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Anesthesia and Analgesia Nov 2017Several clinical trials on hypertonic fluid administration have been completed, but the results have been inconclusive. The objective of this study is to summarize... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several clinical trials on hypertonic fluid administration have been completed, but the results have been inconclusive. The objective of this study is to summarize current evidence for treating hypovolemic patients with hypertonic solutions by performing a systematic review and meta-analysis.
METHODS
Major electronic databases were searched from inception through June 2014. We included only randomized controlled trials involving hemorrhagic shock patients treated with hypertonic solutions. After screening 570 trials, 12 were eligible for the final analysis. Pooled effect estimates were calculated with a random effect model.
RESULTS
The 12 studies included 6 trials comparing 7.5% hypertonic saline (HS) with 0.9% saline or Ringer's lactate solution and 11 trials comparing 7.5% hypertonic saline with dextran (HSD) with isotonic saline or Ringer's lactate. Overall, there were no statistically significant survival benefits for patients treated with HS (relative risk [RR], 0.96; 95% confidence interval [CI], 0.82-1.12) or HSD (RR, 0.92; 95% CI, 0.80-1.06). Treatment with hypertonic solutions was also not associated with increased complications (RR, 1.03; 95% CI, 0.78-1.36). Subgroup analysis on trauma patients in the prehospital or emergency department settings did not change these conclusions. There was no evidence of significant publication bias. Meta-regression analysis did not find any significant sources of heterogeneity.
CONCLUSIONS
Current evidence does not reveal increased mortality when the administration of isotonic solutions is compared to HS or HSD in trauma patients with hemorrhagic shock. HS or HSD may be a viable alternative resuscitation fluid in the prehospital setting. Further studies are needed to determine the optimum volume and regimen of intravenous fluids for the treatment of trauma patients.
Topics: Clinical Trials as Topic; Dextrans; Evidence-Based Medicine; Fluid Therapy; Hemodynamics; Humans; Infusions, Intravenous; Isotonic Solutions; Odds Ratio; Ringer's Lactate; Risk Factors; Saline Solution, Hypertonic; Shock, Hemorrhagic; Sodium Chloride; Time Factors; Treatment Outcome
PubMed: 28930937
DOI: 10.1213/ANE.0000000000002451 -
International Journal of Dental Hygiene May 2017This systematic review aimed to evaluate the scientific evidence on the efficacy of desensitizing mouthwashes for the treatment of dentin hypersensitivity (DH) and root... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
This systematic review aimed to evaluate the scientific evidence on the efficacy of desensitizing mouthwashes for the treatment of dentin hypersensitivity (DH) and root sensitivity (RS).
MATERIAL AND METHODS
A thorough search in MEDLINE, PubMed and Cochrane Plus Library was conducted up to February 2015. Randomized clinical trials, parallel, double-blinded and placebo-controlled, with a follow-up of at least 6 weeks, reporting changes on response to tactile stimuli, thermal/evaporative stimuli or patients' subjective assessment of the pain experienced during their daily life after the home use of desensitizing mouthwashes were considered for inclusion.
RESULTS
The screening of titles and abstracts resulted in seven publications meeting the eligibility criteria. The desensitizing agents evaluated were potassium nitrate (n = 5), aluminium lactate (n = 1) and sodium fluoride (n = 1). A meta-analysis for each of the hypersensitivity stimuli was performed. Results demonstrated statistically significant reduction in sensitivity scores favouring test group when DH was assessed by means of patients' self-reported pain experience (SMD at 8 weeks = 0.77; 95% CI [0.23; 1.31]; P = 0.005). No significant effects were detected in response to tactile or thermal/evaporative stimuli. Meta-regression analysis demonstrated a tendency towards an increased effect favouring test group for the patients' subjective perception, whereas tactile and thermal/evaporative stimuli showed a slight tendency towards a reduction in the efficacy of the test mouthwash.
