Use of Intrathecal Neostigmine as an Adjunct to Other Spinal Medications in Perioperative and Peripartum Analgesia: A Meta-analysis

Intrathecal neostigmine has been used as an adjunct to intrathecal local anaesthetic or opioid to prolong regional analgesia and improve haemodynamic stability, with variable results. This meta-analysis aims to evaluate the effectiveness and side-effects of intrathecal neostigmine in the perioperative and peripartum settings. The literature search was based on Cochrane Controlled Trials Register, EMBASE and MEDLINE (from 1966 to 14 November 2003) databases. Volunteer and animal studies were excluded. We identified 26 studies and 19 were considered suitable for detailed data extraction. Intrathecal neostigmine increased the incidence of nausea and vomiting (OR 5.0, 95% CI: 3.4 to 7.3; P<0.00001), bradycardia requiring intravenous atropine (OR 2.7, 95% CI: 1.4 to 5.4; P=0.005), and anxiety, agitation, or restlessness (OR 10.3, 95% CI: 3.7 to 28.9; P=0.00001). It improved the overall 24 hour VAS score (–1.4 VAS pain score, 95% CI: -1.7 to -1.2, P<0.00001), delayed the time of first request for rescue analgesia (168 min, 95% CI: 125 to 211; P<0.00001), and reduced the total number of rescue injections of nonsteroidal anti-inflammatory drug within the first 24 hours (-0.8, 95% CI: -1.1 to -0.4; P=0.00001). It did not affect the duration of motor blockade (3.5 min, 95% CI: -1.5 to 8.6; P=0.17) or the total amount of ephedrine required (-0.4 mg, 95% CI: -1.5 to 0.7; P=0.5). Adding intrathecal neostigmine to other spinal medications improves perioperative and peripartum analgesia marginally when compared with placebo. It is associated with significant side-effects and the disadvantages outweigh the minor improvement in analgesia achieved.

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A Systematic Review Protocol of The Antiviral Activity of Chloroquine and Hydroxychloroquine Against COVID-19.

10.21203/rs.3.rs-39519/v1 ◽

2020 ◽

Author(s):

Kofi Boamah Mensah ◽

Adwoa Bemah Boamah Mensah ◽

Varsha Bangalee ◽

Frasia Oosthuizen

Keyword(s):

Systematic Review ◽

Antiviral Activity ◽

Animal Studies ◽

Data Extraction ◽

Meta Analysis ◽

Drug Action ◽

Bibliographic Databases ◽

Publication Date ◽

Reference Manager

Abstract Background: The recent outbreak of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), or COVID-19 with no approved medicines has led to global health threat. Currently, repositioning of old medicines seems the most responsible strategy for potential cure and prevention COVID-19. Hydroxychloroquine and chloroquine have shown promising efficacy against COVID-19 related pneumonia in clinical studies. However, the mode of drug action of chloroquine and hydroxychloroquine against SARS-CoV-2 infection is not clear. This review aims to gather evidence on antiviral activity and possible mechanism of drug action of chloroquine and hydroxychloroquine on SARS-CoV-2, including in-vitro, animal studies, and studies in humans.Method: A structured search of five bibliographic databases namely; Medline, Web of Science, PubMed, Cochrane CENTRAL, and Google Scholar will be undertaken to retrieve studies that describe the antiviral activity and possible mechanism of drug action of chloroquine and hydroxychloroquine on SARS-CoV-2. No restrictions will be placed on publication date, but studies will be limited to only publications in English. Duplication of studies will be removed using EndNote reference manager. Three authors will screen the citations independently based on inclusion criteria. Data extraction and assessment of risk of bias will be done independently. Meta-analysis of selected studies will be done wherever suitable.Discussion: We expect that data that will be synthesis will provide enough information to inform COVID-19 care pathways and help clinicians caring for COVID-19 patients. Furthermore, this systematic review will expand our knowledge on the benefits and risks of chloroquine and hydroxychloroquine in management of COVID-19 patients and identify areas of controversies, and quality assessment. This review will provide vital information needed in the development of contextualized guidelines for the management of COVID-19 patients.Systematic review registration: https://doi.org/10.17605/OSF.IO/7DJMU

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Immunization Against Inhibin Promotes Fertility in Cattle: A Meta-Analysis and Quality Assessment

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.687923 ◽

2021 ◽

Vol 8 ◽

Author(s):

LingLi Ma ◽

Zhuo Li ◽

ZhongRen Ma ◽

JianBo Ma ◽

Fei Zhao

Keyword(s):

