Efficacy of High-Dose Polyclonal Intravenous Immunoglobulin in COVID-19: A Systematic Review

Background: Although several therapeutic strategies have been investigated, the optimal treatment approach for patients with coronavirus disease (COVID-19) remains to be elucidated. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of polyclonal intravenous immunoglobulin (IVIG) therapy in COVID-19. Methods: A systematic literature search using appropriate medical subject heading (MeSH) terms was performed through Medline (PubMed), EMBASE, SCOPUS, OVID and Cochrane Library electronic databases. The main outcomes considered were mortality and safety of IVIG versus placebo/standard of care. This review was carried out in accordance with Cochrane methodology including the risk bias assessment and grading of the quality of evidence. Measures of treatment effect were mean differences (MD) together with 95% confidence intervals (CIs) for continuous outcome measures and risk ratio (RR) or MD for binary outcomes. Two reviewers independently extracted data from individual studies, and disagreements were resolved by a third reviewer. Results: A total of 2401 COVID-19 patients from 10 studies (four randomized controlled trials (RCT) and six non-randomized controlled trials (non-RCTs)) were included in the analysis. Participants received IVIG or placebo/standard of care. The use of IVIG was not associated with a significantly reduced risk of death (RR 0.50, 95% CIs 0.18–1.36, p = 0.17 for RCTs; RR 0.95, 95% CIs 0.61–1.58, p = 0.94 for non-RCTs; low certainty of evidence). IVIG significantly reduced the length of hospital stay (MD −2.24, 95% CIs −3.20/−1.27; p = 0.00001; low certainty of evidence), although this difference was significant only for studies evaluating moderate COVID-19 patients. No significant difference was observed in the incidence of overall and serious adverse events between IVIG recipients and controls (very low certainty of evidence). Conclusions: The current evidence from the literature does not support the use of IVIG in COVID-19 patients.

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Dyspnea Measurement in Acute Heart Failure: A Systematic Review and Evidence Map of Randomized Controlled Trials

Frontiers in Medicine ◽

10.3389/fmed.2021.728772 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaoyu Zhang ◽

Chen Zhao ◽

Houjun Zhang ◽

Wenjing Liu ◽

Jingjing Zhang ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Acute Heart Failure ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference ◽

Analytical Approaches

Background: Dyspnea is the most common presenting symptom among patients hospitalized for acute heart failure (AHF). Dyspnea relief constitutes a clinically relevant therapeutic target and endpoint for clinical trials and regulatory approval. However, there have been no widely accepted dyspnea measurement standards in AHF. By systematic review and mapping the current evidence of the applied scales, timing, and results of measurement, we hope to provide some new insights and recommendations for dyspnea measurement.Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched from inception until August 27, 2020. Randomized controlled trials (RCTs) with dyspnea severity measured as the endpoint in patients with AHF were included.Results: Out of a total of 63 studies, 28 had dyspnea as the primary endpoint. The Likert scale (34, 54%) and visual analog scale (VAS) (22, 35%) were most widely used for dyspnea assessment. Among the 43 studies with detailed results, dyspnea was assessed most frequently on days 1, 2, 3, and 6 h after randomization or drug administration. Compared with control groups, better dyspnea relief was observed in the experimental groups in 21 studies. Only four studies that assessed tolvaptan compared with control on the proportion of dyspnea improvement met the criteria for meta-analyses, which did not indicate beneficial effect of dyspnea improvement on day 1 (RR: 1.16; 95% CI: 0.99–1.37; p = 0.07; I2 = 61%).Conclusion: The applied scales, analytical approaches, and timing of measurement are in diversity, which has impeded the comprehensive evaluation of clinical efficacy of potential therapies managing dyspnea in patients with AHF. Developing a more general measurement tool established on the unified unidimensional scales, standardized operation protocol to record the continuation, and clinically significant difference of dyspnea variation may be a promising approach. In addition, to evaluate the effect of experimental therapies on dyspnea more precisely, the screening time and blinded assessment are factors that need to be considered.

