-
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 -
BJOG : An International Journal of... Sep 2014Pregnant and postpartum women with severe hypertension are at increased risk of stroke and require blood pressure (BP) reduction. Parenteral antihypertensives have been... (Review)
Review
BACKGROUND
Pregnant and postpartum women with severe hypertension are at increased risk of stroke and require blood pressure (BP) reduction. Parenteral antihypertensives have been most commonly studied, but oral agents would be ideal for use in busy and resource-constrained settings.
OBJECTIVES
To review systematically, the effectiveness of oral antihypertensive agents for treatment of severe pregnancy/postpartum hypertension.
SEARCH STRATEGY
A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed.
SELECTION CRITERIA
Randomised controlled trials in pregnancy and postpartum with at least one arm consisting of a single oral antihypertensive agent to treat systolic BP ≥ 160 mmHg and/or diastolic BP ≥ 110 mmHg.
DATA COLLECTION AND ANALYSIS
Cochrane RevMan 5.1 was used to calculate relative risk (RR) and weighted mean difference by random effects.
MAIN RESULTS
We identified 15 randomised controlled trials (915 women) in pregnancy and one postpartum trial. Most trials in pregnancy compared oral/sublingual nifedipine capsules (8-10 mg) with another agent, usually parenteral hydralazine or labetalol. Nifedipine achieved treatment success in most women, similar to hydralazine (84% with nifedipine; relative risk [RR] 1.07, 95% confidence interval [95% CI] 0.98-1.17) or labetalol (100% with nifedipine; RR 1.02, 95% CI 0.95-1.09). Less than 2% of women treated with nifedipine experienced hypotension. There were no differences in adverse maternal or fetal outcomes. Target BP was achieved ~ 50% of the time with oral labetalol (100 mg) or methyldopa (250 mg) (47% labetelol versus 56% methyldopa; RR 0.85 95% CI 0.54-1.33).
CONCLUSIONS
Oral nifedipine, and possibly labetalol and methyldopa, are suitable options for treatment of severe hypertension in pregnancy/postpartum.
Topics: Administration, Oral; Antihypertensive Agents; Female; Humans; Hydralazine; Hypertension, Pregnancy-Induced; Labetalol; Methyldopa; Nifedipine; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Randomized Controlled Trials as Topic; Treatment Outcome; Vasodilator Agents
PubMed: 24832366
DOI: 10.1111/1471-0528.12737 -
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 -
The Cochrane Database of Systematic... Dec 2016Asthma is a chronic inflammatory disease of the airways affecting an estimated 334 million people worldwide. During severe exacerbations, patients may need to attend a... (Review)
Review
BACKGROUND
Asthma is a chronic inflammatory disease of the airways affecting an estimated 334 million people worldwide. During severe exacerbations, patients may need to attend a medical centre or hospital emergency department for treatment with systemic corticosteroids, which can be administered intravenously or orally. Some people with asthma are prescribed oral corticosteroids (OCS) for self-administration (i.e. patient-initiated) or to administer to their child with asthma (i.e. parent-initiated), in the event of an exacerbation. This approach to treatment is becoming increasingly common.
OBJECTIVES
To evaluate the effectiveness and safety of patient- or parent-initiated oral steroids for adults and children with asthma exacerbations.
SEARCH METHODS
We identified trials from Cochrane Airways' Specialised Register (CASR) and also conducted a search of the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch). We searched CASR from its inception to 18 May 2016 and trial registries from their inception to 24 August 2016; we imposed no restriction on language of publication.
SELECTION CRITERIA
We looked for randomised controlled trials (RCTs), reported as full-text, those published as abstract only, and unpublished data; we excluded cross-over trials.We looked for studies where adults (aged 18 years or older) or children of school age (aged 5 years or older) with asthma were randomised to receive: (a) any patient-/parent-initiated OCS or (b) placebo, normal care, alternative active treatment, or an identical personalised asthma action plan without the patient- or parent-initiated OCS component.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the search results to identify any studies that met the prespecified inclusion criteria.The prespecified primary outcomes were hospital admissions for asthma, asthma symptoms at follow-up and serious adverse events.
