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Gastrointestinal Endoscopy Apr 2009Insufflation of the lumen is required for visualization during GI endoscopy. Carbon dioxide (CO(2)) has been proposed as an alternative to room air for insufflation. (Review)
Review
BACKGROUND
Insufflation of the lumen is required for visualization during GI endoscopy. Carbon dioxide (CO(2)) has been proposed as an alternative to room air for insufflation.
OBJECTIVES
To assess the safety and efficacy of CO(2) insufflation for endoscopy.
DESIGN
Systematic review that focuses on evidence from randomized controlled trials (RCT).
METHODS
Two investigators independently searched MEDLINE from 1950 to February 13, 2008, to identify all articles that reported the use of CO(2) in a GI endoscopy application. Bibliographies of relevant articles were also hand searched to identify other pertinent reports. Data from RCTs, as well as from nonrandomized studies, were extracted.
RESULTS
Nine RCTs were identified that compared CO(2) and air insufflation for GI endoscopy. Fifteen other nonrandomized studies or reports were also reviewed. In the 8 RCTs in which postprocedural pain was assessed, pain was lower in the CO(2) insufflation group compared with the air group. Two RCTs found decreased flatus in the CO(2) group compared with the air group, and 3 RCTs showed there was decreased bowel distention on abdominal radiography in the CO(2) group compared with the air group. Also, in all 9 RCTs and 6 additional studies in which safety was assessed, there was no CO(2) retention and no adverse pulmonary events related to CO(2) insufflation.
LIMITATIONS
Because of study heterogeneity, meta-analytic techniques could not be used.
CONCLUSIONS
Consistent RCT evidence indicates that CO(2) insufflation is associated with decreased postprocedural pain, flatus, and bowel distention. CO(2) insufflation also appears to be safe in patients without severe underlying pulmonary disease.
Topics: Carbon Dioxide; Endoscopy, Gastrointestinal; Humans; Insufflation
PubMed: 19152906
DOI: 10.1016/j.gie.2008.05.067 -
Epidemiology and Infection Feb 2020In recent years, outbreaks of hand-foot-mouth disease (HFMD) in China, Singapore and other Western Pacific Region, involving millions of children, have become a big... (Meta-Analysis)
Meta-Analysis
In recent years, outbreaks of hand-foot-mouth disease (HFMD) in China, Singapore and other Western Pacific Region, involving millions of children, have become a big threat to public health. This study aimed to quantitatively assess all qualified studies and identify the risk factors for HFMD death. A systematic search of the databases PubMed, Medline, Embase and the Cochrane Library was performed. Study heterogeneity and publication bias were estimated. Seven case-control studies involving 1641 participants (634 died and 1007 survived) were included in the meta-analysis. Human enterovirus 71 infection, male, age ⩽3 years, vomiting, cyanosis, convulsion, duration of fever ⩾3 days, atypical rashes and abdominal distention were not significantly related to HFMD death (P ⩽ 0.05). Lethargy (odds ratio (OR) = 6.62; 95% CI 3.61-12.14; I2 = 0%; P < 0.0001), pneumonoedema/pneumorrhagia (OR = 4.09; 95% CI 2.44-6.87; I2 = 0%; P < 0.0001), seizures (OR = 6.85; 95% CI 2.37-19.74; I2 = 0%; P = 0.0004), dyspnoea (OR = 8.24; 95% CI 2.05-33.19; I2 = 83%; P = 0.003) and coma (OR = 3.76; 95% CI 1.85-7.67; I2 = 0%; P = 0.0003) were significantly associated with HFMD death, which were risk factors for HFMD death.
Topics: Asia; Child, Preschool; Enterovirus A, Human; Female; Hand, Foot and Mouth Disease; Humans; Incidence; Infant; Male; Risk Factors; Survival Analysis
PubMed: 32102711
DOI: 10.1017/S0950268819002279 -
International Journal of Nursing... Dec 2023There are many controversies over the necessity of monitoring gastric residual volume in the nursing care of enteral nutrition. We aimed to conduct an updated... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There are many controversies over the necessity of monitoring gastric residual volume in the nursing care of enteral nutrition. We aimed to conduct an updated meta-analysis to evaluate the effects of monitoring or not monitoring gastric residual volume on patients' outcomes and complications.
METHODS
We searched the Cochrane Library database to 15 April 2021 for randomized controlled trials (RCTs) on the effects of gastric residual volume and no gastric residual volume monitoring. Review Manager software was used for data analysis.