Animal Studies ◽

Quality Evaluation ◽

Data Extraction ◽

Meta Analysis ◽

Follicular Development ◽

Risk Of Bias ◽

Corpora Lutea ◽

Embryo Yield ◽

Grade 3 ◽

Meta Analyses

Superovulation and embryo transfer techniques are important methods in cattle breeding. Combined with traditional superovulation protocols, immunization against inhibin can further improve follicular development and embryo yield. The aim of this study is to determine the efficacy of immunization against inhibin in improving the fertility of cattle through meta-analysis and to provide better clinical veterinary practice guidance. Three English databases (PubMed, EMBASE, Web of Science) were searched for research articles of immunizations against inhibin influence on cattle fertility. Literature screening, data extraction, and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In addition, the Systematic Review Center for Laboratory animal Experimentation (SYRCLE) risk-of-bias (RoB) tool was used to assess the risk of bias of the included animal studies. Potentially relevant studies (317) were identified, and finally 14 eligible studies (all in English) were included. The results of meta-analysis revealed that immunization against inhibin has significant effects on improving the number of ovulations [mean difference (MD) = 0.44, 95% confidence interval (CI) = (0.31, 0.56)], embryos and unfertilized ova [MD = 4.51, 95% CI = (2.28, 6.74)], follicles of the three size categories, the incidence of multiple ovulations [OR = 22.50, 95% CI = (8.13, 62.27)], and the conception rate [OR = 2.36, 95% CI = (1.26, 4.40)]. Moreover, it improved the production of embryos [grades 1 embryos: MD = 3.84, (3.54, 4.15); grade 2 embryos: MD = −0.73, (−0.89, −0.57); grade 3 embryos: MD = −0.50, (−0.75, −0.25); degenerated embryos: MD = 1.16, (−0.51, 2.82); transferable embryos: MD = 2.67, (2.03, 3.31)] and the number of corpora lutea [MD = 1.25, 95% CI = (0.79, 1.71)]. In the above indicators, the differences between the two groups were statistically significant (all p < 0.0001). Additionally, according to the quality evaluation results, the risk of bias in the included studies is relatively high. The quality evaluation of the results of the included studies showed that the risk of bias mainly concentrated in the selective, performance, detection, and reporting of bias aspects.

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A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

BioMed Research International ◽

10.1155/2014/890626 ◽

2014 ◽

Vol 2014 ◽

pp. 1-17 ◽

Cited By ~ 12

Author(s):

Harsha Shanthanna ◽

Balpreet Singh ◽

Gordon Guyatt

Keyword(s):

Systematic Review ◽

Adverse Effects ◽

Urinary Retention ◽

Motor Block ◽

Clinical Success ◽

Meta Analysis ◽

Significant Risk ◽

Regional Analgesia ◽

Rescue Analgesia ◽

Caudal Analgesia

This systematic review and meta-analysis were designed to compare the analgesic effectiveness and adverse effects with the use of caudal analgesia as compared to noncaudal regional analgesia techniques in children undergoing inguinal surgeries. MEDLINE, EMBASE, and CENTRAL (Cochrane) databases were searched for randomized control trials published in English language from 1946 up to 2013. Use of rescue analgesia and adverse effects were considered as primary and secondary outcomes, respectively. Outcomes were pooled using random effects model and reported as risk ratio (RR) with 95% CI. Out of 3240 hits and 24 reports for final selection, 17 were included in this review. Caudal analgesia was found to be better in both early (RR = 0.81 [0.66, 0.99],P=0.04) and late (RR = 0.81 [0.69, 0.96],P=0.01) periods, but with a significant risk of motor block and urinary retention. According to GRADE, the quality of evidence was moderate. Although potentially superior, caudal analgesia increases the chance of motor block and urinary retention. There are limited studies to demonstrate that the technical superiority using ultrasound translates into better clinical success with the inguinal nerve blocks.

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Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055433 ◽

2020 ◽

Vol 30 (1) ◽

pp. 8-15 ◽

Cited By ~ 10

Author(s):

Jasmine N Khouja ◽

Steph F Suddell ◽

Sarah E Peters ◽

Amy E Taylor ◽

Marcus R Munafò

Keyword(s):

Animal Studies ◽

Data Extraction ◽

Meta Analysis ◽

Self Report ◽

Smoking History ◽

Cochrane Library ◽

Cigarette Use ◽

Data Synthesis ◽

Study Selection ◽

Negative Controls

ObjectiveThe aim of this review was to investigate whether e-cigarette use compared with non-use in young non-smokers is associated with subsequent cigarette smoking.Data sourcesPubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts.Study selectionAll studies of young people (up to age 30 years) with a measure of e-cigarette use prior to smoking and an outcome measure of smoking where an OR could be calculated were included (excluding reviews and animal studies).Data extractionIndependent extraction was completed by multiple authors using a preprepared extraction form.Data synthesisOf 9199 results, 17 studies were included in the meta-analysis. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR: 4.59, 95% CI: 3.60 to 5.85) when the results were meta-analysed in a random-effects model. However, there was high heterogeneity (I2=88%).ConclusionsAlthough the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.