MAIN RESULTS
Despite comprehensive searches of electronic databases and clinical trial registries, we did not identify any studies meeting the inclusion criteria for this review. Five potentially relevant studies were excluded for two reasons: the intervention did not meet the inclusion criteria for this review (three studies) and studies had a cross-over design (two studies). Two of the excluded studies asked the relevant clinical question. However, these studies were excluded due to their cross-over design, as per the protocol. We contacted the authors of the cross-over trials who were unable to provide data for the first treatment period (i.e. prior to cross-over).
AUTHORS' CONCLUSIONS
There is currently no evidence from randomised trials (non-cross-over design) to inform the use of patient- or parent-initiated oral corticosteroids in people with asthma.
Topics: Administration, Oral; Adrenal Cortex Hormones; Adult; Anti-Asthmatic Agents; Asthma; Child; Child, Preschool; Disease Progression; Humans; Parents; Patient Safety; Self Administration
PubMed: 27943237
DOI: 10.1002/14651858.CD012195.pub2 -
Bulletin of the World Health... Dec 2014To describe and analyse the characteristics of oral cholera vaccination campaigns; including location, target population, logistics, vaccine coverage and delivery costs. (Review)
Review
OBJECTIVE
To describe and analyse the characteristics of oral cholera vaccination campaigns; including location, target population, logistics, vaccine coverage and delivery costs.
METHODS
We searched PubMed, the World Health Organization (WHO) website and the Cochrane database with no date or language restrictions. We contacted public health personnel, experts in the field and in ministries of health and did targeted web searches.
FINDINGS
A total of 33 documents were included in the analysis. One country, Viet Nam, incorporates oral cholera vaccination into its public health programme and has administered approximately 10.9 million vaccine doses between 1997 and 2012. In addition, over 3 million doses of the two WHO pre-qualified oral cholera vaccines have been administered in more than 16 campaigns around the world between 1997 and 2014. These campaigns have either been pre-emptive or reactive and have taken place under diverse conditions, such as in refugee camps or natural disasters. Estimated two-dose coverage ranged from 46 to 88% of the target population. Approximate delivery cost per fully immunized person ranged from 0.11-3.99 United States dollars.
CONCLUSION
Experience with oral cholera vaccination campaigns continues to increase. Public health officials may draw on this experience and conduct oral cholera vaccination campaigns more frequently.
Topics: Administration, Oral; Cholera; Cholera Vaccines; Global Health; Humans; Immunization Programs; Public Health Practice; Vietnam; World Health Organization
PubMed: 25552772
DOI: 10.2471/BLT.14.139949 -
BioMed Research International 2017NaoXueShu oral liquid invigorates Qi and promotes blood circulation, which is mainly used for treating the acute stage of the meridian of hemorrhagic apoplexy and acute... (Meta-Analysis)
Meta-Analysis Review
NaoXueShu oral liquid invigorates Qi and promotes blood circulation, which is mainly used for treating the acute stage of the meridian of hemorrhagic apoplexy and acute blood stasis syndrome during early convalescence. Its main clinical manifestations include hemiplegia, mouth askew, hemianesthesia, and inarticulateness. It is used mainly in patients with lobar hemorrhage, basal ganglia, and thalamus of the small amount of bleeding without disturbing consciousness of hypertensive cerebral. The purpose of this study was to evaluate the efficacy and adverse effects of NaoXueShu oral liquid on the treatment of cerebral hemorrhage. In this study, literature on randomized controlled trials was collected from seven databases to evaluate the clinical efficiency of the treatment of cerebral hemorrhage alone or combined with Western medicine. The methodologic quality of the included studies was assessed using a standard Cochrane system review and analyzed using RevMan 5.3.0 software. The study included 14 eligible randomized controlled trials. The results showed that the use of NaoXueShu oral liquid alone or combined with other drugs or auxiliary methods can play a significant role in the treatment of cerebral hemorrhage, especially hypertensive intracerebral hemorrhage.