RESULTS
A total of seven RCTs involving 1240 enteral nutrition patients were included. Gastric residual volume monitoring was associated with reduced incidence of vomiting (OR2.33, 95% CI:1.68-3.24), whereas no gastric residual volume monitoring was associated with reduced incidence of unnecessary interruptions of enteral nutrition (OR0.38,95% CI:0.26-0.55). There were no significant differences on the incidence of abdominal distention (OR1.87, 95% CI:0.82-4.28), diarrhoea (OR1.03,95% CI:0.74-1.43), VAP (OR0.83, 95%CI:0.37-1.89), duration of mechanical ventilation (MD -0.06,95% CI:-1.22-1.10), length of ICU stay (MD -1.33, 95% CI:-3.58-0.91) and mortality (OR0.90,95% CI:0.61-1.34).
CONCLUSIONS
Not monitoring gastric residual volume is associated with reduced unnecessary interruptions of enteral nutrition related to inadequate feeding and increased risk of vomiting.
Topics: Humans; Enteral Nutrition; Critical Illness; Residual Volume; Respiration, Artificial; Vomiting; Intensive Care Units
PubMed: 36540042
DOI: 10.1111/ijn.13124 -
The American Journal of Gastroenterology Apr 2009Irritable bowel syndrome (IBS) is a common disorder and available therapies have limited efficacy. Mucosal inflammation and alterations in gut microflora may contribute... (Review)
Review
OBJECTIVES
Irritable bowel syndrome (IBS) is a common disorder and available therapies have limited efficacy. Mucosal inflammation and alterations in gut microflora may contribute to the development of IBS symptoms, and researchers have hypothesized that probiotics might improve these symptoms. The aim of this study was to perform a systematic review of randomized controlled trials (RCTs) evaluating the efficacy, safety, and tolerability of probiotics in the treatment of IBS.
METHODS
Comprehensive literature searches of multiple databases were performed. Study selection criteria were as follows: (i) RCTs, (ii) adults with IBS defined by Manning or Rome II criteria, (iii) single or combination probiotic vs. placebo, and (iv) improvement in IBS symptoms and/or decrease in frequency of adverse events reported. Data about study design and results were extracted in duplicate using standardized data extraction forms. Owing to variability in outcome measures, quantitative pooling of data was not feasible.
RESULTS
A total of 16 RCTs met selection criteria. Of those, 11 studies showed suboptimal study design with inadequate blinding, inadequate trial length, inadequate sample size, and/or lack of intention-to-treat analysis. None of the studies provided quantifiable data about both tolerability and adverse events. Bifidobacterium infantis 35624 showed significant improvement in the composite score for abdominal pain/discomfort, bloating/distention, and/or bowel movement difficulty compared with placebo (P<0.05) in two appropriately designed studies. No other probiotic showed significant improvement in IBS symptoms in an appropriately designed study.
CONCLUSIONS
B. infantis 35624 has shown efficacy for improvement of IBS symptoms. Most RCTs about the utility of probiotics in IBS have not used an appropriate study design and do not adequately report adverse events. Therefore, there is inadequate data to comment on the efficacy of other probiotics. Future probiotic studies should follow Rome II recommendations for appropriate design of an RCT.
Topics: Bifidobacterium; Humans; Irritable Bowel Syndrome; Probiotics; Treatment Outcome
PubMed: 19277023
DOI: 10.1038/ajg.2009.25 -
Journal of Postgraduate Medicine 2017Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains...
PURPOSE OF REVIEW
Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature.
MATERIALS AND METHODS
A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India.
RESULTS
On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1 st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%).
CONCLUSIONS
Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.
Topics: Foreign Bodies; Humans; India; Postoperative Complications
PubMed: 28079043
DOI: 10.4103/0022-3859.198153 -
European Journal of Gastroenterology &... Oct 2019Recently, stem cells have been used in the treatment of viral hepatitis-induced liver cirrhosis (LC), and stem cell therapy is showing potential therapeutic effects on... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Recently, stem cells have been used in the treatment of viral hepatitis-induced liver cirrhosis (LC), and stem cell therapy is showing potential therapeutic effects on liver function improvement. The consensus on effects and safety of stem cell therapy has not been reached, thus it is essential for us to conduct a systematic review and meat-analysis to investigate the efficacy and safety of stem cell therapy for viral hepatitis-induced LC.
