scholarly journals Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027507 ◽  
Author(s):  
Nicholas Riley ◽  
Martinique Vella-Baldacchino ◽  
Neal Thurley ◽  
Sally Hopewell ◽  
Andrew J Carr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Meta Analysis ◽  
Outcome Data ◽  
Injection Therapy ◽  
Current Evidence ◽  
Visual Analogue Scale Pain ◽  
Long Term Effects ◽  
Medium Term ◽  
Short Term

ObjectiveTo evaluate the effectiveness of injection-based therapy in base of thumb osteoarthritis.DesignSystematic review and meta-analysis.Data sourcesMEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO were searched from inception to 22 May 2018.Study selectionRandomised controlled trials (RCTs) and non-RCTs of adults with base of thumb osteoarthritis investigating an injection-based intervention with any comparator/s.Data extraction and analysisData were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random-effects model for short-term and medium-term follow-up.ResultsIn total, 9 RCTs involving 504 patients were identified for inclusion. All compared different injection-based therapies with each other, no studies compared an injection-based therapy with a non-injection-based intervention. Twenty injection-based intervention groups were present within these nine trials, consisting of hyaluronic acid (n=9), corticosteroid (n=7), saline placebo (n=3) and dextrose (n=1). Limited meta-analysis was possible due to the heterogeneity in the injections and outcomes used, as well as incomplete outcome data. Meta-analysis of two RCTs (92 patients) demonstrated reduced Visual Analogue Scale pain on activity with corticosteroid versus hyaluronic acid (mean difference (MD) −1.32, 95% CI −2.23 to −0.41) in the medium term, but no differences in other measures of pain or function in the short term and medium term. Overall, the available evidence does not suggest that any of the commonly used injection therapies are superior to placebo, one another or a non-injection-based comparator.ConclusionCurrent evidence is equivocal regarding the use of injection therapy in base of thumb osteoarthritis, both in terms of which injection-based therapy is the most effective and in terms of whether any injection-based therapy is more effective than other non-injection-based interventions. Given limited understanding of both the short-term and long-term effects, there is a need for a large, methodologically robust RCT investigating the commonly used injection therapies and comparing them with other therapeutic options and placebo.PROSPERO registration numberCRD42018095384.

scholarly journals Intralymphatic immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
M.P. Hoang ◽  
K. Seresirikachorn ◽  
W. Chitsuthipakorn ◽  
K. Snidvongs
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Specific Ige ◽  
Allergic Rhinoconjunctivitis ◽  
Medium Term ◽  
Short Term ◽  
Intralymphatic Immunotherapy ◽  
Specific Igg4 ◽  
Igg4 Level

BACKGROUND: Intralymphatic immunotherapy (ILIT) is a new route of allergen-specific immunotherapy. Data confirming its effect is restricted to a small number of studies. METHODOLOGY: A systematic review with meta-analysis was conducted. The short-term (less than 24 weeks), medium-term (24-52 weeks), and long-term (more than 52 weeks) effects of ILIT in patients with allergic rhinoconjunctivitis (ARC) were assessed. The outcomes were combined symptom and medication scores (CSMS), symptoms visual analog scale (VAS), disease-specific quality of life (QOL), specific IgG4 level, specific IgE level, and adverse events. RESULTS: Eleven randomized controlled trials and 2 cohorts (483 participants) were included. Compared with placebo, short term benefits of ILIT for seasonal ARC improved CSMS, improved VAS and increased specific IgG4 level but did not change QOL or specific IgE level. Medium-term effect improved VAS. Data on the long-term benefit of ILIT remain unavailable and require longer term follow-up studies. There were no clinical benefits of ILIT for perennial ARC. ILIT was safe and well-tolerated. CONCLUSION: ILIT showed short-term benefits for seasonal ARC. The sustained effects of ILIT were inconclusive. It was well tolerated.

scholarly journals Preoperative Somatostatin Analogues in Patients with Newly-diagnosed Acromegaly: A Systematic Review and Meta-analysis of Comparative Studies

