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Children (Basel, Switzerland) Aug 2023Hirschsprung disease (HD) is characterized by absent neuronal innervation of the distal colonic bowel wall and is surgically treated by removing the affected bowel... (Review)
Review
BACKGROUND
Hirschsprung disease (HD) is characterized by absent neuronal innervation of the distal colonic bowel wall and is surgically treated by removing the affected bowel segment via pull-through surgery (PT). Incomplete removal of the affected segment is called transition zone anastomosis (TZA). The current systematic review aims to provide a comprehensive overview of the prevalence and clinical impact of TZA.
METHODS
Pubmed, Embase, Cinahl, and Web of Sciences were searched (last search: October 2020), and studies describing histopathological examination for TZA in patients with HD were included. Data were synthesized into aggregated Event Rates (ER) of TZA using random-effects meta-analysis. The clinical impact was defined in terms of obstructive defecation problems, enterocolitis, soiling, incontinence, and the need for additional surgical procedures. The quality of studies was assessed using the Newcastle-Ottawa Scale.
KEY RESULTS
This systematic review included 34 studies, representing 2207 patients. After excluding series composed of only patients undergoing redo PT, the prevalence was 9% (ER = 0.09, 95% CI = 0.05-0.14, < 0.001, I = 86%). TZA occurred more often after operation techniques other than Duhamel (X = 19.21, = <0.001). Patients with TZA often had obstructive defecation problems (62%), enterocolitis (38%), soiling (28%), and fecal incontinence (24%) in follow-up periods ranging from 6 months to 13 years. Patients with TZA more often had persistent obstructive symptoms (X = 7.26, = 0.007).
CONCLUSIONS AND INFERENCES
TZA is associated with obstructive defecation problems and redo PT and is thus necessary to prevent.
PubMed: 37761437
DOI: 10.3390/children10091475 -
Canadian Journal of Gastroenterology &... 2022This systematic review aimed to summarize evidence to determine the effectiveness of kiwifruit or kiwifruit extracts in the treatment of constipation. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This systematic review aimed to summarize evidence to determine the effectiveness of kiwifruit or kiwifruit extracts in the treatment of constipation.
METHODS
Electronic databases were searched from inception to May 2022 without any age or language limitations. Eligible studies enrolled participants with constipation who were randomized to receive kiwifruit or kiwifruit extracts vs. any nonkiwifruit control. Standardized mean difference (SMD) and mean difference (MD) with confidence intervals (CI) were determined for the following outcomes: frequency of spontaneous bowel movements (SBM), abdominal pain and straining, as well as stool type as determined by the Bristol Stool Scale (BSS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to rate the certainty of evidence. Our review was registered on PROSPERO (CRD42021239397).
RESULTS
Seven RCTs, including 399 participants (82% female; mean age: 42 years (SD 14.6)), were included. Compared with placebo ( = 95), kiwifruit extracts might increase the weekly frequency of SBM (MD: 1.36; 95% CI: -0.44, 3.16) with low certainty of evidence; moreover, it had an uncertain effect on BSS (SMD: 1.54; 95% CI: -1.33, 4.41) with very low certainty of evidence. Additionally, compared with placebo ( = 119), kiwifruit or its extracts reduced abdominal pain (SMD: -1.44, 95% CI -2.83, -1.66) with moderate certainty of the evidence and improved frequency of straining (SMD: -0.29; 95% CI: -1.03, 0.47). Compared with psyllium, kiwifruit may increase the weekly frequency of SBM (MD: 1.01; 95% CI: -0.02, 2.04) with moderate certainty evidence, and may increase the value on the BSS (indicating softer stools) (MD: 0.63; 95% CI: 0.01, 1.25)with low certainty of evidence. Compared to placebo, kiwifruit-encapsulated extracts may result in an increase in minor adverse events (relative risk: 4.58; 95% CI: 0.79, 26.4).
CONCLUSIONS
Among individuals with constipation, there is an overall low certainty of evidence indicating that kiwifruit may increase SBM when compared to placebo or psyllium. Although overall results are promising, establishing the role of kiwifruit in constipation requires large, methodologically rigorous trials. : PROSPERO registration number CRD42021239397.
