scholarly journals Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis

2021 ◽  
Vol 8 ◽  
Author(s):  
Kiera Murphy ◽  
R. Paul Ross ◽  
C. Anthony Ryan ◽  
Eugene M. Dempsey ◽  
Catherine Stanton
Keyword(s):  
Gut Microbiota ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Early Life ◽  
Observational Studies ◽  
Meta Analysis ◽  
Randomized Controlled ◽  
Routine Administration ◽  
Gut Microbiota Composition

Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in preterm infants. The exact mechanism by which NEC develops is poorly understood however there is growing evidence to suggest that perturbations in the early-life gut microbiota composition increase the risk for NEC. Modulation of the gut microbiota with probiotics, prebiotics, or in combination (synbiotics) is an area which has attracted intense interest in recent years. In this narrative review, we present an overview of the role of the gut microbiota in the pathogenesis of NEC. We also examine the evidence currently available from randomized controlled trials, observational studies, systematic reviews, and meta-analysis examining the role of probiotics, prebiotics, and synbiotics in reducing the risk of or preventing NEC. Current clinical practice guidelines with recommendations on the routine administration of probiotics to preterm infants for NEC are also explored.

Mechanical Thromboprophylaxis in Critically Ill Patients: A Systematic Review and Meta-Analysis

2006 ◽  
Vol 15 (4) ◽  
pp. 402-412 ◽  
Author(s):  
Anthony Limpus ◽  
Wendy Chaboyer ◽  
Ellen McDonald ◽  
Lukman Thalib
Keyword(s):  
Intensive Care ◽  
Randomized Controlled Trials ◽  
Observational Studies ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Trauma Patients ◽  
Intensive Care Patients ◽  
Randomized Controlled ◽  
Confounding Variables

• Objective To systematically review the randomized trials, observational studies, and survey evidence on compression and pneumatic devices for thromboprophylaxis in intensive care patients. • Methods Published studies on the use of compression and pneumatic devices in intensive care patients were assessed. A meta-analysis was conducted by using the randomized controlled trials. • Results A total of 21 relevant studies (5 randomized controlled trials, 13 observational studies, and 3 surveys) were found. A total of 811 patients were randomized in the 5 randomized controlled trials; 3421 patients participated in the observational studies. Trauma patients only were enrolled in 4 randomized controlled trials and 4 observational studies. Meta-analysis of 2 randomized controlled trials with similar populations and outcomes revealed that use of compression and pneumatic devices did not reduce the incidence of venous thromboembolism. The pooled risk ratio was 2.37, indicative of favoring the control over the intervention in reducing the deep venous thrombosis; however, the 95% CI of 0.57 to 9.90 indicated no significant differences between the intervention and the control. A range of methodological issues, including bias and confounding variables, make meaningful interpretation of the observational studies difficult. • Conclusions The limited evidence suggests that use of compressive and pneumatic devices yields results not significantly different from results obtained with no treatment or use of low-molecular-weight heparin. Until large randomized controlled trials are conducted, the role of mechanical approaches to thromboprophylaxis for intensive care patients remains uncertain.

scholarly journals The Infant Gut Microbiota and Risk of Asthma: The Effect of Maternal Nutrition during Pregnancy and Lactation

2020 ◽  
Vol 8 (8) ◽  
pp. 1119 ◽  
Author(s):  
Naser A. Alsharairi
Keyword(s):  
Gut Microbiota ◽  
Early Life ◽  
Nutrient Intake ◽  
Maternal Nutrition ◽  
Current Knowledge ◽  
Increased Risk ◽  
Dietary Nutrient ◽  
Pregnancy And Lactation ◽  
Gut Microbiota Composition

Research has amply demonstrated that early life dysbiosis of the gut microbiota influences the propensity to develop asthma. The influence of maternal nutrition on infant gut microbiota is therefore of growing interest. However, a handful of prospective studies have examined the role of maternal dietary patterns during pregnancy in influencing the infant gut microbiota but did not assess whether this resulted in an increased risk of asthma later in life. The mechanisms involved in the process are also, thus far, poorly documented. There have also been few studies examining the effect of maternal dietary nutrient intake during lactation on the milk microbiota, the effect on the infant gut microbiota and, furthermore, the consequences for asthma development remain largely unknown. Therefore, the specific aim of this mini review is summarizing the current knowledge regarding the effect of maternal nutrition during pregnancy and lactation on the infant gut microbiota composition, and whether it has implications for asthma development.

