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Drug Safety Mar 2021Antidepressant use during the first trimester is reported in 4-8% of pregnancies. The use of some selective serotonin reuptake inhibitors during the first trimester has... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Antidepressant use during the first trimester is reported in 4-8% of pregnancies. The use of some selective serotonin reuptake inhibitors during the first trimester has been identified as increasing the odds for congenital heart defects; however, little is known about the safety of non-selective serotonin reuptake inhibitor antidepressants.
OBJECTIVE
The objective of this study was to assess the odds of congenital heart defects associated with the use of antidepressants during the first trimester of pregnancy, and to update the literature as newer studies have been published since the latest systematic literature review and meta-analysis.
METHODS
PubMed and Embase were searched till 3 June, 2020. Study quality was assessed, and study details were extracted. Meta-analyses were performed using RevMan 5.4, which assessed: (1) any antidepressant usage; (2) classes of antidepressants; and (3) individual antidepressants.
RESULTS
Twenty studies were identified, encompassing 5,337,223 pregnancies. The odds ratio for maternal use of any antidepressant during the first trimester of pregnancy and the presence of congenital heart defects from the random effects meta-analysis was 1.28 (95% confidence interval [CI] 1.17-1.41). Significant odds ratios of 1.69 (95% CI 1.37-2.10) and 1.25 (95% CI 1.15-1.37) were reported for serotonin norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors, respectively. A non-statistically significant odds ratio of 1.02 (95% CI 0.82-1.25) was reported for the tricyclic antidepressants. Analyses of individual SSRIs produced significant odds ratios of 1.57 (95% CI 1.25-1.97), 1.36 (95% CI 1.08-1.72), and 1.29 (95% CI 1.14-1.45) for paroxetine, fluoxetine, and sertraline, respectively. The norepinephrine-dopamine-reuptake inhibitor bupropion also produced a significant odds ratio of 1.23 (95% CI 1.01-1.49).
CONCLUSIONS
The selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor classes of antidepressants pose a greater risk for causing congenital heart defects than the tricyclic antidepressants. However, this risk for individual antidepressants within each class varies, and information regarding some antidepressants is still lacking.
Topics: Antidepressive Agents; Antidepressive Agents, Tricyclic; Female; Heart Defects, Congenital; Humans; Norepinephrine; Pregnancy; Serotonin; Selective Serotonin Reuptake Inhibitors
PubMed: 33354752
DOI: 10.1007/s40264-020-01027-x -
BMC Neurology Jun 2023Many drugs are prescribed in relieving acute migraine attacks, we aim to compare metoclopramide with other antimigraine drugs. (Meta-Analysis)
Meta-Analysis
The efficacy and safety of metoclopramide in relieving acute migraine attacks compared with other anti-migraine drugs: a systematic review and network meta-analysis of randomized controlled trials.
BACKGROUND
Many drugs are prescribed in relieving acute migraine attacks, we aim to compare metoclopramide with other antimigraine drugs.
METHODS
We searched online databases like PubMed, Cochrane Library, Scopus, and Web of Science till June 2022 for RCTs that compared metoclopramide alone with placebo or active drugs. The main outcomes were the mean change in headache score and complete headache relief. The secondary outcomes were the rescue medications need, side effects, nausea and recurrence rate. We qualitatively reviewed the outcomes. Then, we performed the network meta-analyses (NMAs) when it was possible. which were done by the Frequentist method using the MetaInsight online software.
RESULTS
Sixteen studies were included with a total of 1934 patients: 826 received metoclopramide, 302 received placebo, and 806 received other active drugs. Metoclopramide was effective in reducing headache outcomes even for 24 h. The intravenous route was the most chosen route in the included studies and showed significant positive results regarding headache outcomes; however, the best route whether intramuscular, intravenous, or suppository was not compared in the previous studies. Also, both 10 and 20 mg doses of metoclopramide were effective in improving headache outcomes; however, there was no direct comparison between both doses and the 10 mg dose was the most frequently used dosage. In NMA of headache change after 30 min or 1 h, metoclopramide effect came after granisetron, ketorolac, chlorpromazine, and Dexketoprofen trometamol. Only granisetron's effect was significantly higher than metoclopramide's effect which was only significantly higher than placebo and sumatriptan. In headache-free symptoms, only prochlorperazine was non-significantly higher than metoclopramide which was higher than other medications and showed significantly higher effects only with placebo. In rescue medication, metoclopramide's effect was only non-significantly lower than prochlorperazine and chlorpromazine while its effect was higher than other drugs and showed higher significant effects only than placebo and valproate. In the recurrence rate, studies showed no significant difference between metoclopramide and other drugs. Metoclopramide significantly decreased nausea more than the placebo. Regarding side effects, metoclopramide showed a lower incidence of mild side effects than pethidine and chlorpromazine and showed a higher incidence of mild side effects than placebo, dexamethasone, and ketorolac. The reported extrapyramidal symptoms with metoclopramide were dystonia or akathisia.
