scholarly journals β lactam monotherapy versus β lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials

BMJ ◽  
2004 ◽  
Vol 328 (7441) ◽  
pp. 668 ◽  
Author(s):  
Mical Paul ◽  
Ishay Benuri-Silbiger ◽  
Karla Soares-Weiser ◽  
Leonard Leibovici
Keyword(s):  
Relative Risk ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Randomised Trials ◽  
Intention To Treat ◽  
Relative Risks ◽  
Development Of Resistance

AbstractObjective To compare β lactam monotherapy with β lactam-aminoglycoside combination therapy for severe infections.Data sources Medline, Embase, Lilacs, Cochrane Library, and conference proceedings, to 2003; references of included studies; contact with all authors. No restrictions, such as language, year of publication, or publication status.Study selection All randomised trials of β lactam monotherapy compared with β lactam-aminoglycoside combination therapy for patients without neutropenia who fulfilled criteria for sepsis.Data selection Two reviewers independently applied selection criteria, performed quality assessment, and extracted the data. The primary outcome assessed was all cause fatality by intention to treat. Relative risks were pooled with the random effect model (relative risk < 1 favours monotherapy).Results 64 trials with 7586 patients were included. There was no difference in all cause fatality (relative risk 0.90, 95% confidence interval 0.77 to 1.06). 12 studies compared the same β lactam (1.02, 0.76 to 1.38), and 31 studies compared different β lactams (0.85, 0.69 to 1.05). Clinical failure was more common with combination treatment overall (0.87, 0.78 to 0.97) and among studies comparing different β lactams (0.76, 0.68 to 0.86). There was no advantage to combination therapy among patients with Gram negative infections (1835 patients) or Pseudomonas aeruginosa infections (426 patients). There was no difference in the rate of development of resistance. Nephrotoxicity was significantly more common with combination therapy (0.36, 0.28 to 0.47). Heterogeneity was not significant for these comparisons.Conclusions In the treatment of sepsis the addition of an aminoglycoside to β lactams should be discouraged. Fatality remains unchanged, while the risk for adverse events is increased.

Novel oral anticoagulats for the treatment of left ventricle thrombosis: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Serenelli ◽  
F Vitali ◽  
R Pavasini ◽  
E Tonet ◽  
G Pompei ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Ventricular Thrombus

Abstract Funding Acknowledgements Type of funding sources: None. Background novel oral anticoagulants (NOACs) are not guideline-recommanded treatment for left ventricular thrombus.  Purpose: the aim of this meta-analysis is to compare NOACs versus vitamin-K atagonsits (VKAs) efficacy in treating left ventricular thrombus (LVT). Methods: we systematically searched MEDLINE, Cochrane Library, Biomed Central, and Web of Science for trials comparing NOACs versus VKAs in the setting of LVT. Five studies, out of the 74 initially selected after first screening, were included in the meta-analysis. For the development of this meta-analysis, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. The shortlisted studies were retrieved as full articles and appraised independently by two unblinded reviewers. The Mantel-Haensel method with a random effect model was used for the pooled analysis. The primary outcome was the occurrence of stroke and systemic embolism. Secondary outcome was occurrence of left ventricular thrombosis resolution during treatment.  Results: 707 patients were included in the analysis for the primary outcome. Of these, 230 were treated with NOACs and 477 with VKAs. The pooled OR for the primary outcome was 0.71 (95% CI 0.18-2.86, I2 67%), thus showing similar effect in term of ischaemic protection. A total of 698 patients, 228 on NOACs and 470 on VKAs were included in the analysis of the secondary outcome. The pooled OR for the secondary outcome pooled OR 0.97, 95% CI 0.56-1.68, I2 46%. Conclusions and Relevance: NOACs seem to have a similar efficacy profile compare to VKAs and so they should be considered as an alternative treatment for left ventricular thrombosis. Large prospective randomized clinical trials are needed to confirm this exploratory finding. Abstract Figure 1

scholarly journals Prevalence of Human Papilloma Virus in Patients With Colorectal Cancer: A Systematic Review and Meta-analysis

