profile of xanthines in COPD: a network meta-analysis

2018 ◽  
Vol 27 (148) ◽  
pp. 180010 ◽  
Author(s):  
Mario Cazzola ◽  
Luigino Calzetta ◽  
Peter J. Barnes ◽  
Gerard J. Criner ◽  
Fernando J. Martinez ◽  
...  
Keyword(s):  
Adverse Events ◽  
Safety Profile ◽  
Meta Analysis ◽  
Forced Expiratory Volume ◽  
Therapeutic Window ◽  
Comparable Efficacy ◽  
Chronic Obstructive ◽  
Efficacy And Safety ◽  
Quantitative Synthesis ◽  
The Impact

Theophylline can still have a role in the management of stable chronic obstructive pulmonary disease (COPD), but its use remains controversial, mainly due to its narrow therapeutic window. Doxofylline, another xanthine, is an effective bronchodilator and displays a better safety profile than theophylline. Therefore, we performed a quantitative synthesis to compare the efficacy and safety profile of different xanthines in COPD.The primary end-point of this meta-analysis was the impact of xanthines on lung function. In addition, we assessed the risk of adverse events by normalising data on safety as a function of person-weeks. Data obtained from 998 COPD patients were selected from 14 studies and meta-analysed using a network approach.The combined surface under the cumulative ranking curve (SUCRA) analysis of efficacy (change from baseline in forced expiratory volume in 1 s) and safety (risk of adverse events) showed that doxofylline was superior to aminophylline (comparable efficacy and significantly better safety), bamiphylline (significantly better efficacy and comparable safety), and theophylline (comparable efficacy and significantly better safety).Considering the overall efficacy/safety profile of the investigated agents, the results of this quantitative synthesis suggest that doxofylline seems to be the best xanthine for the treatment of COPD.

scholarly journals Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis

2020 ◽  
Vol 8 (1) ◽  
pp. e001225
Author(s):  
Yaqian Mao ◽  
Wei Lin ◽  
Junping Wen ◽  
Gang Chen
Keyword(s):  
Systematic Review ◽  
Economic Development ◽  
Clinical Outcomes ◽  
Mobile Health ◽  
Treatment Strategy ◽  
Meta Analysis ◽  
Developed Countries ◽  
Mhealth Intervention ◽  
The Impact ◽  
Different Levels

With the continuous development of science and technology, mobile health (mHealth) intervention has been proposed as a treatment strategy for managing chronic diseases. In some developed countries, mHealth intervention has been proven to remarkably improve both the quality of care for patients with chronic illnesses and the clinical outcomes of these patients. However, the effectiveness of mHealth in developing countries remains unclear. Based on this fact, we conducted this systematic review and meta-analysis to evaluate the impact of mHealth on countries with different levels of economic development. To this end, we searched Pubmed, ResearchGate, Embase and Cochrane databases for articles published from January 2008 to June 2019. All of the studies included were randomized controlled trials. A meta-analysis was performed using the Stata software. A total of 51 articles (including 13 054 participants) were eligible for our systematic review and meta-analysis. We discovered that mHealth intervention did not only play a major role in improving clinical outcomes compared with conventional care, but also had a positive impact on countries with different levels of economic development. More importantly, our study also found that clinical outcomes could be ameliorated even further by combining mHealth with human intelligence rather than using mHealth intervention exclusively. According to our analytical results, mHealth intervention could be used as a treatment strategy to optimize the management of diabetes and hypertension in countries with different levels of economic development.

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