CONCLUSIONS
There exists a tendency towards a decrease in DH or RS scores with time in both treatment groups, with significant differences in favour of test group when sensitivity is evaluated in terms of patients' self-reported sensitivity symptoms.
Topics: Aluminum Compounds; Dentin Desensitizing Agents; Dentin Sensitivity; Double-Blind Method; Follow-Up Studies; Lactates; Mouthwashes; Nitrates; Pain Measurement; Potassium Compounds; Randomized Controlled Trials as Topic; Self Report; Sodium Fluoride; Tooth Root
PubMed: 27762076
DOI: 10.1111/idh.12250 -
Journal of the International Society of... Feb 2021The effects of sodium bicarbonate (NaHCO) on anaerobic and aerobic capacity are commonly acknowledged as unclear due to the contrasting evidence thus, the present study... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The effects of sodium bicarbonate (NaHCO) on anaerobic and aerobic capacity are commonly acknowledged as unclear due to the contrasting evidence thus, the present study analyzes the contribution of NaHCO to energy metabolism during exercise.
METHODS
Following a search through five databases, 17 studies were found to meet the inclusion criteria. Meta-analyses of standardized mean differences (SMDs) were performed using a random-effects model to determine the effects of NaHCO supplementation on energy metabolism. Subgroup meta-analyses were conducted for the anaerobic-based exercise (assessed by changes in pH, bicarbonate ion [HCO], base excess [BE] and blood lactate [BLa]) vs. aerobic-based exercise (assessed by changes in oxygen uptake [VO], carbon dioxide production [VCO], partial pressure of oxygen [PO] and partial pressure of carbon dioxide [PCO]).
RESULTS
The meta-analysis indicated that NaHCO ingestion improves pH (SMD = 1.38, 95% CI: 0.97 to 1.79, P < 0.001; I = 69%), HCO (SMD = 1.63, 95% CI: 1.10 to 2.17, P < 0.001; I = 80%), BE (SMD = 1.67, 95% CI: 1.16 to 2.19, P < 0.001, I = 77%), BLa (SMD = 0.72, 95% CI: 0.34 to 1.11, P < 0.001, I = 68%) and PCO (SMD = 0.51, 95% CI: 0.13 to 0.90, P = 0.009, I = 0%) but there were no differences between VO, VCO and PO compared with the placebo condition.
CONCLUSIONS
This meta-analysis has found that the anaerobic metabolism system (AnMS), especially the glycolytic but not the oxidative system during exercise is affected by ingestion of NaHCO. The ideal way is to ingest it is in a gelatin capsule in the acute mode and to use a dose of 0.3 g•kg body mass of NaHCO 90 min before the exercise in which energy is supplied by the glycolytic system.
Topics: Anaerobiosis; Bicarbonates; Carbon Dioxide; Energy Metabolism; Exercise; Humans; Hydrogen-Ion Concentration; Lactic Acid; Oxygen; Sodium Bicarbonate
PubMed: 33546730
DOI: 10.1186/s12970-021-00410-y -
Journal of Breath Research Feb 2017This study aimed to analyze the impact of chewing gum on halitosis parameters. Three databases were searched with the following focused question: 'Can chewing gum... (Meta-Analysis)
Meta-Analysis Review
This study aimed to analyze the impact of chewing gum on halitosis parameters. Three databases were searched with the following focused question: 'Can chewing gum additionally reduce halitosis parameters, such as organoleptic scores and volatile sulfur compounds (VSC), when compared to a control treatment'? Controlled clinical trials presenting at least two halitosis measurements (organoleptic scores and/or VSC) were included. Ten studies were included, and different active ingredients were used. One study was performed using a chewing gum without any active ingredient. Chewing gum containing probiotic bacterium was shown to significantly reduce the organoleptic scores. Chewing gums containing zinc acetate and magnolia bark extract as well as allylisothiocyanate (AITC) with zinc lactate significantly reduced the levels of VSC in comparison to a placebo chewing gum. Furthermore, a sodium bicarbonate-containing chewing gum significantly reduced the VSC levels in comparison to rinsing with water. Furthermore, eucalyptus-extract chewing gum showed significant reductions in both organoleptic scores and VSC when compared with a control chewing gum. Chewing gum containing sucrose was able to reduce the VSC levels, in comparison to xylitol and zinc citrate chewing gum, but only for 5 min. It was concluded that chewing gums containing probiotics Lactobaccilus, zinc acetate and magnolia bark extract, eucalyptus-extract, and AITC with zinc lactate may be suitable for halitosis management. However, the low number of included studies and the high heterogeneity among the selected studies may limit the clinical applications of these findings.
