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Alternative Therapies in Health and... Nov 2023This systematic review aimed to identify independent prognostic factors of severe pneumonia.
OBJECTIVES
This systematic review aimed to identify independent prognostic factors of severe pneumonia.
METHODS
A systematic search was undertaken in Pubmed, Embase, and Web of Science from inception to March 2023 to find cohort studies investigating the association between prognostic factors and adverse outcomes of severe pneumonia in adult patients. The study selection process involved screening the title and abstract of articles to identify relevant studies on severe pneumonia in adult patients. Inclusion criteria included studies with a prospective or retrospective longitudinal design, investigating prognostic factors, and performing multivariate analysis. Exclusion criteria included non-English or non-Chinese studies, studies focusing on severe pneumonia in children, studies conducting only univariate analysis, and conference abstracts, reviews, and case reports. The risk of bias was assessed by the Quality In Prognosis Studies (QUIPS) tool.
RESULTS
A total of 27 published studies, including both prospective and retrospective cohort studies, were included. These studies reported on 53 different prognostic factors and covered four unique outcomes. The quality assessment indicated that 59.3% of the studies had a low risk of bias. Age, functional dependence, heart rate, and oxygen saturation/respiratory rate index were found to be associated with mortality. Additionally, various laboratory indexes, such as serum cholinesterase, albumin, and blood urea nitrogen to creatinine ratio, demonstrated either protective or risk factors for prognosis. Injury and comorbidities, including acute renal failure, chronic lung disease, and Glasgow Coma Scale, were identified as risk factors for mortality. Scoring tools like Acute Physiological and Chronic Health Evaluation (APACHE) II score, CURB-65 score, and Pneumonia Severity Index (PSI) score showed associations with mortality. Lastly, certain treatment protocols, such as vasoactive agent use, vasopressor use, and mechanical ventilation, were found to increase the risk of mortality, while invasive mechanical ventilation and the use of remdesivir and steroids had a positive impact on prognosis. These findings provide valuable insights for clinicians in predicting and managing severe pneumonia outcomes.
CONCLUSION
This most comprehensive review identified 53 unique prognostic factors of severe pneumonia, which provided a reference for subsequent researchers to construct models to predict clinical outcomes in patients with severe pneumonia for clinical use. By identifying prognostic factors through multivariate analysis, healthcare providers can better assess the severity and prognosis of individual patients. This knowledge can aid in treatment planning, resource allocation, and determining the appropriate level of care for patients with severe pneumonia. Additionally, understanding the prognostic factors can help identify high-risk patients who may require more intensive monitoring or interventions. Overall, this study provides valuable insights that can inform clinical practice and improve patient outcomes in the management of severe pneumonia.
PubMed: 37971449
DOI: No ID Found -
Frontiers in Endocrinology 2024Thin endometrium (TE) is defined as a mid-luteal endometrial thickness ≤7mm. TE can affect endometrial tolerance, leading to lower embryo implantation rates and...
Thin endometrium (TE) is defined as a mid-luteal endometrial thickness ≤7mm. TE can affect endometrial tolerance, leading to lower embryo implantation rates and clinical pregnancy rates, and is also associated with impaired outcomes from assisted reproductive treatment. Herein, we systematically review TE causes, mechanisms, and treatments. TE pathogenesis has multiple causes, with the endometrium becoming thinner with age under hormonal influence. In addition, uterine cavity factors are important, as the inflammatory environment may affect expressions of certain genes thereby inhibiting endometrial stromal cell proliferation and promoting apoptosis. Long-term oral contraceptive use or the use of ovulation-promoting drugs are also definite factors contributing to endometrial thinning. Other patients have primary factors, for which the clinical etiology remains unknown. The main therapeutic strategies available for TE are pharmacological (including hormonal and vasoactive drugs), regenerative medicine, intrauterine infusion of growth factor-granulocyte colony-stimulating factor, autologous platelet-rich plasma, and complementary alternative therapies (including traditional Chinese herbal medicine and acupuncture). However, the associated mechanisms of action are currently unclear. Clinical scholars have proposed various approaches to improve treatment outcomes in patients with TE, and are exploring the principles of efficacy, offering potentials for novel treatments. It is hoped that this will improve TE tolerance, increase embryo implantation rates, and help more couples with infertility with effective treatments.
Topics: Female; Humans; Pregnancy; Embryo Implantation; Endometrium; Infertility, Female
PubMed: 38745960
DOI: 10.3389/fendo.2024.1269382 -
Brain Sciences Dec 2023Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme expressed in different cells of the central nervous system (CNS) and involved in the... (Review)
Review
BACKGROUND
Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme expressed in different cells of the central nervous system (CNS) and involved in the regulation of cerebral blood flow (CBF). The aim of this review was to understand the effects of acetazolamide on CBF, intracranial pressure (ICP) and brain tissue oxygenation (PbtO) after an acute brain injury (ABI).
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA), we performed a comprehensive, computer-based, literature research on the PubMed platform to identify studies that have reported the effects on CBF, ICP, or PbtO of acetazolamide administered either for therapeutic or diagnostic purposes in patients with subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, and hypoxic-ischemic encephalopathy.