CONCLUSION
A dose of 10 mg IV Metoclopramide was effective in relieving migraine attacks with minimal side effects. Compared to other active drugs, it only showed a lower significant effect compared with granisetron regarding headache change while it showed significantly higher effects only with placebo in both rescue medication needs and headache-free symptoms and valproate in only rescue medication need. Also, it significantly decreased headache scores more than placebo and sumatriptan. However, more studies are needed to support our results.
Topics: Humans; Metoclopramide; Sumatriptan; Network Meta-Analysis; Prochlorperazine; Chlorpromazine; Granisetron; Valproic Acid; Ketorolac; Randomized Controlled Trials as Topic; Migraine Disorders; Nausea; Headache
PubMed: 37291500
DOI: 10.1186/s12883-023-03259-7 -
The American Journal of Emergency... Apr 2023Cardiogenic shock (CS) is associated with high morbidity and mortality. In recent times, there is increasing interest in the role of angiotensin II in CS. We sought to... (Review)
Review
BACKGROUND
Cardiogenic shock (CS) is associated with high morbidity and mortality. In recent times, there is increasing interest in the role of angiotensin II in CS. We sought to systematically review the current literature on the use of angiotensin II in CS.
METHODS
PubMed, EMBASE, Medline, Web of Science, PubMed Central, and CINAHL databases were systematically searched for studies that evaluated the efficacy of angiotensin II in patients with CS during 01/01/2010-07/07/2022. Outcomes of interest included change in mean arterial pressure (MAP), vasoactive medication requirements (percent change in norepinephrine equivalent [NEE] dose), all-cause mortality, and adverse events.
RESULTS
Of the total 2,402 search results, 15 studies comprising 195 patients were included of which 156 (80%) received angiotensin II. Eleven patients (84.6%) in case reports and case series with reported MAP data at hour 12 noted an increase in MAP. Two studies noted a positive hemodynamic response (defined a priori) in eight (88.9%) and five (35.7%) patients. Eight studies reported a reduction in NEE dose at hour 12 after angiotensin II administration and one study noted a 100% reduction in NEE dose. Out of 47 patients with documented information, 13 patients had adverse outcomes which included hepatic injury (2), digital ischemia (1), ischemic optic neuropathy (1), ischemic colitis (2), agitated delirium (1), and thrombotic events (2).
CONCLUSIONS
In this first systematic review of angiotensin II in CS, we note the early clinical experience. Angiotensin II was associated with improvements in MAP, decrease in vasopressor requirements, and minimal reported adverse events.
Topics: Humans; Shock, Cardiogenic; Angiotensin II; Vasoconstrictor Agents; Norepinephrine; Arterial Pressure; Peptide Hormones; Shock
PubMed: 36753927
DOI: 10.1016/j.ajem.2023.01.050 -
Advances in Wound Care Oct 2023Pressure injury (PI) is a common critical presentation in intensive care units (ICU) and is an important clinical concern in critical care settings. Some developing... (Meta-Analysis)
Meta-Analysis Review
Pressure injury (PI) is a common critical presentation in intensive care units (ICU) and is an important clinical concern in critical care settings. Some developing data support the vasoconstrictor agent administration as a potential risk factor; however, synthesis of available evidence has not been completed. Comprehensive tactics were employed to search electronic databases PubMed, Web of Science, and Ovid Embase for data on vasoconstrictor agent administration associated with PI in ICU patients. Extraction was limited to studies that matched the inclusion criteria. The pooled odds ratio and 95% confidence intervals (95% CI) were calculated for dichotomous outcomes. Twenty-six studies were included, involving 50,192 patients who matched the selection criteria. Around 5.8% of patients (2,523/43,210) got PI in total. PI occurred in 10.9% (1,496/13,675) of the vasoconstrictor agent administration population and 3.5% (1,027/29,503) of the drug-free population. The pooled unadjusted odds ratio was 2.83 (95% CI = 2.21-3.64, < 0.001). The adjusted odds ratio was 1.83 (95% CI = 1.26-2.68, = 0.002). Subgroup analysis and meta-regression found that the risk of PI did not vary with research design, time of occurrence, patient age, or male proportion. Vasoconstrictor agent administration raised the risk of PI in critical care patients by nearly twofold. More emphasis should be placed on the timely prevention of PI in patients receiving vasoconstrictor agent administration in the ICU.