Topics: Abdominal Pain; Adult; Constipation; Defecation; Female; Humans; Male; Plant Extracts; Psyllium; Randomized Controlled Trials as Topic
PubMed: 36247043
DOI: 10.1155/2022/7596920 -
Complementary Therapies in Medicine May 2023Postoperative gastrointestinal dysfunction (PGD) is a common complication in patients undergoing gastrointestinal surgery. Several studies have evaluated the effect of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative gastrointestinal dysfunction (PGD) is a common complication in patients undergoing gastrointestinal surgery. Several studies have evaluated the effect of transcutaneous electrical acupoint stimulation (TEAS) on PGD, so we conducted a systematic review and meta-analysis to better understand these studies methodologic limitations and summarize clinical effects.
METHODS
Articles (published from January 2010 to April 2022) were searched from the following databases: Wanfang Database, China National Knowledge Infrastructure (CNKI), Cochrane Library, PubMed, Web of Science and Embase. Two authors conducted literature selection, data extraction and statistical analysis independently. This meta-analysis used RevMan 5.4 software to implement statistical analysis and applied Cochrane bias risk tool to assess methodologic weaknesses of included articles. We assessed the effect of TEAS on time to first flatus, first defecation and bowel sound recovery through meta-analyses using a random-effects model.
RESULTS
The meta-analysis included 10 articles including 1497 patients. This study showed that TEAS could effectively promote postoperative gastrointestinal function recovery by analyzing the time to first flatus (MD-14.81 h, 95% CI -15.88 to -13.75 h), time to first defecation (MD-14.68 h, 95% CI -20.59 to -8.76 h), time to bowel sound recovery (MD-5.79 h, 95% CI -10.87 to -0.71 h), length of hospital stay (MD-1.48d, 95% CI -1.86 to -1.11d), and the incidence of postoperative nausea and vomiting (PONV) (OR 0.41, 95% CI 0.29-0.58). In addition, we assessed the quality of the articles and found small sample sizes and lower methodological quality in some articles.
CONCLUSION
Our meta-analysis revealed that TEAS could be a nonpharmacological treatment for PGD in patients after gastrointestinal surgery. However, positive findings should be treated carefully and future studies with high quality and large samples are needed to support this results.
Topics: Humans; Digestive System Surgical Procedures; Acupuncture Points; Flatulence; Postoperative Nausea and Vomiting; Postoperative Period; Gastrointestinal Diseases
PubMed: 36842636
DOI: 10.1016/j.ctim.2023.102938 -
Annals of Medicine Dec 2024Although ERAS Program had some advantages in laparoscopic distal gastrectomy (LDG), its efficacy and safety remained unclear. We conducted a systematic review and... (Meta-Analysis)
Meta-Analysis
The efficacy and safety of enhanced recovery after surgery (ERAS) Program in laparoscopic distal gastrectomy: a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
Although ERAS Program had some advantages in laparoscopic distal gastrectomy (LDG), its efficacy and safety remained unclear. We conducted a systematic review and meta-analysis to assess the efficacy and safety of the ERAS group and the traditional care (TC) group in LDG.
METHODS
Multiple databases were retrieved from 1 January 2000 to 30 April 2023. The risk ratio (RR), standardized mean difference (SMD) and their 95% confidence interval (CI) were used to estimate the results.
RESULTS
Our meta-analysis contained 17 randomized controlled trials (RCTs) studies, which comprised 1468 patients. Regarding efficacy, the ERAS group had significantly shorter postoperative time to first flatus (SMD = -1.29 [95% CI: -1.68, -0.90]), shorter time to first defecation (SMD = -1.26 [95% CI: -1.90, -0.61]), shorter hospital stays (SMD = -0.99 [95% CI: -1.34, -0.63]), and lower hospitalization costs (SMD = -1.17 [95% CI: -1.86, -0.48]) compared to the TC group. Furthermore, in the ERAS group, C-reactive protein levels were lower on postoperative days 1, 3 or 4, and 7; albumin levels were higher on postoperative days 3 or 4 and 7; and interleukin-6 levels were lower on postoperative days 1 and 3. Regarding safety, the overall postoperative complication rate was lower in the ERAS group (RR: 0.76 [95% CI: 0.60, 0.97]), but there was no significant difference in the individual postoperative complication rate. Other indicators were also not statistically significant.
CONCLUSION
The combination of ERAS Program with laparoscopy surgery was safe and effective for the perioperative management of patients with distal gastric cancer.