scholarly journals Nutritional strategies and gut microbiota composition as risk factors for necrotizing enterocolitis in very-preterm infants

2017 ◽  
Vol 106 (3) ◽  
pp. 821-830 ◽  
Author(s):  
Jean-Christophe Rozé ◽  
Pierre-Yves Ancel ◽  
Patricia Lepage ◽  
Laetitia Martin-Marchand ◽  
Ziad Al Nabhani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gut Microbiota ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Microbiota Composition ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Nutritional Strategies ◽  
Gut Microbiota Composition

scholarly journals P.063 Endovascular Treatment of Acute Ischemic Stroke in Patients with Pre-morbid Disability: A Meta-analysis

2021 ◽  
Vol 48 (s3) ◽  
pp. S37-S37
Author(s):  
F Bala ◽  
B Beland ◽  
A Ganesh
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Random Effects ◽  
Observational Studies ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Endovascular Thrombectomy ◽  
Randomized Controlled ◽  
Stroke Disability

Background: Practice-changing trials of endovascular thrombectomy (EVT) for acute stroke excluded patients with pre-morbid disability. Observational studies may inform the role of EVT in this population. We performed a meta-analysis to estimate the effect of EVT in patients with pre-morbid disability. Methods: We adhered to PRISMA guidelines and searched Medline and Embase for studies describing EVT in adults with and without pre-morbid disability with stroke. Random-effects meta-analysis was used to pool outcomes, including favorable outcomes (mRS=0-2 or return to baseline), no increase in disability at 90 days, symptomatic ICH (sICH) and 90-day mortality. Results: We included 8 studies with 5570 patients (mRS 3-5=863, mRS 0-2=4,707). Patients with pre-morbid disability were more likely to return to their baseline mRS (aOR 2.53, 95% CI=1.47-4.36), although they had higher 90-day mortality (aOR=2.21, 95% CI=1.66-2.93). aOR for favorable outcome (aOR=0.83, 95% CI=0.67-1.03) or sICH (aOR=1.07, 95% CI=0.74-1.54) was not significantly different between groups. Conclusions: Observational studies suggest that EVT is safe in patients with pre-stroke disability and may result in comparable return to pre-stroke status as in patients without such disability. These findings argue against the routine exclusion of patients with pre-morbid disability from EVT and merit validation with randomized controlled trials.

scholarly journals Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 192
Author(s):  
Isadora Beghetti ◽  
Davide Panizza ◽  
Jacopo Lenzi ◽  
Davide Gori ◽  
Silvia Martini ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Relative Effect ◽  
Outcome Data ◽  
Feeding Type ◽  
Credible Intervals ◽  
Meta Analyses

Background: Recent evidence supports a role of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants. Methods: A systematic review and network meta-analysis of randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants, focusing on the differential effect of type of feeding, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving formula (alone or with HM) was performed. Results: Fifty-one trials were included (10,664 infants, 29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup analysis according to feeding. In the overall analysis, Lactobacillus acidophilus LB revealed the most promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00–0.21). The subgroup analysis showed that Bifidobacterium lactis Bb-12/B94 was associated with a reduced risk of NEC stage ≥2 in both feeding type populations, with a discrepancy in the relative effect size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01–0.49 vs. OR 0.32; 95% CrIs 0.10–0.36). Conclusions: B. lactis Bb-12/B94 could reduce NEC risk with a different size effect according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively small populations, and outcome data according to feeding type are not available for all RCTs. Further trials are needed to confirm the present findings.

scholarly journals The role of early colonoscopy in patients presenting with acute lower gastrointestinal bleeding: a systematic review and meta-analysis

2018 ◽  
Vol 11 ◽  
pp. 1756283X1875718 ◽  
Author(s):  
Ira Roshan Afshar ◽  
Mo Seyed Sadr ◽  
Lisa L. Strate ◽  
Myriam Martel ◽  
Charles Menard ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Observational Studies ◽  
Meta Analysis ◽  
Lower Gastrointestinal Bleeding ◽  
Significant Heterogeneity ◽  
Randomized Controlled ◽  
Mean Differences ◽  
High Level

