scholarly journals A különféle trimetazidinkészítmények klinikai hatása stabil anginával járó krónikus koszorúér-szindrómában. Frissített módszeres áttekintés és metaanalízis

2020 ◽  
Vol 161 (16) ◽  
pp. 611-622
Author(s):  
Viktor L. Nagy ◽  
Zoltán Herold
Keyword(s):  
Cochrane Library ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register

Absztrakt: Bevezetés: A trimetazidin olyan metabolikus hatású anyag, amelynek hatékonysága igazolást nyert a stabil koszorúér-szindróma kezelésében. Az ajánlás szerint a trimetazidin második vonalbeli kezelésként megfontolandó az angina gyakoriságának csökkentésére és a terhelési tolerancia javítására azokban a betegekben, akiknek a tünetei nem kontrollálhatók megfelelően béta-blokkolók, kalciumcsatorna-blokkolók és tartós nitrátok adása mellett. Célkitűzés: Jelen vizsgálatunkban a különböző adagolású (3 × 20 mg, 2 × 35 mg, 1 × 80 mg) trimetazidinkészítmények hatékonyságát kívántuk tisztázni stabil angina pectorisban. Az elsődleges klinikai célváltozók a következők voltak: heti anginaszám, valamint a heti rövid hatástartamú sublingualis nitrátfogyasztás. Módszer: Mindketten adatgyűjtést végeztünk a PubMed, a Cochrane Library és a Cochrane Central Register of Controlled Trials adatbázisokban az 1967-től 2019. szeptember 30-ig terjedő időszakra vonatkozóan. A statisztikai elemzést standard metaanalízis-módszerekkel hajtottuk végre. Eredmények: Összesen 31 randomizált, kontrollált, illetve obszervációs tanulmány került bevonásra. 9856 beteg (átlagéletkor: 59,6 év, férfi: 61,6%) kezelését értékeltük. A trimetazidin a randomizált tanulmányokban a placebóval összehasonlítva csökkentette a heti anginaszámot (átlagos különbség: –1,84, 95% CI: –2,39; –1,30; p<0,0001) és a heti nitroglicerin-fogyasztást (–1,65, 95% CI: –2,17; –1,14; p<0,0001). A trimetazidin a kiinduláshoz képest a kombinációs és az obszervációs vizsgálatokban csökkentette a heti anginaszámot (átlagos különbség: –3,73, 95% CI: –4,53; –2,92; p<0,0001) és a heti nitroglicerin-fogyasztást (–3,23, 95% CI: –4,23; –2,24; p<0,0001). A három kezelési dózis között az anginaszám csökkenésében és a nitroglicerin-fogyasztásban nem lehetett különbséget kimutatni (p = 0,57, illetve p = 0,48). További eredményeink: a két primer változó vizitről vizitre csökkent; nagyobb beválasztási anginaszám a rövidebb időtartamú tanulmányokban és a kisebb adagú trimetazidint kapók között fordult elő gyakrabban, és ezek a betegek a többieknél fiatalabbak voltak. A rövidebb időtartamú tanulmányokban a kezdeti nitroglicerin-igény, illetve a -csökkenés nagyobb volt a hosszabb időtartamúakhoz képest. Következtetések: A trimetazidin kedvező klinikai hatású stabil angina pectorisban, az alkalmazott adagtól függetlenül. Új megállapításunk az, hogy a súlyosabb állapotú, fiatalabb betegek kezelésének klinikai haszna a legnagyobb. Orv Hetil. 2020; 161(16): 611–622.

Cochrane corner: ergonomic positioning or equipment for treating carpal tunnel syndrome

2013 ◽  
Vol 38 (5) ◽  
pp. 580-581 ◽  
Author(s):  
S. Buchan ◽  
R. Amirfeyz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Surgical Intervention ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register ◽  
Tunnel Syndrome ◽  
Mean Differences ◽  
The Cochrane Library

Background: Non-surgical treatments, including ergonomic positioning or equipment, are sometimes offered to people experiencing mild to moderate symptoms from carpal tunnel syndrome. The effectiveness and duration from ergonomic positioning or equipment interventions for treating carpal tunnel syndrome are unknown. Objectives: To assess the effects of ergonomic positioning compared with no treatment, a placebo or another non-surgical intervention in people with carpal tunnel syndrome. Search methods: We searched the Cochrane Neuromuscular Disease Group Specialized Register (14 June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 2, in The Cochrane Library), MEDLINE (1966 to June 2011), EMBASE (1980 to June 2011), CINAHL Plus (1937 to June 2011), and AMED (1985 to June 2011). We also reviewed the reference lists of randomized or quasi-randomized trials identified from the electronic search. Selection criteria: Randomized or quasi-randomized controlled trials comparing ergonomic positioning or equipment with no treatment, placebo or another non-surgical intervention in people with carpal tunnel syndrome. Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of included studies. They calculated risk ratios and mean differences with 95% confidence intervals for the primary and secondary outcomes. Results of clinically and statistically homogeneous trials were pooled, where possible, to provide estimates of the effect of ergonomic positioning or equipment.

