scholarly journals Safety of dihydroartemisinin-piperaquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria among children in Africa: a systematic review and meta-analysis of randomized control trials

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Dawit Getachew Assefa ◽  
Eden Dagnachew Zeleke ◽  
Wondwosen Molla ◽  
Nebiyu Mengistu ◽  
Ahmedin Sefa ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Meta Analysis ◽  
Plasmodium Falciparum Malaria ◽  
Randomized Control Trials ◽  
High Quality ◽  
Quality Of Evidence ◽  
Online Databases ◽  
Randomized Control ◽  
Comparative Safety

Abstract Background The efficacies of artemisinin based combinations have been excellent in Africa, but also comprehensive evidence regarding their safety would be important. The aim of this review was to synthesize available evidence on the safety of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated Plasmodium falciparum malaria among children in Africa. Methods A systematic literature search was done to identify relevant articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Center for Clinical Trial database (CENTRAL) for retrieving randomized control trials comparing safety of DHA-PQ and AL for treatment of uncomplicated P. falciparum malaria among children in Africa. The search was performed from August 2020 to 30 April 2021. Using Rev-Man software (V5.4.1), the extracted data from eligible studies were pooled as risk ratio (RR) with 95% confidence interval (CI). Results In this review, 18 studies were included, which involved 10,498 participants were included. Compared to AL, DHA-PQ was associated with a slightly higher frequency of early vomiting (RR 2.26, 95% CI 1.46 to 3.50; participants = 7796; studies = 10; I2 = 0%, high quality of evidence), cough (RR 1.06, 95% CI 1.01 to 1.11; participants = 8013; studies = 13; I2 = 0%, high quality of evidence), and diarrhoea (RR 1.16, 95% CI 1.03 to 1.31; participants = 6841; studies = 11; I2 = 8%, high quality of evidence) were more frequent in DHA-PQ treatment arm. Conclusion From this review, it can be concluded that early vomiting, diarrhoea, and cough were common were significantly more frequent in patients who were treated with the DHA-PQ than that of AL, and both drugs are well tolerated. More studies comparing AL with DHA-PQ are needed to determine the comparative safety of these drugs.

scholarly journals Safety of Dihydroartemisinin-Piperaquine Versus Artemether-Lumefantrine For the Treatment of Uncomplicated Plasmodium Falciparum Malaria Among Children in Africa: a Systematic Review and Meta-Analysis of Randomized Control Trials

2021 ◽  
Author(s):  
Dawit Getachew Assefa ◽  
Gizachew Yismaw ◽  
Eyasu Makonnen
Keyword(s):  
Meta Analysis ◽  
Plasmodium Falciparum Malaria ◽  
Randomized Control Trials ◽  
High Quality ◽  
Quality Of Evidence ◽  
Online Databases ◽  
Randomized Control ◽  
Comparative Safety ◽  
Uncomplicated Plasmodium Falciparum Malaria

Abstract Background: The efficacies of artemisinin based combinations have been excellent in Africa, but little or no attention has been given to their safety. The aim of this review was to synthesize available evidence on the safety of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated P.falciparum malaria among children in Africa.Method: A systematic literature search was done to identify relevant articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Center for Clinical Trial database (CENTRAL) for retrieving randomized control trials comparing safety of DHA-PQ and AL for treatment of uncomplicated P.falciparum malaria among children in Africa. The search was performed from August 2020 to 30 April 2021. Using Rev-Man software (V5.4.1), the extracted data from eligible studies were pooled as risk ratio (RR) with 95% confidence interval (CI).Result: In this review, 18 studies were included, which involved 10,498 participants were included. Compared to AL, DHA-PQ was associated with a slightly higher frequency of early vomiting (RR 2.26, 95% CI 1.46 to 3.50; participants = 7796; studies = 10; I2 = 0%, high quality of evidence), cough (RR 1.06, 95% CI 1.01 to 1.11; participants = 8013; studies = 13; I2 = 0%, high quality of evidence), and diarrhea (RR 1.16, 95% CI 1.03 to 1.31; participants = 6841; studies = 11; I2 = 8%, high quality of evidence) were more frequent in DHA-PQ treatment arm. Conclusion: From this review, it can be concluded that early vomiting, diarrhea, and cough were significantly more frequent in patients who were treated with the DHA-PQ than that of AL, and both drugs are well tolerated. More studies comparing AL with DHA-PQ are needed to determine the comparative safety of these drugs.