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Eye Acupuncture Treatment for Stroke: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/871327 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Zeng-Hua Bai ◽

Zhi-Xing Zhang ◽

Chun-Ri Li ◽

Mei Wang ◽

Meong-Ju Kim ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Western Medicine ◽

Current Evidence ◽

Effect Estimate ◽

Controlled Trials ◽

Search Activity ◽

Randomized Controlled ◽

Significant Difference ◽

Eye Acupuncture

There were applications of eye acupuncture for stroke patients. Unfortunately, similar to many other Traditional Chinese Medicine (TCM) treatments, it lacks comprehensive evaluation and system review for its effect and safety.Objective. This study is a systematic review to appraise the safety and effectiveness of eye acupuncture for stroke.Methods. “Eye acupuncture therapy” in eleven databases was searched by randomized controlled trials and quasi-randomized controlled trials. The search activity was ended in April 2014. The data were extracted and assessed by three independent authors. Rev Man 5.0 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval.Results. Sixteen trials (1120 patients) were involved with generally poor methodological quality. The study indicated that when eye acupuncture was combined with western medicine compared to western medicine, there was a significant difference in the areas of mental state, swallow function, and NDS. When eye acupuncture was combined with western medicine and rehabilitation compared to western medicine and rehabilitation, there was significant difference in the changes of SSS, FMA, and constipation symptoms evaluation. No adverse events or side effects have been reported.Conclusions. The current evidence is insufficient and the rigorously designed trials are warranted.

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Comparison of nephroscopy and cystoscopy used in the treatment of bladder stones: a systematic review and meta-analysis of randomized controlled trials

BMC Surgery ◽

10.1186/s12893-021-01461-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Liping Gou ◽

Zhenghao Wang ◽

Ye Zhou ◽

Xiaofeng Zheng

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Operative Time ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Bladder Stones ◽

Randomized Controlled ◽

Significant Difference

Abstract Background A systematic review and meta-analysis was conducted to compare the safety and efficiency of nephroscopy and cystoscopy in transurethral cystolithotripsy (TUCL) for bladder stones (BS). Methods The PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases were searched up to January 2021 for studies assessing the effect of different types of endoscopes among patients who underwent TUCL. The search strategy and study selection process were in accordance with the PRISMA statement. Results Five randomized controlled trials were included in the meta-analysis. The results showed no difference in stone-free rate (RR = 1.00, CI = 0.98–1.02, p = 1.00) between the two groups and nonsignificant heterogeneity (I2 = 0%, p = 1.00), and all patients were rendered stone free. Use of the nephroscope significantly shortened the operative time compared with the cystoscope group (RR= − 26.26, CI = − 35.84 to − 16.68, p < 0.00001), and there was significant heterogeneity (I2= 87%, p < 0.00001). There was no significant difference in mean urethral entries (RR = 0.66, CI = − 0.71 to − 2.04, p = 0.35), hospitalization (MD = 0.08, 95% CI = − 0.07 to 0.23, p = 0.31) or total complication rate (RR=1.37, 95% CI = 0.47–4.00, p = 0.56) between the two groups. Conclusions In conclusion, this systematic review demonstrates that both nephroscopy and cystoscopy have high stone clearance efficiency, low rates of complications and short hospitalizations. The mean urethral entries depend on the treatment method for large stone fragments. However, the use of nephroscopy can significantly reduce the operative time.

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Hydroxychloroquine plus standard of care compared with standard of care alone in COVID-19: a meta-analysis of randomized controlled trials

Scientific Reports ◽

10.1038/s41598-021-91089-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Bahman Amani ◽

Ahmad Khanijahani ◽

Behnam Amani

Keyword(s):

Adverse Events ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Standard Of Care ◽

Cochrane Library ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Significant Difference

AbstractThe efficacy and safety of Hydroxychloroquine (HCQ) in treating coronavirus disease (COVID-19) is disputed. This systematic review and meta-analysis aimed to examine the efficacy and safety of HCQ in addition to standard of care (SOC) in COVID-19. PubMed, the Cochrane Library, Embase, Web of sciences, and medRxiv were searched up to March 15, 2021. Clinical studies registry databases were also searched for identifying potential clinical trials. The references list of the key studies was reviewed to identify additional relevant resources. The quality of the included studies was evaluated using the Cochrane Collaboration tool and Jadad checklist. Meta-analysis was performed using RevMan software (version 5.3). Eleven randomized controlled trials with a total number of 8161 patients were identified as eligible for meta-analysis. No significant differences were observed between the two treatment groups in terms of negative rate of polymerase chain reaction (PCR) (Risk ratio [RR]: 0.99, 95% confidence interval (CI) 0.90, 1.08; P = 0.76), PCR negative conversion time (Mean difference [MD]: − 1.06, 95% CI − 3.10, 0.97; P = 0.30), all-cause mortality (RR: 1.09, 95% CI 1.00, 1.20; P = 0.06), body temperature recovery time (MD: − 0.64, 95% CI − 1.37, 0.10; P = 0.09), length of hospital stay (MD: − 0.17, 95% CI − 0.80, 0.46; P = 0.59), use of mechanical ventilation (RR: 1.12, 95% CI 0.95, 1.32; P = 0.19), and disease progression (RR = 0.82, 95% CI 0.37, 1.85; P = 0.64). However, there was a significant difference between two groups regarding adverse events (RR: 1.81, 95% CI 1.36, 2.42; P < 0.05). The findings suggest that the addition of HCQ to SOC has no benefit in the treatment of hospitalized patients with COVID-19. Additionally, it is associated with more adverse events.

