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The International Journal of... Jun 2024Central nervous system involvement by Brucella species is the most morbid form of brucellosis disease. Studies on neurobrucellosis are scarce and limited to case reports... (Meta-Analysis)
Meta-Analysis
PURPOSE
Central nervous system involvement by Brucella species is the most morbid form of brucellosis disease. Studies on neurobrucellosis are scarce and limited to case reports and series. Brucella is unable to infect or harm neurons without the assistance of monocytes. This raises the question of whether ceftriaxone-based regimens are effective.
METHODS
The primary aim of this study was to identify, evaluate, and summarize the findings of all relevant individual studies in the past 30 years to help better understand the disease. To achieve this, a broad systematic search was undertaken to identify all relevant records. Epidemiological and clinical features of the disease were assessed by the pooled analysis of descriptive studies. Through a meta-analysis, the treatment period duration was compared between the ceftriaxone-based and oral regimens using Standardized mean differences to measure effect size.
RESULTS
448 patients were included in the Meta-analyses from 5 studies. A moderate positive effect was found for ceftriaxone-based regimens over oral treatments, and there was a significant difference between these two groups (SMD 0.428, 95% CI -0.63 to -0.22, I 2 = 37.64). Neurobrucellosis has a different clinical picture in pediatric patients. The disease is less chronic in children. Fever, nausea and vomiting, fatigue, and abdominal pain were significantly more prevalent symptoms in children, and Convulsions, ascites, sensorineural hearing loss, and papilledema were significantly more prevalent signs in children than adults.
CONCLUSION
It is recommended to initiate the treatment of neurobrucellosis with IV ceftriaxone therapy in combination with oral therapy.
Topics: Adult; Humans; Child; Ceftriaxone; Administration, Oral; Brucella; Brucellosis; Fatigue
PubMed: 35930502
DOI: 10.1080/00207454.2022.2100776 -
International Journal of Gynecological... Jul 2016This study aimed to evaluate the efficacy and safety of oral progestin treatment for early-stage endometrial cancer. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to evaluate the efficacy and safety of oral progestin treatment for early-stage endometrial cancer.
METHODS
We conducted a systematic review and meta-analysis of the proportions from observational studies. Original studies were selected if patients with early-stage endometrial cancer, especially those of reproductive age, were treated with oral progestin. We conducted searches on studies listed in MEDLINE, EMBASE, and Cochrane that were published through June 2014, and relevant articles were also searched. The methodological quality of the included studies was assessed using the Newcastle-Ottawa quality assessment scale. Funnel plots and metaregression analyses were used to assess bias.
RESULTS
The final sample included 25 articles involving 445 patients. Based on a random-effects model, patients achieved a disease regression rate of 82.4% (95% confidence interval [CI], 75.3%-88.7%), a relapse rate of 25.0% (95% CI, 15.8%-35.2%), a pregnancy rate of 28.8% (95% CI, 22.5%-35.5%), and a live birth rate of 19.6% (95% CI, 12.8%-27.4%). Body weight gain, liver dysfunction, and abnormal blood coagulation test results were the most common treatment-related adverse effects. Only 2 disease-related deaths were reported during the follow-up duration.
CONCLUSIONS
Based on the present systematic review and meta-analysis, oral progestin treatment is feasible and safe for patients of reproductive age.
Topics: Administration, Oral; Endometrial Neoplasms; Female; Humans; Neoplasm Staging; Observational Studies as Topic; Progestins
PubMed: 27177279
DOI: 10.1097/IGC.0000000000000723 -
Thrombosis Research Feb 2018Approximately 4-6% of patients treated with oral anticoagulants (OAC) will suffer from major hemorrhage or be in need of urgent surgery necessitating anticoagulant... (Review)
Review
INTRODUCTION
Approximately 4-6% of patients treated with oral anticoagulants (OAC) will suffer from major hemorrhage or be in need of urgent surgery necessitating anticoagulant reversal therapy. Several new oral anticoagulants and reversal agents have been introduced that make it difficult for physicians to stay updated on the current evidence of reversal management. This study aims to review the recent literature on oral anticoagulation reversal therapy and to present the current evidence in an easily approachable manner.
