Does Topical Antibiotic Prophylaxis Reduce Post—Tympanostomy Tube Otorrhea?

1994 ◽  
Vol 103 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Philip Garcia ◽  
George A. Gates ◽  
Kenneth B. Schechtman
Keyword(s):  
Antimicrobial Agents ◽  
Antimicrobial Prophylaxis ◽  
Meta Analysis ◽  
Tympanostomy Tube ◽  
Continued Use ◽  
The Difference ◽  
Prophylactic Use ◽  
Low Incidence ◽  
Topical Antimicrobial ◽  
Patient Studies

Purulent otorrhea is the most common complication of tympanostomy tube (TT) insertion. It may occur in the postoperative period or at any time during the sojourn of the tube. The efficacy of topical antimicrobial prophylaxis against purulent postoperative otorrhea (PPO) has been examined in 5 prospective, randomized studies; all demonstrated a reduction in PPO from topical antimicrobial prophylaxis, but in only 1 study was the difference statistically significant. Because the 5 studies used 2 different experimental designs — By-patient, and by-ear — a single meta-analysis could not be done. However, the by-patient studies met the criteria for meta-analysis, which demonstrated a combined odds ratio of 0.12 (95% confidence interval 0.04 to 0.37, p = .0002). This represents an 85% reduction in otorrhea, which is judged to be clinically as well as statistically significant. We conclude from the available evidence that prophylactic use of topical antimicrobial agents following TT insertion consistently reduces the rate of PPO. However, the low incidence of PPO and the heterogeneity of the published studies prevent making a final judgment for or against the continued use of these agents. Therefore, given that these potentially ototoxic agents are frequently administered to prevent postoperative otorrhea, further study of this subject is warranted. In the meantime, we recommend judicious use of these agents following TT insertion in those cases at higher risk for PPO, namely those with mucoid or purulent effusion.

scholarly journals Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yang Zhou ◽  
Abdul Mannan ◽  
Yuan Han ◽  
He Liu ◽  
Hui-Lian Guan ◽  
...  
Keyword(s):  
Side Effects ◽  
Incidence Rate ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Central Register ◽  
Postanesthetic Shivering ◽  
Significant Difference ◽  
The Difference ◽  
Prophylactic Use

Abstract Background Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We searched the following databases: Medline, Embase, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the difference of the incidence rate of postanesthetic shivering between ketamine group and placebo group. The secondary outcomes were the sedation score and incidence of the side effects caused by ketamine and any other drugs utilized in the studies. Results In this meta-analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine reduced the incidence rate of postanesthetic shivering compared to a placebo (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P<0.01). Regarding side effects, there was no evident variability of the incidence of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared to a placebo. Hallucinations were more frequently observed in patients who received higher doses of ketamine. No significant difference was found in the incidence of postanesthetic shivering with ketamine versus other pharmacological interventions. Conclusions Ketamine can prevent postanesthetic shivering without severe side effects. However, ketamine shows no advantage over other anti-shivering drugs.

scholarly journals Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: A system review and meta analysis

2019 ◽  
Author(s):  
Yang Zhou ◽  
Abdul Mannan ◽  
Yuan Han ◽  
He Liu ◽  
Hui-Lian Guan ◽  
...  
Keyword(s):  
Side Effects ◽  
Incidence Rate ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Central Register ◽  
Postanesthetic Shivering ◽  
Significant Difference ◽  
The Difference ◽  
Prophylactic Use

Abstract Background Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We used a systematic approach, also known as meta-analysis, to further address postoperative shivering. We searched the following databases: Medline, Embase, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the difference of the incidence rate of postanesthetic shivering between ketamine group and placebo group . The secondary outcomes were the sedation score and incidence of the side effects caused by ketamine and any other drugs utilized in the studies. Results In this meta-analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine reduced the incidence rate of postanesthetic shivering compared to a placebo (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P＜0.01). Regarding side effects, there was no evident variability of the incidence of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared to a placebo. Hallucinations were more frequently observed in patients who received higher doses of ketamine. No significant difference was found in the incidence of postanesthetic shivering with ketamine versus other pharmacological interventions. Conclusions Ketamine can prevent postanesthetic shivering without severe side effects. However, ketamine shows no advantage over other anti-shivering drugs.

scholarly journals P14.43 Histone H3F3A and HIST1H3B K27M mutations in pediatric high-grade gliomas: the Florentine experience

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii76-iii77
Author(s):  
M Guidi
Keyword(s):  
Meta Analysis ◽  
Histone H3 ◽  
Histone Variants ◽  
Statistical Correlation ◽  
High Grade ◽  
K27m Mutation ◽  
High Grade Gliomas ◽  
The Difference ◽  
Low Incidence ◽  
Line Of Therapy