Topics: Administration, Oral; Cerebral Hemorrhage; Female; Humans; Male; Plant Preparations
PubMed: 28630871
DOI: 10.1155/2017/8542576 -
Osteoarthritis and Cartilage Sep 2021Current global guidelines regarding the first-line analgesics (acetaminophen, topical or oral non-steroidal anti-inflammatory drugs [NSAIDs]) for knee osteoarthritis... (Comparative Study)
Comparative Study Meta-Analysis
Comparative efficacy and safety of acetaminophen, topical and oral non-steroidal anti-inflammatory drugs for knee osteoarthritis: evidence from a network meta-analysis of randomized controlled trials and real-world data.
OBJECTIVE
Current global guidelines regarding the first-line analgesics (acetaminophen, topical or oral non-steroidal anti-inflammatory drugs [NSAIDs]) for knee osteoarthritis remain controversial and their comparative risk-benefit profiles have yet to be adequately assessed.
DESIGN
Pubmed, Embase, Cochrane Library, and Web of Science were searched from database inception to March 2021 for randomized controlled trials (RCTs) comparing acetaminophen, topical NSAIDs and oral NSAIDs directly or indirectly in knee osteoarthritis. Bayesian network meta-analyses were conducted. A propensity-score matched cohort study was also conducted among patients with knee osteoarthritis in The Health Improvement Network database.
RESULTS
122 RCTs (47,113 participants) were networked. Topical NSAIDs were superior to acetaminophen (standardized mean difference [SMD] = -0.29, 95% credible interval [CrI]: -0.52 to -0.06) and not statistically different from oral NSAIDs (SMD = 0.03, 95% CrI: -0.16 to 0.22) for function. It had lower risk of gastrointestinal adverse effects (AEs) than acetaminophen (risk ratio [RR] = 0.52, 95%CrI: 0.35 to 0.76) and oral NSAIDs (RR = 0.46, 95%CrI: 0.34 to 0.61) in RCTs. In real-world data, topical NSAIDs showed lower risks of all-cause mortality (hazard ratio [HR] = 0.59, 95% confidence interval [CI]: 0.52 to 0.68), cardiovascular diseases (HR = 0.73, 95%CI: 0.63 to 0.85) and gastrointestinal bleeding (HR = 0.53, 95%CI: 0.41 to 0.69) than acetaminophen during the one-year follow-up (n = 22,158 participants/group). A better safety profile was also observed for topical than oral NSAIDs (n = 14,218 participants/group).
CONCLUSIONS
Topical NSAIDs are more effective than acetaminophen but not oral NSAIDs for function improvement in people with knee osteoarthritis. Topical NSAIDs are safer than acetaminophen or oral NSAIDs in trials and real-world data.
Topics: Acetaminophen; Administration, Oral; Administration, Topical; Anti-Inflammatory Agents, Non-Steroidal; Humans; Network Meta-Analysis; Osteoarthritis, Knee; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 34174454
DOI: 10.1016/j.joca.2021.06.004 -
Scientific Reports Sep 2023Cancer-related anorexia/cachexia syndrome (CACS) is characterized by anorexia and loss of body weight. Evidence is insufficient to strongly endorse any pharmacologic... (Meta-Analysis)
Meta-Analysis
Cancer-related anorexia/cachexia syndrome (CACS) is characterized by anorexia and loss of body weight. Evidence is insufficient to strongly endorse any pharmacologic agent for the treatment of CACS. In this systematic review, we assessed the efficacy of oral anamorelin treatment for patients with CACS. On July 6, 2022, we systematically searched the following databases for randomized controlled trials (RCTs) of adults with CACS comparing oral anamorelin versus placebo: CENTRAL, PubMed, EMBASE, and ICHUSHI. The primary outcomes were total body weight (TBW), patient-reported quality of life (QOL), and adverse events (AEs). Secondary outcomes included lean body mass (LBM), overall survival (OS), non-dominant hand grip strength (HGS), and appetite. We included seven RCTs with a total of 1944 CACS patients. Anamorelin significantly increased TBW (mean difference (MD) 1.73, 95% confidence interval (CI) 1.34-2.13, p < 0.00001), LBM (MD 1.06, 95% CI 0.30-1.81, p = 0.006), and QOL (standardized mean difference (SMD) 0.16, 95% CI 0.04-0.27, p = 0.006) compared with placebo without a significant difference in all AEs, severe AEs, OS, HGS or appetite. Anamorelin may be an effective treatment for CACS patients; however, further studies are needed to confirm the efficacy and safety of this drug.
