scholarly journals Do Various Treatment Modalities of Vesicoureteral Reflux Have Any Adverse Effects in Pediatric Patients? A Meta-Analysis

2021 ◽  
pp. 1-9
Author(s):  
Min Xie ◽  
Xiaogai Xu ◽  
Zhenjie Cao ◽  
Huijie Xiao
Keyword(s):  
Vesicoureteral Reflux ◽  
Random Effects ◽  
Renal Scarring ◽  
Meta Analysis ◽  
Forest Plot ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Random Effects Model ◽  
Recurrent Utis ◽  
Tract Infections

<b><i>Purpose:</i></b> Vesicoureteral reflux (VUR) is a risk factor for various renal problems like recurrent urinary tract infections (UTIs), pyelonephritis, renal scarring, hypertension, and other renal parenchymal defects. The interventions followed by pediatricians include low-dose antibiotic treatment, surgical correction, and endoscopy. This meta-analysis aimed to assess the advantages and drawbacks of various primary VUR treatment options. <b><i>Search Strategy:</i></b> The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists of journals, and abstracts from conference proceedings were all used to find randomized controlled trials. The articles were retrieved from 1985 till 2020. Twenty articles were used for the data analysis. <b><i>Criteria for Selection:</i></b> Surgery, long-term antibiotic prophylaxis, noninvasive techniques, and any mix of therapies are also options for treating VUR. <b><i>Collection and Interpretation of Data:</i></b> Two authors searched the literature separately, determining research qualifications, assessing accuracy, and extracting and entering results. The odds ratio (OR) of these studies was used to construct the forest plot. The random-effects model was used to pool the data. Also, the random-effects model was used with statistical significance at a <i>p</i> value &#x3c; 0.05 to assess the difference in side effects after treatment of VUR using different modalities. <b><i>Results:</i></b> We found no statistically significant differences between surgery plus antibiotics and antibiotic alone-treated patients in terms of recurrent UTIs (OR = 0.581; 95% confidence interval [CI] 0.259–1.30), renal parenchymal defects (OR = 1.149; 95% CI 0.75–1.754), and renal scarring (OR = 1.042; 95% CI 0.72–1.50). However, the risk of developing pyelonephritis after surgical treatment of VUR was lesser than that in the conservative approach, that is, antibiotics (OR = 0.345; 95% CI 0.126–0.946.), positive urine culture (OR = 0.617; 95% CI 0.428–0.890), and recurrent UTIs were more common in the placebo group than in the antibiotic group (<i>p</i> &#x3c; 0.05; OR = 0.639; 95% CI 0.436–0.936) which is statistically significant. <b><i>Conclusion:</i></b> Based on current research, we recommend that a child with a UTI and significant VUR be treated conservatively at first, with surgical care reserved for children who have issues with antimicrobials or have clinically significant VUR that persists after several years of follow-up.

scholarly journals Effect of Renin-Angiotensin-Aldosterone System inhibitors on outcomes of COVID-19 patients with hypertension: Systematic review and Meta-analysis

2020 ◽  
Author(s):  
Tamirat Bekele Beressa ◽  
Tamiru Sahilu ◽  
Serawit Deyno
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Random Effects Model ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Central Register ◽  
Raas Inhibitors

Objective: This research aimed to systematically review and summarize the influence of Renin-Angiotensin-Aldosterone System (RAAS) inhibitors on the outcome of COVID_19 patients with hypertension. Methods: Electronic databases; PubMed/Medline, CINAHL, the Cochrane Central Register of Controlled Trials, clinical trial.gov, and Google Scholar were searched from 2019 to June 1, 2020. Additionally, the references of identified articles were also searched. Results: A total of 9 articles comprising 3,823 patients were incorporated; 1416 patients on RAAS inhibitors and 3469 on non-RAAS inhibitors. The study demonstrated that the taking of RAAS inhibitors in COVID_19 patients with hypertension significantly reduced mortality where patients on RAAS inhibitors had a 27% decrease of mortality (RR= 0.73 [95% CI: 0.63- 0.85, p<0.0001, I2=0%, random-effects model]) compared to those not taking ACEI/ARB. No significant association were observed in disease severity (RR= 0.92 (95% CI: 0.74- 1.14) and hospitalization (WMD= -2.33[95% CI: -5.60, 0.75]), random-effects model. Conclusion: This study supports RAAS inhibitors safe use among COVID_19 patients with hypertension. Keywords: COVID_19, ACEI, ARB, Hypertension, Coronavirus