Cochrane corner: water for wound cleansing

2012 ◽  
Vol 37 (4) ◽  
pp. 375-376 ◽  
Author(s):  
J. Henton ◽  
A. Jain
Keyword(s):  
Tap Water ◽  
Data Extraction ◽  
Healing Process ◽  
Cost Effective ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Ovid Medline ◽  
Central Register ◽  
The Cochrane Library

Background: Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and does not interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective; however, there is an unresolved debate about its use. Objectives: The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. Search strategy: For this update we searched the Cochrane Wounds Group Specialised Register (Searched 22 February 2010); The Cochrane Central Register of Controlled Trials (CENTRAL) ( The Cochrane Library, 2010 Issue 1); Ovid MEDLINE – 2007 to February Week 2 2010; Ovid MEDLINE – In-Process & Other Non-Indexed Citations (Searched19 February 2010); Ovid EMBASE – 2007 to 2010 Week 06; EBSCO CINAHL – 2007 to 22 February 2010. Selection criteria: Randomized and quasi-randomized controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing. Data collection and analysis: Two review authors independently carried out trial selection, data extraction and quality assessment. We settled differences in opinion by discussion. We pooled some data using a random-effects model.

scholarly journals Comparative Analysis of 9 COVID-19 Convalescent Plasma Protocols Registered by Cochrane Central Register of Controlled Trials

2020 ◽  
Keyword(s):  
Controlled Trial ◽  
Immunoglobulin M ◽  
Ordinal Scale ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
China National Knowledge Infrastructure ◽  
Open Label ◽  
Central Register

Context: Coronavirus disease 2019 (COVID-19) has progressed into a public health emergency of international concern. Passive immunotherapy has been successfully used for the treatment of infectious diseases since the 1890s. It is necessary and constructive to compare and analyze COVID-19 convalescent plasma (CCP) randomized controlled trials (RCTs) to help clinicians to have a potential option for COVID-19. Evidence Acquisition: In this study, eight databases were searched on May 1, 2020, such as China National Knowledge Infrastructure, PubMed, and Cochrane Library, with the search fields of "Title Abstract Keyword" of "Convalescent plasma AND COVID-19" or " Convalescent plasma AND SARS-CoV-2". The outcome of interest was clinical RCTs for COVID-19. Results: The search retrieved nine relevant CCP protocols for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). All nine trials were randomized, parallel assignment, interventional, clinical treatment studies with NCT04344535, NCT04345289, and NCT04323800 masking and the rest open-label. The estimated enrollment is within the range of 40-1,500 subjects, and five trials will be finished in 2020 as opposed to two in 2021 and two in 2022. Except for NCT04323800 on the prevention of COVID-19, other eight trials will test and verify the effectiveness and safety of CCP for the treatment of COVID-19. The used dosage of CCP is within the range of 200-600 mL. NCT04344535, NCT04323800, and NCT04346446 use standard donor plasma in controlled groups in comparison to NCT04348656, NCT04342182, NCT04333251, and NCT04345523 without any positive drug in controlled groups. NCT04332835 adds hydroxychloroquine to both groups, and only NCT04345289 is a six-armed placebo-controlled trial. Primary and secondary outcome measures are differently expressed in the nine trials. Nevertheless, they can be summarized as ㈠ changes in time, day, and number of a 7-point ordinal scale. There are ㈡ changes in SARS-CoV-2 ribonucleic acid (i.e., viral load), anti-SARS-CoV-2 antibody titers (i.e., immunoglobulin M and immunoglobulin G), C-reactive protein, lymphocyte count, lactate dehydrogenase, and interleukin 6 on a specified day or during a specific period. Conclusion: The nine well-designed RCT trials will establish the efficacy of CCP for the treatment of SARS-CoV-2 from the perspective of evidence-based medicine.