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chengxian Yang ◽  
Ge Li ◽  
Shenzhong Jiang ◽  
Xinjie Bao ◽  
Renzhi Wang
Keyword(s):  
Systematic Review ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Somatostatin Analogues ◽  
Long Term Results ◽  
Current Evidence ◽  
Cochrane Library ◽  
Cure Rate ◽  
Short Term

Abstract Biochemical remission after transsphenoidal surgery is still unsatisfied in acromegaly patients with macroadenomas, especially with invasive macroadenomas. Concerning the impact of preoperative somatostatin analogues (SSAs) on surgical outcomes, previous studies with limited cases reported conflicting results. To assess current evidence of preoperative medical treatment, we performed a systematic review and meta-analysis of comparative studies. A literature search was conducted in Pubmed, Embase, and the Cochrane Library. Five randomized controlled trials (RCT) and seven non-RCT comparative studies were included. These studies mainly focused on pituitary macroadenomas though a small number of microadenoma cases were included. For safety, preoperative SSAs were not associated with elevated risks of postoperative complications. With respect to efficacy, the short-term cure rate was improved by preoperative SSAs, but the long-term cure rate showed no significant improvement. For invasive macroadenomas, the short-term cure rate was also improved, but the long-term results were not evaluable in clinical practice because adjuvant therapy was generally required. In conclusion, preoperative SSAs are safe in patients with acromegaly, and the favorable impact on surgical results is restricted to the short-term cure rate in macroadenomas and invasive macroadenomas. Further well-designed RCTs to examine long-term results are awaited to update the finding of this meta-analysis.

Hyaluronic acid for post sinus surgery care: systematic review and meta-analysis

2017 ◽  
Vol 131 (S1) ◽  
pp. S2-S11 ◽  
Author(s):  
E Fong ◽  
M Garcia ◽  
C M Woods ◽  
E Ooi
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Adhesion Formation ◽  
Sinus Surgery ◽  
Current Evidence ◽  
Secondary Outcome ◽  
Control Group ◽  
Patient Reported

AbstractBackground:Wound healing after endoscopic sinus surgery may result in adhesion formation. Hyaluronic acid may prevent synechiae development. A systematic review was performed to evaluate the current evidence on the clinical efficacy of hyaluronic acid applied to the nasal cavity after sinus surgery.Methods:Studies using hyaluronic acid as an adjunct treatment following endoscopic sinus surgery for chronic rhinosinusitis were identified. The primary outcome was adhesion formation rates. A meta-analysis was performed on adhesion event frequency. Secondary outcome measures included other endoscopic findings and patient-reported outcomes.Results:Thirteen studies (501 patients) met the selection criteria. A meta-analysis of adhesion formation frequency on endoscopy demonstrated a lower risk ratio in the hyaluronic acid intervention group (42 out of 283 cases) compared to the control group (81 out of 282) of 0.52 (95 per cent confidence interval = 0.37–0.72). Hyaluronic acid use was not associated with any significant adverse events.Conclusion:Hyaluronic acid appears to be clinically safe and well tolerated, and may be useful in the early stages after sinus surgery to limit adhesion rate. Further research, including larger randomised controlled trials, is required to evaluate patient- and clinician-reported outcomes of hyaluronic acid post sinus surgery.

scholarly journals Mannitol cannot reduce the mortality on acute severe traumatic brain injury (TBI) patients: a meta–analyses and systematic review

2015 ◽  
Vol 3 ◽  
pp. 1-8 ◽  
Author(s):  
Kai Wang ◽  
Mingwei Sun ◽  
Hua Jiang ◽  
Xiao-ping Cao ◽  
Jun Zeng
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Brain Injuries ◽  
Meta Analysis ◽  
Outcome Data ◽  
Control Treatment ◽  
Current Evidence ◽  
Cochrane Library