MATERIALS AND METHODS
A systematic literature search was conducted using PubMed and EMBASE to identify the latest publications on both vitamin K antagonist (VKA) and direct oral anticoagulant (DOAC) reversal strategies. All studies on humans who received any acute reversal management of VKA treatment were included, except case studies. Since only two studies on acute reversal of DOAC treatment have been published, clinical trials on healthy volunteers were also included.
RESULTS
Twenty-one studies with a total of 4783 VKA treated patients, and 12 studies with a total of 529 DOAC treated patients were included. Elevated INR values due to VKA treatment could be reversed (INR≤1.5) in 63.1% (95% CI: 61.0-65.2) of study subjects after treatment with 4F-PCC, as compared with 12.2% (95% CI: 8.2-16.2) after treatment with fresh frozen plasma (FFP), (p<0.001). Thromboembolism occurred in 1.6% (95% CI: 1.2-2.1) of VKA-patients treated with 4F-PCC, and in 4.5% (95% CI: 2.3-6.7) of FFP-treated patients. To date, reversal of laboratory parameters has been demonstrated for two reversal agents specific to DOACs: idarucizumab for dabigatran reversal and andexanet-alfa for factor Xa-inhibitor reversal.
CONCLUSIONS
This review supports the use of PCC for VKA reversal, specifically for 4F-PCC over FFP for laboratory reversal. There are no studies on clinical efficacy of non-specific agents for DOAC reversal and the evidence for laboratory reversal is not consistent.
Topics: Administration, Oral; Anticoagulants; Female; Humans; Male; Vitamin K
PubMed: 29258056
DOI: 10.1016/j.thromres.2017.12.003 -
Preventive Veterinary Medicine Jan 2015Antimicrobials play an important role in animal and human health care. It was the aim of this systematic review to assess the effects of oral administration of... (Review)
Review
Antimicrobials play an important role in animal and human health care. It was the aim of this systematic review to assess the effects of oral administration of antimicrobials on the development of antimicrobial resistance (AMR) in Escherichia coli (E. coli) from chickens. Moreover, the effects of the administration of more than one antimicrobial and of different dosages were studied. Literature was searched in November 2012 from the electronic databases ISI Web of Science, PubMed, Scopus and a national literature database (DIMDI) as well as the database ProQuest LLC. The search was updated in March 2014. Original studies describing a treatment (A) and a control group of either non-treatment (C) or initial value (0) and determining AMR in E. coli at different sample points (SP) were included. The literature search resulted in 35 full text articles on the topic, seven (20%) of which contained sufficient information on the administered antimicrobial and the impact of treatment on AMR. Most papers described the use of more than one antimicrobial, several dosages, controls (non-treatment or pre-treatment) and measured AMR at different SPs leading to a total of 227 SPs on the impact of the use of antimicrobials on AMR in chickens. 74% of the SPs (168/227) described a higher AMR-rate in E. coli from treated animals than from controls. After the administration of a single antimicrobial, AMR increased at 72% of the SPs. Administration of more than one antimicrobial increased AMR at 82% of the SPs. Higher dosages were associated with similar or higher AMR rates. The limited number of studies for each antimicrobial agent and the high variability in the resistance effect call for more well designed studies on the impact of oral administration on AMR development and spread.
Topics: Administration, Oral; Animals; Anti-Infective Agents; Chickens; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections
PubMed: 25433717
DOI: 10.1016/j.prevetmed.2014.11.010 -
Drug Research Apr 2016Melatonin is traditionally administered orally but has a poor and variable bioavailability. This study aims to present an overview of studies investigating the... (Review)
Review
BACKGROUND
Melatonin is traditionally administered orally but has a poor and variable bioavailability. This study aims to present an overview of studies investigating the pharmacokinetics of alternative administration routes of melatonin.