2019 ◽  
Vol 7 (4) ◽  
pp. 106-112
Author(s):  
Masoud Dadashi ◽  
Shaian Tavakolian ◽  
Ebrahim Faghihloo
Keyword(s):  
Colorectal Cancer ◽  
Meta Analysis ◽  
Scientific Information ◽  
Random Effect ◽  
Random Effect Model ◽  
Hpv Infection ◽  
High Rate ◽  
Cochrane Library ◽  
High Risk Behaviors ◽  
The World

Background: Human papillomavirus (HPV) is considered as one of the most common carcinogenic viruses in humans throughout the world and is mostly associated with gynecologic malignancies. However, it is also one of the environmental factors that is involved in colorectal cancer (CRC). Objective: A meta-analysis was performed to investigate the prevalence of HPV infection in patients suffering from the CRC. Methods: The frequency of the HPV in patients with CRC was studied from 2001 to 2016. To this end, several databases were reviewed, including PubMed, Web of Science, Embase, Cochrane Library, Google Scholar, Iranmedex, and the Scientific Information Database. Then, the analysis was done by Comprehensive Meta-Analysis (V2.0, Biostat) software. Considering heterogeneity between different studies, the random effect model was used and then the results were checked with Cochran’s Q-statistic. Results: The meta-analysis revealed that the frequency of HPV infection in patients with CRC was 33.7% (a 95% CI of 28.4-39.5). The additional stratified analysis also showed that HPV infection in CRC patients was more widespread in European countries compared to Asian and American countries. Conclusion: The high rate of HPV infection is a major concern in sexually transmitted diseases around the world, therefore, controlling high-risk behaviors, vaccination, screening, and HPV subtyping can be useful in managing HPV infections.

scholarly journals Abdominal obesity and gastroesophageal cancer risk: systematic review and meta-analysis of prospective studies

2017 ◽  
Vol 37 (3) ◽  
Author(s):  
Xuan Du ◽  
Khemayanto Hidayat ◽  
Bi-Min Shi
Keyword(s):  
Esophageal Cancer ◽  
Abdominal Obesity ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Final Analysis ◽  
Gastric Cardia Adenocarcinoma ◽  
Gastroesophageal Cancer ◽  
Relative Risks ◽  
Increased Risk

To systematically and quantitatively review the relation of abdominal obesity, as measured by waist circumference (WC) and waist to hip ratio (WHR), to total gastroesophageal cancer, gastric cancer (GC), and esophageal cancer. PubMed and Web of Science databases were searched for studies assessing the association between abdominal obesity and gastroesophageal cancer (GC and/or esophageal cancer) up to August 2016. A random-effect model was used to calculate the summary relative risks (RRs) and 95% confidence intervals (CIs). Seven prospective cohort studies – one publication included two separate cohorts – from six publications were included in the final analysis. A total of 2130 gastroesophageal cancer cases diagnosed amongst 913182 participants. Higher WC and WHR were significantly associated with increased risk of total gastroesophageal cancer (WC: RR 1.68, 95% CI: 1.38, 2.04; WHR: RR 1.49, 95% CI: 1.19, 1.88), GC (WC: RR 1.48, 95% CI: 1.24, 1.78; WHR: 1.33, 95% CI: 1.04, 1.70), and esophageal cancer (WC: RR 2.06, 95% CI: 1.30, 3.24; WHR: RR 1.99, 95% CI: 1.05, 3.75).Findings from our subgroup analyses showed non-significant positive associations between gastric non-cardia adenocarcinoma (GNCA) and both measures of abdominal adiposity, while gastric cardia adenocarcinoma (GCA) was positively associated with WC but not with WHR. On analysis restricted to studies that adjusted for body mass index (BMI), WC was positively associated with GC and esophageal cancer, whereas WHR was positively associated with risk of GC only. Although limited, the findings from our meta-analysis suggest the potential role of abdominal obesity in the etiology of gastric and esophageal cancers.

