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BMC Public Health Mar 2015Prevalence of multidrug resistant tuberculosis (MDR-TB), defined as in vitro resistance to both rifampicin and isoniazid with or without resistance to other TB drugs, in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prevalence of multidrug resistant tuberculosis (MDR-TB), defined as in vitro resistance to both rifampicin and isoniazid with or without resistance to other TB drugs, in sub-Saharan Africa (SSA) is reportedly low compared to other regions. These estimates are based on data reported to the World Health Organization (WHO) on drug resistance surveys, which may suffer from a reporting bias. We set out to evaluate the variation in prevalence of drug resistant tuberculosis (DR-TB) and its determinants across SSA countries among new and previously treated TB patients.
METHODS
The aim was to perform a systematic review and meta-analysis of DR-TB prevalence and associated risk factors in SSA. PubMed, EMBASE, Cochrane and bibliographies of DR-TB studies were searched. Surveys at national or sub-national level, with reported DR-TB prevalence (or sufficient data to calculate a prevalence) to isoniazid (INH), rifampicin (RMP), ethambutol (EMB), and streptomycin (SM) conducted in SSA excluding the Republic of South Africa, published between 2003 and 2013 with no language restriction were considered. Two authors searched and reviewed the studies for eligibility and extracted the data in pre-defined forms. Forest plots of all prevalence estimates by resistance outcome were performed. Summary estimates were calculated using random effects models, when appropriate. Associations between any DR-TB and MDR-TB with potential risk factors were examined through subgroup analyses stratified by new and previously treated patients.
RESULTS
A total of 726 studies were identified, of which 27 articles fulfilled the inclusion criteria. Studies reported drug susceptibility testing (DST) results for a total of 13,465 new and 1,776 previously treated TB patients. Pooled estimate of any DR-TB prevalence among the new cases was 12.6% (95% CI 10.6-15.0) while for MDR-TB this was 1.5% (95% CI 1.0-2.3). Among previously treated patients, these were 27.2% (95% CI 21.4-33.8) and 10.3% (95% CI 5.8-17.4%), respectively. DR-TB (any and MDR-TB) did not vary significantly with respect to study characteristics.
CONCLUSIONS
The reported prevalence of DR-TB in SSA is low compared to WHO estimates. MDR-TB in this region does not seem to be driven by the high HIV prevalence rates.
Topics: Africa South of the Sahara; Antitubercular Agents; Bacteriological Techniques; Ethambutol; Humans; Isoniazid; Prevalence; Rifampin; Risk Factors; Streptomycin; Tuberculosis, Multidrug-Resistant; World Health Organization
PubMed: 25880829
DOI: 10.1186/s12889-015-1614-8 -
European Journal of Pediatrics Jan 2023The diuretic effect of the combined furosemide and aminophylline/theophylline among pediatric patients remains unclear. The primary aim of this systematic review was to... (Review)
Review
UNLABELLED
The diuretic effect of the combined furosemide and aminophylline/theophylline among pediatric patients remains unclear. The primary aim of this systematic review was to examine the clinical diuretic effects (urine output and fluid balance) of co-administration of furosemide and aminophylline/theophylline as compared to furosemide alone in pediatric population. Ovid MEDLINE, CENTRAL, and EMBASE were searched from its inception until March 2022 for observational studies and randomized controlled trials (RCTs) comparing the administration of furosemide versus furosemide and aminophylline/theophylline in pediatric population. Case reports, case series, commentaries, letters to editors, systematic reviews, and meta-analyses were excluded. Five articles with a total sample population of 187 patients were included in this systematic review. As compared to the furosemide alone, our pooled data demonstrated that co-administration of furosemide and aminophylline/theophylline was associated with higher urine output (mean difference: 2.91 [90% CI 1.54 to 4.27], p < 0.0001, I = 90%) and a more negative fluid balance (mean difference - 28.27 [95% CI: - 46.21 to - 10.33], p = 0.002, I = 56%) than those who received furosemide alone.