Topics: Adult; Humans; Anorexia; Cachexia; Neoplasms; Administration, Oral
PubMed: 37709824
DOI: 10.1038/s41598-023-42446-x -
Medicine May 2018Tranexamic acid (TXA) is an antifibrinolytic drug widely used as a blood-sparing technique in total knee arthroplasty (TKA), and it is usually administrated by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tranexamic acid (TXA) is an antifibrinolytic drug widely used as a blood-sparing technique in total knee arthroplasty (TKA), and it is usually administrated by intravenous or intraarticular injection. Recently, the oral form of TXA has been applied in TKA patients. However, there is no final consensus regarding the effectiveness and safety of oral TXA. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of oral TXA versus control for blood loss after TKA.
METHODS
We searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases for relevant studies through August 2017. The mean difference (MD) of total blood loss, hemoglobin (Hb) drop, hematocrit (Hct), drain output, and risk difference (RD) of transfusion rate and thromboembolic complications in the TXA and control groups were pooled throughout the study. The outcomes were pooled by Stata 12.0.
RESULTS
A total of 5 RCTs (608 patients) were included in this study. All the included studies were randomized and the quality of included studies was relatively high. The pooled results indicated that the oral TXA group had significantly less Hb drop (standardized mean difference [SMD], -0.936; 95% confidence intervals [CI], -1.118,-0.754), Hct drop (SMD, -0.693; 95% CI, -1.113, -0.274), and drain output (SMD, -0.793; 95% CI, -0.959, -0.628) than the control group. No statistically significant differences were found in transfusion rate and the incidence of thromboembolic complications between the 2 groups. Total blood loss could not be evaluated for the insufficient date.
CONCLUSIONS
Our meta-analysis suggested that the administration of oral TXA provided significantly better results with respect to Hb drop, Hct drop, and drain output without increasing the transfusion rate and the risk of thromboembolic complications after TKA. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.
Topics: Administration, Oral; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Drainage; Hematocrit; Hemoglobinometry; Humans; Thromboembolism; Tranexamic Acid
PubMed: 29718858
DOI: 10.1097/MD.0000000000010587 -
Medicine Dec 2023Neonatal hypoglycemia (NH) is the most prevalent metabolic disorder in neonates and glucose gel in oral solution is a relatively new treatment option for NH. We aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neonatal hypoglycemia (NH) is the most prevalent metabolic disorder in neonates and glucose gel in oral solution is a relatively new treatment option for NH. We aimed to determine whether oral glucose gel can prevent NH.
METHODS
We conducted an open literature search using PubMed, Embase, Cochrane Library, and Web of Science. We used relative risk as the statistical data, expressed each outcome effect as a 95% confidence interval, and conducted a heterogeneity test. If heterogeneity statistics indicated that I2 was ≥ 50%, the random effects model analysis was used; otherwise, the fixed effects model analysis was conducted, and sensitivity analyses were conducted for all outcomes.
RESULTS
In this review, we included a total of 10 studies involving 4801 neonates. Meta-analysis revealed that there were no significant differences between the preventive oral glucose gel group and the control group in terms of blood glucose concentration, glucose concentration 30 minutes after the first breastfeeding, length of stay, Bayley-III composite score, subsequent need for intravenous injection of glucose, 24-hour glucose > 50 mg/dL, separation from mother for treatment of hypoglycemia/admitted to neonatal intensive care unit for hypoglycemia, normoglycemia after 1 to 2 treatments, or normoglycemia after more than 2 treatments, breastfeeding at discharge, delayed feeding, neurosensory impairment, parental satisfaction, developmental delay, and seizure. The subsequent intake was significantly lower in the glucose gel group compared to the control group.
INTERPRETATION
The use of oral glucose gel as a preventative measure may not reduce the incidence of NH. In order to assess the efficacy of glucose gel in preventing NH, a more high-quality, large-sample, and rigorously designed randomized controlled trial is required.
Topics: Infant, Newborn; Female; Humans; Glucose; Hypoglycemia; Administration, Oral; Breast Feeding; Gels; Infant, Newborn, Diseases
PubMed: 38050311
DOI: 10.1097/MD.0000000000036137