scholarly journals Efficacy of miltefosine compared with glucantime for the treatment of cutaneous leishmaniasis: a systematic review and meta-analysis

2019 ◽  
Vol 41 ◽  
pp. e2019011 ◽  
Author(s):  
Sohrab Iranpour ◽  
Ali Hosseinzadeh ◽  
Abbas Alipour
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Cutaneous Leishmaniasis ◽  
Publication Bias ◽  
Meta Analysis ◽  
World Health ◽  
Cochrane Central Register ◽  
Significant Difference ◽  
Meta Regression ◽  
Trim And Fill

Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including “miltefosine,” “glucantime,” and “Leishmania.” The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I2 index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.

scholarly journals The impact of inclusion, dose and duration of pyrazinamide (PZA) on efficacy and safety outcomes in tuberculosis: systematic review and meta-analysis protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
James D. Millard ◽  
Elizabeth A. Mackay ◽  
Laura J. Bonnett ◽  
Geraint R. Davies
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Safety Outcomes ◽  
Meta Regression ◽  
Indirect Comparisons

Abstract Background Pyrazinamide (PZA) is a key component of current and future regimens for tuberculosis (TB). Inclusion of PZA at higher doses and for longer durations may improve efficacy outcomes but must be balanced against the potential for worse safety outcomes. Methods We will search for randomised and quasi-randomised clinical trials in adult participants with and without the inclusion of PZA in TB treatment regimens in the Cochrane infectious diseases group’s trials register, Cochrane central register of controlled trials (CENTRAL), MEDLINE, EMBASE, LILACS, the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) international clinical trials registry platform. One author will screen abstracts and remove ineligible studies (10% of which will be double-screened by a second author). Two authors will review full texts for inclusion. Safety and efficacy data will be extracted to pre-piloted forms by one author (10% of which will be double-extracted by a second author). The Cochrane risk of bias tool will be used to assess study quality. The study has three objectives: the association of (1) inclusion, (2) dose and (3) duration of PZA with efficacy and safety outcomes. Risk ratios as relative measures of effect for direct comparisons within trials (all objectives) and proportions as absolute measures of effect for indirect comparisons across trials (for objectives 2 and 3) will be calculated. If there is insufficient data for direct comparisons within trials for objective 1, indirect comparisons between trials will be performed. Measures of effect will be pooled, with corresponding 95% confidence intervals and p values. Meta-analysis will be performed using the generalised inverse variance method for fixed effects models (FEM) or the DerSimonian-Laird method for random effects models (REM). For indirect comparisons, meta-regression for absolute measures against dose and duration data will be performed. Heterogeneity will be quantified through the I2-statistic for direct comparisons and the τ2 statistic for indirect comparisons using meta-regression. Discussion The current use of PZA for TB is based on over 60 years of clinical trial data, but this has never been synthesised to guide rationale use in future regimens and clinical trials. Systematic review registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019138735

scholarly journals The Effect of Probiotics, Prebiotics, and Synbiotics on CD4 Counts in HIV-Infected Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Yuan-Sheng Fu ◽  
Qin-Shu Chu ◽  
Akililu Alemu Ashuro ◽  
Dong-Sheng Di ◽  
Qi Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Cd4 Counts ◽  
Cell Counts ◽  
Significant Difference

Background. Probiotics as a potential adjuvant therapy may improve the restoration of the intestinal CD4+ T-cell population in HIV-infected patients, whereas findings from clinical trials are inconsistent. This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to quantify the effects of probiotic, prebiotic, and synbiotic supplementation on CD4 counts in HIV-infected patients. Methods. We searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials for relevant articles published up to March 20, 2020. Two authors independently performed the study selection, data extraction, and risk of bias assessment. Data were pooled by using the random effects model, and weighted mean difference (WMD) was considered the summary effect size. Publication bias was evaluated by a funnel plot and Egger’s test. Results. The search strategy identified 1712 citations. After screening, a total of 16 RCTs with 19 trials were included in the meta-analysis. Pooling of the extracted data indicated no significant difference between the probiotics/prebiotics/synbiotics and placebo groups on CD4 counts ( WMD = 3.86 , 95% confidence interval (CI) -24.72 to 32.45, P = 0.791 ). In subgroup analysis, a significant increase in CD4 counts was found in the study with high risk of bias ( WMD = 188 , 95% CI 108.74 to 227.26, P ≤ 0.001 ). Egger’s test showed no evidence of significant publication bias ( P = 0.936 ). Conclusions. In summary, the evidence for the efficacy of probiotics, prebiotics, and synbiotics in improving HIV-infected patients’ CD4 counts as presented in currently published RCTs is insufficient. Therefore, further comprehensive studies are needed to reveal the exact effect of probiotics, prebiotics, and synbiotics on CD4+ cell counts.