scholarly journals Delayed antibiotic prescribing for respiratory tract infections: protocol of an individual patient data meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e026925 ◽  
Author(s):  
Beth Stuart ◽  
Hilda Hounkpatin ◽  
Taeko Becque ◽  
Guiqing Yao ◽  
Shihua Zhu ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Patient Data ◽  
Published Data ◽  
Controlled Trials ◽  
Antibiotic Prescribing ◽  
Cochrane Central Register ◽  
Life Years ◽  
Tract Infections

IntroductionDelayed prescribing can be a useful strategy to reduce antibiotic prescribing, but it is not clear for whom delayed prescribing might be effective. This protocol outlines an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) and observational cohort studies to explore the overall effect of delayed prescribing and identify key patient characteristics that are associated with efficacy of delayed prescribing.Methods and analysisA systematic search of the databases Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Plus and Web of Science was conducted to identify relevant studies from inception to October 2017. Outcomes of interest include duration of illness, severity of illness, complication, reconsultation and patient satisfaction. Study authors of eligible papers will be contacted and invited to contribute raw IPD data. IPD data will be checked against published data, harmonised and aggregated to create one large IPD database. Multilevel regression will be performed to explore interaction effects between treatment allocation and patient characteristics. The economic evaluation will be conducted based on IPD from the combined trial and observational studies to estimate the differences in costs and effectiveness for delayed prescribing compared with normal practice. A decision model will be developed to assess potential savings and cost-effectiveness in terms of reduced antibiotic usage of delayed prescribing and quality-adjusted life years.Ethics and disseminationEthical approval was obtained from the University of Southampton Faculty of Medicine Research Ethics Committee (Reference number: 30068). Findings of this study will be published in peer-reviewed academic journals as well as General Practice trade journals and will be presented at national and international conferences. The results will have important public health implications, shaping the way in which antibiotics are prescribed in the future and to whom delayed prescriptions are issued.PROSPERO registration numberCRD42018079400.

scholarly journals Effects of Tea Consumption on Anthropometric Parameters, Metabolic Indexes and Hormone Levels of Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Wenjuan Shen ◽  
Yujia Pan ◽  
Bao Jin ◽  
Zongyu Zhang ◽  
Tianjiao You ◽  
...  
Keyword(s):  
Systematic Review ◽  
Body Weight ◽  
Randomized Controlled Trials ◽  
Green Tea ◽  
Random Effects ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Controlled Trials ◽  
Random Effects Model ◽  
Randomized Controlled