Abstract Background Pediatric high- grade gliomas (HGGs) represent a malignancy with a poor survival. The genetic analysis of these entities has identified useful mutations for an improved prognostic framing. The research of mutations in all H3 histone variants (HIST1H3B and H3F3A) could be usefull to define tumors with different prognosis and phenotypes inasmuch they seems to drive two distinct oncogenic programmes. MATERIALS E METHODS We performed a retrospective analysis of pediatric HGGs. We evaluated the type of histone H3 mutated and we performed a meta-analysis comparing our results with literature data. RESULTS We evaluated 41 cases of pediatric HGGs (median age of patients: 7 years old, range: 0–32):): 32 anaplastic astrocytoma (78,5%), 9 glioblastoma multiforme (25,9%), We have researched the K27M mutations in the distinct histone H3 variants (i.e. HIST1H3B and H3F3A). The mutation H3F3A K27M was found in 6 patients instead HIST1H3B K27 mutations was found in a single patient with GBM. All the patients with H3F3A K27M mutation had a progression disease but without statistical correlation (p:0,07). They had a worse prognosis with a median overall survival of 15,5 months (p: 0.0014) versus wild type patients (not reached). H3.3K27M mutation status is a significant predictor of OS with a hazard ratio of 4.499 (p = 0.0001). The patient with HIST1H3B K27 mutation died after first line of therapy. Conclusions Due to the low incidence of the mutation HIST1H3B in our series we can’t define the difference with two variants. However, the research of K27M mutation in HGGs has diagnostic and prognostic role. The role of histone H3 mutated could predict the outcome in HGGs patients and it could give us more informations compared to the clinic and radiological characteristic of the tumors.

scholarly journals Does routine topical antimicrobial administration prevent sternal wound infection after cardiac surgery?

2020 ◽  
Author(s):  
Pedro Lamares Magro ◽  
Miguel Sousa Uva
Keyword(s):  
Cardiac Surgery ◽  
Wound Infection ◽  
Risk Reduction ◽  
Antimicrobial Agents ◽  
Meta Analysis ◽  
The Body ◽  
Sternal Wound Infection ◽  
Application Protocols ◽  
Topical Antimicrobial ◽  
Antimicrobial Administration

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Does routine topical antimicrobial administration prevent sternal wound infection (SWI) after cardiac surgery? Altogether &gt;238 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several different antimicrobial agents, dosages and application protocols were found in the literature. Regarding topical vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76% risk reduction in any SWI. Collagen-gentamicin sponge application was associated with a 38% risk reduction in SWI in another meta-analysis by Kowalewski et al., which included 4 randomized control trials and &gt;23 000 patients. Lower evidence observational studies found benefit in the use of different regimes, including: combination of vancomycin paste and subcutaneous gentamycin; combined cefazoline and gentamicin spray; isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We conclude that, in light of the body of evidence available, topical antibiotic application prevents SWI, including both superficial and deep SWI. The strongest evidence, derived from 2 meta-analyses, is related to the use of gentamicin-collagen sponges and topical vancomycin. Heterogeneity throughout studies regarding antibiotic agents, dosages, application protocols and SWI definition makes providing general recommendations challenging.

Relationship between total plasma homocysteine and the risk of aneurysms – a meta-analysis

VASA ◽  
2020 ◽  
pp. 1-6
Author(s):  
Hanji Zhang ◽  
Dexin Yin ◽  
Yue Zhao ◽  
Yezhou Li ◽  
Dejiang Yao ◽  
...  
Keyword(s):  
Large Scale ◽  
Meta Analysis ◽  
Single Species ◽  
Total Plasma ◽  
Control Groups ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
The Difference ◽  
The Relationship ◽  
Healthy Participants

Summary: Our meta-analysis focused on the relationship between homocysteine (Hcy) level and the incidence of aneurysms and looked at the relationship between smoking, hypertension and aneurysms. A systematic literature search of Pubmed, Web of Science, and Embase databases (up to March 31, 2020) resulted in the identification of 19 studies, including 2,629 aneurysm patients and 6,497 healthy participants. Combined analysis of the included studies showed that number of smoking, hypertension and hyperhomocysteinemia (HHcy) in aneurysm patients was higher than that in the control groups, and the total plasma Hcy level in aneurysm patients was also higher. These findings suggest that smoking, hypertension and HHcy may be risk factors for the development and progression of aneurysms. Although the heterogeneity of meta-analysis was significant, it was found that the heterogeneity might come from the difference between race and disease species through subgroup analysis. Large-scale randomized controlled studies of single species and single disease species are needed in the future to supplement the accuracy of the results.

Age Differences in Eye Movements During Reading: Degenerative Problems or Compensatory Strategy?

2019 ◽  
Vol 24 (4) ◽  
pp. 297-311
Author(s):  
José David Moreno ◽  
José A. León ◽  
Lorena A. M. Arnal ◽  
Juan Botella
Keyword(s):  
Eye Movements ◽  
Eye Movement ◽  
Meta Analysis ◽  
Age Groups ◽  
Behavioral Changes ◽  
Aging Effects ◽  
Movement Data ◽  
Sentence Reading ◽  
The Difference ◽  
Eye Movements During Reading

Abstract. We report the results of a meta-analysis of 22 experiments comparing the eye movement data obtained from young ( Mage = 21 years) and old ( Mage = 73 years) readers. The data included six eye movement measures (mean gaze duration, mean fixation duration, total sentence reading time, mean number of fixations, mean number of regressions, and mean length of progressive saccade eye movements). Estimates were obtained of the typified mean difference, d, between the age groups in all six measures. The results showed positive combined effect size estimates in favor of the young adult group (between 0.54 and 3.66 in all measures), although the difference for the mean number of fixations was not significant. Young adults make in a systematic way, shorter gazes, fewer regressions, and shorter saccadic movements during reading than older adults, and they also read faster. The meta-analysis results confirm statistically the most common patterns observed in previous research; therefore, eye movements seem to be a useful tool to measure behavioral changes due to the aging process. Moreover, these results do not allow us to discard either of the two main hypotheses assessed for explaining the observed aging effects, namely neural degenerative problems and the adoption of compensatory strategies.

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