scholarly journals Safety of Dihydroartemisinin-piperaquine Versus Artemether-lumefantrine for the Treatment of Uncomplicated Plasmodium Falciparum Malaria Among Children in Africa: A Systematic Review and Meta-analysis of Randomized Control Trials

2021 ◽  
Author(s):  
Dawit Getachew Assefa ◽  
Gizachew Yesmaw ◽  
Eyasu Makonnen
Keyword(s):  
Meta Analysis ◽  
Plasmodium Falciparum Malaria ◽  
Randomized Control Trials ◽  
High Quality ◽  
Quality Of Evidence ◽  
Online Databases ◽  
Randomized Control ◽  
Comparative Safety ◽  
Uncomplicated Plasmodium Falciparum Malaria

Abstract Background: The efficacies of artemisinin based combinations have been excellent in Africa, but little or no attention has been given to their safety. The aim of this review was to synthesize available evidence on the safety of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated P.falciparum malaria among children in Africa.Method: A systematic literature search was done to identify relevant articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Center for Clinical Trial database (CENTRAL) for retrieving randomized control trials comparing safety of DHA-PQ and AL for treatment of uncomplicated P.falciparum malaria among children in Africa. The search was performed from August 2020 to 30 April 2021. Using Rev-Man software (V5.4.1), the extracted data from eligible studies were pooled as risk ratio (RR) with 95% confidence interval (CI).Result: In this review, 18 studies were included, which involved 10,498 participants were included. Compared to AL, DHA-PQ was associated with a slightly higher frequency of early vomiting (RR 2.26, 95% CI 1.46 to 3.50; participants = 7796; studies = 10; I2 = 0%, high quality of evidence), cough (RR 1.06, 95% CI 1.01 to 1.11; participants = 8013; studies = 13; I2 = 0%, high quality of evidence), and diarrhea (RR 1.16, 95% CI 1.03 to 1.31; participants = 6841; studies = 11; I2 = 8%, high quality of evidence) were more frequent in DHA-PQ treatment arm.Conclusion: From this review, it can be concluded that early vomiting, diarrhea, and cough were significantly more frequent in patients who were treated with the DHA-PQ than that of AL, and both drugs are well tolerated. More studies comparing AL with DHA-PQ are needed to determine the comparative safety of these drugs.

Efficacy and Safety of Dihydroartemisinin-Piperaquine Versus Artemether-Lumefantrine for Treatment of Uncomplicated Plasmodium Falciparum Malaria In African Children: A Systematic Review And Meta-Analysis of Randomized Control Trials

2021 ◽  
Author(s):  
Dawit Getachew Assefa ◽  
Gizachew Yesmaw ◽  
Eyasu Makonnen
Keyword(s):  
Plasmodium Falciparum ◽  
Treatment Failure ◽  
Meta Analysis ◽  
Randomized Control Trials ◽  
Efficacy And Safety ◽  
High Quality ◽  
Quality Of Evidence ◽  
African Children ◽  
Randomized Control