Topics: Breath Tests; Chewing Gum; Halitosis; Humans; Publication Bias
PubMed: 28212110
DOI: 10.1088/1752-7163/aa5cc2 -
General Psychiatry 2019Cognitive-behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived... (Review)
Review
Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder.
BACKGROUND
Cognitive-behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat. In a recently developed computational model formalising these theories of panic attacks, it was observed that the response to a simulated perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder. In this review, we evaluate whether this observation is borne out in the empirical literature that has examined responses to biological challenge (eg, CO inhalation) and their relation to subsequent panic attacks and panic disorder.
METHOD
We searched PubMed, Web of Science and PsycINFO using keywords denoting provocation agents (eg, sodium lactate) and procedures (eg, infusion) combined with keywords relevant to panic disorder (eg, panic). Articles were eligible if they used response to a biological challenge paradigm to prospectively predict panic attacks or panic disorder.
RESULTS
We identified four eligible studies. Pooled effect sizes suggest that there is biological challenge response has a moderate prospective association with subsequent panic attacks, but no prospective relationship with panic disorder.
CONCLUSIONS
These findings provide support for the prediction derived from cognitive-behavioural theories and some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerability to panic attacks pending further research and development.
TRIAL REGISTRATION NUMBER
135908.
PubMed: 31922089
DOI: 10.1136/gpsych-2019-100140 -
International Journal of Oral and... Feb 2018This systematic review aimed to investigate whether intra-articular injections of platelet-rich plasma (PRP) are beneficial for the treatment of degenerative... (Review)
Review
This systematic review aimed to investigate whether intra-articular injections of platelet-rich plasma (PRP) are beneficial for the treatment of degenerative temporomandibular disorders, such as temporomandibular joint osteoarthritis (TMJ-OA) and disc displacement with osteoarthritic lesions, when compared to other treatments, such as injections of hyaluronic acid (HA) or saline. An electronic search of the MEDLINE and Scopus databases was performed using combinations of the terms "temporomandibular" and "platelet rich plasma", to identify studies reported in English and published up until May 2017. A hand-search of relevant journals and the reference lists of selected articles was also performed. The initial screening identified 153 records, of which only six fulfilled the inclusion criteria and were included in this review. Of these studies, three compared PRP with HA, while three compared PRP with Ringer's lactate or saline. Four of the studies found PRP injections to be superior in terms of improvements in mandibular range of motion and pain intensity up to 12 months after treatment, while the remaining two studies found similar results for the different treatments. There is slight evidence for the potential benefits of intra-articular injections of PRP in patients with TMJ-OA. However, a standardized protocol for PRP preparation and application needs to be established.
Topics: Humans; Hyaluronic Acid; Injections, Intra-Articular; Isotonic Solutions; Platelet-Rich Plasma; Range of Motion, Articular; Ringer's Lactate; Sodium Chloride; Temporomandibular Joint Disorders
PubMed: 29066000
DOI: 10.1016/j.ijom.2017.09.014 -
The Cochrane Database of Systematic... Nov 2016Inadvertent perioperative hypothermia (a drop in core temperature to below 36°C) occurs because normal temperature regulation is disrupted during surgery, mainly... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Inadvertent perioperative hypothermia (a drop in core temperature to below 36°C) occurs because normal temperature regulation is disrupted during surgery, mainly because of the effects of anaesthetic drugs and exposure of the skin for prolonged periods. Many different ways of maintaining body temperature have been proposed, one of which involves administration of intravenous nutrients during the perioperative period that may reduce heat loss by increasing metabolism, thereby increasing heat production.