CONCLUSION
This is the first paper summarizing the evidence of combined use of furosemide with aminophylline/theophylline in pediatric population. Our systematic review demonstrated that the co-administration of furosemide and aminophylline/theophylline could potentially yield better diuretic effects of urine output and negative fluid balance than furosemide alone in pediatric patients with fluid overload. Given the substantial degree of heterogeneity and low level of evidence, future adequately powered trials are warranted to provide evidence regarding the combined use of aminophylline/theophylline and furosemide as diuretic in the pediatric population.
WHAT IS KNOWN
• Fluid overload is associated with poor prognosis for children in the intensive care unit. • The ineffective result of furosemide alone, even at high dose, as diuretic agent for children with diuretic resistant fluid overload in the intensive care unit.
WHAT IS NEW
• This is the first systematic review that compares furosemide alone and co-administration of furosemide and aminophylline/theophylline. • This paper showed potential benefit of co-administration of furosemide and aminophylline/theophylline promoting urine output and negative fluid balance compared to furosemide alone.
Topics: Child; Humans; Diuretics; Theophylline; Aminophylline; Furosemide
PubMed: 36251063
DOI: 10.1007/s00431-022-04655-w -
The Cochrane Database of Systematic... Oct 2023Methylxanthines, including caffeine, theophylline, and aminophylline, work as stimulants of the respiratory drive, and decrease apnea of prematurity, a developmental... (Review)
Review
BACKGROUND
Methylxanthines, including caffeine, theophylline, and aminophylline, work as stimulants of the respiratory drive, and decrease apnea of prematurity, a developmental disorder common in preterm infants. In particular, caffeine has been reported to improve important clinical outcomes, including bronchopulmonary dysplasia (BPD) and neurodevelopmental disability. However, there is uncertainty regarding the efficacy of caffeine compared to other methylxanthines.
OBJECTIVES
To assess the effects of caffeine compared to aminophylline or theophylline in preterm infants at risk of apnea, with apnea, or in the peri-extubation phase.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, Epistemonikos, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and clinicaltrials.gov in February 2023. We also checked the reference lists of relevant articles to identify additional studies.
SELECTION CRITERIA
Studies: randomized controlled trials (RCTs) and quasi-RCTs Participants: infants born before 34 weeks of gestation for prevention and extubation trials, and infants born before 37 weeks of gestation for treatment trials Intervention and comparison: caffeine versus theophylline or caffeine versus aminophylline. We included all doses and duration of treatment.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We evaluated treatment effects using a fixed-effect model with risk ratio (RR), risk difference (RD), and 95% confidence intervals (CI) for categorical data, and mean, standard deviation, and mean difference for continuous data. We used the GRADE approach to evaluate the certainty of evidence.
MAIN RESULTS
We included 22 trials enrolling 1776 preterm infants. The indication for treatment was prevention of apnea in three studies, treatment of apnea in 13 studies, and extubation management in three studies. In three studies, there were multiple indications for treatment, and in one study, the indication for treatment was unclear. In 19 included studies, the infants had a mean gestational age between 28 and 32 weeks and a mean birth weight between 1000 g and 1500 g. One study's participants had a mean gestational age of more than 32 weeks, and two studies had participants with a mean birth weight of 1500 g or more. Caffeine administrated for any indication may result in little to no difference in all-cause mortality prior to hospital discharge compared to other methylxanthines (RR 1.12, 95% CI 0.68 to 1.84; RD 0.02, 95% CI -0.05 to 0.08; 2 studies, 396 infants; low-certainty evidence). Only one study enrolling 79 infants reported components of the outcome moderate to severe neurodevelopmental disability at 18 to 26 months. The evidence is very uncertain about the effect of caffeine on cognitive developmental delay compared to other methylxanthines (RR 0.17, 95% CI 0.02 to 1.37; RD -0.12, 95% CI -0.24 to 0.01; 1 study, 79 infants; very