scholarly journals Mean Platelet Volume and Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Zhongwei Zhou ◽  
Hongmei Chen ◽  
Mingzhong Sun ◽  
Huixiang Ju
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Mean Platelet Volume ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Platelet Volume

Aim. To evaluate the association between mean platelet volume (MPV) and gestational diabetes mellitus (GDM). Methods. A systematic literature search was performed in PubMed, EMBASE, Web of Science, and The Cochrane Library up to 4 September 2017. Pooled standardized mean differences (SMD) and 95% confidence interval (CI) were calculated using a random-effect model. Results. Nineteen studies comprising 1361 GDM patients and 1911 normal pregnant women were included. MPV was increased in GDM patients when compared with healthy pregnant women (SMD: 0.79; 95% CI: 0.43–1.16; P<0.001). Subgroup analyses revealed that such trend was consistent in the third-trimester (SMD: 1.35; 95% CI: 0.72–1.98), Turkish (SMD: 0.81; 95% CI: 0.43–1.19), and Italian (SMD: 2.78; 95% CI: 2.22–3.34) patients with GDM and the patients diagnosed based on Carpenter and Coustan criteria (SMD: 1.04; 95% CI: 0.42–1.65). Significantly higher MPV also were observed within cross-sectional studies (SMD: 0.99; 95% CI: 0.49–1.49). Remarkable between-study heterogeneity and potential publication bias were observed in this meta-analysis; however, sensitivity analysis indicated that the results were not unduly influenced by any single study. Conclusions. GDM patients are accompanied by increased MPV, strengthening the clinical evidence that MPV may be a predictive marker for GDM.

Association of smokeless tobacco and cerebrovascular accident: a systematic review and meta-analysis of global data

2019 ◽  
Vol 42 (2) ◽  
pp. e150-e157 ◽  
Author(s):  
R Gupta ◽  
S Gupta ◽  
S Sharma ◽  
D N Sinha ◽  
R Mehrotra
Keyword(s):  
Smokeless Tobacco ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Group Analysis ◽  
Chewing Tobacco ◽  
Fatal Stroke ◽  
Relative Risks ◽  
Study Characteristics ◽  
Gender Based

Abstract Background The association of smokeless tobacco (SLT) with stroke has been dealt with in only a few reviews. The present meta-analysis aims to present the updated comprehensive summary risk of stroke in adult SLT users along with sub group analysis. Methods A systematic literature search for articles evaluating risk of stroke in SLT users was conducted. The study characteristics and risk estimates were extracted independently by two authors (RG and SG). Random-effect model was used to estimate the summary relative risks. Results The overall risk of stroke in SLT users was found to be significantly higher (1.17, 95% CI 1.04–1.30) compared to non-users, especially for users in Southeast Asian region. The results remained unchanged even after strict adjustment for smoking (1.18, 95% CI 1.04–1.32). SLT users had 1.34 times or 13.4% higher risk of fatal stroke, though risk of nonfatal stroke was not enhanced. Significantly higher risk of stroke was seen in users of chewing tobacco (1.35, 95% CI 1.20–1.50) in comparison to non-chewers. Gender-based analysis showed enhanced risk of fatal stroke in both male and female users. SLT-attributable fraction of fatal stroke was highest for India at 14.8%. Conclusion The significant higher risk of stroke with SLT use, even after adjustment for smoking, emphasizes the imperative need to include SLT cessation advice for control and prevention of stroke.

scholarly journals The Associations between VEGF Gene Polymorphisms and Diabetic Retinopathy Susceptibility: A Meta-Analysis of 11 Case-Control Studies

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Liyuan Han ◽  
Lina Zhang ◽  
Wenhua Xing ◽  
Renjie Zhuo ◽  
XiaLu Lin ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Recessive Model ◽  
Cochrane Library ◽  
Published Data ◽  
Case Control Studies ◽  
Asian Populations ◽  
Effect Model