OBJECTIVES
To assess the effectiveness of preoperative or intraoperative intravenous nutrients in preventing perioperative hypothermia and its complications during surgery in adults.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; November 2015) in the Cochrane Library; MEDLINE, Ovid SP (1956 to November 2015); Embase, Ovid SP (1982 to November 2015); the Institute for Scientific Information (ISI) Web of Science (1950 to November 2015); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO host; 1980 to November 2015), as well as the reference lists of identified articles. We also searched the Current Controlled Trials website and ClincalTrials.gov.
SELECTION CRITERIA
Randomized controlled trials (RCTs) of intravenous nutrients compared with control or other interventions given to maintain normothermia in adults undergoing surgery.
DATA COLLECTION AND ANALYSIS
Two review authors extracted data and assessed risk of bias for each included trial, and a third review author checked details if necessary. We contacted some study authors to request additional information.
MAIN RESULTS
We included 14 trials (n = 565), 13 (n = 525) of which compared intravenous administration of amino acids to a control (usually saline solution or Ringer's lactate). The remaining trial (n = 40) compared intravenous administration of fructose versus a control. We noted much variation in these trials, which used different types of surgery, variable durations of surgery, and different types of participants. Most trials were at high or unclear risk of bias owing to inappropriate or unclear randomization methods, and to unclear participant and assessor blinding. This may have influenced results, but it is unclear how results might have been influenced.No trials reported any of our prespecified primary outcomes, which were risk of hypothermia and major cardiovascular events. Therefore, we decided to analyse data related to core body temperature instead as a primary outcome. It was not possible to conduct meta-analysis of data related to amino acid infusion for the 60-minute and 120-minute time points, as we observed significant statistical heterogeneity in the results. Some trials showed that higher temperatures were associated with amino acids, but not all trials reported statistically significant results, and some trials reported the opposite result, where the amino acid group had a lower core temperature than the control group. It was possible to conduct meta-analysis for six studies (n = 249) that provided data relating to the end of surgery. Amino acids led to a statistically significant increase in core temperature in comparison to those receiving control (MD = 0.46°C 95% CI 0.33 to 0.59; I 0.0%; random-effects; moderate quality evidence).Three trials (n = 155) reported shivering as an outcome. Meta-analysis did not show a clear effect, and so it is uncertain whether amino acids reduce the risk of shivering (RR 0.36, 95% CI 0.13 to 1.00; I = 93%; random-effects model; very low-quality evidence).
AUTHORS' CONCLUSIONS
Intravenous amino acids may keep participants up to a half-degree C warmer than the control. This difference was statistically significant at the end of surgery, but not at other time points. However, the clinical importance of this finding remains unclear. It is also unclear whether amino acids have any effect on the risk of shivering and if intravenous nutrients confer any other benefits or harms, as high-quality data about these outcomes are lacking.
Topics: Administration, Intravenous; Adult; Amino Acids; Body Temperature; Fructose; Humans; Hypothermia; Isotonic Solutions; Randomized Controlled Trials as Topic; Ringer's Lactate; Shivering; Sodium Chloride; Time Factors
PubMed: 27875631
DOI: 10.1002/14651858.CD009906.pub2 -
European Journal of Medical Research Aug 2020More severe cases of COVID- 19 are more likely to be hospitalized and around one-fifth, needing ICU admission. Understanding the common laboratory features of COVID-19... (Meta-Analysis)
Meta-Analysis
BACKGROUND
More severe cases of COVID- 19 are more likely to be hospitalized and around one-fifth, needing ICU admission. Understanding the common laboratory features of COVID-19 in more severe cases versus non-severe patients could be quite useful for clinicians and might help to predict the model of disease progression. This systematic review and meta-analysis aimed to compare the laboratory test findings in severe vs. non-severe confirmed infected cases of COVID-19.