Abstract Background: Emergence of Plasmodium falciparum resistance to artemisinin and its derivatives poses a threat to global effort in controlling malaria. Resistance has already emerged to most antimalarial drugs in common use. On the other hand, significant number of the developing world in genral and African population in particular is sufferring from malaria of whom many are children.The aim of this review was, therefore, to compare the efficacy and safety of dihydroartemisinin-piperaquine and artemether-lumefantrine for treatment of uncomplicated P.falciparum malaria in African children.Method: A computerized systematic search method was used to search for articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Center for Clinical Trial database (CENTRAL) for retrieving randomized control trials comparing efficacy and safety of DHA-PQ and AL for treatment of uncomplicated P.falciparum malaria in African children. The search was performed from August 2020 to 30 April 2021. Using Rev-Man software (V5.4), R-studio, and Comprehensive Meta-analysis software, the extracted data from eligible studies were pooled as risk ratio (RR) with 95% confidence interval (CI).Result: In this review, 25 studies which involved a total of 13,198 participants were included. PCR unadjusted treatment failure in children aged between 6 months and 15 years was significantly lower in DHA-PQ treatment arm on day 28 than that of AL (RR 0.14, 95% CI 0.08 to 0.26; participants = 1302; studies = 4; I2 = 0%, high quality of evidence). Consistently, the PCR adjusted treatment failure was significantly lower with DHA-PQ treatment group on day 28 (RR 0.45, 95% CI 0.29 to 0.68; participants = 8508; studies = 16; I2 = 51%, high quality of evidence) and on day 42 (RR 0.60, 95% CI 0.47 to 0.78; participants = 5959; studies = 17; I2 = 0%, high quality of evidence). However, the efficacy was ≥95% in both treatment groups on day 28. On days 28 and 42, a significant increase in serum hemoglobin level from the baseline was also observed in DHA-PQ treatment arm (SMD 0.15, 95% CI 0.05 to 0.26; participants = 2715; studies = 4; I2 = 32%, high quality of evidence) and (MD 0.35, 95% CI 0.12 to 0.59; participants = 1434; studies = 3; I2 = 35%, high quality of evidence), respectively. Compared to AL, DHA-PQ was associated with a slightly higher frequency of early vomiting (RR 2.26, 95% CI 1.46 to 3.50; participants = 7796; studies = 10; I2 = 0%, high quality of evidence), vomiting (RR 1.02, 95% CI 0.87 to 1.19; participants = 8789; studies = 13; I2 = 20%, high quality of evidence), cough (RR 1.06, 95% CI 1.01 to 1.11; participants = 8013; studies = 13; I2 = 0%, high quality of evidence), and diarrhea (RR 1.16, 95% CI 1.03 to 1.31; participants = 6841; studies = 11; I2 = 8%, high quality of evidence) were more frequent in DHA-PQ treatment arm.Conclusion: From this review, it can be concluded that DHA-PQ reduces new infection and recrudescence with significant impact on hemoglobin recovery more than AL, and both drugs are well tolerated. DHA-PQ may, therefore be recommended as a first line treatment for uncomplicated P.falciparum malaria in Africa, while use of AL continues.

scholarly journals Efficacy of dihydroartemisinin-piperaquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria among children in Africa: a systematic review and meta-analysis of randomized control trials

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dawit Getachew Assefa ◽  
Gizachew Yismaw ◽  
Eyasu Makonnen
Keyword(s):  
Plasmodium Falciparum ◽  
Treatment Failure ◽  
Falciparum Malaria ◽  
Meta Analysis ◽  
Uncomplicated Falciparum Malaria ◽  
Randomized Control Trials ◽  
High Quality ◽  
Quality Of Evidence ◽  
Randomized Control

Abstract Background Emergence of Plasmodium falciparum resistance to artemisinin and its derivatives poses a threat to the global effort to control malaria. The emergence of anti-malarial resistance has become a great public health challenge and continues to be a leading threat to ongoing malaria control efforts. The aim of this review was to synthesize available evidence on the efficacy of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated falciparum malaria among children in Africa. Methods A systematic literature search was done to identify relevant articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Central Register of Controlled Trials’ database (CENTRAL) for retrieving randomized control trials comparing efficacy of DHA-PQ and AL for treatment of uncomplicated falciparum malaria in African children. The search was performed from August 2020 to April 2021. Using Rev-Man software (V5.4.1), R-studio and Comprehensive Meta-analysis software version 3, the extracted data from eligible studies were pooled as risk ratio (RR) with 95% confidence interval (CI). Results In this review, 25 studies which involved a total of 13,198 participants were included. PCR-unadjusted treatment failure in children aged between 6 months and 15 years was significantly lower in the DHA-PQ treatment arm on day 28 than that of AL (RR 0.14, 95% CI 0.08–0.26; participants = 1302; studies = 4; I2 = 0%, high quality of evidence). Consistently, the PCR-adjusted treatment failure was significantly lower with DHA-PQ treatment group on day 28 (RR 0.45, 95% CI 0.29–0.68; participants = 8508; studies = 16; I2 = 51%, high quality of evidence) and on day 42 (RR 0.60, 95% CI 0.47–0.78; participants = 5959; studies = 17; I2 = 0%, high quality of evidence). However, the efficacy was ≥ 95% in both treatment groups on day 28. Conclusion From this review, it can be concluded that DHA-PQ reduces new infection and recrudescence on days 28 and 42 more than AL. This may trigger DHA-PQ to become a first-line treatment option.