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Comparison of Anterior Versus Posterior Approach in the Treatment of Thoracolumbar Fractures: A Systematic Review

International Surgery ◽

10.9738/intsurg-d-14-00135.1 ◽

2015 ◽

Vol 100 (6) ◽

pp. 1124-1133 ◽

Cited By ~ 16

Author(s):

Qicong Zhu ◽

Fengchao Shi ◽

Weihua Cai ◽

Jianling Bai ◽

Jin Fan ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Randomized Controlled Trials ◽

Posterior Approach ◽

Cochrane Library ◽

Controlled Trials ◽

Thoracolumbar Fractures ◽

Randomized Controlled ◽

Perioperative Blood Loss ◽

Significant Difference

Despite extensive research on thoracolumbar fractures, controversy still exists about which approach is the most appropriate. Lack of evidence-based practice may result in patients being treated inappropriately. The objective of study was to perform a systematic review of the effectiveness of the anterior and posterior approaches in the treatment of thoracolumbar fractures. We conducted searches of PubMed and the Cochrane Library, searching for relevant trials up to August 2013 that compared anterior and posterior for the treatment of thoracolumbar fractures. The key words “anterior,” “posterior,” “thoracolumbar fracture,” “CCT,” and “RCT” were used. We assessed all included literature by using the Cochrane handbook (version 5.1). The results were expressed as the mean difference for continuous outcomes and risk difference for dichotomous outcomes, with a 95% confidence interval, using RevMan version 5.2. There were 3 randomized controlled trials and 11 clinical controlled trials included. The meta-analysis showed no significant difference between groups regarding Cobb angle, the Frankel scale, ASIA/JOA motor score, complications, and number of patients returning to work. Compared with the anterior approach, the posterior approach demonstrated superior canal decompression. In the burst fracture subgroup, operative times were significantly shorter and perioperative blood loss was less in the posterior approach group. The posterior approach is more effective for canal decompression, operative times, and perioperative blood loss. However, because of the lack of randomized controlled trials, and because of large sample size studies, heterogeneity was significant between reports. The optimal treatment for thoracolumbar fractures requires further study.

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Motherwort Injection for Preventing Postpartum Hemorrhage in Women with Vaginal Delivery: A Systematic Review and Meta-Analysis of Randomized Evidence

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2019/1803876 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Jiajie Yu ◽

Yujia Cai ◽

Guanyue Su ◽

Youping Li

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Randomized Controlled Trials ◽

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Risk Of Bias ◽

Current Evidence ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference

Background. Motherwort injection, a common traditional Chinese medicine, is widely used for the prevention of postpartum hemorrhage (PPH), which has been found to be potential benefit in clinical practice.Objectives. This study aimed to conduct a rigorous systematic review of randomized evidence to offer a comprehensive overview regarding the efficacy and safety of motherwort injection in maternal women with virginal delivery.Methods. We included all randomized controlled trials involving pregnant women in vaginal delivery comparing motherwort injection or combination of motherwort injection and oxytocin with oxytocin alone for preventing postpartum hemorrhage. Paired reviewers independently screened citations, assessed risk of bias, and extracted data. Random-effects model by Mantel-Haenszal method was applied to pool the data. Predefined subgroup analyses and sensitivity analyses were conducted to explore the heterogeneity and robustness of results. The GRADE approach was used to rate the quality of evidence.Main Results. 37 randomized controlled trials involving 7887 participants were included, all of which were at moderate to high risk of bias. Meta-analyses of eight trials showed no significant difference in blood loss and PPH events between oxytocin versus motherwort injection (very low quality). However, pooling of 29 trials suggested a reduced risk of blood loss (within 2 hours: MD -55.06mL, 95% CI -84.06 to -26.06; within 24 hours: MD -85.57 mL, 95% CI -94.26 to -76.88, very low quality), PPH events (RR 0.29, 95% CI 0.21 to 0.39, low quality), and adverse events (Peto OR 0.53, 95% CI 0.40 to 0.70, very low quality) in participants treated with motherwort injection and oxytocin versus oxytocin alone.Conclusions. The current evidence supports the suggestion that the additional use of motherwort injection on oxytocin had a preferable outcome. However, given that the evidence is not definitive with low quality, further careful designed and conducted randomized controlled trials in larger population are warranted to conform the effects.