Topics: Humans; Male; Pressure Ulcer; Critical Care; Intensive Care Units; Risk Factors
PubMed: 36448592
DOI: 10.1089/wound.2022.0081 -
Journal of Oral Rehabilitation May 2021To synthesise and critically review the association between sleep bruxism (SB) and stress symptoms in adults. A systematic review was performed. The search was completed... (Meta-Analysis)
Meta-Analysis Review
To synthesise and critically review the association between sleep bruxism (SB) and stress symptoms in adults. A systematic review was performed. The search was completed using seven primary electronic databases in addition to a grey literature search. Two reviewers blindly selected studies based on pre-defined eligibility criteria. Risk of bias of the included articles was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. RevMan 5.4 was used to perform the meta-analysis. The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Ten studies were included for qualitative analysis, of which three were included for quantitative analysis. Three studies were evaluated to have low risk of bias, and seven were assessed with moderate risk of bias. Quality of evidence was classified as very low for all outcomes. Individuals with SB were found to have higher levels of some self-reported stress symptoms as assessed through questionnaires with a mean difference of 4.59 (95% CI 0.26-8.92). Biomarkers like epinephrine, norepinephrine, cortisol, adrenaline, dopamine, noradrenaline and prolidase enzyme levels also showed a positive association with SB. Although some associations were identified between probable SB and self-reported stress symptoms and biomarkers of stress in adults, given that the quality of evidence was found to be very low, caution should be exercised in interpreting these results. These findings suggest that additional and better designed studies are warranted in order to clarify the link between SB and stress.
Topics: Adult; Cross-Sectional Studies; Epinephrine; Humans; Self Report; Sleep Bruxism; Surveys and Questionnaires
PubMed: 33377534
DOI: 10.1111/joor.13142 -
Neuroscience and Biobehavioral Reviews Sep 2023Recent lifestyle changes have resulted in tremendous peer pressure and mental stress, and increased the incidences of chronic psychological disorders; like addiction,... (Review)
Review
Recent lifestyle changes have resulted in tremendous peer pressure and mental stress, and increased the incidences of chronic psychological disorders; like addiction, depression and anxiety (ADA). In this context, the stress-tolerance levels vary amongst individuals and genetic factors play prominent roles. Vulnerable individuals may often be drawn towards drug-addiction to combat stress. This systematic review critically appraises the relationship of various genetic factors linked with the incidences of ADA development. For coherence, we focused solely on cocaine as a substance of abuse in this study. Online scholarly databases were used to screen pertinent literature using apt keywords; and the final retrieval included 42 primary-research articles. The major conclusion drawn from this systematic analysis states that there are 51 genes linked with the development of ADA; and 3 (BDNF, PERIOD2 and SLC6A4) of them are common to all the three aspects of ADA. Further, inter-connectivity analyses of the 51 genes further endorsed the central presence of BDNF and SLC6A4 genes in the development of ADA disorders. The conclusions derived from this systematic study pave the way for future studies for the identification of diagnostic biomarkers and drug targets; and for the development of novel and effective therapeutic regimens against ADA.
Topics: Humans; Cocaine-Related Disorders; Depression; Brain-Derived Neurotrophic Factor; Anxiety; Anxiety Disorders; Cocaine; Serotonin Plasma Membrane Transport Proteins
PubMed: 37271299
DOI: 10.1016/j.neubiorev.2023.105270 -
International Journal of Molecular... Jun 2023The functions of cocaine- and amphetamine-regulated transcript (CART) neuropeptide encoded by the gene vary from modifying behavior and pain sensitivity to being an... (Review)
Review
The functions of cocaine- and amphetamine-regulated transcript (CART) neuropeptide encoded by the gene vary from modifying behavior and pain sensitivity to being an antioxidant. Putative CART peptide receptor GPR160 was implicated recently in the pathogenesis of cancer. However, the exact role of CART protein in the development of neoplasms remains unclear. This systematic review includes articles retrieved from the Scopus, PubMed, Web of Science and Medline Complete databases. Nineteen publications that met the inclusion criteria and describe the association of CART and cancer were analyzed. CART is expressed in various types of cancer, e.g., in breast cancer and neuroendocrine tumors (NETs). The role of CART as a potential biomarker in breast cancer, stomach adenocarcinoma, glioma and some types of NETs was suggested. In various cancer cell lines, acts an oncogene, enhancing cellular survival by the activation of the ERK pathway, the stimulation of other pro-survival molecules, the inhibition of apoptosis or the increase in cyclin D1 levels. In breast cancer, CART was reported to protect tumor cells from tamoxifen-mediated death. Taken together, these data support the role of CART activity in the pathogenesis of cancer, thus opening new diagnostic and therapeutic approaches in neoplastic disorders.
