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Paediatric Anaesthesia Nov 2023Conventionally, tracheal tubes have been used for general anesthesia in pediatric laparoscopic surgeries. Recently, supraglottic devices are being used for the same. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Conventionally, tracheal tubes have been used for general anesthesia in pediatric laparoscopic surgeries. Recently, supraglottic devices are being used for the same. The performance of supraglottic devices versus tracheal tubes in children undergoing laparoscopic surgery is uncertain.
METHODS
A systematic review and meta-analysis of randomized controlled trials that compared supraglottic devices versus tracheal tubes in patients ≤18 years undergoing laparoscopic surgery under general anesthesia was conducted. The outcomes were peak airway pressures (cm H O), end-tidal carbon dioxide during pneumoperitoneum (mm Hg), recovery time (min), postoperative sore throat and adverse events. Mean difference and odds ratio, with 95% confidence intervals were reported using a random effect model.
RESULTS
Eight trials (n = 591) were included in the final meta-analysis. There was no statistically significant difference in the peak airway pressures (MD 0.58, 95% CI: -0.65 to 1.8; p = .36) and end-tidal carbon dioxide (MD -0.60, 95% CI: -2.00 to 0.80; p = .40) during pneumoperitoneum in the supraglottic device and the tracheal tube group. The tracheal tube group had higher odds of sore throat (OR 3.30, 95% CI: 1.69-6.45; p = .0005) and the supraglottic airway group had faster recovery time (MD 4.21, 95% CI: 3.12-5.31; p < .0001), which were statistically significant. The certainty of evidence is graded low.
CONCLUSION
There is low quality evidence to suggest that for pediatric laparoscopic surgeries of short duration, supraglottic devices could provide comparable intraoperative ventilation in terms of peak airway pressures and end tidal carbon dioxide, with lower odds of postoperative sore throat and faster recovery time when compared to tracheal tubes.
Topics: Humans; Child; Intubation, Intratracheal; Carbon Dioxide; Pneumoperitoneum; Laparoscopy; Pharyngitis; Laryngeal Masks
PubMed: 37386873
DOI: 10.1111/pan.14725 -
International Journal of Pediatric... Aug 2021allergy may be an important risk factor for adenotonsillar disease in children, although conflicting results have been reported in the literature. In previous articles,...
INTRODUCTION
allergy may be an important risk factor for adenotonsillar disease in children, although conflicting results have been reported in the literature. In previous articles, authors often failed in distinguishing between adeno-tonsillar hypertrophy and recurrent tonsillitis and in not discriminating between isolated or combined adenoid and tonsillar hypertrophy.
AIM
to evaluate clinical evidence and biomarkers linking allergy to different phenotypes of adeno-tonsillar disease. Furthermore, we questioned whether anti-allergy treatment might prevent occurrence of adeno-tonsillar disease or improve its specific management.
METHODS
our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1010 articles finally screened. This resulted in 21 full texts that were included in a qualitative analysis.
RESULTS
literature data support the association between allergy and combined adeno-tonsillar hypertrophy and isolated adenoid hypertrophy, whereas describe a mainly negative correlation between allergy and isolated tonsillar hypertrophy. The results of this review suggest that local allergic inflammation may play a role in adeno-tonsillar hypertrophy. Data correlating bacterial recurrent tonsillitis and allergy are few, although evidence from the lab revealed that allergy might suppress innate immunity in tonsillar tissue by reducing levels of anti-microbial proteins.
CONCLUSION
basing on our qualitative analyses allergy should not be misdiagnosed in children with combined adenotonsillar hypertrophy or isolated adenoid hypertrophy, whereas evidence do not support a link between allergy and isolated tonsil hypertrophy. Finally, some data support a link between allergy and recurrent adeno-tonsillar infection although future studies are required to confirm this data. We summarized our conclusions in a practical algorithm.
Topics: Biomarkers; Child; Humans; Hypersensitivity; Hypertrophy; Palatine Tonsil; Tonsillectomy; Tonsillitis
PubMed: 34153930
DOI: 10.1016/j.ijporl.2021.110799 -
Otolaryngology--head and Neck Surgery :... Feb 2021To review all available biomedical literature to assess published data regarding the effect of pediatric tonsillectomy on the culture results of potentially pathogenic... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To review all available biomedical literature to assess published data regarding the effect of pediatric tonsillectomy on the culture results of potentially pathogenic respiratory pharyngeal bacteria before and after surgery.