RESULTS
From the initial search, 3430 records were identified and, through data selection, 11 of them were included for the qualitative analysis. No data on the effect of acetazolamide on ICP or PbtO were found. Cerebral vasomotor reactivity (VMR-i.e., the changing in vascular tone due to a vasoactive substance) to acetazolamide tends to change during the evolution of ABI, with the nadir occurring during the subacute stage. Moreover, VMR reduction was correlated with clinical outcome.
CONCLUSIONS
This systematic review showed that the available studies on the effects of acetazolamide on brain hemodynamics in patients with ABI are scarce. Further research is required to better understand the potential role of this drug in ABI patients.
PubMed: 38137126
DOI: 10.3390/brainsci13121678 -
International Wound Journal Aug 2023Sepsis is a potentially lethal condition that occurs when the body's response to infection damages tissue and organs. The production of inflammatory mediators typically... (Meta-Analysis)
Meta-Analysis
Sepsis is a potentially lethal condition that occurs when the body's response to infection damages tissue and organs. The production of inflammatory mediators typically assists in defending the body against infection; however, an overreaction to inflammation can cause coagulation problems, vascular endothelial damage, and organ hypoperfusion. Blood purification methods, such as plasmapheresis, can effectively remove inflammatory mediators from plasma. The purpose of this meta-analysis was to explore the efficacy of plasma exchange for sepsis treatment as noted in recent studies. The authors searched the Pubmed (Medline), Cochrane Central Register of Controlled Trials (The Cochrane Library), Embase (Ovid), and Scopus databases and included controlled clinical studies that compared plasmapheresis or plasma filtration with conventional treatment in patients with severe sepsis. The Newcastle-Ottawa Scale literature quality assessment tool was used to assess the risk of bias. The primary study outcome was all-cause mortality. The random effects model was adopted for conducting the meta-analysis. Among the 1013 records found, the study included 5 trials, all of which carried a low risk of bias. The use of plasmapheresis was associated with a longer stay in the intensive care unit (odds ratio [OR], 0.85, 95% confidence interval [CI], 0.39-1.32, heterogeneity [I ] = 0%), a significant reduction in all-cause mortality (OR, 0.54, 95% CI, 0.33-0.89, I = 70%), and reduced mortality (OR, 0.29, 95% CI, 0.13-0.67, I = 0%) in adults; the results for children differed from this (OR, 0.79, 95% CI, 0.36-1.72, I = 89%). Four trials reported no adverse events; one trial reported an adverse event related to plasma exchange, including an instance of hypotension in one patient. Plasmapheresis appeared to be an effective treatment for patients suffering from sepsis. A large number of additional randomised controlled trials are needed to confirm this finding.
Topics: Humans; Plasma Exchange; Sepsis; Treatment Outcome; Controlled Clinical Trials as Topic
PubMed: 36717980
DOI: 10.1111/iwj.14059 -
Frontiers in Pharmacology 2024Cardiogenic shock (CS) is the primary cause of death in patients suffering acute myocardial infarction. As an emerging and efficacious therapeutic approach, Chinese... (Review)
Review
Comparative efficacy of Chinese herbal injections in patients with cardiogenic shock (CS): a systematic review and Bayesian network meta-analysis of randomized controlled trials.
Cardiogenic shock (CS) is the primary cause of death in patients suffering acute myocardial infarction. As an emerging and efficacious therapeutic approach, Chinese herbal injections (CHIs) are gaining significant popularity in China. However, the optimal CHIs for treating CS remain uncertain. We searched eight databases from inception to 30 September 2023. Subsequently, we conducted the Bayesian network meta-analysis (NMA). Interventions were ranked based on the surface under the cumulative ranking curve (SUCRA) probability values. To compare the effects of CHIs on two distinct outcomes, a clustering analysis was performed. Furthermore, the quality of the studies was assessed. For the study, we included 43 RCTs, encompassing 2,707 participants. The study evaluated six herbal injections, namely, Shenfu injection (SF), Shengmai injection (SM), Shenmai injection (Sm), Danshen injection (DS), Huangqi injection (HQ), and Xinmailong injection (XML). The analysis findings suggested that Sm (MD = -1.05, 95% CI: -2.10, -0.09) and SF (MD = -0.81, 95% CI: -1.40, -0.25) showed better efficacy compared to Western medicine (WM) alone in reducing in-hospital mortality. The SUCRA values revealed that Sm + WM ranked first in terms of in-hospital mortality, cardiac index (CI), and hourly urine output but second in improving left ventricular ejection fraction (LVEF) and mean arterial pressure (MAP). SF + WM, however, had the greatest impact on raising the clinical effective rate. In MAP, SM + WM came out on top. Moreover, in terms of safety, only 14 studies (31.8%), including five types of CHIs: SF, Sm, SM, HQ, and XML, observed adverse drug reactions. To summarize, this analysis discovered that, in terms of patients suffering from CS, CHIs + WM yielded significantly greater advantages than WM alone. Based on in-hospital mortality and the remaining outcomes, Sm performed excellently among all the involved CHIs. : https:// www.Crd.york.ac.uk/prospero/, identifier: CRD42022347053.
PubMed: 38476325
DOI: 10.3389/fphar.2024.1348360