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The effect of dexmedetomidine and clonidine on the inflammatory response in critical illness: a systematic review of animal and human studies

Critical Care ◽

10.1186/s13054-019-2690-4 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 5

Author(s):

Charles A. Flanders ◽

Alistair S. Rocke ◽

Stuart A. Edwardson ◽

J. Kenneth Baillie ◽

Timothy S. Walsh

Keyword(s):

Systematic Review ◽

Critical Illness ◽

Clinical Outcomes ◽

Animal Studies ◽

Data Extraction ◽

Meta Analysis ◽

Human Studies ◽

Cochrane Library ◽

Anti Inflammatory ◽

Sedative Drugs

Abstract Background The α2 agonists, dexmedetomidine and clonidine, are used as sedative drugs during critical illness. These drugs may have anti-inflammatory effects, which might be relevant to critical illness, but a systematic review of published literature has not been published. We reviewed animal and human studies relevant to critical illness to summarise the evidence for an anti-inflammatory effect from α2 agonists. Methods We searched PubMed, the Cochrane library, and Medline. Animal and human studies published in English were included. Broad search terms were used: dexmedetomidine or clonidine, sepsis, and inflammation. Reference lists were screened for additional publications. Titles and abstracts were screened independently by two reviewers and full-text articles obtained for potentially eligible studies. Data extraction used a bespoke template given study diversity, and quality assessment was qualitative. Results Study diversity meant meta-analysis was not feasible so descriptive synthesis was undertaken. We identified 30 animal studies (caecal ligation/puncture (9), lipopolysaccharide (14), acute lung injury (5), and ischaemia-reperfusion syndrome (5)), and 9 human studies. Most animal (26 dexmedetomidine, 4 clonidine) and all human studies used dexmedetomidine. In animal studies, α2 agonists reduced serum and/or tissue TNFα (20 studies), IL-6 (17 studies), IL-1β (7 studies), NFκB (6 studies), TLR4 (6 studies), and a range of other mediators. Timing and doses varied widely, but in many cases were not directly relevant to human sedation use. In human studies, dexmedetomidine reduced CRP (4 studies), TNFα (5 studies), IL-6 (6 studies), IL-1β (3 studies), and altered several other mediators. Most studies were small and low quality. No studies related effects to clinical outcomes. Conclusion Evidence supports potential anti-inflammatory effects from α2 agonists, but the relevance to clinically important outcomes is uncertain. Further work should explore whether dose relationships with inflammation and clinical outcomes are present which might be separate from sedation-mediated effects.

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Preclinical Evidence and Mechanism of Xingnaojing Injection for Cerebral Ischemia: A Systematic Review and Meta-Analysis of Animal Studies

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/9624175 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12

Author(s):

Rong Ma ◽

Xiao Ma ◽

Jianxia Wen ◽

Jian Wang ◽

Qian Xie ◽

...

Keyword(s):