Topics: Humans; Enhanced Recovery After Surgery; Randomized Controlled Trials as Topic; Laparoscopy; Length of Stay; Postoperative Complications; Gastrectomy; Treatment Outcome
PubMed: 38279689
DOI: 10.1080/07853890.2024.2306194 -
Frontiers in Psychiatry 2021Clinical evidence suggests that acupuncture is effective for relieving abdominal pain and distension in acute pancreatitis (AP). However, there is a lack of systematic...
Clinical evidence suggests that acupuncture is effective for relieving abdominal pain and distension in acute pancreatitis (AP). However, there is a lack of systematic reviews and meta-analyses that provide high-quality evidence of the efficacy and safety of acupuncture in this context. To assess the efficacy and safety of acupuncture for relieving abdominal pain and distension in AP. We searched the PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, VIP, and China Biomedical Literature databases. Randomized controlled trials of acupuncture plus routine treatment (RT) vs. RT alone or RT plus sham/placebo acupuncture were included. Primary outcomes included total effectiveness rate, VAS scores for abdominal pain and distension, and time until relief of abdominal pain and distension. Secondary outcomes included time until recovery of bowel sound, time until first defecation, length of hospital stay, and APACHE II score. Nineteen eligible original studies ( = 1,503) were included. The results showed that acupuncture in combination with RT had a significant advantage in terms of increasing the total effectiveness rate [risk ratio: 1.15; 95% confidence interval (CI): 1.06-1.24; = 0.001]. Acupuncture also reduced the VAS score for abdominal pain [weighted mean difference (WMD): -1.45; 95% CI: -1.71 to -1.19; < 0.0001] and the VAS score for abdominal distension (WMD: -0.71; 95% CI: -1.04 to -0.37; < 0.0001) in patients with AP. Other results also showed the efficacy of acupuncture. One study reported adverse events after acupuncture. Acupuncture in combination with RT has a better effect than RT alone for relieving abdominal pain and distension in AP. More rigorous studies are needed to confirm this result. PROSPERO CRD42019147503 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=147503).
PubMed: 34925110
DOI: 10.3389/fpsyt.2021.786401 -
The Journal of Pediatrics Oct 2023To summarize available data on defecation frequency and stool consistency of healthy children up to age 4 in order to estimate normal references values. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize available data on defecation frequency and stool consistency of healthy children up to age 4 in order to estimate normal references values.
STUDY DESIGN
Systematic review including cross-sectional, observational, and interventional studies published in English, that reported on defecation frequency and/or stool consistency in healthy children 0-4 years old.
RESULTS
Seventy-five studies were included with 16 393 children and 40 033 measurements of defecation frequency and/or stool consistency. Based on visual inspection of defecation frequency data, a differentiation was made between two age categories: young infants (0-14 weeks old) and young children (15 weeks-4 years old). Young infants had a mean defecation frequency of 21.8 per week (95 % CI, 3.9-35.2) compared with 10.9 (CI, 5.7-16.7) in young children (P < .001). Among young infants, human milk-fed (HMF) infants had the highest mean defecation frequency per week (23.2 [CI, 8.8-38.1]), followed by formula-fed (FF) infants (13.7 [CI 5.4-23.9]), and mixed-fed (MF) infants (20.7 [CI, 7.0-30.2]). Hard stools were infrequently reported in young infants (1.5%) compared with young children (10.5%), and a reduction in the frequency of soft/watery stools was observed with higher age (27.0% in young infants compared with 6.2% in young children). HMF young infants had softer stools compared with FF young infants.
CONCLUSIONS
Young infants (0-14 weeks old) have softer and more frequent stools compared with young children (15 weeks-4 years old).
Topics: Infant; Humans; Child; Child, Preschool; Infant, Newborn; Defecation; Cross-Sectional Studies; Milk, Human; Diarrhea; Food, Formulated; Feces
PubMed: 37331467
DOI: 10.1016/j.jpeds.2023.113559 -
Infectious Diseases 2022A Soil-transmitted helminthic infection (STHIs) remains a notable health problem in resource-limited countries.
BACKGROUND
A Soil-transmitted helminthic infection (STHIs) remains a notable health problem in resource-limited countries.
OBJECTIVE
This systematic review and meta-analysis aimed to determine the overall prevalence of STH infections in Ethiopia.
METHODS
Articles written in English were searched from online public databases. Searching terms taken separately and jointly were "prevalence," "soil-transmitted helminths" "nematode," "Geo-helminths," "roundworm," "Necator," "Ancylostoma," "Ascaris," "Trichuris," "hookworm," "whipworm," "," "associated factors," and "Ethiopia." We used STATA version 14 for meta-analysis and Cochran's Q test statistics and the test for heterogeneity.