Aims. Published data on the associations of VEGF polymorphisms with diabetic retinopathy (DR) susceptibility are inconclusive. A systematic meta-analysis was undertaken to clarify this topic.Methods. Data were collected from the following electronic databases: PubMed, Embase, OVID, Web of Science, Elsevier Science Direct, Excerpta Medica Database (EMBASE), and Cochrane Library with the last report up to January 10, 2014. ORs and 95% CIs were calculated for VEGF–2578C/A (rs699947), –1154G/A (rs1570360), –460T/C (rs833061), −634G>C (rs2010963), and +936C/T (rs3025039) in at least two published studies. Meta-analysis was performed in a fixed/random effect model by using the software STATA 12.0.Results. A total of 11 studies fulfilling the inclusion criteria were included in this meta-analysis. A significant relationship between VEGF+936C/T (rs3025039) polymorphism and DR was found in a recessive model (OR = 3.19, 95% CI = 1.20–8.41, andP(z)=0.01) in Asian and overall populations, while a significant association was also found between –460T/C (rs833061) polymorphism and DR risk under a recessive model (OR = 2.12, 95% CI = 1.12–4.01, andP(z)=0.02).Conclusions. Our meta-analysis demonstrates that +936C/T (rs3025039) is likely to be associated with susceptibility to DR in Asian populations, and the recessive model of –460T/C (rs833061) is associated with elevated DR susceptibility.

The efficacy of drug treatments for dysthymia: a systematic review and meta-analysis

1999 ◽  
Vol 29 (6) ◽  
pp. 1273-1289 ◽  
Author(s):  
M. S. DE LIMA ◽  
M. HOTOPH ◽  
S. WESSELY
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Common Mental Disorder ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Dysthymic Disorder ◽  
Number Needed To Treat ◽  
Relative Risks ◽  
Co Morbidity ◽  
Drug Treatments

Background. Dysthymia is a common mental disorder, associated with considerable disability and high co-morbidity. This review assessed the role of pharmacological treatment.Methods. All randomized-controlled trials that compared active drug versus placebo for dysthymic patients were included. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated with the Random Effect Model method. Where possible, number needed to treat and number needed to harm were estimated.Results. Fifteen trials were included for the main comparisons. Similar results were obtained in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and ritanserin). The pooled RR treatment response was 0·68 (95% CI 0·59–0·78) for TCA, 0·64 (95% CI 0·55–0·74) for SSRIs, 0·59 (95% CI 0·48–0·71) for MAOIs. Other drugs (amisulpride, amineptine and ritanserin) showed similar results. Patients treated on TCA were more likely to report adverse events, compared with placebo. There were no differences in response to active treatment when dysthymia was compared to either dysthymia plus major depression or briefer non-major depressive states.Conclusions. Drug treatment appears to be effective in the short-term management of dysthymic disorder. The choice of drug should take into account specific side-effects profile of each drug.

scholarly journals Breast Cancer Risk in Rheumatoid Arthritis: An Update Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Guo Tian ◽  
Jia-Ning Liang ◽  
Zhuo-Yun Wang ◽  
Dian Zhou
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Number Of Patients ◽  
The Impact

Background. The incidence of breast cancer in RA patients remains controversial. Thus we performed a meta-analysis to investigate the impact of RA on breast cancer.Methods. Published literature was available from PubMed, Embase, and Cochrane Library. Pooled standardized incidence rate (SIR) was computed by random-effect model analysis.Results. We identified 16 separate studies in the present study, in which the number of patients ranged from 458 to 84,475. We did not find the increased cancer risk in RA patients (SIR=0.86, 95%CI=0.72–1.02). However, subgroup analysis showed that breast cancer risk in RA patients was positively different in Caucasians (SIR=0.82, 95%CI=0.73–0.93) and non-Caucasians (SIR=1.21, 95%CI=1.19–1.23), respectively. In subgroup analysis by style, a reduced incidence was found in hospital-based case subjects (SIR=0.82, 95%CI=0.69–0.97). Similarly, subgroup analysis for adjusted factors indicated that in A3 (age and sex) and A4 (age, sex, and race/ethnicity) the risk was decreased (SIR=0.87, 95%CI=0.76–0.99;SIR=0.63, 95%CI=0.59–0.67).Conclusions. The meta-analysis revealed no increased breast cancer risk in RA patients. However, in the subgroup analysis, the risk of breast cancer is increased in non-Caucasians patients with RA while it decreased in Caucasian population, hospital-based case subjects, and A3 group. Such relationship may provide preference for risk of breast cancer in different population.