low-certainty evidence). The evidence is very uncertain about the effect of caffeine on language developmental delay compared to other methylxanthines (RR 0.76, 95% CI 0.37 to 1.58; RD -0.07, 95% CI -0.27 to 0.12; 1 study, 79 infants; very low-certainty evidence). The evidence is very uncertain about the effect of caffeine on motor developmental delay compared to other methylxanthines (RR 0.50, 95% CI 0.13 to 1.96; RD -0.07, 95% CI -0.21 to 0.07; 1 study, 79 infants; very low-certainty evidence). The evidence is very uncertain about the effect of caffeine on visual and hearing impairment compared to other methylxanthines. At 24 months of age, visual impairment was seen in 8 out of 11 infants and 10 out of 11 infants in the caffeine and other methylxanthines groups, respectively. Hearing impairment was seen in 2 out of 5 infants and 1 out of 1 infant in the caffeine and other methylxanthines groups, respectively. No studies reported the outcomes cerebral palsy, gross motor disability, and mental development. Compared to other methylxanthines, caffeine may result in little to no difference in BPD/chronic lung disease, defined as 28 days of oxygen exposure at 36 weeks' postmenstrual age (RR 1.40, 95% CI 0.92 to 2.11; RD 0.04, 95% CI -0.01 to 0.09; 3 studies, 481 infants; low-certainty evidence). The evidence is very uncertain about the effect of caffeine on side effects (tachycardia, agitation, or feed intolerance) leading to a reduction in dose or withholding of methylxanthines compared to other methylxanthines (RR 0.17, 95% CI 0.02 to 1.32; RD -0.29, 95% CI -0.57 to -0.02; 1 study, 30 infants; very low-certainty evidence). Caffeine may result in little to no difference in duration of hospital stay compared to other methylxanthines (median (interquartile range): caffeine 43 days (27.5 to 61.5); other methylxanthines 39 days (28 to 55)). No studies reported the outcome seizures.
AUTHORS' CONCLUSIONS
Although caffeine has been shown to improve important clinical outcomes, in the few studies that compared caffeine to other methylxanthines, there might be little to no difference in mortality, bronchopulmonary dysplasia, and duration of hospital stay. The evidence is very uncertain about the effect of caffeine compared to other methylxanthines on long-term development and side effects. Although caffeine or other methylxanthines are widely used in preterm infants, there is little direct evidence to support the choice of which methylxanthine to use. More research is needed, especially on extremely preterm infants born before 28 weeks of gestation. Data from four ongoing studies might provide more evidence on the effects of caffeine or other methylxanthines.
Topics: Humans; Infant, Newborn; Aminophylline; Apnea; Birth Weight; Bronchopulmonary Dysplasia; Caffeine; Hearing Loss; Infant, Extremely Premature; Theophylline; Randomized Controlled Trials as Topic
PubMed: 37791592
DOI: 10.1002/14651858.CD015462.pub2 -
European Journal of Nuclear Medicine... Feb 2022The performance of Ga-PSMA PET/CT-MR has been evaluated in prostate cancer (PCa), showing significant results. However, even a technically accurate imaging procedure... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The performance of Ga-PSMA PET/CT-MR has been evaluated in prostate cancer (PCa), showing significant results. However, even a technically accurate imaging procedure requires a high interobserver agreement in its interpretation to implement in patients' management. This study aims to perform a systematic review and meta-analysis on the interobserver variability in Ga-PSMA PET/CT-MR imaging in PCa patients.
METHODS
We conducted a systematic review and meta-analysis on the interobserver variability, including studies: (1) providing Kappa (K) as the inter-observer agreement test or the essential data to calculate it, (2) providing the K confidence interval or the essential crude data to calculate it, (3) measuring K statistic based on the appropriate use criteria for the inter-observer agreement.
RESULTS
Twelve studies, providing 1585 Ga-PSMA PET/CT-MR studies reviewed by 62 independent readers, were included. In general, the pooled inter-observer agreement was interpreted as substantial for all analyzed groups, including tumoral lesions in the prostate bed, lymphadenopathies, bone metastasis, and soft-tissue metastasis (all between 0.6 and 0.8). The regional lymphadenopathy group (0.74) obtained the highest agreement, while the lowest was for soft tissue metastasis (0.65).