Cerebral Ischemia ◽

Animal Studies ◽

Ischemia Reperfusion Injury ◽

Data Extraction ◽

Ischemia Reperfusion ◽

Meta Analysis ◽

Neuronal Cell ◽

Cochrane Library ◽

Control Group ◽

Xingnaojing Injection

Objectives. Cerebral ischemia can cause severe harm to people’s health with the characteristics of high incidence, high disability, and high mortality. Xingnaojing injection (XNJI) is widely used in the treatment of cerebral ischemia. The aim of this review is to evaluate the efficacy and mechanism of XNJI in animal models of cerebral ischemia. Methods. Total seven electronic databases in English or Chinese (CNKI, Wanfang, VMIS, PubMed, MEDLINE, Embase, and the Cochrane Library) about most experiments and studies which came out before June 2018 of XNJI for cerebral ischemia have been searched. Data extraction, quality assessment, and meta-analysis are conducted according to the Cochrane standards and RevMan 5.3 software. Results. We have identified 23 eligible studies and made a meta-analysis based on these studies. Meta-analysis shows that XNJI contributes significantly to reduction in neurological deficit score (P = 0.0002, MD = −1.25, 95% CI: −1.92, −0.58) compared with the control group of cerebral ischemia. Subgroup analytic results demonstrate that XNJI has been more effective in animal model of cerebral ischemia-reperfusion injury (P = 0.009, MD = −1.35, 95%CI: −2.36, −0.34) than that of permanent cerebral ischemia (P = 0.0002, MD = −1.08, 95%CI: −1.66, −0.51). Compared with control group, XNJI could remarkably reduce cerebral infarction area (P < 0.00001, MD = −14.98, 95%CI: −21.36, −8.59), brain edema (P < 0.00001, MD = −4.64, 95%CI: −5.38, −3.90), and neuronal cell apoptosis (P < 0.0001, MD = −12.21, 95%CI: 18.05, −6.37). Meanwhile, the meta-analysis shows that XNJI has a significant anti-inflammatory effect, and the levels of TNF-α, IL-6, and IL-1β are significantly reduced by XNJI (P = 0.001, MD = −4.13, 95%CI:−6.68, −1.58; P < 0.00001, MD = −119.23, 95%CI: −138.04, −100.43; P = 0.21, MD = −228.69, 95% CI: −586.20, 128.83). Additionally, XNJI could raise the body's antioxidant function and the level of SOD and GSH-Px (P = 0.002, MD = 53.02, 95% CI: −20.52, 85.78; P = 0.01, MD = 8.65, 95% CI: 1.77, 15.48) and decrease the level of MDA (P < 0.00001, MD = −4.16, 95% CI: −5.50, −2.82). Conclusion. XNJI might be effective in cerebral ischemia by regulating oxidative stress and inflammatory reaction.

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Acupuncture for Diarrhoea-Predominant Irritable Bowel Syndrome: A Network Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/2890465 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 4

Author(s):

Lingping Zhu ◽

Yunhui Ma ◽

Shasha Ye ◽

Zhiqun Shu

Keyword(s):

Irritable Bowel Syndrome ◽

Side Effects ◽

Data Extraction ◽

Meta Analysis ◽

Sham Acupuncture ◽

Cochrane Library ◽

Highly Qualified ◽

Pinaverium Bromide ◽

Irritable Bowel ◽

Better Than

Background. The objective of this study was to compare the efficacy and side effects of acupuncture, sham acupuncture, and drugs in the treatment of diarrhoea-predominant irritable bowel syndrome. Methods. Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs were comprehensively retrieved from electronic databases (such as PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, VIP Database, and CBM) up to December 2017. Additional references were obtained from review articles. With document quality evaluations and data extraction, Network Meta-Analysis was performed using a random-effects model under a frequentist framework. Results. A total of 29 studies (n = 9369) were included; 19 were high-quality studies, and 10 were low-quality studies. NMA showed the following: (1) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome is acupuncture, sham acupuncture, pinaverium bromide, alosetron = eluxadoline, ramosetron, and rifaximin; (2) the ranking of treatments in terms of severity of side effects in diarrhoea-predominant irritable bowel syndrome is rifaximin, alosetron, ramosetron = pinaverium bromide, sham acupuncture, and acupuncture; and (3) the treatment of diarrhoea-predominant irritable bowel syndrome includes common acupoints such as ST25, ST36, ST37, SP6, GV20, and EX-HN3. Conclusion. Acupuncture may improve diarrhoea-predominant irritable bowel syndrome better than drugs and has the fewest side effects. Sham acupuncture may have curative effect except for placebo effect. In the future, it is necessary to perform highly qualified research to prove this result. Pinaverium bromide also has good curative effects with fewer side effects than other drugs.

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Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis

10.1101/19007005 ◽

2019 ◽

Cited By ~ 2

Author(s):

Jasmine N Khouja ◽

Steph F Suddell ◽

Sarah Peters ◽

Amy E Taylor ◽

Marcus R Munafò

Keyword(s):

Animal Studies ◽

Data Extraction ◽

Meta Analysis ◽

Self Report ◽

Smoking History ◽

Cochrane Library ◽

Cigarette Use ◽

Data Synthesis ◽

Study Selection ◽

Negative Controls

AbstractObjectiveThe aim of this review was to investigate whether e-cigarette use compared to non-use in young non-smokers is associated with subsequent cigarette smoking.Data sourcesPubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts.Study selectionAll studies of young people (up to age 30 years) with a measure of e-cigarette use prior to smoking and an outcome measure of smoking where an odds ratio could be calculated were included (excluding reviews and animal studies).Data ExtractionIndependent extraction was completed by multiple authors using a pre-prepared extraction form.Data synthesisOf 9,199 results, 17 studies were included in the meta-analysis. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR 4.59, 95% CI 3.60 to 5.85) when the results were meta-analysed in a random effects model. However, there was high heterogeneity (I2 = 88%).ConclusionsWhilst the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.