scholarly journals Detecting Melanoma Antigen Family A3 Expression in Solid/Non-Solid Human Tumor

2020 ◽  
Author(s):  
Haoran Jiang ◽  
Lihao Zhao ◽  
Han Yang ◽  
Mengjing Zhao ◽  
Yuxia Duan ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Human Tumor ◽  
Squamous Carcinoma ◽  
Cochrane Library ◽  
Published Data ◽  
Melanoma Antigen ◽  
Effect Model ◽  
Positive Rate

Abstract Background: MAGEA3 is a member of melanoma antigen family and has been recognized to express in many types of human cancers recently. In spite of the development of cancer vaccine, the prognostic value of MAGEA3 has not been well evaluated, due to the variability of clinical data and lack of clinical trials on the prognostic values.Method: Studies that evaluated MAGEA3 expression with a follow-up for at least 36 months were selected by searching in PubMed, WOS, Cochrane library, Embase. Published data was recorded and calculated into odds ratios (OR) for mortality in three or five years with Mantel-Haenszel random-effect model. Results: 11 studies were selected. The median positive rate was 45%. MAGEA3 always combines with worse survival on three or five years survival. The correlation between MAGEA3 and squamous carcinoma seemed stronger than adenocarcinoma on three-year OS while things got a reverse when it came to five-year OS. Most importantly, we found that all solid tumors originated from endoderm seemed to enjoy a strongest correlation among all the three germ layers.Conclusion: In this meta-analysis, we found that the expression of MAGEA3 can connect with worse outcome, and it probably can be a predictor for patients’ prognosis in clinical practice.

scholarly journals Association between aberrant APC promoter methylation and breast cancer pathogenesis: a meta-analysis of 35 observational studies

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2203 ◽  
Author(s):  
Dan Zhou ◽  
Weiwei Tang ◽  
Wenyi Wang ◽  
Xiaoyan Pan ◽  
Han-Xiang An ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Studies ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Wnt Signaling Pathway ◽  
Detection Methods ◽  
Cochrane Library ◽  
Cancer Pathogenesis ◽  
Potential Biomarker

Background.Adenomatous polyposis coli (APC) is widely known as an antagonist of the Wnt signaling pathway via the inactivation ofβ-catenin. An increasing number of studies have reported that APC methylation contributes to the predisposition to breast cancer (BC). However, recent studies have yielded conflicting results.Methods.Herein, we systematically carried out a meta-analysis to assess the correlation between APC methylation and BC risk. Based on searches of the Cochrane Library, PubMed, Web of Science and Embase databases, the odds ratio (OR) with 95% confidence interval (CI) values were pooled and summarized.Results.A total of 31 articles involving 35 observational studies with 2,483 cases and 1,218 controls met the inclusion criteria. The results demonstrated that the frequency of APC methylation was significantly higher in BC cases than controls under a random effect model (OR= 8.92, 95% CI [5.12–15.52]). Subgroup analysis further confirmed the reliable results, regardless of the sample types detected, methylation detection methods applied and different regions included. Interestingly, our results also showed that the frequency of APC methylation was significantly lower in early-stage BC patients than late-stage ones (OR= 0.62, 95% CI [0.42–0.93]).Conclusion.APC methylation might play an indispensable role in the pathogenesis of BC and could be regarded as a potential biomarker for the diagnosis of BC.

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