DATA SOURCES
Biomedical literature databases (PubMed, Embase, Web of Science) from January 1970 to December 2019.
REVIEW METHODS
A systematic review of the literature was performed with the assistance of a medical librarian. Inclusion criteria consisted of pediatric patients and extractable data regarding respiratory bacteria culture data before and after tonsillectomy. Meta-analysis with random effects modeling was used on a limited basis.
RESULTS
Only 5 studies met the inclusion criteria. The grand mean age was 5.9 years; the sample size range was 31 to 134; and the range of follow-up was 1 to 12 months. Group A beta hemolytic was generally the least commonly cultured pathogenic bacteria on preoperative cultures. Qualitative culture data generally showed an overall decrease in potentially pathogenic bacteria and some increase in nonpathologic respiratory flora after tonsillectomy. Meta-analysis showed significant reductions in postoperative culture rates for group A beta hemolytic (positive post- vs preoperative culture: risk ratio [RR], 0.144; 95% CI, 0-0.342), (RR, 0.437; 95% CI, 0.266-0.608), and (RR, 0.268; 95% CI, 0-0.567) and mixed results for (0.736; 95% CI, 0.446-1.03) but no significant reduction for (RR, 0.774; 95% CI, 0.157-1.39).
CONCLUSION
The majority of published evidence shows that pediatric tonsillectomy appears to reduce the quantity of most cultured potentially pathogenic respiratory bacteria in the pharynx after surgery. The implications and possible benefits of this favorable change in the microbiologic environment after surgery require further study.
Topics: Bacteria; Child; Humans; Pharynx; Postoperative Period; Tonsillectomy; Tonsillitis
PubMed: 32689869
DOI: 10.1177/0194599820944907 -
European Archives of... Jun 2022The aims of this systematic review were to (1) explore the evidence for improved quality of life (QOL) in adult patients undergoing tonsillectomy because of recurrent... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aims of this systematic review were to (1) explore the evidence for improved quality of life (QOL) in adult patients undergoing tonsillectomy because of recurrent acute tonsillitis (RT) and (2) evaluate which set of guidelines for tonsillectomy in adult RT patients is preferable, using QOL as outcome measure.
METHODS
A systematic search was conducted in the PubMed, Embase, and Scopus databases. RCT/cohort studies exploring the effect of elective tonsillectomy in adult RT patients using any QOL assessment tool no less than 6 months after surgery were included. Studies were divided into two guideline groups based on the number of tonsillitis episodes required for tonsillectomy (Group 1: ≥ 5; Group 2: ≤ 4).
RESULTS
A total of 364 unique records were identified. Seven studies (n = 409 patients) were included in a qualitative analysis and four studies were included in a meta-analysis. Patients' QOL rose significantly, primarily because of improvements in the general and physical domains. In the meta-analysis, 96% (293/304) of patients benefitted from tonsillectomy. Patients included in guideline Group 1 studies had significantly higher QOL scores (Glasgow Benefit Inventory (GBI) 39.6) compared to patients in Group 2 studies (GBI 24.9) (p < 0.001).
CONCLUSION
Adult patients undergoing tonsillectomy because of RT reported improved QOL 6-84 months after surgery. The benefit of tonsillectomy was higher among patients in studies with a higher minimum number of tonsillitis episodes compared to those included in studies with less strict criteria. Whether the improved QOL outweigh the morbidity associated with surgery in both guideline groups remains unclear.