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Chemotherapy Alone Versus Chemotherapy Plus Radiotherapy for Early Stage Hodgkin Lymphoma.

Blood ◽

10.1182/blood.v110.11.2320.2320 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2320-2320 ◽

Cited By ~ 2

Author(s):

Fareed A. Rehan ◽

Corinne Brillant ◽

Holger Schulz ◽

Ina Knauel ◽

Julia Bohlius ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Hodgkin Lymphoma ◽

Early Stage ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Early Stages ◽

Significant Difference ◽

Substantial Heterogeneity

Abstract Both chemotherapy (CT) alone and combined modality therapy (CMT) are effective modalities for the treatment of early stages of Hodgkin lymphoma (HL). However, the optimal choice of treatment is still being discussed. Different research groups reported that ABVD-like CT followed by radiotherapy is highly effective for early favourable and early unfavourable (intermediate) stage HL. A recently conducted randomized trial aimed at determining whether CMT is superior to CT alone in early stages, showed no significant difference in 5 year overall survival (OS) and event-free survival in patients treated with either 4–6 cycles of ABVD alone or 2 cycles of ABVD plus radiotherapy. Thus, this systematic review and meta-analysis was performed for a more comprehensive comparison. Methods: Only randomized controlled trials (RCT) comparing CT alone with CMT in newly diagnosed adults with early stages of HL (CS IA, IB, IIA, IIB) were included. Medline and Cochrane Library were systematically searched for randomized controlled trials from 1975 to 2007. Patients who received CMT were considered as experimental group and patients who received ABVD-like CT alone were considered as control group. Data were collected from full text publications or abstracts and treatment effects for OS were calculated as hazard ratios (HR). Results: A total of 590 references were screened. Four eligible RCTs were identified, including 1207 patients with early-stage HL (early favourable and early unfavourable stages). Between 1983 and 2004, 765 patients where treated with CMT and 442 patients with CT alone. The OS for the CMT group was significantly better than the OS for the CT-alone group (HR: 0.54; 95% CI [0.35 - 0.84]; p = 0.006), but there was evidence for a substantial heterogeneity between the studies (I2 = 69%, p=0.02). Discussion: First results of this systematic review showed improved OS for patients treated with CMT in early-stage HL compared to patients treated with CT alone. The substantial heterogeneity between the trials should be clarified. Further comprehensive analyses are ongoing and will provide more detailed information.

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Role of Whole Grain Consumption in Glycaemic Control of Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nutrients ◽

10.3390/nu14010109 ◽

2021 ◽

Vol 14 (1) ◽

pp. 109

Author(s):

Dengfeng Xu ◽

Lingmeng Fu ◽

Da Pan ◽

Yifei Lu ◽

Chao Yang ◽

...

Keyword(s):

Systematic Review ◽

Glycaemic Control ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Diabetic Patients ◽

Controlled Trials ◽

Whole Grain ◽

Randomized Controlled ◽

Significant Difference

Background: Observational studies have indicated beneficial effects of whole grain consumption on human health. However, no evidence based on randomized controlled trials has been established. Our objective was to perform a systematic review and meta-analysis of randomized controlled trials to assess the effects of whole grain consumption in glycaemic control of diabetic patients. Methods: A comprehensive search in four databases (Web of Science, Pubmed, Scopus and Cochrane library) was conducted to collect potential articles which measured the roles of whole grain consumption on glycaemic control up to October 2021. Results: A total of 16 eligible trials involving 1068 subjects were identified to evaluate the pooled effect. The overall results indicated that compared with the control group, whole grain intake presented a significantly reduced concentration in fast plasma glucose (WMD = −0.51mmol/L, 95% CI: −0.73, −0.28; = 88.6%, p < 0.001), a homeostasis model assessment of insulin resistance (WMD = −0.39μU × mol/L2, 95% CI: −0.73, −0.04; = 58.4%, p = 0.014), and glycosylated haemoglobin (WMD = −0.56%, 95% CI: −0.88, −0.25, = 88.5%, p < 0.001), while no significant difference was observed in fast plasma insulin level between groups (SMD = −0.05, 95% CI: −0.25, 0.14; = 40.7%, p = 0.120). In terms of incremental area under the curve (iAUC), data suggested that whole grain effected a significant decrease in Glucose-iAUC (WMD = −233.09 min × mmol/L, 95% CI: −451.62, −14.57; = 96.1%, p < 0.001) and Insulin-iAUC (SMD = −4.80, 95% CI: −8.36, −1.23; = 89.9%, p = 0.002), although only in a small number of studies. Of note, there is evidence for modest unexplained heterogeneity in the present meta-analysis. Conclusion: Whole grain consumption confers a beneficial effect on glucose metabolism in patients with diabetes. Regrettably, since relevant studies were scarce, we failed to provide confident evidence of whole grain consumption on acute effects including Glucose-iAUC and Insulin-iAUC, which should be addressed in further trials.