METHODS
Electronic databases were systematically searched in PubMed, EMBASE, Scopus, Web of Science, and Google Scholar from the beginning of 2019 to 3rd of March 2020. Heterogeneity across included studies was determined using Cochrane's Q test and the I statistic. We used the fixed or random-effect models to pool the weighted mean differences (WMDs) or standardized mean differences and 95% confidence intervals (CIs).
FINDINGS
Out of a total of 3009 citations, 17 articles (22 studies, 21 from China and one study from Singapore) with 3396 ranging from 12 to1099 patients were included. Our meta-analyses showed a significant decrease in lymphocyte, monocyte, and eosinophil, hemoglobin, platelet, albumin, serum sodium, lymphocyte to C-reactive protein ratio (LCR), leukocyte to C-reactive protein ratio (LeCR), leukocyte to IL-6 ratio (LeIR), and an increase in the neutrophil, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, blood urea nitrogen (BUN), creatinine (Cr), erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Procalcitonin (PCT), lactate dehydrogenase (LDH), fibrinogen, prothrombin time (PT), D-dimer, glucose level, and neutrophil to lymphocyte ratio (NLR) in the severe group compared with the non-severe group. No significant changes in white blood cells (WBC), Creatine Kinase (CK), troponin I, myoglobin, IL-6 and K between the two groups were observed.
INTERPRETATION
This meta-analysis provides evidence for the differentiation of severe cases of COVID-19 based on laboratory test results at the time of ICU admission. Future well-methodologically designed studies from other populations are strongly recommended.
Topics: Asia; Asian People; Betacoronavirus; Blood Coagulation; Blood Glucose; Blood Sedimentation; C-Reactive Protein; COVID-19; China; Clinical Laboratory Techniques; Coronavirus Infections; Disease Progression; Fibrin Fibrinogen Degradation Products; Hospitalization; Humans; Inflammation; Interleukin-6; L-Lactate Dehydrogenase; Lymphocytes; Neutrophils; Pandemics; Pneumonia, Viral; SARS-CoV-2; Singapore; Treatment Outcome; Troponin I
PubMed: 32746929
DOI: 10.1186/s40001-020-00432-3 -
Journal of Clinical Laboratory Analysis Dec 2020A common problem in clinical laboratories is maintaining the stability of analytes during pre-analytical processes. The aim of this study was to systematically summarize...
OBJECTIVE
A common problem in clinical laboratories is maintaining the stability of analytes during pre-analytical processes. The aim of this study was to systematically summarize the results of a set of studies about the biochemical analytes stability.
METHODS
A literature search was performed on the Advanced search field of PubMed using the keywords: "(stability) AND (analytes OR laboratory analytes OR laboratory tests OR biochemical analytes OR biochemical tests OR biochemical laboratory tests)." A total of 56 entries were obtained. After applying the selection criteria, 20 articles were included in the study.
RESULTS
In the 20 included references, up to 123 different analytes were assessed. The 34 analytes in order of the most frequently studied analytes were evaluated: Alanine aminotransferase, aspartate aminotransferase, potassium, triglyceride, alkaline phosphatase, creatinine, total cholesterol, albumin, lactate dehydrogenase, sodium, calcium, γ-glutamyltransferase, total bilirubin, urea, creatine kinase, inorganic phosphate, total protein, uric acid, amylase, chloride, high-density lipoprotein, magnesium, glucose, C-reactive protein, bicarbonate, ferritin, iron, lipase, transferrin, cobalamin, cortisol, folate, free thyroxine, and thyroid-stimulating hormone. Stable test results could be varied between 2 hours and 1 week according to the type of samples and/or type of blood collection tubes on a basic classification set as refrigerated or room temperature.
CONCLUSIONS
Biochemical analytes stability could be improved if the best pre-analytical approaches are used.
Topics: Biomarkers; Blood Chemical Analysis; Blood Specimen Collection; Humans; Sample Size; Time Factors
PubMed: 32869910
DOI: 10.1002/jcla.23551