Topics: Acute Disease; Adult; Humans; Quality of Life; Recurrence; Tonsillectomy; Tonsillitis
PubMed: 35044507
DOI: 10.1007/s00405-022-07260-7 -
Sexual Health Aug 2019We conducted a systematic review and meta-analysis of published randomised controlled trials of dapoxetine for premature ejaculation. We systematically searched Embase,... (Meta-Analysis)
Meta-Analysis
We conducted a systematic review and meta-analysis of published randomised controlled trials of dapoxetine for premature ejaculation. We systematically searched Embase, PubMed, Cochrane, Web of Knowledge, FDA.gov and Clinical Trials.gov for studies reporting dapoxetine in men with premature ejaculation. Efficacy endpoints included intravaginal ejaculatory latency times (IELT), personal distress related to ejaculation (PDRE) and treatment-emergent adverse events (TEAEs) was used to evaluate safety. Data were analysed using a random-effects model. Electronic search identified 276 papers. The final analysis included eight papers (n = 8422 subjects). Analysis of the pooled results indicated efficacy in both IELT (weighted mean difference (WMD) = 1.67, 95% confidence interval (CI) 1.45-1.89) and PDRE (relative risk = 1.26, 95% CI 1.18-1.35). Subgroup analysis indicated efficacy (i.e. increase in IELT) for 30- and 60-mg on-demand dapoxetine (WMD 1.38 (95% CI 1.01-1.75) and 1.62 (95% CI 1.40-1.84) respectively), as well as daily use of 60 mg dapoxetine (WMD 2.18, 95% CI 1.71-2.64). The safety profile was acceptable. Based on the different effects of magnitude of the three dosing regimens, we recommend a stepwise approach, starting with 30 mg on demand, then 60 mg on demand and finally 60 mg dapoxetine daily.
Topics: Benzylamines; Diarrhea; Dizziness; Headache; Humans; Male; Naphthalenes; Nasopharyngitis; Nausea; Premature Ejaculation; Psychological Distress; Selective Serotonin Reuptake Inhibitors; Time Factors; Treatment Outcome
PubMed: 32172793
DOI: 10.1071/SH18005 -
Canadian Journal of Anaesthesia =... Oct 2019Postoperative sore throat (POST) is a relatively common morbidity. Topical lidocaine lubricants have been proposed to prevent POST; however, their effectiveness remains... (Meta-Analysis)
Meta-Analysis
PURPOSE
Postoperative sore throat (POST) is a relatively common morbidity. Topical lidocaine lubricants have been proposed to prevent POST; however, their effectiveness remains uncertain. This meta-analysis aimed to evaluate the prophylactic effect of lidocaine lubrications against POST, cough, and hoarseness in adult patients after surgery.
METHODS
Randomized-controlled trials from PubMed, Embase, the Cochrane Library, and the ClinicalTrials.gov registry that were published from inception until 26 March 2018 were included that compared the effectiveness of lidocaine lubricants with that of controls in preventing the incidence of overall POST and moderate to severe POST (POSTMS) at the first and 24th postoperative hour (POST-1h, POST-24h, POSTMS-1h, and POSTMS-24h). Postoperative cough and hoarseness at the 24th postoperative hour were also studied. Bias assessment and subgroup, sensitivity, and trial sequential analyses were also performed.
RESULTS
Fourteen randomized-controlled trials (n = 2146) were selected. The incidences of POST-1h and POST-24h were 41.1 % and 22.6 % for the lidocaine group, and 41.9% and 23.5% for the control group, respectively. No effect was found on any of the outcome measurements. The overall risk ratios were 1.11 (95% confidence interval [CI], 0.82 to 1.51) and 1.06 (95% CI, 0.37 to 3.02) for the incidence of POST-1h and POSTMS-1h, respectively; 0.99 (95% CI, 0.83 to 1.17) and 0.49 (95% CI, 0.16 to 1.50) for POST-24h and POSTMS-24h, respectively; and, 1.09 (95% CI, 0.71 to 1.66) and 0.91 (95% CI, 0.66 to1.24) for postoperative cough (PC)-24h and postoperative hoarseness (PH)-24h, respectively.
CONCLUSION
Lidocaine lubricants applied on the tips of endotracheal tube are not effective against the morbidities of POST, PC, and PH.
TRIAL REGISTRATION
PROSPERO (CRD42017073259); registered 26 October, 2017.
Topics: Adult; Anesthetics, Local; Cough; Hoarseness; Humans; Intubation, Intratracheal; Lidocaine; Lubricants; Pharyngitis; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 31187403
DOI: 10.1007/s12630-019-01408-6 -
Otolaryngology--head and Neck Surgery :... Oct 2023To investigate the impact of the surgical indication on posttonsillectomy bleed rates. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the impact of the surgical indication on posttonsillectomy bleed rates.
DATA SOURCES
PubMed, Scopus, CINAHL.