scholarly journals Ranking videolaryngoscopes and direct laryngoscopes by orotracheal intubation performance in children: protocol of a systematic review and network meta-analysis of randomized clinical trials at patient level

2021 ◽  
Author(s):  
Clístenes C Carvalho ◽  
Stéphanie LPA Regueira ◽  
Ana Beatriz S Souza ◽  
Lucas MLF Medeiros ◽  
Marielle BS Manoel
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
A Priori ◽  
Orotracheal Intubation ◽  
Sensitivity Analyses ◽  
Intubation Attempt ◽  
Cochrane Central Register ◽  
Meta Regression

ABSTRACTBackgroundVideolaryngoscopy was shown to improve glottic visualization in children as compared to direct laryngoscopy, but at the expenses of delayed time for intubation. As little evidence is available regarding the relative performance of different laryngoscopes at present, we designed this systematic review and network meta-analysis to rank the different videolaryngoscopes (VLs) and direct laryngoscopes (DLs) for orotracheal intubation in children.MethodsWe will conduct a search in PubMed, LILACS, Scielo, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 1) on 27/01/2021. We will include randomized clinical trials fully reported with patients aged ≤ 18 years, making comparisons between different types of laryngoscopes (any of both VLs and DLs) for failed first intubation attempt, intubation time, number of attempts at intubation or number of unsuccessful intubations, failed intubation, glottic view score, or adverse responses to endotracheal intubation. Pooled effects will be estimated by both fixed and random-effects models and presented according to qualitative and quantitative heterogeneity assessment. Sensitivity analyses will be performed as well as a priori subgroup, meta-regression and multiple meta-regression analyses. Additionally, network meta-analyses will be applied to rank the different VLs and DLs. We will also assess the risk of selective publication by funnel plot asymmetry.DiscussionThis systematic review and network meta-analysis aim to understand which laryngoscopes perform better than others for orotracheal intubation.Systematic review registrationThe current protocol was submitted to PROSPERO on 25/01/2021.

scholarly journals Ranking videolaryngoscopes by orotracheal intubation performance: protocol of a systematic review and network meta-analysis of clinical trials at patient level

2021 ◽  
Author(s):  
Clístenes Crístian de Carvalho ◽  
Danielle Melo da Silva ◽  
Victor Macedo Lemos ◽  
Thiago Gadelha Batista dos Santos ◽  
Ikaro Cavalcante Agra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
A Priori ◽  
Macintosh Laryngoscope ◽  
Orotracheal Intubation ◽  
Sensitivity Analyses ◽  
Cochrane Central Register ◽  
Meta Regression

ABSTRACTBackgroundVideolaryngoscopes (VLs) are regarded to improve glottic visualization as compared to Macintosh laryngoscope (ML). However, we currently do not know which one would be the best choice. We then designed this systematic review and network meta-analysis to rank the different VLs as compared to ML.MethodsWe will conduct a search in PubMed, LILACS, Scielo, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 6) on 11/01/2021. We will include randomized clinical trials fully reported with patients aged ≥ 16 years, comparing VLs with ML for failed intubation with the device, failed first intubation attempts, number of intubation attempts, time for intubation, difficulty of intubation, and improved visualization of the larynx. Pooled effects will be estimated by both fixed and random-effects models and presented according to qualitative and quantitative heterogeneity assessment. Sensitivity analyses will be performed as well as a priori subgroup, meta-regression and multiple meta-regression analyses. Additionally, network meta-analyses will be applied to rank the different VLs as compared to ML. We will also assess the risk of selective publication by funnel plot asymmetry.DiscussionThis systematic review and network meta-analysis aim at helping health services and clinicians involved in airway manipulation choose the best VLs for orotracheal intubation.Systematic review registrationThe current protocol was submitted to PROSPERO on 07/01/2021.

scholarly journals EFFECTIVENESS OF ACAMPROSATE FOR TINNITUS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL TRIALS

2021 ◽  
Author(s):  
Osmar Clayton Person ◽  
Fernando Veiga Angelico Junior ◽  
Rodrigo Lima de Godoy Santos ◽  
William Marasini de Rezende ◽  
Maria Fernanda Giusti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Medical Science ◽  
Placebo Response ◽  
Cochrane Central Register ◽  
Significant Difference ◽  
Tinnitus Treatment