Immediate Effect of Fan Therapy in Terminal Cancer With Dyspnea at Rest: A Meta-Analysis

2019 ◽  
Vol 37 (4) ◽  
pp. 294-299 ◽  
Author(s):  
Jun Kako ◽  
Masamitsu Kobayashi ◽  
Yasufumi Oosono ◽  
Kohei Kajiwara ◽  
Mika Miyashita
Keyword(s):  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Terminal Cancer ◽  
Cochrane Central Register ◽  
Patients With Cancer ◽  
Central Register ◽  
Nonmalignant Disease ◽  
The Cochrane Library

Background: Dyspnea is a common distressing symptom in patients with malignant and nonmalignant diseases. Fan therapy, which uses a fan to blow air toward the patient’s face, can alleviate dyspnea; however, its efficacy remains unclear. Aim: To examine the immediate efficacy of fan therapy for alleviation of dyspnea at rest. Design: Meta-analysis. Data sources: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and Scopus from January 1, 1987, to August 21, 2018 (PROSPERO-CRD42018108610). In addition, we hand-searched studies and used the similar articles feature on PubMed to search for articles. Randomized controlled trials comparing the effects of fan therapy with placebo or other interventions to alleviate dyspnea at rest, in which patients were aged ≥18 years, were eligible for inclusion in the review. We excluded articles on long-term intervention involving fan therapy and complex intervention (including fan therapy). The risk of bias assessment was conducted using the Cochrane tool, and the meta-analysis was performed using RevMan version 5.3. Results: We identified a total of 218 studies; 2 met our criteria for inclusion in the meta-analysis. Fan therapy significantly improved dyspnea at rest in terminally ill patients with cancer compared to control groups (mean difference: −1.31, 95% confidence interval: −1.79 to −0.83, P < .001). There were no studies that met the inclusion criteria regarding fan therapy for patients with nonmalignant disease. Conclusions: This meta-analysis demonstrated that fan therapy may be an effective intervention for dyspnea at rest in patients with terminal cancer.

Functional cortical changes associated with shoulder instability – a systematic review

2021 ◽  
pp. 175857322110190
Author(s):  
Morissa F Livett ◽  
Deborah Williams ◽  
Hayley Potter ◽  
Melinda Cairns
Keyword(s):  
Systematic Review ◽  
Joint Instability ◽  
Glenohumeral Joint ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Cortical Function ◽  
High Quality Research ◽  
Central Register ◽  
Rehabilitative Measures ◽  
Randomised Controlled

Background Glenohumeral joint instability is associated with structural deficits and/or alterations in sensory and motor processing; however, a proportion of patients with glenohumeral joint instability fail to respond to surgical and rehabilitative measures. This systematic review aimed to establish if functional cortical changes occur in patients with glenohumeral joint instability. Methods AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, PEDro, Pubmed, PsychINFO and Scopus were searched from inception to 17 March 2021. Randomised controlled trials and non-randomised trials were included and quality was appraised using the Downs and Black tool. Results One thousand two hundred seventy-nine records were identified of which five were included in the review. All studies showed altered cortical function when comparing instability patients with healthy controls and included areas associated with higher cortical functions. Discussion The findings of this systematic review offer some insight as to why interventions addressing peripheral pathoanatomical factors in patients with glenohumeral joint instability may fail in some cases due to functional cortical changes. However, data are of moderate to high risk of bias. Further high-quality research is required to ascertain the degree of functional cortical changes associated with the type and duration of glenohumeral joint instability.

O papel da fisioterapia no tratamento das cefaleias: revisão de literatura

2016 ◽  
pp. 33-42
Author(s):  
Débora Wanderley ◽  
Joaquim José de Souza Costa Neto ◽  
Marcelo Moraes Valença ◽  
Daniella Araújo de Oliveira
Keyword(s):  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register

A intolerância aos movimentos, incapacidade do pescoço e alterações nos músculos pericranianos são aspectos que podem interferir durante as crises de migrânea. A presença destes achados tornou a fisioterapia uma modalidade terapêutica alternativa para as cefaleias. Assim, as desordens estruturais e comportamentais musculares podem promover modificações na biomecânica da cabeça e região cervical, bem como limitações na mobilidade cervical no paciente com cefaleia, as quais podem ser tratadas por meio de diferentes modalidades fisioterapêuticas. O objetivo deste estudo foi revisar as publicações mais relevantes sobre o papel da fisioterapia no tratamento das cefaleias, a fim de fundamentar e direcionar o tratamento não farmacológico destes pacientes. Foi feito um levantamento da literatura, entre setembro/2015 e maio/2016, nas bases de dados MEDLINE/ PubMed, LILACS e Cochrane Central Register of Controlled Trials - CENTRAL, buscando ensaios clínicos randomizados e quasi randomizados sobre o tema. Os descritores do MeSH/DeCS utilizados foram: 'cefaleia', 'modalidades de fisioterapia', e seus equivalentes em inglês. Foram identificados 589 artigos, dos quais 19 foram incluídos, segundo os critérios de elegibilidade. De acordo com os resultados dos estudos avaliados, a fisioterapia promove melhora da cefaleia, dos sintomas associados e das disfunções musculoesqueléticas relacionadas. Entre as modalidades utilizadas estão correção postural, mobilização da coluna, alongamento muscular, técnicas de relaxamento, massagem, exercícios ativos ou passivos, entre outras. Devido à baixa qualidade metodológica da maioria dos estudos, são necessários novos ensaios controlados e randomizados, baseados nos critérios diagnósticos da ICHD, utilizando protocolos descritos de maneira mais detalhada e reprodutível, incluindo a avaliação de efeitos adversos.