REVIEW METHODS
A systematic review was performed searching for articles published from the date of inception to July 6, 2022. English language articles describing posttonsillectomy hemorrhage rates in pediatric patients (age ≤ 18) stratified by indication were selected for inclusion. A meta-analysis of proportions with comparison (Δ) of weighted proportions was conducted. All studies were assessed for risk of bias.
RESULTS
A total of 72 articles with 173,970 patients were selected for inclusion. The most common indications were chronic/recurrent tonsillitis (CT/RT), obstructive sleep apnea/sleep-disordered breathing (OSA/SDB), and adenotonsillar hypertrophy (ATH). Posttonsillectomy hemorrhage rates for CT/RT, OSA/SDB, and ATH were 3.57%, 3.69%, and 2.72%, respectively. Patients operated on for a combination of CT/RT and OSA/SDB had a bleed rate of 5.99% which was significantly higher than those operated on for CT/RT alone (Δ2.42%, p = .0006), OSA/SDB alone (Δ2.30%, p = .0016), and ATH alone (Δ3.27%, p < .0001). Additionally, those operated on for a combination of ATH and CT/RT had a hemorrhage rate of 6.93%, significantly higher than those operated on for CT/RT alone (Δ3.36%, p = .0003), OSA/SDB alone (Δ3.01%, p = .0014), and ATH alone (Δ3.98%, p < .0001).
CONCLUSION
Patients operated on for multiple indications had significantly higher rates of posttonsillectomy hemorrhage than those operated on for a single surgical indication. Better documentation of patients with multiple indications would help further characterize the magnitude of the compounding effect described here.
Topics: Child; Humans; Tonsillectomy; Sleep Apnea, Obstructive; Palatine Tonsil; Adenoidectomy; Tonsillitis; Hemorrhage; Hypertrophy
PubMed: 37003296
DOI: 10.1002/ohn.339 -
Zhongguo Zhong Yao Za Zhi = Zhongguo... Nov 2023This study aims to systematically review the efficacy and safety of Shufeng Jiedu Capsules in the treatment of influenza. The randomized controlled trial(RCT) of Shufeng... (Meta-Analysis)
Meta-Analysis
This study aims to systematically review the efficacy and safety of Shufeng Jiedu Capsules in the treatment of influenza. The randomized controlled trial(RCT) of Shufeng Jiedu Capsules alone or in combination with conventional western medicine for treating influenza were retrieved from PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, VIP, Wanfang, and ClinicalTrails.gov. The data analysis was performed in RevMan 5.4.1. The Cochrane risk of bias assessment tool was used to evaluate the quality of the involved RCT, and GRADEpro GDT to assess the quality of the evidence. A total of 11 RCTs involving 1 836 patients were included in this study. Compared with conventional western medicine, Shufeng Jiedu Capsules/Shufeng Jiedu Capsules + conventional western medicine improved the response rate(RR=1.09, 95%CI[1.03, 1.15], P=0.002), shortened the time to relief of cough, and increased the 3-day sore throat relief rate, whereas there was no significant difference in the time to fever abatement, the time to relief of sore throat, 3-day cough relief rate, or 3-day runny nose relief rate. Subgroup-analysis showed that Shufeng Jiedu Capsules + conventional western medicine improved the response rate(RR=1.11, 95%CI[1.08, 1.15], P<0.000 01), shortened the time to relief of cough, and increased the 3-day relief rate of symptoms(cough, sore throat, and runny nose) compared with conventional western medicine alone, while there was no significant difference in the time to fever abatement or the time to relief of sore throat. Shufeng Jiedu Capsules alone could not improve the response rate(RR=0.97, 95%CI[0.93, 1.02], P=0.19). In addition, Shufeng Jiedu Capsules/Shufeng Jiedu Capsules + conventional western medicine vs conventional western medicine were no significant difference in adverse reactions(RR=0.98, 95%CI[0.57, 1.69], P=0.95). The available evidence suggests that Shufeng Jiedu Capsules is effective and safe in the treatment of influenza, and the combination of Shufeng Jiedu Capsules with conventional western medicine can accelerate the relief of symptoms. However, since the number and quality of the included studies were low, the above findings remained to be further verified by multicenter RCT with large sample sizes.