CONCLUSION
This study showed a substantial interobserver agreement in the overall interpretation and detecting locoregional and distant involvement with Ga-PSMA PET/CT-MR in PCa patients.
Topics: Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms
PubMed: 34767046
DOI: 10.1007/s00259-021-05616-5 -
International Endodontic Journal Jun 2022The effects of ethylenediaminetetraacetic acid (EDTA) on regenerative endodontic procedures (REPs) are controversial, because, despite releasing growth factors from... (Review)
Review
BACKGROUND
The effects of ethylenediaminetetraacetic acid (EDTA) on regenerative endodontic procedures (REPs) are controversial, because, despite releasing growth factors from dentine, some studies show negative effects on cell behaviour.
OBJECTIVES
The aim of the study was to investigate the influence of the use of EDTA in REP on the growth factors' release, cell behaviour and tissue regeneration.
METHODS
A systematic search was conducted (PubMed/Medline, Scopus, Cochrane Library, Web of Science, Embase, OpenGrey and reference lists) up to February 2021. Only in vivo and in vitro studies evaluating the effects of EDTA on the biological factors of dentine, pulp/periapical tissues and cell behaviour were eligible. Studies without a control group or available full text were excluded. The growth factors' release was the primary outcome. Risk of bias in the in vitro and in vivo studies was performed according to Joanna Briggs Institute's Checklist and SYRCLE's RoB tool, respectively.
RESULTS
Of the 1848 articles retrieved, 36 were selected. Amongst these, 32 were in vitro, three animal studies and one with both models. The EDTA concentrations ranged from 3% to 15%, at different times. Regarding growth factors' release (17 studies), 15 studies found significant transforming growth factor (TGF)-β release after dentine conditioning with EDTA, and most found no influence on vascular endothelial growth factor release. Regarding cell behaviour (26 studies), eight studies showed no influence of EDTA-treated dentine on cell viability, whereas, five, nine and six studies showed higher cell migration, adhesion and differentiation respectively. No influence of EDTA conditioning was observed in animal studies. In vitro studies had a low risk of bias, whereas animal studies had high risk of bias. Meta-analysis was unfeasible.
DISCUSSION
This review found that EDTA increased TGF-β release and improved cell activity. However, well-designed histological analyses using immature teeth models are needed.
CONCLUSIONS
High-quality in vitro evidence suggests that EDTA-treated dentine positively influences TGF-β release, cell migration, attachment and differentiation; further research to evaluate its influence on tissue regeneration is necessary due to low methodological quality of the animal studies.
Topics: Dental Pulp; Edetic Acid; Regenerative Endodontics; Transforming Growth Factor beta; Vascular Endothelial Growth Factor A
PubMed: 35305029
DOI: 10.1111/iej.13728 -
Journal of Animal Physiology and Animal... Feb 2018The use of functional amino acids during pregnancy has been linked to improved reproduction in mammals. In this context, arginine is a precursor in the synthesis of... (Review)
Review
The use of functional amino acids during pregnancy has been linked to improved reproduction in mammals. In this context, arginine is a precursor in the synthesis of numerous molecules, such as nitric oxide and polyamines, which play an important role during reproduction. However, contradictory studies are found in the literature, particularly regarding the amount of supplementation and the period of pregnancy in which it is used. The objective of this study was to evaluate the effects of dietary arginine supplementation for pregnant sows on foetal development via a systematic review. The search for papers was performed during the month of December 2015, in the databases ISI Web of Science, Science Direct, Scopus, and SciELO. From a total of 5675 returned studies, only 13 papers were selected after applying selection criteria. Most (47%) of the studies that evaluated the effects of dietary arginine supplementation on foetal development in pigs used 1% arginine. Supplementation was initiated in the first third of pregnancy in 47% of tests, including in both primiparous and multiparous sows. These studies showed positive results for embryo survival and foetal development, evidenced by the increase in placental weight and the number and weight of piglets born alive. Of all evaluated studies, 53% showed benefits on foetal development. It is concluded that supplementing dietary arginine in gestating sows can benefit embryo survival and foetal development. However, to establish a supplementation plan with this amino acid, aspects related to the period of pregnancy, supplementation levels, and source of arginine must be well defined.