Reducción de eventos cardiovasculares de Lomitapida versus Estatinas en pacientes con diagnóstico de hipercolesterolemia familiar. Protocolo de revisión sistemática.

10.52011/0097 ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maritza Auxiliadora Torres Valdez ◽  
Lorena Alexandra Muñoz Avila ◽  
Carlos Enrique Ortega Espinoza ◽  
Franklin Geovany Mora Bravo ◽  
Diego Fernando Barzallo Zeas
Keyword(s):  
Controlled Trials ◽  
Cochrane Central Register ◽  
Electronic Library ◽  
Central Register ◽  
Revisión Sistemática

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico dominante que produce hipercolesterolemia y desarrollo prematuro de enfermedades cardiovasculares. Las estatinas han sido el medicamento de elección en estos pacientes, sin embargo, un buen porcentaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas recomendadas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado primarias: 1. Niveles de LDL, HDL pos tratamiento. 2. Presencia de eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). La evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspección visual del diagrama de embudo. La evaluación de la calidad de la evidencia se realizará usando la evaluación GRADE.

scholarly journals Meta-Analysis: Randomized Trials of Lactobacillus plantarum on Immune Regulation Over the Last Decades

2021 ◽  
Vol 12 ◽  
Author(s):  
Wei Zhao ◽  
Chuantao Peng ◽  
Hafiz Arbab Sakandar ◽  
Lai-Yu Kwok ◽  
Wenyi Zhang
Keyword(s):  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register ◽  
Tnf Α ◽  
Ifn Γ ◽  
The Mean ◽  
Regulatory Effects ◽  
Mean Differences ◽  
Necrosis Factor

Lactobacillus (L.) plantarum strains, belong to lactic acid bacteria group, are considered indispensable probiotics. Here, we performed meta-analysis to evaluate the regulatory effects of L. plantarum on the immunity during clinical trials. This meta-analysis was conducted by searching across four most common literature databases, namely, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PubMed. Clinical trial articles that met the inclusion and exclusion criteria were analyzed by Review Manager (version 5.3). p-value &lt; 0.05 of the total effect was considered statistically significant. Finally, total of 677 references were retrieved, among which six references and 18 randomized controlled trials were included in the meta-analysis. The mean differences observed at 95% confidence interval: interleukin (IL)-4, −0.48 pg/mL (−0.79 to −0.17; p &lt; 0.05); IL-10, 9.88 pg/mL (6.52 to 13.2; p &lt; 0.05); tumor necrosis factor (TNF)-α, −2.34 pg/mL (−3.5 to −1.19; p &lt; 0.05); interferon (IFN)-γ, −0.99 pg/mL (−1.56 to −0.41; p &lt; 0.05). Therefore, meta-analysis results suggested that L. plantarum could promote host immunity by regulating pro-inflammatory and anti-inflammatory cytokines.

scholarly journals Azithromycin in patients with Covid-19; a systematic review and metanalysis

2021 ◽  
Author(s):  
Luis Ayerbe ◽  
Ivo Forgnone ◽  
Carlos Risco-Risco ◽  
Maria Perez-Pinar ◽  
Salma Ayis
Keyword(s):  
Systematic Review ◽  
Clinical Severity ◽  
Future Research ◽  
Controlled Trials ◽  
Clinical Settings ◽  
Cochrane Central Register ◽  
Random Effects Models ◽  
Central Register ◽  
Significant Difference ◽  
Observational Design

Background: Azithromycin (AZM) has been widely used in the management of Covid-19. However, the evidence on its actual effects remains disperse and difficult to apply in clinical settings. This systematic review and metanalysis summarizes the studies on the beneficial and adverse effect of AZM in patients with Covid-19. Methods: The PRISMA 2020 statement criteria were followed. Randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of patients treated, and not treated, with AZM, indexed until the 5th of July 2021, were searched in PubMed, Embase, The Web of Science, Scopus, The Cochrane Central Register of Controlled Trials, and MedRXivs. We used Random-effects models to estimate pooled effect size from aggregate data. Results: The initial search produced 4950 results. Finally, 16 studies, five RCTs and 11 with an observational design, with a total of 22984 patients, were included. The metanalysis showed no difference in mortality for those treated, or not, with AZM, OR: 0.95 (0.79-1.13). There was also no significant difference for those treated, and not, with AZM in need for hospital admission or time to admission from ambulatory settings, clinical severity, need for intensive care, or adverse effects. Conclusions: These results presented in this review do not support the use of AZM in the management of Covid-19. They also show that any harm caused to the patient who received it is unlikely. Future research on treatment for patients with Covid-19 may need to focus on other drugs

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