Objective: The use of early colonoscopy in the management of acute lower gastrointestinal bleeding (LGIB) is controversial, with disparate evidence. We aim to formally characterize the utility of early colonoscopy (within 24 h) in managing acute LGIB. Design: A systematic literature search to August 2016 identified fully published and abstracts of randomized controlled trials (RCTs) and observational studies assessing early colonoscopy in acute LGIB. Single-arm studies were also included to define incidence. Primary outcomes were overall rebleeding rates and time to rebleeding. Secondary outcomes included mortality, surgery, length of stay (LOS), definite cause of bleeding and adverse events (AEs). Odds ratios (OR) and weighted mean differences (WMD) were calculated. Results: Of 897 citations, 10 single-arm, 9 observational studies, and 2 RCTS were included (25,781 patients). Rebleeding was no different between patients undergoing early colonoscopy and controls (seven studies, OR = 0.89, 95% CI 0.49–1.62), or RCT data only (OR = 1.00, 95% CI 0.52–1.62). Early colonoscopy detected more definitive sources of bleeding (OR = 4.12, 95% CI 2.00–8.49), and was associated with shorter LOS colonoscopy (WMD = −1.52, 95% CI −2.54 to −0.50 days). No other differences were noted between early and late colonoscopy. AEs occurred in 4.0%, (95% CI 2.9%; 5.4%) of early colonoscopies. Included studies were of low quality, with significant heterogeneity for some outcomes. Conclusion: Early colonoscopy in acute LGIB does not decrease rebleeding, mortality or need for surgery, but is associated with increased detection of definitive sources of bleeding, shorter LOS, with low complication incidence. However, the quality of evidence is low, highlighting the need for additional high-level studies.

scholarly journals β1-blocker in sepsis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Daisuke Hasegawa ◽  
Ryota Sato ◽  
Osamu Nishida
Keyword(s):  
Heart Rate ◽  
Oxygen Delivery ◽  
Sinus Tachycardia ◽  
Meta Analysis ◽  
Lactate Production ◽  
Volume Index ◽  
Initial Resuscitation ◽  
Randomized Controlled ◽  
Metabolic Systems

Abstract Background The use of ultrashort-acting β1-blockers recently has attracted attention in septic patients with non-compensatory tachycardia. We summarized the metabolic and hemodynamic effects and the clinical evidence of ultrashort-acting β1-blockers. Main body A recent meta-analysis showed that ultrashort-acting β1-blockers reduced the mortality in septic patients with persistent tachycardia. However, its mechanism to improve mortality is not fully understood yet. We often use lactate as a marker of oxygen delivery, but an impaired oxygen use rather than reduced oxygen delivery has been recently proposed as a more reasonable explanation of hyperlactatemia in patients with sepsis, leading to a question of whether β1-blockers affect metabolic systems. While the stimulation of the β2-receptor accelerates glycolysis and lactate production, the role of β1-blocker in lactate production remains unclear and studies investigating the role of β1-blockers in lactate kinetics are warranted. A meta-analysis also reported that ultrashort-acting β1-blockers increased stroke volume index, while it reduced heart rate, resulting in unchanged cardiac index, mean arterial pressure, and norepinephrine requirement at 24 h, leading to an improvement of cardiovascular efficiency. On the other hand, a recent study reported that heart rate reduction using fast esmolol titration in the very early phase of septic shock caused hemodynamic instability, suggesting that ultrashort-acting β1-blockers should be started only after completing initial resuscitation. While many clinicians still do not feel comfortable controlling sinus tachycardia, one randomized controlled trial in which the majority had sinus tachycardia suggested the mortality benefit of ultrashort-acting β1-blockers. Therefore, it still deems to be reasonable to control sinus tachycardia with ultrashort-acting β1-blockers after completing initial resuscitation. Conclusion Accumulating evidence is supporting the use of ultrashort-acting β1-blockers while larger randomized controlled trials to clarify the effect of ultrashort-acting β1-blockers are still warranted.

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