Topics: Animal Nutritional Physiological Phenomena; Animals; Arginine; Dietary Supplements; Female; Fetal Development; Pregnancy; Prenatal Nutritional Physiological Phenomena; Swine
PubMed: 28263002
DOI: 10.1111/jpn.12679 -
AJR. American Journal of Roentgenology Jan 2023Accumulating evidence indicates that hepatocellular adenoma (HCA) may have a higher frequency of hepatobiliary phase (HBP) iso- or hyperintensity than previously... (Meta-Analysis)
Meta-Analysis Review
Accumulating evidence indicates that hepatocellular adenoma (HCA) may have a higher frequency of hepatobiliary phase (HBP) iso- or hyperintensity than previously reported. The purpose of this study was to evaluate the proportion of HCA that shows iso- or hyperintensity in the HBP of gadoxetic acid-enhanced MRI, stratified by HCA subtype (-inactivated [H-HCA], inflammatory [I-HCA], β-catenin-activated [B-HCA], and unclassified [U-HCA] HCA), and to assess the diagnostic performance of HBP iso- or hyperintensity for differentiating focal nodular hyperplasia (FNH) from HCA. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched through February 14, 2022, for articles reporting HBP signal intensity on gadoxetic acid-enhanced MRI among pathologically proven HCAs, stratified by subtype. The pooled proportion of HBP iso- or hyperintensity was determined for each subtype and compared using metaregression. Diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from all HCA subtypes combined and from B-HCA and U-HCA combined was assessed using bivariate modeling. Twenty-eight studies (12 original investigations, 16 case reports or case series) were included, yielding 364 patients with 410 HCAs (112 H-HCAs, 203 I-HCAs, 33 B-HCAs, 62 U-HCAs). Pooled proportion of HBP iso- or hyperintensity was 14% (95% CI, 4-26%) among all HCAs, 0% (95% CI, 0-2%) among H-HCAs, 11% (95% CI, 0-29%) among U-HCAs, 14% (95% CI, 2-31%) among I-HCAs, and 59% (95% CI, 26-88%) among B-HCAs; metaregression showed significant difference among subtypes ( < .001). In four studies reporting diagnostic performance information, HBP iso- or hyperintensity had sensitivity of 99% (95% CI, 57-100%) and specificity of 89% (95% CI, 82-94%) for differentiating FNH from all HCA subtypes and sensitivity of 99% (95% CI, 53-100%) and specificity of 65% (95% CI, 44-80%) for differentiating FNH from B-HCA or U-HCA. HCA subtypes other than H-HCA show proportions of HBP iso- or hyperintensity ranging from 11% (U-HCA) to 59% (B-HCA). Low prevalence of B-HCA has contributed to prior reports of high diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from HCA. Radiologists should recognize the low specificity of HBP iso- or hyperintensity on gadoxetic acid-enhanced MRI for differentiating FNH from certain HCA subtypes.
Topics: Humans; Adenoma, Liver Cell; Liver Neoplasms; Contrast Media; Sensitivity and Specificity; Gadolinium DTPA; Magnetic Resonance Imaging; Focal Nodular Hyperplasia; Amines; Retrospective Studies; Diagnosis, Differential
PubMed: 35920706
DOI: 10.2214/AJR.22.27989 -
Nephrology (Carlton, Vic.) Apr 2022Sevelamer, has been shown to have many pleiotropic actions on lipid panel, various inflammatory markers, and blood glucose levels in chronic kidney disease patients. We... (Meta-Analysis)
Meta-Analysis Review
Sevelamer, has been shown to have many pleiotropic actions on lipid panel, various inflammatory markers, and blood glucose levels in chronic kidney disease patients. We conducted a systematic review and meta-analysis to compare these pleiotropic effects of sevelamer to other phosphate binders used in chronic kidney disease patients. The relevant randomized controlled trials published from 1 January 2001 to 31 November 2019 on the following databases: Cochrane Central Register of Controlled Trials published in The Cochrane Library, PubMed, Scopus and Google Scholar were identified. All the included studies were independently assessed for eligibility and risk of bias. The modified data extraction form of Cochrane was used. This review included 44 studies for qualitative analysis and 28 reports for quantitative analysis. A meta-analysis of three studies (n = 180) showed that glycated haemoglobin had significantly decreased in sevelamer-treated patients (MD: 0.5%; p = <.001). Compared with calcium-based phosphate binders, sevelamer showed a significant reduction in low-density lipoprotein (MD: -19.43 mg/dL; p = <.001) and total cholesterol (MD: -19.98 mg/dL; p < .001). A significant increase in high-density lipoprotein (MD: 1.29 mg/dL; p = .05) was also prominent in sevelamer treated patients. However, we were not able to observe a significant change in other biochemical parameters such as TG, CRP, hs-CRP, FGF-23, IL-6 and albumin as, no statistically significant difference was observed.