Abstract Background We aimed to systematically review the efficacy of mannitol (MTL) on patients with acute severe traumatic brain injury (TBI). Methods Databases such as PubMed (US National Library of Medicine), CENTRAL (The Cochrane Library 2014, Issue 3), ISI (Web of Science: Science Citation Index Expanded), Chinese Biomedicine Database (CBM), and China Knowledge Resource Integrated Database (CNKI) have been searched for relevant studies published between 1 January 2003 and 1 October 2014. We have established inclusion and exclusion criteria to identify RCTs, which were suitable to be enrolled in the systematic review. The comparison group could be hypertonic saline (HS), hydroxyethyl starch, or others. The quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and modified Jadad score scale. The major outcome was mortality, followed by the secondary outcomes such as neurological outcome, days on intensive care unit (ICU), and ventilator day. In addition, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and mean arterial pressure (MAP) were used as the surrogate endpoints. Data synthesis and meta-analysis was conducted by using R (version 3.7-0.). Results When 176 potential relevant literatures and abstracts have been screened, four RCTs met all the inclusion criteria and were enrolled for the meta-analysis. Amongst all the enrolled studies, two trials have provided the primary outcome data. There was no heterogeneity between two studies (I2 = 0 %) and a fixed model was used for meta-analysis (n = 53), pooled result indicated that the mortality was similar in mannitol intervention and control treatment, OR = 0.80, 95 % CI [0.27, 2.37], P = 0.38. We found that both mannitol and HS were efficient in decreasing the ICP. Furthermore, the effect of the HS on the ICP appeared to be more effective in the patients with diffuse brain injuries than mannitol did. Conclusions As a conclusion, the mannitol therapy cannot reduce the mortality risk of acute severe traumatic brain injury. Current evidence does not support the mannitol as an effective treatment of acute severe traumatic brain injury. The well-designed randomized controlled trials are in urgent need to demonstrate the adoption of mannitol to acute severe traumatic brain injury.

Balloon Tamponade and Esophageal Stenting for Esophageal Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-analysis

2019 ◽  
Vol 39 (02) ◽  
pp. 178-194 ◽  
Author(s):  
Susana Rodrigues ◽  
Andrés Cárdenas ◽  
Àngels Escorsell ◽  
Jaime Bosch
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Medium Term ◽  
Short Term ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Balloon Tamponade ◽  
Acute Variceal Bleeding

AbstractFailure to control variceal bleeding with current recommendations occurs in 10 to 20% of cases. This systematic review and meta-analysis analyzes the experience, results, and complications of “bridge” therapies for failure to control acute variceal bleeding: balloon tamponade and esophageal stents. The main outcomes assessed were failure to control bleeding and mortality in the short-term and medium-term follow-up, and adverse events. Balloon tamponade studies had a pooled rate of short-term failure to control bleeding of 35.5%, and adverse events in over 20% of cases; 9.7% resulting in death. Stenting failed to control bleeding in the short term and medium term in 12.7 and 21.5% of cases of severe or refractory variceal bleeding, respectively, despite stent migration in 23.8% of cases. Medium-term mortality rates were similar in both therapies. Although only one trial compared these treatments, the available evidence consistently supports that stents serve as a better and safer bridge therapy in refractory acute variceal bleeding.

Diagnostic stability of acute and transient psychotic disorder: A systematic review and meta-analysis

2016 ◽  
Vol 33 (S1) ◽  
pp. S137-S137 ◽  
Author(s):  
Á. López Díaz ◽  
S. Galiano Rus ◽  
A. Soler Iborte ◽  
J.I. Aznarte López ◽  
J.L. Fernández González
Keyword(s):  
Systematic Review ◽  
Psychotic Disorder ◽  
Fixed Effects ◽  
Case Reports ◽  
Meta Analysis ◽  
Medium Term ◽  
Short Term ◽  
Diagnostic Stability ◽  
Icd 10