ObjectiveOur aim was to conduct a systematic review and meta-analysis to assess the effectiveness and safety of tea supplements for patients with polycystic ovary syndrome (PCOS).MethodsWe conducted searches of the published literature in PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure (CNKI), VIP database, and Wanfang Database in 1985 to September 2021. Data from randomized controlled trials (RCTs) were obtained to assess the effects of tea versus placebo in women with PCOS. Weighted mean differences (WMDs) were pooled using a random-effects model or risks ratios (RRs) using a random-effects model.ResultsSix RCTs (235 participants) were included in our systematic review. Tea supplements as adjuvant therapy led to greater improvement in body weight (WMD −2.71, 95% CI −4.95 to −0.46, P = 0.02, I2 = 0%), fasting blood glucose (FBG: WMD −0.40, 95% CI −0.59 to −0.20, P &lt; 0.0001, I2 = 0%) and fasting insulin (FINS: WMD −3.40, 95% CI −4.76 to −2.03, P &lt; 0.00001, I2 = 0%) when compared with placebo. There were no significant differences of body mass index, waist circumference, hip circumference, waist-to-hip ratio (WHR), body fat rate, total testosterone, free testosterone (FT), dehydroepiandrosterone, luteinizing hormone or follicular-stimulating hormone (FSH) between the two groups. In addition, subgroup analysis suggested that green tea was effective on body weight, FINS, FBG, FT, and FSH, and herbal tea can also reduce FT levels, tea supplements had a significant impact on FBG and FSH in trials with intervention duration ≥ 3 months, and intervention lasting less than 3 months can improve FINS. Tea had significant effect on reducing WHR, FBG and FSH in Asian PCOS patients, but not in Caucasians. And there was no statistically significant effect of tea on weight and FINS in Asians, but it was effective for Caucasian participants. Compared with placebo, tea supplements did not cause significant adverse reactions (RR 1.45, 95% CI 0.30 to 6.90, P = 0.65, I2 = 0%).ConclusionThis meta-analysis suggests that consumption of tea supplementation in women with PCOS could significantly decrease the levels of FBG and FINS as well as reduce body weight. Especially green tea, not only has the above effects, but also has a significant effect on improving a variety of reproductive hormone indexes. Furthermore, tea supplementation is a relatively safe therapy for PCOS patients. Systematic Review RegistrationPROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=212755, identifier CRD42021249196.

scholarly journals Ceftazidime-Avibactam Combination Therapy Compared to Ceftazidime-Avibactam Monotherapy for the Treatment of Severe Infections Due to Carbapenem-Resistant Pathogens: A Systematic Review and Network Meta-Analysis

Antibiotics ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. 388 ◽  
Author(s):  
Marco Fiore ◽  
Aniello Alfieri ◽  
Sveva Di Franco ◽  
Maria Caterina Pace ◽  
Vittorio Simeon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Retrospective Studies ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Beta Lactam ◽  
Qualitative Synthesis ◽  
Severe Infections ◽  
Tract Infections

Ceftazidime-avibactam (CZA) is a novel beta-lactam beta-lactamase inhibitor combination approved for the treatment of complicated urinary tract infections, complicated intra-abdominal infections, and for hospital-acquired/ventilator-associated pneumonia. The aim of this systematic review (PROSPERO registration number: CRD42019128927) was to evaluate the effectiveness of CZA combination therapy versus CZA monotherapy in the treatment of severe infections. The databases included in the search, until 12 February 2020, were MEDLINE by PubMed, EMBASE, and The Cochrane Central Register of Controlled Trials. We included both randomized controlled trials (RCTs) and non-randomized studies published in peer-reviewed journals and in the English language. The primary outcome was all-cause mortality (longest follow-up) evaluated in patients with the diagnosis of infection with at least one pathogen; secondary outcomes were clinical and microbiological improvement/cure. Thirteen studies were included in the qualitative synthesis: 7 RCTs and 6 retrospective studies All the six retrospective studies identified carbapenamase-producing Enterobacteriaceae (CRE) as the cause of infection and for this reason were included in the network meta-analysis (NMA); the quality of the studies, assessed using the New Castle-Ottawa Scale, was moderate-high. In all the six retrospective studies included in the NMA, CZA was used in large part for off-label indications (mostly blood stream infections: 80–100% of patients included). No difference in mortality rate was observed in patients undergoing CZA combination therapy compared to CZA monotherapy [n = 503 patients, direct evidence OR: 0.96, 95% CI: 0.65–1.41].