Topics: Calcium; Chelating Agents; Humans; Phosphates; Renal Dialysis; Renal Insufficiency, Chronic; Sevelamer
PubMed: 34882904
DOI: 10.1111/nep.14011 -
International Urology and Nephrology May 2018To evaluate the efficacy and safety of PA21 versus sevelamer in dialysis patients. (Comparative Study)
Comparative Study Meta-Analysis Review
AIM
To evaluate the efficacy and safety of PA21 versus sevelamer in dialysis patients.
METHODS
We searched Medline, Embase, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing PA21 and sevelamer in dialysis patients.
RESULTS
Four studies were included. Compared with sevelamer group, PA21 needed fewer mean daily number of tablets (WMD, - 7.97 pill; 95% CI, - 11.28 to - 4.65, p < 0.00001), developed fewer all adverse events (RR = 1.05; 95% CI, 1.00 to 1.11, p = 0.05), and developed fewer gastrointestinal adverse events (RR = 1.32; 95% CI, 1.15 to 1.53, p = 0.0001). There was no significant difference in serum phosphorus between two groups (WMD, - 0.07 mmol/L; 95% CI, - 0.15 to 0.02, p = 0.12). As for serum calcium, there was also no significant difference between two groups (WMD, 0.27 mmol/L; 95% CI, - 0.63 to 1.17, p = 0.55).
CONCLUSION
PA21 can effectively control serum phosphorus with lower pill burden and less side effects than sevelamer. PA21 might be another valuable choice for dialysis patients with hyperphosphatemia when patients are unable to tolerate sevelamer.
Topics: Calcium; Chelating Agents; Ferric Compounds; Hypercalcemia; Hyperphosphatemia; Kidney Failure, Chronic; Phosphorus; Randomized Controlled Trials as Topic; Renal Dialysis; Sevelamer
PubMed: 29294216
DOI: 10.1007/s11255-017-1774-9 -
Journal of Nephrology Jun 2016Hyperphosphatemia is common in chronic kidney disease (CKD) and is treated by dietary measures, dialysis techniques and/or phosphate binders. For the present review... (Review)
Review
Hyperphosphatemia is common in chronic kidney disease (CKD) and is treated by dietary measures, dialysis techniques and/or phosphate binders. For the present review PubMed was searched for new publications on phosphate binders appearing between January 2010 and October 2015. This review summarizes the latest information on non-pharmacological measures and their problems in lowering phosphate in CKD patients, effects of phosphate binders on morbidity and mortality, adherence to phosphate binder therapy as well as new information on specific aspects of the various phosphate binders on the market: calcium acetate, calcium carbonate, magnesium-containing phosphate binders, polymeric phosphate binders (sevelamer, bixalomer, colestilan), lanthanum carbonate, ferric citrate, sucroferric oxyhydroxide, aluminum-containing phosphate binders, and new compounds in development. The review also briefly covers the emerging field of drugs targeting intestinal phosphate transporters.
Topics: Drug Combinations; Ferric Compounds; Humans; Hyperphosphatemia; Lanthanum; Phosphates; Polyamines; Renal Insufficiency, Chronic; Sevelamer; Sucrose
PubMed: 26800972
DOI: 10.1007/s40620-016-0266-9