IntroductionThe validity and diagnostic stability of acute and transient psychotic disorder (ATPD) has been questioned by several authors, since its introduction in the International Statistical Classification of Diseases (ICD-10).ObjectiveTo determine the overall diagnostic stability of ATPD in scientific literature.MethodA systematic review and meta-analysis of prospective studies and retrospective chart reviews. Computerized search was performed in MEDLINE/PubMed, EMBASE, and Google Scholar, using the terms: “acute and transient psychotic disorder”, or “acute psychosis”, and “stability”, or “outcome”, or “long-term”, or “follow-up”, or “course”. Search was restricted to works in English published between 1993 and 2015, according to ICD-10 criteria. Opinion articles, individual case reports, researches with less than ten subjects, and overlapping studies were excluded. Data analysis was conducted using MedCalc software, version 15.8. Statistical procedure was calculated for meta-analysis of proportions.ResultsTwenty-six studies met the inclusion criteria (n = 10852). For methodological purposes, a distinction was made between short-term (less than 2 years), medium-term (between 2–7 years), and long-term stability (more than 7 years). For short-term group (k = 5), the overall stability was 60.69% (fixed effects model); Cochran's heterogeneity statistic Q = 14.9, I2 = 73.15%, P = 0.0049. For medium-term group (k = 15), it was 49.99%; Q = 181.6, I2 = 92.29%, P < 0.0001. For long-term group (k = 6), it was 61.86%; Q = 35.12, I2 = 92.29%, P < 0.0001.ConclusionThe global stability of ATPD indicates at the validity of the construct, but should be redefined in future revisions of ICD, to clarify better diagnostic criteria, and more predictive power.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Laparoscopic Sleeve-Fundoplication for Morbidly Obese Patients with Gastroesophageal Reflux: Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Alberto Aiolfi ◽  
Giancarlo Micheletto ◽  
Jacopo Marin ◽  
Emanuele Rausa ◽  
Gianluca Bonitta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastroesophageal Reflux ◽  
De Novo ◽  
Gastric Perforation ◽  
Meta Analysis ◽  
Reoperation Rate ◽  
Current Evidence ◽  
Morbidly Obese ◽  
Complication Rates ◽  
Long Term Effects

Abstract Introduction Laparoscopic sleeve gastrectomy (LSG) has rapidly become popular with excellent results. However, LSG may exacerbate or increase the risk of “de novo” gastroesophageal reflux disease (GERD). Adding a fundoplication has been proposed to increase the lower esophageal sphincter competency. The aim of this study was to examine the current evidence and outcomes of sleeve-fundoplication (Sleeve-F). Materials and Methods Systematic review and meta-analysis. Web of Science, PubMed, and Embase data sets were consulted. Results Six studies (485 patients) met the inclusion criteria. The age of the patient population ranged from 17 to 72 years old and 82% were females. All patients underwent sleeve-fundoplication. Rossetti, Collis-Nissen, and Nissen were the most commonly performed fundoplications. The estimated pooled prevalence of postoperative leak, gastric perforation, and overall complications were 1.0% (95% CI = 0.0–2.0%), 2.9% (95% CI = 0.0–8.3%), and 9.8% (95% CI = 6.7–13.4%), respectively. The pooled reoperation rate was 4.1% (95% CI = 1.3–10%). There was no mortality. At 12-month follow-up, the estimated pooled BMI and %EWL were 29.9 kg/m2 (95% CI = 28.5–31.2) and 66.2% (95% CI = 59.3–71.1), respectively, while esophagitis, PPI consumption, and GERD rates were 8.0% (95% CI 3–21%), 7.8% (95% CI 5–13%), and 11% (95% CI 4–26%). Conclusions This systematic review and meta-analysis shows that current evidence for Sleeve-F is limited with high postoperative gastric perforation and overall complication rates. Weight loss and GERD resolution seem promising in the short term; however, further studies are warranted to explore long-term effects with instrumental investigations. Sleeve-F should be considered cautiously while future well-structured randomized trials are warranted.

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