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Anaesthesia Jan 2024We conducted a systematic review of the literature reporting phenylephrine-induced changes in blood pressure, cardiac output, cerebral blood flow and cerebral tissue... (Review)
Review
We conducted a systematic review of the literature reporting phenylephrine-induced changes in blood pressure, cardiac output, cerebral blood flow and cerebral tissue oxygen saturation as measured by near-infrared spectroscopy in humans. We used the proportion change of the group mean values reported by the original studies in our analysis. Phenylephrine elevates blood pressure whilst concurrently inducing a reduction in cardiac output. Furthermore, despite increasing cerebral blood flow, it decreases cerebral tissue oxygen saturation. The extent of phenylephrine's influence on cardiac output (r = -0.54 and p = 0.09 in awake humans; r = -0.55 and p = 0.007 in anaesthetised humans), cerebral blood flow (r = 0.65 and p = 0.002 in awake humans; r = 0.80 and p = 0.003 in anaesthetised humans) and cerebral tissue oxygen saturation (r = -0.72 and p = 0.03 in awake humans; r = -0.24 and p = 0.48 in anaesthetised humans) appears closely linked to the magnitude of phenylephrine-induced blood pressure changes. When comparing the effects of phenylephrine in awake and anaesthetised humans, we found no evidence of a significant difference in cardiac output, cerebral blood flow or cerebral tissue oxygen saturation. There was also no evidence of a significant difference in effect on systemic and cerebral circulations whether phenylephrine was given by bolus or infusion. We explore the underlying mechanisms driving the phenylephrine-induced cardiac output reduction, cerebral blood flow increase and cerebral tissue oxygen saturation decrease. Individualised treatment approaches, close monitoring and consideration of potential risks and benefits remain vital to the safe and effective use of phenylephrine in acute care.
Topics: Humans; Phenylephrine; Vasoconstrictor Agents; Oxygen; Blood Pressure; Cerebrovascular Circulation
PubMed: 37948131
DOI: 10.1111/anae.16172 -
International Journal of Clinical... Jun 2024To describe the efficacy of atropine in controlling salivary flow in patients with sialorrhea or drooling. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To describe the efficacy of atropine in controlling salivary flow in patients with sialorrhea or drooling.
MATERIALS AND METHODS
We included randomized controlled studies, quasi-randomized trials, case reports, clinical trials, systematic reviews, and meta-analyses assessing the use of atropine in patients with sialorrhea or drooling. The endpoints were reduction in salivary flow rate, amount of saliva secreted, reduction in clinical symptoms of sialorrhea, death rattle intensity, or reduction in drooling intensity as measured by an objective scale such as the drooling intensity scale.
RESULTS
A total of 56 studies with 2,378 patients were included in the systematic review. The underlying disease states included brain injury, amyotrophic lateral sclerosis, cerebral palsy, clozapine- and perphenazine-induced sialorrhea, Parkinson's disease, and terminal illness. The routes of atropine administration included sublingual, intravenous, subcutaneous, oral tablet or solution, and direct injection of atropine into parotid glands or at the base of the tongue. The generalized estimated equation regression models showed that sublingual administration is superior to oral and subcutaneous routes.
CONCLUSION
Atropine is efficacious in managing sialorrhea in most disease states. Sublingual administration of atropine is superior to other routes of administration in reducing salivary flow in patients with sialorrhea.
Topics: Sialorrhea; Humans; Atropine; Treatment Outcome; Salivation
PubMed: 38577753
DOI: 10.5414/CP204538 -
The American Journal of Emergency... Mar 2024The preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and meta-analysis comparing rates of in-hospital mortality, refractory shock, and hemodynamic parameters in post-cardiac arrest patients who received either norepinephrine or epinephrine as primary vasopressor support.
METHODS
We conducted a search of PubMed, Cochrane Library, and CINAHL from 2000 to 2022. Included studies were prospective, retrospective, or published abstracts comparing norepinephrine and epinephrine in adults with post-cardiac arrest shock or with cardiogenic shock and extractable post-cardiac arrest data. The primary outcome of interest was in-hospital mortality. Other outcomes included incidence of arrhythmias or refractory shock.