RESULT
From 297 reviewed articles 41 fulfilled the inclusion criteria. The pooled prevalence of STH infections in Ethiopia was 36.78% Ascaris lumbricoides had the highest pooled prevalence 17.63%, followed by hook worm12.35%. Trichuris trichiura 7.24% when the prevalence of was 2.16% (95% CI: 0.97-3.35). Age, sex, residence, family education level, lack of shoe wearing habits and open defecation were identified as risk factors for STH infection. Eating unwashed and uncooked fruit and vegetables increased the risk of STH infection by 1.88 times while untrimmed finger nail and lack of hand washing habits increase the risk of STH infection by 1.28 and 3.16 times respectively with 95% CI.
LIMITATION
Lack of published studies from Afar, Gambela, Somali, and Benshangul gumuz regions may affect the true picture. The other limitation is that the search strategy will be restricted articles published only in the English language but there might be articles that published using another language.
CONCLUSION
Ascaris lumbricoides, hookworms and Trichuris trichiura, are the most prevalent soil-transmitted helminthes infections in Ethiopia. Age, sex, residence, family education level, lack of shoe wearing habits Open defecation untrimmed finger nail and lack of hand washing habits significantly associated with STH infection. When eating unwashed, uncooked fruit and vegetables were not significantly associated with STH infection. Strategic use of anti-helminthic, health education, and adequate sanitation, taking into account this epidemiologic information is helpful in the control of STH infections in Ethiopia.
PubMed: 35356097
DOI: 10.1177/11786337211055437 -
The American Journal of Clinical... Sep 2020Chronic undernutrition in children continues to be a global public health concern. Ethiopia has documented a significant decline in the prevalence of childhood stunting,...
BACKGROUND
Chronic undernutrition in children continues to be a global public health concern. Ethiopia has documented a significant decline in the prevalence of childhood stunting, a measure of chronic undernutrition, over the last 20 y.
OBJECTIVES
The aim of this research was to conduct a systematic assessment of the determinants that have driven child stunting reduction in Ethiopia from 2000 to 2016, focused on the national, community, household, and individual level.
METHODS
This study employed both quantitative and qualitative methods. Specifically, a systematic literature review, retrospective quantitative data analysis using Demographic and Health Surveys from 2000-2016, qualitative data collection and analysis, and analyses of key nutrition-specific and -sensitive policies and programs were undertaken.
RESULTS
National stunting prevalence improved from 51% in 2000 to 32% in 2016. Regional variations exist, as do pro-rich, pro-urban, and pro-educated inequalities. Child height-for-age z score (HAZ) decomposition explained >100% of predicted change in mean HAZ between 2000 and 2016, with key factors including increases in total consumable crop yield (32% of change), increased number of health workers (28%), reduction in open defecation (13%), parental education (10%), maternal nutrition (5%), economic improvement (4%), and reduced diarrhea incidence (4%). Policies and programs that were key to stunting decline focused on promoting rural agriculture to improve food security; decentralization of the health system, incorporating health extension workers to improve rural access to health services and reduce open defecation; multisectoral poverty reduction strategies; and a commitment to improving girls' education. Interviews with national and regional stakeholders and mothers in communities presented improvements in health service access, women and girls' education, improved agricultural production, and improved sanitation and child care practices as drivers of stunting reduction.
CONCLUSIONS
Ethiopia's stunting decline was driven by both nutrition-specific and -sensitive sectors, with particular focus on the agriculture sector, health care access, sanitation, and education.
Topics: Adult; Child; Child, Preschool; Ethiopia; Female; Food Security; Growth Disorders; Humans; Infant; Male; Maternal Nutritional Physiological Phenomena; Nutritional Status; Poverty; Retrospective Studies; Rural Population; Sanitation; Young Adult
PubMed: 32844167
DOI: 10.1093/ajcn/nqaa163 -
Journal of Parasitology Research 2020Human intestinal protozoan parasitic infections (HIPPIs) are a series of public health problems in developing countries like Ethiopia. The overall prevalence of HIPPIs... (Review)
Review
BACKGROUND
Human intestinal protozoan parasitic infections (HIPPIs) are a series of public health problems in developing countries like Ethiopia. The overall prevalence of HIPPIs in Ethiopia is not known. Therefore, this systematic review and meta-analysis study is aimed at determining the overall prevalence of HIPPIs in Ethiopia.