Topics: Humans; Female; Nerve Tissue Proteins; Neuroendocrine Tumors; Breast Neoplasms; Tamoxifen; Cocaine
PubMed: 37373130
DOI: 10.3390/ijms24129986 -
Shock (Augusta, Ga.) Nov 2023Background: Vasopressor plays a crucial role in septic shock. However, the time for vasopressor initiation remains controversial. We conducted a systematic review and... (Meta-Analysis)
Meta-Analysis
Background: Vasopressor plays a crucial role in septic shock. However, the time for vasopressor initiation remains controversial. We conducted a systematic review and meta-analysis to explore its initiation timing for septic shock patients. Methods: PubMed, Cochrane Library, Embase, and Web of Sciences were searched from inception to July 12, 2023, for relevant studies. Primary outcome was short-term mortality. Meta-analysis was performed using Stata 15.0. Results: Twenty-three studies were assessed, including 2 randomized controlled trials and 21 cohort studies. The early group resulted in lower short-term mortality than the late group (OR [95% CI] = 0.775 [0.673 to 0.893], P = 0.000, I2 = 67.8%). The significance existed in the norepinephrine and vasopressin in subgroup analysis. No significant difference was considered in the association between each hour's vasopressor delay and mortality (OR [95% CI] = 1.02 [0.99 to 1.051], P = 0.195, I2 = 57.5%). The early group had an earlier achievement of target MAP ( P < 0.001), shorter vasopressor use duration ( P < 0.001), lower serum lactate level at 24 h ( P = 0.003), lower incidence of kidney injury ( P = 0.001), renal replacement therapy use ( P = 0.022), and longer ventilation-free days to 28 days ( P < 0.001). Conclusions: Early initiation of vasopressor (1-6 h within septic shock onset) would be more beneficial to septic shock patients. The conclusion needs to be further validated by more well-designed randomized controlled trials.
Topics: Humans; Shock, Septic; Vasoconstrictor Agents; Norepinephrine; Cohort Studies; Renal Replacement Therapy
PubMed: 37695641
DOI: 10.1097/SHK.0000000000002214 -
Neurological Sciences : Official... Aug 2014Although the pathogenesis of migraine is very complex and has not been thoughtfully elucidated, general consensus exists to date that this condition should be considered... (Review)
Review
Although the pathogenesis of migraine is very complex and has not been thoughtfully elucidated, general consensus exists to date that this condition should be considered a primary neurovascular disorder with an important inflammatory component. Owing to epidemiological evidence of increased risk of migraine in overweight and obese subjects and to the inverse relationship that exists between serum adiponectin concentration and obesity, we performed an electronic search on Medline, Scopus and Web of Science, using the keywords "migraine" and "adiponectin" with no language or date restriction to explore the existence of an association between serum adiponectin and migraine. According to our search criteria, five studies were finally included in this systematic review, four cross-sectional (totaling 300 patients with migraine and 177 controls) and one interventional. Collectively, the results of our analysis suggest that a link between serum adiponectin and migraine remains elusive, at the best. The four cross-sectional studies failed to find any significant association, whereas the outcome of the single interventional study reported a rather modest variation of serum adiponectin concentration in a very limited sample size. Further larger studies are needed to firmly establish the existence of a relationship between adiponectin metabolism and migraine.
Topics: Adiponectin; Adult; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Migraine Disorders; Naproxen; Obesity; Sumatriptan
PubMed: 24648004
DOI: 10.1007/s10072-014-1719-3 -
Current Pharmaceutical Design 2023We aimed to evaluate the effectiveness of topical tranexamic acid (TXA) versus topical vasoconstrictors in the management of epistaxis via a systematic review and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aimed to evaluate the effectiveness of topical tranexamic acid (TXA) versus topical vasoconstrictors in the management of epistaxis via a systematic review and meta-analysis.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were followed for the meta-analysis. We systematically searched Embase, Web of Science, Cochrane Library, CNKI, and PubMed for randomized controlled trials (from inception to August 2022; no language restrictions), comparing the effect of topical TXA and topical vasoconstrictors on the treatment of epistaxis. The Q test was used to evaluate heterogeneity, and funnel plots were utilized to identify bias. For the meta-analysis, the fixedeffects model was employed, and the t-test was utilized to determine significance.
RESULTS
Of 1012 identified studies, 5 were found to be eligible for our analysis. In total, 598 patients were included; 297 of them received TXA and 301 received vasoconstrictors. Hemostasis was more likely to be achieved at the first re-assessment in patients treated with TXA. Subgroup analysis indicated patients treated with TXA to have less likelihood of bleeding recurrence, compared to patients treated with vasoconstrictors. The detected time interval of rebleeding was 10 min, between 24 h to 72 h, and after 7 days, respectively, and the differences were significant between the two groups of patients treated with TXA and vasoconstrictors.
CONCLUSION
Topical TXA was associated with better post-treatment hemorrhagic arrest rates compared to topical vasoconstrictors in the management of epistaxis.
Topics: Humans; Tranexamic Acid; Antifibrinolytic Agents; Epistaxis; Vasoconstrictor Agents; Administration, Topical
PubMed: 36786144
DOI: 10.2174/1381612829666230214093136