RESULTS
The database search returned 2646 studies. Two studies involving 853 participants were included in the systematic review. The proposed meta-analysis was deferred due to low yield. Crude incidence of in-hospital mortality was numerically higher in the epinephrine group compared with norepinephrine in both studies, but only statistically significant in one. Risk of bias was moderate to severe for in-hospital mortality. Additional outcomes were reported differently between studies, minimizing direct comparison.
CONCLUSION
The vasopressor with the best mortality and hemodynamic outcomes in post-cardiac arrest shock remains unclear. Randomized studies are crucial to remedy this.
Topics: Adult; Humans; Norepinephrine; Shock, Cardiogenic; Prospective Studies; Retrospective Studies; Epinephrine; Vasoconstrictor Agents; Heart Arrest; Shock; Hemodynamics
PubMed: 38150986
DOI: 10.1016/j.ajem.2023.12.031 -
Clinical Ophthalmology (Auckland, N.Z.) 2023Diabetic retinopathy (DR) is a leading cause of blindness. Early DR screening is essential, but the infrastructure can be less affordable in low resource countries. This... (Review)
Review
PURPOSE
Diabetic retinopathy (DR) is a leading cause of blindness. Early DR screening is essential, but the infrastructure can be less affordable in low resource countries. This study aims to review the accuracy of low-cost smartphone-based fundus cameras for DR screening in adult patients with diabetes.
METHODS
We performed a systematic literature search to find studies that reported the sensitivity and specificity of low-cost smartphone-based devices for fundus photography in adult patients with diabetes. We searched three databases (MEDLINE, Google Scholar, Scopus) and one register (Cochrane CENTRAL). We presented the accuracy values by grouping the diagnosis into three: any DR, referrable DR, and diabetic macular oedema (DMO). Risk of bias and applicability of the studies were assessed using QUADAS-2.
RESULTS
Five out of 294 retrieved records were included with a total of six smartphone-based devices reviewed. All of the reference diagnostic methods used in the included studies were either indirect ophthalmoscopy or slit-lamp examinations and all smartphone-based devices' imaging protocols used mydriatic drops. The reported sensitivity and specificity for any DR were 52-92.2% and 73.3-99%; for referral DR were 21-91.4% and 64.9-100%; and for DMO were 29.4-81% and 95-100%, respectively.
CONCLUSION
Sensitivity available low-cost smartphone-based devices for DR screening were acceptable and their specificity particularly for detecting referrable DR and DMO were considerably good. These findings support their potential utilization for DR screening in a low resources setting.
PubMed: 37614846
DOI: 10.2147/OPTH.S416422 -
The Journal of Manual & Manipulative... Feb 2024Spinal manipulation (SM) has been hypothesized to influence the autonomic nervous system (ANS). Further, it has been proposed that the effects may vary depending on the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Spinal manipulation (SM) has been hypothesized to influence the autonomic nervous system (ANS). Further, it has been proposed that the effects may vary depending on the segment manipulated. The aim of this systematic review was to synthesize the current level of evidence for SM in influencing the ANS in healthy and/or symptomatic population.
METHODS
Various databases ( = 8) were searched (inception till May 2023) and 14 trials ( = 618 participants) were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. The data were synthesized using standard mean differences and meta-analysis for the primary outcome measures. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest.
RESULTS
Overall, there was low quality evidence that SM did not influence any measure of ANS including heart rate variability (HRV), oxy-hemoglobin, blood pressure, epinephrine and nor-epinephrine. However, there was low quality evidence that cervical spine manipulation may influence high frequency parameter of HRV, indicating its influence on the parasympathetic nervous system.
CONCLUSION
When compared with control or sham interventions, SM did not alter the ANS. Due to invalid methodologies and the low quality of included studies, findings must be interpreted with great caution. Future studies are needed which employ rigorous data collection processes to verify the true physiological implications of SM on ANS.