scholarly journals Acupuncture For Major Depressive Disorder: A Systematic Review and Meta-Analysis of High-Quality Randomized Control Trials

2021 ◽  
Author(s):  
Guixing Xu ◽  
Qiwei Xiao ◽  
Biqing Huang ◽  
Hanzhou Lei ◽  
Zihan Yin ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Sham Acupuncture ◽  
Randomized Control Trials ◽  
High Quality ◽  
Major Depressive ◽  
Quality Of Evidence ◽  
High Quality Evidence ◽  
Randomized Control ◽  
Quality Evidence

Abstract Background: The effects of acupuncture for major depressive disorder (MDD) uncertain. This review aims to determine the effects of Acupuncture for MDD .Methods: Eight Database were searched to identify randomized control trials (RCTs) on Acupuncture for MDD. All RCTs with adult participants undergoing acupuncture treatment for MDD were included. The primary outcome measure was the 24-item Hamilton rating scale for depression (HAMD-24). We used random-effects meta-analysis to synthesis the results with mean difference or odds ratio. Furthermore, the potential heterogeneity was tested through meta-regression/subgroup analyses/sensitive analysis. The quality of evidence for each outcome was assessed by the Grading of Recommendations Assessment, Development and Evaluation approach.Results: Forty-three studies were included: 9 acupuncture versus sham-acupuncture (n=920), 26 acupuncture versus antidepressants (n=2169), 9 acupuncture plus antidepressants versus antidepressants (n=667). Of the 43 high-quality articles, 24 and 8 were determined to have a low and moderate risk of bias, respectively. The pooled results for HAMD-24 and SDS revealed the clinical benefits of Acupuncture or Acupuncture plus antidepressants compared to sham-acupuncture or antidepressants, with high quality evidence. Furthermore, high quality of evidence showed that acupuncture led to fewer adverse effects compared to antidepressants.Conclusions: Acupuncture or acupuncture plus antidepressants were significantly associated with reduced HAMD-24 scores, with high-quality evidence. More rigorous trials are needed to identify the optimal frequency of Acupuncture for MDD and integrate such evidence into clinical care to reduce antidepressant use.

scholarly journals The effectiveness of M-Health associated with cardiac rehabilitation on functional capacity and cardiovascular risk factors: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A C Campagnolo Goncalves Toledo ◽  
N Soares De Almeida ◽  
A Pierucci ◽  
A Straioto Salomao ◽  
I Ribeiro Lemes ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Meta Analysis ◽  
Medium Term ◽  
Short Term ◽  
High Quality ◽  
Quality Of Evidence ◽  
High Quality Evidence ◽  
Quality Evidence