METHODS
A systematic literature search was performed and included experimental or clinical studies, investigating pharmacokinetics of alternative administration routes of melatonin in vivo. Alternative administration routes were defined as all administration routes except oral and intravenous.
RESULTS
10 studies were included in the review. Intranasal administration exhibited a quick absorption rate and high bioavailability. Transdermal administration displayed a variable absorption rate and possible deposition of melatonin in the skin. Oral transmucosal administration of melatonin exhibited a high plasma concentration compared to oral administration. Subcutaneous injection of melatonin displayed a rapid absorption rate compared to oral administration.
CONCLUSION
Intranasal administration of melatonin has a large potential, and more research in humans is warranted. Transdermal application of melatonin has a possible use in a local application, due to slow absorption and deposition in the skin. Oral transmucosal administration may potentially be a clinically relevant due to avoiding first-pass metabolism. Subcutaneous injection of melatonin did not document any advantages compared to other administration routes.
Topics: Administration, Cutaneous; Administration, Intranasal; Administration, Mucosal; Administration, Oral; Animals; Biological Availability; Humans; Injections, Subcutaneous; Melatonin
PubMed: 26514093
DOI: 10.1055/s-0035-1565083 -
The Cochrane Database of Systematic... Jul 2015Between 6% and 15% of neonates develop hyperbilirubinaemia requiring treatment. Successful management of neonatal hyperbilirubinaemia relies on prevention and early... (Review)
Review
BACKGROUND
Between 6% and 15% of neonates develop hyperbilirubinaemia requiring treatment. Successful management of neonatal hyperbilirubinaemia relies on prevention and early treatment, with phototherapy being the mainstay of treatment. Oral zinc has been reported to decrease the serum total bilirubin (STB), presumably by decreasing the enterohepatic circulation.
OBJECTIVES
To determine the effect of oral zinc supplementation compared to placebo or no treatment on the incidence of hyperbilirubinaemia in neonates during the first week of life and to assess the safety of oral zinc in enrolled neonates.
SEARCH METHODS
We searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE (1966 to November 30, 2014), and EMBASE (1990 to November 30, 2014).
SELECTION CRITERIA
Randomised controlled trials were eligible for inclusion if they enrolled neonates (term and preterm) to whom oral zinc, in a dose of 10 to 20 mg/day, was initiated within the first 96 hours of life, for any duration until day seven, compared with no treatment or placebo.
DATA COLLECTION AND ANALYSIS
We used the standard methods of The Cochrane Collaboration and its Neonatal Review Group for data collection and analysis.
MAIN RESULTS
Only one study met the criteria of inclusion in the review. This study compared oral zinc with placebo. Oral zinc was administered in a dose of 5 mL twice daily from day 2 to day 7 postpartum. The drug was administered into the mouth of the infant by the plastic measure provided with the bottle or with a spoon. Incidence of hyperbilirubinaemia, defined as serum total bilirubin (STB) ≥ 15 mg/dL, was similar between groups (N = 286; risk ratio (RR) 0.94, 95% confidence interval (CI) 0.58 to 1.52). Mean STB levels, mg/dL, at 72 ± 12 hours were comparable in both the groups (N = 286; mean difference (MD) -0.20; 95% CI -1.03 to 0.63). Although the duration of phototherapy in the zinc group was significantly shorter compared to the placebo group (N = 286; MD -12.80, 95% CI -16.93 to -8.67), the incidence of need for phototherapy was comparable across both the groups (N = 286; RR 1.20; 95% CI 0.66 to 2.18). Incidences of side effects like vomiting (N = 286; RR 0.65, 95% CI 0.19 to 2.25), diarrhoea (N = 286; RR 2.92, 95% CI 0.31 to 27.71), and rash (N = 286; RR 2.92, 95% CI 0.12 to 71.03) were found to be rare and statistically comparable between groups.