Topics: Humans; Autonomic Nervous System; Epinephrine; Heart Rate; Manipulation, Spinal; Parasympathetic Nervous System
PubMed: 38044657
DOI: 10.1080/10669817.2023.2285196 -
American Journal of Ophthalmology Jul 2024To evaluate the diagnostic accuracy of artificial intelligence (AI)-based automated diabetic retinopathy (DR) screening in real-world settings. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the diagnostic accuracy of artificial intelligence (AI)-based automated diabetic retinopathy (DR) screening in real-world settings.
DESIGN
Systematic review and meta-analysis METHODS: We conducted a systematic review of relevant literature from January 2012 to August 2022 using databases including PubMed, Scopus and Web of Science. The quality of studies was evaluated using Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2) checklist. We calculated pooled accuracy, sensitivity, specificity, and diagnostic odds ratio (DOR) as summary measures. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO - CRD42022367034).
RESULTS
We included 34 studies which utilized AI algorithms for diagnosing DR based on real-world fundus images. Quality assessment of these studies indicated a low risk of bias and low applicability concern. Among gradable images, the overall pooled accuracy, sensitivity, specificity, and DOR were 81%, 94% (95% CI: 92.0-96.0), 89% (95% CI: 85.0-92.0) and 128 (95% CI: 80-204) respectively. Sub-group analysis showed that, when acceptable quality imaging could be obtained, non-mydriatic fundus images had a better DOR of 143 (95% CI: 82-251) and studies using 2 field images had a better DOR of 161 (95% CI 74-347). Our meta-regression analysis revealed a statistically significant association between DOR and variables such as the income status, and the type of fundus camera.
CONCLUSION
Our findings indicate that AI algorithms have acceptable performance in screening for DR using fundus images compared to human graders. Implementing a fundus camera with AI-based software has the potential to assist ophthalmologists in reducing their workload and improving the accuracy of DR diagnosis.
Topics: Humans; Diabetic Retinopathy; Artificial Intelligence; Reproducibility of Results; Sensitivity and Specificity; Mass Screening; Algorithms
PubMed: 38438095
DOI: 10.1016/j.ajo.2024.02.012 -
Journal of Obstetrics and Gynaecology... Feb 2024The current meta-analysis was designed to investigate the impact of Hyoscine N-butyl bromide (HBB) rectal on labour duration and the rate of cervical dilatation by... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The current meta-analysis was designed to investigate the impact of Hyoscine N-butyl bromide (HBB) rectal on labour duration and the rate of cervical dilatation by consolidating the available data.
METHODS
The search of Medline through the PubMed interface, Scopus, ScienceDirect, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed for original articles concerning the effects of HBB rectal on the duration of labour published prior to 26 June 2023. Search terms were based on Medical Subject Headings without time and language restrictions. They included: Hyoscine, Scopolamine, HBB, Buscopan, Buscolysin, Buscapine, rectal, suppository, childbirth, delivery, active phase, second stage, cervical dilatation, labour, labour, and duration of labour. The Comprehensive Meta-Analysis V3 software was used for all analyses.
RESULTS
Five randomized control trials and 1 non-randomized study involving 1310 women were included in the systematic review. Two studies were excluded from the meta-analysis because of heterogeneous interventions and a lack of mean and SD results. The results determined that HBB rectal administration significantly decreased the duration of the active phase (pooled mean difference -193.893; 95% CI -229.173 to -158.613, P < 0.001; I squares = 90.097%) and second stage of labour (pooled mean difference -2.911; 95% CI -5.486 to -0.336, P = 0.027; I squares = 90.097%). Also, the cervical dilatation rate in the active phase of labour was 0.981 cm/h higher than in the control group (I = 0.0%; P < 0.001).
CONCLUSION
This meta-analysis found that HBB rectal administration shortened the active labour phase and second stage and increased the rate of cervix dilatation; consequently, it can be used as a cost-effective intervention for low-risk pregnant women during labour. However, our findings also suggest that more robust clinical trials are required to generate evidence and confirm the use of HBB during labour for clinical practice guidelines.