METHODS
Articles written in English were searched from online public databases. Searching terms used were "prevalence," "intestinal protozoan parasite," "associated factors," and "Ethiopia." We used Stata version 14 for meta-analysis and Cochran's test statistics and the test for heterogeneity.
RESULT
A total of 286 articles were reviewed, but only 45 of them fulfilled the inclusion criteria. The pooled prevalence of HIPPIs in Ethiopia was 25.01% (95% CI: 20.08%-29.95%) where / is the most prevalent (14.09%, 95% CI: 11.03%-17.14%) followed by (10.03%, 95% CI: 7.69%-12.38%) and spp. (5.93%, 95% CI: 2.95%-8.91%). This meta-analysis showed that family size (OR: 3.7, 95% CI: 1.45-5.85), source of drinking water (OR: 3.33, 95% CI: 1.30-5.36), open field defecation (OR: 2.91, 95% CI: 1.60-4.21), handwashing habit (OR: 2.82, 95% CI: 2.01-3.63), playing with soil (OR: 2.15, 95% CI: 1.01-3.29), the habit of eating raw vegetables (OR: 1.77, 95% CI: 1.03-2.51), and fingernail trimming (OR: 1.70, 95% CI: 0.89-2.25) were strongly associated with the HIPPIs in Ethiopia. High heterogeneity on the prevalence of HIPPIs was observed among studies within and among regions ( > 99% and ≤ 0.01).
CONCLUSION
The prevalence of HIPPIs was significantly high among the Ethiopian population. Family size, source of drinking water, open field defecation, handwashing habit, the habit of eating raw vegetables, and fingernail trimming habits were significantly associated with HIPPIs.
PubMed: 33083045
DOI: 10.1155/2020/8884064 -
Frontiers in Oncology 2023Acupuncture has been shown to be effective in restoring gastrointestinal function in tumor patients receiving the enhanced recovery after surgery (ERAS) protocol. The...
Effect of acupuncture inclusion in the enhanced recovery after surgery protocol on tumor patient gastrointestinal function: a systematic review and meta-analysis of randomized controlled studies.
INTRODUCTION
Acupuncture has been shown to be effective in restoring gastrointestinal function in tumor patients receiving the enhanced recovery after surgery (ERAS) protocol. The present systematic review and meta-analysis aimed to evaluate the rationality and efficacy of integrating acupuncture in the ERAS strategy to recuperate gastrointestinal function.
METHODS
We searched eleven databases for relevant randomized clinical trials (RCTs) of acupuncture for the treatment of gastrointestinal dysfunction in tumor patients treated with the ERAS protocol. The quality of each article was assessed using the Cochrane Collaboration risk of bias criteria and the modified Jadad Scale. As individual symptoms, the primary outcomes were time to postoperative oral food intake, time to first flatus, time to first distension and peristaltic sound recovery time (PSRT). Pain control, adverse events, and acupoint names reported in the included studies were also investigated.
RESULTS
Of the 211 reviewed abstracts, 9 studies (702 patients) met eligibility criteria and were included in the present systematic review and meta‑analysis. Compared to control groups, acupuncture groups showed a significant reduction in time to postoperative oral food intake [standardized mean difference (SMD) = -0.77, 95% confidence interval (CI) -1.18 to -0.35], time to first flatus (SMD=-0.81, 95% CI -1.13 to -0.48), time to first defecation (SMD=-0.91, 95% CI -1.41 to -0.41, PSRT (SMD=-0.92, 95% CI -1.93 to 0.08), and pain intensity (SMD=-0.60, 95% CI -0.83 to -0.37).The Zusanli (ST36) and Shangjuxu (ST37) acupoints were used in eight of the nine included studies. Adverse events related to acupuncture were observed in two studies, and only one case of bruising was reported.
DISCUSSION
The present systematic review and meta‑analysis suggested that acupuncture significantly improves recovery of gastrointestinal function and pain control in tumor patients receiving the ERAS protocol compared to the control group. Moreover, ST36 and ST37 were the most frequently used acupoints. Although the safety of acupuncture was poorly described in the included studies, the available data suggested that acupuncture is a safe treatment with only mild side effects. These findings provide evidence-based recommendations for the inclusion of acupuncture in the ERAS protocol for tumor patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/ PROSPERO, identifier CRD42023430211.
PubMed: 37655096
DOI: 10.3389/fonc.2023.1232754