Introduction: The effectiveness of tinnitus treatment represents a huge gap in the medical science. Acamprosate is a glutamatergic antagonist drug and GABA-agonist that could be used to control tinnitus due to its action on peripheral and central neurotransmission. Purpose: To assess the effectiveness of acamprosate in the treatment of tinnitus. Material and Methods: This is a systematic review and we searched for randomized clinical trials linking acamprosate to tinnitus in six databases: Cochrane - Central Register of Controlled Trials - CENTRAL (2021), PUBMED (1966-2021), EMBASE (1974-2021), IBECS (1982-2021), QINSIGHT (2021) and SCOPUS (2021). Two researchers independently extracted the data and assessed the quality of the studies. Results: Two trials involving 121 patients were included. The methodological quality of these studies was low. Both studies evaluated as primary outcome the efficacy of acamprosate in improving tinnitus. The meta-analysis by random model resulted in no significant difference between the groups treated with acamprosate and placebo (RR = 3,69, 95% CI 0,87-15,62; p=0,08), considering tinnitus improvement. Conclusions: There is no evidence that acamprosate is effective for tinnitus treatment. We recommend new trials using rigorous methodology. Randomization and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies.

Effects of diacerein intake on cardiometabolic profiles in type 2 diabetics: a systematic review and meta-analysis of clinical trials.

2020 ◽  
Vol 27 ◽  
Author(s):  
Peyman Nowrouzi-Sohrabi ◽  
Reza Tabrizi ◽  
Mohammad Jalali ◽  
Navid Jamali ◽  
Shahla Rezaei ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Body Weight ◽  
Total Cholesterol ◽  
Ldl Cholesterol ◽  
Meta Analysis ◽  
Hdl Cholesterol ◽  
Cochrane Central Register ◽  
Statistical Heterogeneity

Introduction: A systematic review and meta-analysis of clinical trials was undertaken to evaluate the effect of diacerein intake on cardiometabolic profiles in patients with type 2 diabetes mellitus (T2DM). Methods: Electronic databases such as PubMed, EMBASE, Scopus, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials were searched from inception to 31 July 2019. Statistical heterogeneity was evaluated using Cochran’s Q test and I-square (I2 ) statistic. Data were pooled using random-effect models and weighted mean difference (WMD). Results: From 1,733 citations, seven clinical trials were eligible for inclusion and meta-analysis. A significant reduction in hemoglobin A1c (HbA1c) (WMD -0.73; 95%CI -1.25 to -0.21; P= 0.006; I2 = 72.2%) and body mass index (BMI) (WMD -0.55; 95%CI -1.03 to -0.07; P= 0.026; I2 = 9.5%) were identified. However, no significant effect of diacerein intake was identified on fasting blood sugar (FBS) (WMD - 9.00; 95%CI -22.57 to 4.57; P= 0.194; I2 = 60.5%), homeostatic model assessment for insulin resistance (HOMA-IR) (WMD 0.39; 95%CI 0.95 to 1.73; P= 0.569; I2 = 2.2%), body weight (WMD -0.54; 95%CI -1.10 to 0.02; P= 0.059), triglycerides (WMD -0.56; 95%CI -24.16 to 23.03; P= 0.963; I2 = 0.0%), total-cholesterol (WMD -0.21; 95%CI -12.19 to 11.78; P= 0.973; I2 = 0.0%), HDL-cholesterol (WMD -0.96; 95%CI -2.85 to 0.93; P= 0.321; I2 = 0.0%), and LDL-cholesterol levels (WMD -0.09; 95%CI -8.43 to 8.25; P= 0.983; I2 = 37.8%). Conclusion: Diacerein intake may reduce HbA1c and BMI; however, no evidence of effect was observed for FBS, HOMA-IR, body weight, triglycerides, total-cholesterol, HDL-cholesterol or LDL-cholesterol.

scholarly journals Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 23-34
Author(s):  
Katherine P Hooper ◽  
Matthew H Anstey ◽  
Edward Litton
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Diagnostic Testing ◽  
Intervention Group ◽  
Cochrane Central Register ◽  
Safety And Efficacy ◽  
Significant Difference

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

scholarly journals Prevalence of At-Risk Marriages among Couples attending Premarital Screening (PMS) Programs: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
BibiAsma Syed ◽  
Mashael Alshafai ◽  
Karam Turk-Adawi
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Sensitivity Analysis ◽  
Publication Bias ◽  
Meta Analysis ◽  
Genetic Diseases ◽  
World Health ◽  
Middle East Countries ◽  
Mesh Terms ◽  
Premarital Screening