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The Effect of Statins on Orthodontic Tooth Movements: A Meta-analysis of Animal Studies

Avicenna Journal of Dental Research ◽

10.34172/ajdr.2021.06 ◽

2021 ◽

Vol 13 (1) ◽

pp. 28-37

Author(s):

Zohreh Afshari ◽

Shabnam Tahamtan ◽

Farinaz Shirban

Keyword(s):

Animal Studies ◽

Tooth Movement ◽

Data Extraction ◽

Meta Analysis ◽

Orthodontic Tooth Movement ◽

Risk Of Bias ◽

Area Of Interest ◽

Model Study ◽

Study Selection ◽

Current Area

Background: Statins are effective therapeutic agents for the treatment of cardiovascular diseases. Their favorable effects on various aspects of oral health including promising effects on bone metabolism and pleiotropic impacts such as anti-inflammatory properties made these drugs a current area of interest in the field of orthodontics. Therefore, the aim of this study was to evaluate the effects of statins on orthodontic tooth movement (OTM) in animals undergoing orthodontic treatments. Methods: Several databases were comprehensively searched for studies measuring the effects of statins on the OTM up to January 2020, including MEDLINE, ISI Web of Science, EMBASE, Scopus, and Cochrane. Animal studies evaluating the effects of statins on tooth movements in animals undergoing orthodontic treatments were selected based on the PICO model .Study selection, data extraction, risk of bias, and study quality assessment were independently performed by two reviewers. Finally, the data were analyzed using random-effects meta-analysis and the mean difference (MD) was used for comparing the outcome measures. Results: Three randomized trials were finally included in this meta-analysis. According to the Systematic Review Centre for Laboratory animal Experimentation Tool, all the included studies had at least one domain at a high risk of bias. The amount of the OTM was insignificantly lower in the statin group (MD = 0.134 mm, %95 confidence interval = -0.020-0.288, P>0.05). Conclusions: Due to the low quality and methodological inconsistencies among the included studies, conclusive confirmation regarding the effect of statins on the OTM remains debatable. Trail Registration: The protocol of this study was registered on PROSPERO (https://www.crd.york.ac.uk/ PROSPERO/) with the ID # CRD42020164155.

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Efficacy of topical cannabinoids in the management of pain: a systematic review and meta-analysis of animal studies

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102719 ◽

2022 ◽

pp. rapm-2021-102719

Author(s):

Lukas D Linde ◽

Carey M Ogryzlo ◽

Cassandra M Choles ◽

Brian E Cairns ◽

John L K Kramer

Keyword(s):

Pain Management ◽

Side Effects ◽

Animal Studies ◽

Controlled Trial ◽

Meta Analysis ◽

Preliminary Evidence ◽

Human Studies ◽

Tail Flick ◽

Major Barrier ◽

Pain Ratings

Background/importanceCannabinoids are emerging as an alternative pain management option, preliminarily supported by preclinical and clinical studies. Unwanted side effects from oral or inhaled cannabinoids remain, however, a major barrier to widespread use. Peripherally acting cannabinoids (eg, topically applied) may circumvent these side effects while providing localized pain management.ObjectiveOur purpose was to systematically review the literature on the effectiveness of peripherally acting cannabinoids for pain management.Evidence reviewWe searched MEDLINE, EMBASE, CENTRAL, CINAHL, and PubMed databases. Included studies examined the effect of topical/peripherally administered cannabinoids on pain ratings in humans, as well as pain-related outcomes in animals (eg, paw withdrawal). Due to a lack of trials, human studies were summarized in a narrative synthesis. Separate meta-analyses were performed for animal studies using radiant tail flick or paw withdrawal outcomes.FindingsOur search yielded 1182 studies following removal of duplicates, with 46 studies (6 human, 40 animal) included. Human studies (one randomized controlled trial and five case studies/series) reported no adverse events to topical cannabinoids and preliminary evidence of decreased pain ratings. Animal studies reporting tail flick (5) (2.81, 95% CI 1.93 to 3.69, p<0.001) and mechanical withdrawal (11) (2.74, 95% CI 1.82 to 3.67, p<0.001) reported prolonged responses (analgesia) in peripheral cannabinoid groups compared with controls.ConclusionsPreclinical animal studies provided low-quality evidence for peripherally administered cannabinoids to provide regional, antinociceptive effects. The scarcity of high-quality human studies underscores the need to translate preclinical evidence into well-controlled human trials.

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