Topics: Pregnancy; Female; Humans; Butylscopolammonium Bromide; Labor Stage, First; Scopolamine; Labor, Obstetric; Randomized Controlled Trials as Topic; Hydrocarbons, Brominated
PubMed: 37993100
DOI: 10.1016/j.jogc.2023.102292 -
The Journal of Manual & Manipulative... Feb 2024The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population.
METHODS
This is a systematic review update. Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest.
RESULTS
There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD -0.42, 95% CI - 0.74 to -0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine.
CONCLUSION
Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.
Topics: Humans; Manipulation, Spinal; Hydrocortisone; Neurotensin; Biomarkers; Epinephrine
PubMed: 37671460
DOI: 10.1080/10669817.2023.2252187 -
BMC Cardiovascular Disorders May 2024Despite their continued use, the effectiveness and safety of vasopressors in post-cardiac arrest patients remain controversial. This study examined the efficacy of... (Meta-Analysis)
Meta-Analysis
BACKGROUND & OBJECTIVE
Despite their continued use, the effectiveness and safety of vasopressors in post-cardiac arrest patients remain controversial. This study examined the efficacy of various vasopressors in cardiac arrest patients in terms of clinical, morbidity, and mortality outcomes.
METHODS
A comprehensive literature search was performed using online databases (MeSH terms: MEDLINE (Ovid), CENTRAL (Cochrane Library), Embase (Ovid), CINAHL, Scopus, and Google Scholar) from 1997 to 2023 for relevant English language studies. The primary outcomes of interest for this study included short-term survival leading to death, return of spontaneous circulation (ROSC), survival to hospital discharge, neurological outcomes, survival to hospital admission, myocardial infarction, and incidence of arrhythmias.
RESULTS
In this meta-analysis, 26 studies, including 16 RCTs and ten non-RCTs, were evaluated. The focus was on the efficacy of epinephrine, vasopressin, methylprednisolone, dopamine, and their combinations in medical emergencies. Epinephrine treatment was associated with better odds of survival to hospital discharge (OR = 1.52, 95%CI [1.20, 1.94]; p < 0.001) and achieving ROSC (OR = 3.60, 95% CI [3.45, 3.76], P < 0.00001)) over placebo but not in other outcomes of interest such as short-term survival/ death at 28-30 days, survival to hospital admission, or neurological function. In addition, our analysis indicates non-superiority of vasopressin or epinephrine vasopressin-plus-epinephrine therapy over epinephrine monotherapy except for survival to hospital admission where the combinatorial therapy was associated with better outcome (0.76, 95%CI [0.64, 0.92]; p = 0.004). Similarly, we noted the non-superiority of vasopressin-plus-methylprednisolone versus placebo. Finally, while higher odds of survival to hospital discharge (OR = 3.35, 95%CI [1.81, 6.2]; p < 0.001) and ROSC (OR = 2.87, 95%CI [1.97, 4.19]; p < 0.001) favoring placebo over VSE therapy were observed, the risk of lethal arrhythmia was not statistically significant. There was insufficient literature to assess the effects of dopamine versus other treatment modalities meta-analytically.
CONCLUSION
This meta-analysis indicated that only epinephrine yielded superior outcomes among vasopressors than placebo, albeit limited to survival to hospital discharge and ROSC. Additionally, we demonstrate the non-superiority of vasopressin over epinephrine, although vasopressin could not be compared to placebo due to the paucity of data. The addition of vasopressin to epinephrine treatment only improved survival to hospital admission.
Topics: Humans; Vasoconstrictor Agents; Treatment Outcome; Out-of-Hospital Cardiac Arrest; Risk Factors; Return of Spontaneous Circulation; Male; Middle Aged; Female; Aged; Time Factors; Cardiopulmonary Resuscitation; Epinephrine; Recovery of Function; Risk Assessment; Vasopressins; Patient Discharge; Adult
PubMed: 38816786
DOI: 10.1186/s12872-024-03962-4