AUTHORS' CONCLUSIONS
The limited evidence available has not shown that oral zinc supplementation given to infants up to one week old reduces the incidence of hyperbilirubinaemia or need for phototherapy.
Topics: Administration, Oral; Humans; Hyperbilirubinemia, Neonatal; Incidence; Infant, Newborn; Phototherapy; Randomized Controlled Trials as Topic; Zinc
PubMed: 26171899
DOI: 10.1002/14651858.CD008432.pub2 -
The Cochrane Database of Systematic... Apr 2016Review withdrawn from Issue 4, 2016. Replaced by new reviews 'Short‐course oral steroids alone for chronic rhinosinusitis' (Head 2016a) and 'Short‐course oral... (Meta-Analysis)
Meta-Analysis Review
Review withdrawn from Issue 4, 2016. Replaced by new reviews 'Short‐course oral steroids alone for chronic rhinosinusitis' (Head 2016a) and 'Short‐course oral steroids as an adjunct therapy for chronic rhinosinusitis' (Head 2016b). The editorial group responsible for this previously published document have withdrawn it from publication.
Topics: Administration, Oral; Humans; Nasal Obstruction; Nasal Polyps; Olfaction Disorders; Prednisone; Randomized Controlled Trials as Topic; Steroids
PubMed: 27111708
DOI: 10.1002/14651858.CD005232.pub4 -
The Cochrane Database of Systematic... Sep 2014Leg ulcers affect up to one percent of people at some time in their life. Leg ulceration is chronic in nature and ulcers may be present for months or even years without... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Leg ulcers affect up to one percent of people at some time in their life. Leg ulceration is chronic in nature and ulcers may be present for months or even years without healing. After healing there is a high risk of recurrence. Treatments include wound dressings alongside the treatment of underlying medical problems such as poor blood supply, infection and poor nutrition.
OBJECTIVES
To assess the effectiveness of oral zinc in healing arterial or venous leg ulcers.
SEARCH METHODS
For this seventh update we searched The Cochrane Wounds Group Specialised Register (searched 02 September 2014) and The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8). In the original version of the review a company manufacturing zinc sulphate tablets was asked for references to relevant trials.
SELECTION CRITERIA
Randomised controlled trials comparing oral zinc sulphate with placebo or no treatment in people with arterial or venous leg ulcers were eligible for inclusion. There were no restrictions on date or language of publication. The main outcome measure used was complete healing of the ulcers. Trials were eligible for inclusion if they measured ulcer healing objectively by documenting time to complete healing, proportion of ulcers healed during the study, or healing rates of ulcers.
DATA COLLECTION AND ANALYSIS
All data extraction and assessment of trial quality was done by both authors independently.
MAIN RESULTS
Six small trials (183 participants) were eligible for inclusion. Four trials considered people with venous ulcers, one trial involved people with arterial ulcers and one people with mixed aetiology ulcers. Serum zinc was measured in four trials and four trials compared oral zinc sulphate with placebo in people with venous ulcers; pooling these trials indicated no statistically significant difference between the two groups for healing (RR 1.22, 95%CI 0.88 to 1.68). Overall, there is no evidence that oral zinc increases the healing of arterial or venous leg ulcers.
AUTHORS' CONCLUSIONS
Oral zinc sulphate does not appear to aid the healing of arterial and venous leg ulcers, however all included studies were small and at unclear risk of bias (due to poor reporting).
Topics: Administration, Oral; Astringents; Humans; Leg Ulcer; Randomized Controlled Trials as Topic; Wound Healing; Zinc; Zinc Sulfate
PubMed: 25202988
DOI: 10.1002/14651858.CD001273.pub3 -
Journal of Obstetrics and Gynaecology... Dec 2020To assess the efficacy of oral misoprostol for induction of labour (IOL) in the context of term pre-labour rupture of membranes (TPROM), and to assess pregnancy outcomes... (Review)
Review
OBJECTIVE
To assess the efficacy of oral misoprostol for induction of labour (IOL) in the context of term pre-labour rupture of membranes (TPROM), and to assess pregnancy outcomes following the administration of oral misoprostol.