Background: Hemoglobinopathies are among the most common inherited genetic diseases. The World Health Organization estimates that at least 5% of the world’s population are carriers for hemoglobinopathies (2.9% for thalassemia and 2.3% for sickle cell disease). Programs like premarital screening (PMS) have been developed in most Middle East countries on a mandatory basis to reduce atrisk marriages by providing counseling after a confirmed “genetic carrier” state for hemoglobinopathies. Aim/Objective: The aim of this systematic review and meta-analysis was to estimate the prevalence of atrisk marriages globally and see the variation by region, income level, ethnicity, study period, implementation year of PMS program, study design and consanguinity proportion. Methods: Different databases such as PubMed, Science Direct, and Scopus were searched systematically by using key terms and MeSH Terms. Studies from Google Scholar and reference lists of studies were also collected, and the author extracted all relevant data. Two reviewers independently conducted quality assessment by using Hoy et al (2012) risk of bias tool. Quality effects model (QEM) was used due to considerable heterogeneity observed between studies. Subgroup analysis and sensitivity analysis were also performed for assessing the causes of heterogeneity. Results: A total of 15 studies were included in this meta-analysis. The overall pooled prevalence of at-risk marriages among total couples at-risk was 64% (95% CI: 49%- 78%). Estimates of several subgroups were found to be different as compared to the overall pooled estimate. Funnel plot and Doi plot indicated the presence of publication bias. Sensitivity analysis including only studies with low risk led to a pooled estimate of 52% (CI: 46%, 57%) and indicated absence of publication bias. Conclusion and recommendations: The pooled estimates varied widely and there was a substantial heterogeneity among studies, therefore, there is a need for more well-designed studies across different countries. Moreover, the importance of the quality of counseling sessions should be stressed and combined with efforts in other community sectors, such as high schools where students can attain high knowledge regarding genetic diseases before the age of marriage.

scholarly journals The efficacy and safety of interferons for the treatment of patients with COVID-19: protocol for systematic review and meta-analysis of controlled trials

2021 ◽  
Author(s):  
Afsaneh Noormandi ◽  
Mohammad Fathalipour ◽  
Reza Daryabeygi-Khotbehsara ◽  
Soheil Hassanipour
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Global Pandemic ◽  
The World ◽  
Health Organization ◽  
Time Of Administration

Background and objective: COVID-19 has since been declared a global pandemic by the World Health Organization (WHO), infecting millions worldwide. The use of Interferon (INF) subtypes previously examined in the treatment of SARS and MERS is also being initiated in some clinical trials. Although different clinical trials were evaluated IFNs in the treatment of COVID-19, their efficacy and safety remain unknown. Therefore, this study aims to systematically assess IFNs efficacy and safety in treating patients with COVID-19. Methods: The protocol has been registered in the PROSPERO International Prospective Register (CRD42020200643) on 24 July 2020. This protocol has been arranged according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 checklist. Discussion: Due to lack of approved medication for the covid-19 treatment and also various mutations of this virus, evaluated the efficacy and safety of medications by various studies could help for finding treatments with high effectiveness. IFNs are one of the medications that have been administered in covid-19 infection.  Moreover, the best time of administration and dose of this medication was unknown. Although meta-analysis is a potent source for assessing the accuracy of subjects, heterogeneity of articles is a potent limitation of our work.

Effects of the endocrine disruptor vinclozolin in male reproduction: a systematic review and meta-analysis†

2021 ◽  
Author(s):  
Mariana Feijó ◽  
Roberta V L Martins ◽  
Sílvia Socorro ◽  
Luísa Pereira ◽  
Sara Correia
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Endocrine Disrupting Chemicals ◽  
Reproductive Organs ◽  
Male Reproduction ◽  
Mean Differences ◽  
Trim And Fill ◽  
Meta Analyses ◽  
Q Statistic

Abstract Endocrine-disrupting chemicals have become an issue of scientific and public discussion. Vinclozolin (VNZ) is a fungicide that competitively antagonizes the binding of natural androgens to their receptor, disturbing the function of tissues that are sensitive to these hormones, as is the case of the male reproductive organs. A systematic review with meta-analyses of rodent studies was conducted to answer the following question: Does exposure to VNZ affect sperm parameters and testicular/epididymal weight? The methodology was prespecified according to the Cochrane Handbook for Systematic Reviews and PRISMA recommendations. Sixteen articles met the inclusion criteria, comprising a total of 1189 animals. The risk of publication bias was assessed using the Trim and Fill adjustment, funnel plot, and Egger regression test. Heterogeneity and inconsistency across the findings were tested using the Q-statistic and I2 of Higgins, respectively. Sensitivity was also analyzed. Statistical analysis was performed on Comprehensive Meta-Analysis software (Version 2.0), using random models and weighted mean differences along with a 95% confidence interval. Sperm motility, counts, daily sperm production (evidence of publication bias), and epididymis weight were decreased in VNZ-treated animals. Exposure length and dose, as well as the time point of exposure, influenced the obtained results. Despite the moderate/high heterogeneity observed, the sensitivity analysis overall demonstrated the robustness of the findings. The quality scores of the included studies were superior to 4 in a total of 9, then classified as good. The obtained data corroborate the capability of VNZ exposure to disrupt spermatogenic output and compromise male fertility.

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