Topics: Humans; Influenza, Human; Drugs, Chinese Herbal; Capsules; Cough; Pharyngitis; Rhinorrhea; Multicenter Studies as Topic
PubMed: 38114228
DOI: 10.19540/j.cnki.cjcmm.20230804.501 -
Journal of Drugs in Dermatology : JDD Aug 2022Patients treated with biological therapy for hidradenitis suppurativa (HS) are at an increased risk of infectious complications. However, it is unclear whether these... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patients treated with biological therapy for hidradenitis suppurativa (HS) are at an increased risk of infectious complications. However, it is unclear whether these patients are at an increased risk of acquiring infections. The most common infection reported in patients taking biologic therapies are respiratory tract infections. The purpose of this study is to review the risk and incidence rate of upper respiratory tract infections (URTI), nasopharyngitis, and influenza in patients treated with biologics for HS.
METHODS
A comprehensive literature search was completed using databases (MEDLINE and EMBASE) and clinical trial registries (clinicaltrials.gov) to identify trials that reported the risk and incidence rate of URTIs, nasopharyngitis, and influenza in patients using biological therapy for moderate to severe HS. Each study was assessed for bias using the GRADE system.
FINDINGS
There were nine studies included in this review including five placebo-controlled studies of patients with moderate to severe HS treated with biological therapy. We found the risk of URTI, nasopharyngitis, and influenza was not significantly different in patients taking biological therapy when compared to placebo (RR 1.23; 95% CI 0.66-2.30and RR 0.93; 95% CI 0.66-1.31, RR 1.03; 95% CI 0.41-2.56, respectively).
CONCLUSIONS
This systematic review and meta-analysis did not find significantly different risks of URTI, nasopharyngitis, and influenza in patients taking biological therapy when compared to placebo. However, these data were limited by the sample size and number of studies available. Future high-quality, high-power, and long-term studies are needed to support the data available on this topic. J Drugs Dermatol. 2022;21(8): 819-824. doi:10.36849/JDD.6433.
Topics: Biological Products; Hidradenitis Suppurativa; Humans; Incidence; Nasopharyngitis; Respiratory Tract Infections
PubMed: 35946977
DOI: 10.36849/JDD.6433 -
Journal of the European Academy of... Dec 2022Tumour necrosis factor inhibitors (TNFis) are commonly used for treating psoriatic diseases; however, the risk of infection while receiving TNFis remains uncertain. The... (Meta-Analysis)
Meta-Analysis Review
Tumour necrosis factor inhibitors (TNFis) are commonly used for treating psoriatic diseases; however, the risk of infection while receiving TNFis remains uncertain. The aim of this study was to investigate the infection risk in patients with psoriatic disease receiving TNFis. A prospectively registered systematic literature search was conducted in Medline (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and the ClinicalTrials.gov databases from inception to December 31, 2021. We included double-blind randomized controlled trials that compared TNFis or other biologics with placebo in adults with psoriasis or psoriatic arthritis. The primary outcomes included overall and serious infection risks, and secondary outcomes included upper respiratory infections and nasopharyngitis risks. The risk ratio of the dichotomous outcome was calculated using the Mantel-Haenszel method with random effects, and heterogeneity was assessed using Cochran's Q statistic and quantified using the I-squared statistic. A total of 48 studies with 15 464 patients with psoriatic diseases were included. The meta-analysis demonstrated a slightly increased overall infection risk (risk ratio = 1.09; 95% confidence interval, 1.02-1.15) but not serious infection risk (risk ratio = 0.95; 95% confidence interval, 0.61-1.49) among patients receiving TNFis. There were also no increased risks of upper respiratory infections (risk ratio = 1.10; 95% confidence interval, 0.94-1.28) or nasopharyngitis (risk ratio = 1.14; 95% confidence interval, 1.00-1.30). In subgroup analyses using the fixed effects model, only etanercept and certolizumab pegol were, respectively, associated with an increased risk of overall infection (RR = 1.14, 95% CI, 1.03-1.27) and upper respiratory infections (RR = 1.42, 95% CI, 1.02-1.98). In conclusion, evidence to date suggests an increased overall infection risk that is generally tolerable in patients with psoriatic diseases receiving TNFis. There are no increased risks of serious infections, upper respiratory infections or nasopharyngitis.
Topics: Adult; Humans; Tumor Necrosis Factor Inhibitors; Nasopharyngitis; Randomized Controlled Trials as Topic; Certolizumab Pegol; Etanercept
PubMed: 35793472
DOI: 10.1111/jdv.18407