DATA SOURCES
A systematic literature search was performed using Ovid Medline, Embase, PubMed, and the Cochrane Database of Systematic Reviews.
STUDY SELECTION
Eligible studies were quasi-experimental trials or randomized controlled trials involving the use of oral misoprostol in singleton cephalic term pregnancies with confirmed rupture of membranes and no spontaneous labour at the time of membranes rupture, in mothers with no contraindications to vaginal delivery. Studies were excluded if they utilized vaginal misoprostol, excluded primigravid participants, or if the full text of the article was not accessible in English.
DATA EXTRACTION
Data were extracted by two reviewers using a standardized data extraction form. Study quality was assessed using the modified Jadad score.
DATA SYNTHESIS
Twelve randomized controlled trials that included 1489 singleton pregnancies were included. Doses of oral misoprostol ranged from 20 to 200 μg. The incidence of vaginal birth ranged from 73.0%-95.0% in the oral misoprostol group compared with 52.4%-94% in the control group. Hyperstimulation was infrequent, ranging from 0% to 13.8% in the oral misoprostol group compared with 0%-24% in the control group. Two trials, involving a total of 144 women that compared 50 μg of oral misoprostol every 4 hours versus expectant management followed by PGE gel showed a higher incidence of vaginal birth with misoprostol (pooled risk ratio 1.33, 95% confidence interval 1.10-1.61).
CONCLUSION
Oral misoprostol appears to be a safe and effective for IOL in TPROM. However, the varying administration, dose, and frequency reported in the literature highlights the need to develop a standardized protocol for use in Canadian obstetrical practice.
Topics: Administration, Intravaginal; Administration, Oral; Canada; Cervical Ripening; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy Trimester, Third
PubMed: 32362580
DOI: 10.1016/j.jogc.2020.02.111 -
The Journal of Antimicrobial... Nov 2019Worldwide many neonates suffer from bacterial infections. Adequate treatment is important but is associated with prolonged hospitalization for intravenous... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Worldwide many neonates suffer from bacterial infections. Adequate treatment is important but is associated with prolonged hospitalization for intravenous administration. In older children, oral switch therapy has been proven effective and safe for several indications and is now standard care.
OBJECTIVES
To evaluate the currently available evidence on pharmacokinetics, safety and efficacy of oral antibiotics and oral switch therapy in neonates (0-28 days old).
METHODS
We performed systematic searches in Medline, Embase.com, Cochrane, Google Scholar and Web of Science. Studies were eligible if they described the use of oral antibiotics in neonates (0-28 days old), including antibiotic switch studies and pharmacological studies.
RESULTS
Thirty-one studies met the inclusion criteria. Compared with parenteral administration, oral antibiotics generally reach their maximum concentration later and have a lower bioavailability, but in the majority of cases adequate serum levels for bacterial killing are reached. Furthermore, studies on efficacy of oral antibiotics showed equal relapse rates (OR 0.95; 95% CI 0.79-1.16; I2 0%) or mortality (OR 1.11; 95% CI 0.72-1.72; I2 0%). Moreover, a reduction in hospital stay was observed.
CONCLUSIONS
Oral antibiotics administered to neonates are absorbed and result in adequate serum levels, judged by MICs of relevant pathogens, over time. Efficacy studies are promising but robust evidence is lacking, most importantly because in many cases clinical efficacy and safety are not properly addressed. Early oral antibiotic switch therapy in neonates could be beneficial for both families and healthcare systems. There is a need for additional well-designed trials in different settings.
Topics: Administration, Oral; Anti-Bacterial Agents; Bacterial Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Randomized Controlled Trials as Topic; Retrospective Studies; Sepsis
PubMed: 31236572
DOI: 10.1093/jac/dkz252