A Meta-analysis of Outcomes After Routine Aspiration of the Gallbladder During Cholecystectomy

2011 ◽  
Vol 96 (1) ◽  
pp. 21-27 ◽  
Author(s):  
M. R. S. Siddiqui ◽  
M. S. Sajid ◽  
A. Nisar ◽  
H. Ali ◽  
A. Zaborszky ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Random Effects ◽  
Meta Analysis ◽  
Gallbladder Perforation ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Random Effects Model ◽  
Infection Rates ◽  
Randomized Controlled ◽  
Significant Difference

Abstract We conducted a meta-analysis of published literature comparing outcomes after aspirating (ASP) the gallbladder versus nonaspiration (NASP). Electronic databases were searched from January 1985 to November 2009. A meta-analysis was performed to obtain a summative outcome. Two randomized, controlled trials involving 360 patients were analyzed. A total of 180 patients were in the ASP group, and 180 were in the NASP group. There was no significant increase in operative time in the ASP group compared with the NASP group [random-effects model: standardized mean difference, −0.72; 95% confidence interval (CI), −2.16, 0.71; z  =  0.99; df  =  1; P  =  0.32], but there was significant heterogeneity among trials (Q  =  42.4; P &lt; 0.001; I2  =  98%). Patients undergoing ASP were less likely to have a gallbladder perforation [random-effects model: risk ratio (RR), 0.42; 95% CI, 0.19, 0.96; z  =  2.05; df  =  1; P &lt; 0.05], but no difference was found regarding the loss of gallstones (random-effects model: RR, 1.33; 95% CI, 0.30, 5.85; z  =  0.38; df  =  1; P  =  0.70). No difference was seen for liver bed bleeding (P  =  0.43) or overall 30-day infection rates (P  =  0.66). After aspiration, gallbladder perforation rates may be lower. This does not appear to translate into decreased loss of gallstones or infection rates. There was no significant difference between techniques in blood loss from the liver bed. Further randomized, controlled trials and follow-up studies are required to confirm these results and to establish long-term sequelae.

scholarly journals Protocol for a systematic review and meta-analysis assessing the effectiveness of deprescribing in falls prevention in older people

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e047190
Author(s):  
Lotta J Seppala ◽  
Nellie Kamkar ◽  
Jesper Ryg ◽  
Tahir Masud ◽  
Joost Daams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Current Knowledge ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Falls Prevention ◽  
Sensitivity Analyses ◽  
Forest Plot ◽  
Controlled Trials ◽  
Cochrane Central Register

IntroductionOne of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge.Methods and analysisThis systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses.Ethics and disseminationEthics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines.PROSPERO registration numberCRD42020218231.

scholarly journals Effectiveness of Acupuncture on Urinary Retention: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Chengwen Zheng ◽  
Zaoying Li ◽  
Haizhen Lu ◽  
Yi Zhou
Keyword(s):  
Randomized Controlled Trials ◽  
Urinary Retention ◽  
Random Effects ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Acupuncture Group ◽  
Control Group ◽  
Controlled Trials ◽  
Random Effects Model ◽  
Randomized Controlled

Objectives. This study aimed to evaluate the safety and efficacy of acupuncture in the treatment of urinary retention (UR). Methods. Randomized controlled trials investigating the effectiveness of acupuncture in the treatment of UR were identified by searching seven comprehensive databases (Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Chinese Biomedical Literature Database) prior to September 2020. Data analysis was performed using RevMan, version 5.3, and Stata software, version 14.0. Results. A total of 12 studies with 979 participants were included. A random-effects model was used to conduct a meta-analysis on the acupuncture group and the control group. The results show that acupuncture can effectively promote spontaneous urination and reduce anxiety in patients with poor urination (relative risk: 1.35; 95% confidence interval (CI): 1.19–1.53; P < 0.00001 ). The random-effects model showed significant differences in residual urine volume between the acupuncture group and the control group (MD: −84.79, 95% CI: −135.62 to −33.94; P = 0.001 ). Conclusion. Acupuncture is safe and effective in the treatment of UR. However, since the current level of evidence is limited, high-quality, large-sample, multi-center, clinical randomized controlled trials are needed to further confirm our conclusions in the future.

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