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Effect of Biocompatible Peritoneal Dialysis Solution on Residual Renal Function: A Systematic Review of Randomized Controlled Trials

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00331 ◽

2014 ◽

Vol 34 (7) ◽

pp. 724-731 ◽

Cited By ~ 22

Author(s):

Eun-Young Seo ◽

Sook Hee An ◽

Jang-Hee Cho ◽

Hae Sun Suh ◽

Sun-Hee Park ◽

...

Keyword(s):

Systematic Review ◽

Renal Function ◽

Peritoneal Dialysis ◽

Randomized Controlled Trials ◽

Residual Renal Function ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference

Introduction Residual renal function (RRF) plays an important role in outcome of peritoneal dialysis (PD) including mortality. It is, therefore, important to provide a strategy for the preservation of RRF. The objective of this study was to evaluate relative protective effects of new glucose-based multicompartmental PD solution (PDS), which is well known to be more biocompatible than glucose-based conventional PDS, on RRF compared to conventional PDS by performing a systematic review (SR) of randomized controlled trials. Methods We searched studies presented up to January 2014 in MEDLINE, EMBASE, the COCHRANE library, and local databases. Three independent reviewers reviewed and extracted prespecified data from each study. The random effects model, a more conservative analysis model, was used to combine trials and to perform stratified analyses based on the duration of follow-up. Study quality was assessed using the Cochrane Handbook for risk of bias. Eleven articles with 1,034 patients were identified for the SR. Results The heterogeneity of the studies under 12 months was very high, and the heterogeneity decreased substantially when we stratified studies by the duration of follow-up. The mean difference of the studies after 12 months was 0.46 mL/min/1.73 m2 (95% confidence interval = 0.25 to + 0.67). Conclusion New PDS showed the effect to preserve and improve RRF for long-term use compared to conventional PDS, even though it did not show a significant difference to preserve RRF for short-term use.

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Inhibition of Aspirin-Induced Gastrointestinal Injury: Systematic Review and Network Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2021.730681 ◽

2021 ◽

Vol 12 ◽

Author(s):

Wan-tong Zhang ◽

Miao-ran Wang ◽

Guo-dong Hua ◽

Qiu-yan Li ◽

Xu-jie Wang ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Large Sample Size ◽

Cochrane Central Register ◽

Gastrointestinal Injury ◽

Randomized Controlled

Background: Administration of aspirin has the potential for significant side effects of gastrointestinal (GI) injury mainly caused by gastric acid stimulation, especially in long-term users or users with original gastrointestinal diseases. The debate on the optimal treatment of aspirin-induced gastrointestinal injury is ongoing. We aimed to compare and rank the different treatments for aspirin-induced gastrointestinal injury based on current evidence.Methods: We searched PubMed, EMBASE, Cochrane Library (Cochrane Central Register of Controlled Trials), and Chinese databases for published randomized controlled trials (RCTs) of different treatments for aspirin-induced gastrointestinal injury from inception to 1 May 2021. All of the direct and indirect evidence included was rated by network meta-analysis under a Bayesian framework.Results: A total of 10 RCTs, which comprised 503 participants, were included in the analysis. The overall quality of evidence was rated as moderate to high. Eleven different treatments, including omeprazole, lansoprazole, rabeprazole, famotidine, geranylgeranylacetone, misoprostol, ranitidine bismuth citrate, chili, phosphatidylcholine complex, omeprazole plus rebamipide, and placebo, were evaluated in terms of preventing gastrointestinal injury. It was suggested that omeprazole plus rebamipide outperformed other treatments, whereas geranylgeranylacetone and placebo were among the least treatments.Conclusion: This is the first systematic review and network meta-analysis of different treatments for aspirin-induced gastrointestinal injury. Our study suggested that omeprazole plus rebamipide might be considered the best option to treat aspirin-induced gastrointestinal injury. More multicenter, high quality, large sample size randomized controlled trials will confirm the advantages of these medicines in the treatment of aspirin-induced gastrointestinal injury in the future.

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