Abstract Introduction Smartphone applications for health (M-Health) seem to overcome barriers to access Cardiovascular Rehabilitation Programs (CRP), because of their high degree of acceptance and also their potential to influence the frequency of physical exercise in weight loss. Objective To analyze the effectiveness of the combination of M-Health and CRP compared to CRP alone on functional capacity, adherence to CRP, management of cardiovascular risk factors in cardiac patients. Design Systematic Review and Meta-Analysis. Methods The following databases were used Medline via Ovid, EMBASE, Central, PEDro and SPORTDiscus via EBSCOhost from their inception until July/2020. We included randomized controlled trials investigating the effects of M-Health in combination with CRP compared to CRP alone in adults with heart disease, and the interventions with M-Health consisted of text messages, e-mails, and applications. The primary outcome of this review was functional capacity, measured by VO2peak, or self-reported physical activity (METs.min/week). PEDro scale was used to assess the methodological quality of the studies and the GRADE approach to assess the overall quality of evidence. Pooled estimates were calculated using a random effect model to obtain mean difference (MD) or standardized mean differences (SMD) and their respectives 95% confidence intervals (CI). Results Nineteen RCTs were eligible, the median risk of bias was 7 out of 10 points. The primary endpoint was analyzed by subgroups, time of intervention and kind of type CRP, eigthteen of these studies assessed functional capacity. CRP in combination with a m-health intervention was more effective than CRP alone in improving VO2peak, ml/min/kg, (MD: 0.84, CI: 0.30 to 1.38; I2=0%, high quality evidence, 12 trials, n=1889) at short-term follow-up, but at medium-term follow-up (MD: 0.84, CI: −0.26 to 1.41; I2=0%, high quality evidence, 8 trials, n=927,). Similarly, CRP associated with m-health was superior to CRP alone in increasing self-reported at short-term, METs.min/week, (MD:1.31, CI: −0.24 to 2.37; I2 = not aplicable, very low quality evidence, 1 trial, n=18), and at medium-term follow-up (MD: 0.18, CI: −0.01 to 0.36; I2=56%, moderate quality evidence, 4 trials, n=1107). Conclusion High quality of evidence shows that M-Health improves cardiorespiratory fitness at short-term follow-up. In addition, supervised program showed to be more effective than non-supervised. Funding Acknowledgement Type of funding sources: None.

The Effect of Prehospital Epinephrine in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 34 (05) ◽  
pp. 532-539 ◽  
Author(s):  
K.T. Ng ◽  
W.Y. Teoh
Keyword(s):  
Systematic Review ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Quality Of Evidence ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

AbstractIntroduction:Epinephrine has been recommended for out-of-hospital cardiac arrest (OHCA) resuscitation for nearly one century, but its efficacy and safety remain unclear in the literature. The primary aim of this review was to determine whether epinephrine increases the return of spontaneous circulation in OHCA patients.Methods:A systematic review and meta-analysis were conducted using the following databases: MEDLINE, EMBASE, and CENTRAL, from their inception until October 2018. All the randomized controlled trials (RCTs) were included. Observational studies, case reports, case series, and non-systematic reviews were excluded.Results:Two trials including 8,548 patients were eligible for inclusion in the data synthesis. In patients who received epinephrine during OHCA, the incidence of return of spontaneous circulation was increased, with an odds ratio (95%CI) of 4.25 (3.79-4.75), P <.001, high-quality of evidence. The number of patients transported to hospital was increased in patients who had prehospital epinephrine, with an odds ratio (95%CI) of 2.31 (2.11-2.53), P <.001, high-quality of evidence. The prehospital use of epinephrine was associated with an increased survival to hospital discharge, the odds ratio (95%CI) being 1.43 (1.10-1.87), P = .008, moderate-quality of evidence. No significant effect was noted on the favorable neurologic state of patient at hospital discharge, with an odds ratio (95%CI) of 1.21 (0.90-1.64), P = .21, moderate-quality of evidence.Conclusions:This meta-analysis suggests that the prehospital use of epinephrine increases return of spontaneous circulation, transport of patients to hospital, and survival to hospital discharge for OHCA. However, no significant effects on favorable neurologic function at hospital discharge were demonstrated. The general quality of evidence ranged from moderate to high.

Problem-Solving Therapy

2017 ◽  
Author(s):  
Nancy P. Kropf ◽  
Sherry M. Cummings
Keyword(s):  
Problem Solving ◽  
Meta Analysis ◽  
Randomized Control Trials ◽  
Problem Solving Therapy ◽  
Related Quality ◽  
Health Related ◽  
Randomized Control ◽  
Meta Analyses ◽  
And Coping

Chapter 6, “Problem-Solving Therapy: Evidence-Based Practice,” details the research evidence concerning the effectiveness of problem-solving therapy (PST) for use with older adults. Only meta-analyses or randomized control trials (RCT) were included in this review. One meta-analysis and fifteen randomized control trials were identified that investigated PST outcomes on older adult depression, health-related quality of life, and coping. Outcomes of these studies determined that this therapy is effective in reducing anxiety and depression, and increasing problem-solving abilities in both community-based and in-home settings. Additionally, consistent support was found for the efficacy of telephone and video-phone PST, suggesting that these alternate means of administration may help overcome barriers to the receipt of mental health services experienced by homebound elders.

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