MATERIALS AND METHODS
Medline, Embase, SinoMed and Cochrane Library databases were searched with appropriate keywords through 5 August 2018. We included eight trials involving 467 patients. The pooled weight mean difference (WMD) and 95% confidence interval (CI) were calculated using a fixed or random effects model. Quality assessment and publication bias were also performed. The selected studies were considered for meta-analysis using RevMan V5.3.
RESULTS
Compared with traditional therapy group, autologous stem cell transplantation increased the level of albumin (WMD: 2.47, 95% CI: 1.05-3.90, P < 0.001), but decreased the level of total bilirubin (WMD: -2.26, 95% CI: -3.61 to -0.90, P = 0.001), alanine aminotransferase (WMD: -9.16, 95% CI: -16.47 to -1.85, P = 0.01) and prothrombin time (WMD: -3.02, 95% CI: -4.83 to -1.22, P = 0.001). Clinical symptoms such as edema, fatigue, anorexia and abdominal distention were alleviated. Model for End-Stage Liver Disease and Child-Pugh scores were decreased after stem cell therapy. Whereas, there was no statistically significant difference between two groups regarding aspartate aminotransferase, prothrombin time activity, ascites and pleural fluid. No procedure-related complications were found.
CONCLUSION
Autologous stem cell transplantation might have beneficial effects on patients with viral hepatitis-induced LC and is relatively safe for these patients. Further high-quality randomized controlled trials are needed.
Topics: Hepatitis, Viral, Human; Humans; Liver Cirrhosis; Models, Statistical; Stem Cell Transplantation; Transplantation, Autologous; Treatment Outcome
PubMed: 31206409
DOI: 10.1097/MEG.0000000000001455 -
Journal of Traditional Chinese Medicine... Dec 2020To evaluate the effectiveness and safety of a Shenlingbaizhu (SLBZ) formula in the treatment of irritable bowel syndrome (IBS). The effectiveness of SLBZ with or without... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness and safety of a Shenlingbaizhu (SLBZ) formula in the treatment of irritable bowel syndrome (IBS). The effectiveness of SLBZ with or without conventional treatment was compared to that of conventional treatment alone.
METHODS
A comprehensive literature search of four Chinese electronic databases, three English language databases, and two English language trial registries from inception to June 2019 was performed. Two authors independently screened the citations and retrieved full publications of randomized trials on the use of SLBZ with or without conventional treatment for IBS. The methodological quality of the trials was assessed with the Cochrane Collaboration's tool for assessing the risk of bias. Data were extracted and subjected to Meta-analysis to compare the efficacy of the SLBZ formula with or without conventional treatment to conventional treatment alone.
RESULTS
Thirteen trials (comprising a total of 868 patients with IBS) were included in this review. The risk of bias of all 13 included trials was assessed as moderate. The SLBZ formula was associated with significant improvements in cure rate [relative risk (RR) score of 2.38, 95% confidence interval (CI) 1.43 to 3.95, I 2 = 0%; 8 trials, n = 487, fixed-effects model (FEM)], diarrhea severity score [mean difference (MD) score of -0.62, 95% CI -1.05 to -0.20, I 2 = 88%; 4 trials, n = 286, random effects model (REM)], abdominal pain severity score (MD score of -0.61, 95% CI -0.70 to -0.52, I 2 = 63%; 4 trials, n = 286, FEM), and abdominal distention severity score (MD score of -0.88, 95% CI -1.54 to -0.21, I 2 = 91%; 3 trials, n = 226, REM) compared to the conventional treatment alone. Adverse events were reported in five trials but only one of these indicated any adverse events associated with SLBZ.
CONCLUSION
Based on the 13 trials reviewed here, the SLBZ formula with or without conventional treatment appeared to be safe and more effective in improving the cure rate and reducing the severity of diarrhea, abdominal pain, and abdominal distention compared to conventional treatment alone. However, these trials only generated a moderate quality of evidence, and well-designed and high-quality random controlled trials of the SLBZ formula for the treatment of IBS are required to confirm the efficacy of this treatment option.
Topics: Drugs, Chinese Herbal; Humans; Irritable Bowel Syndrome; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 33258340
DOI: 10.19852/j.cnki.jtcm.2020.06.001 -
Nutricion Hospitalaria Feb 2017Although guidelines emphasize that the provision of enteral nutrition (EN) should be as close as the patient's needs, prospective studies question this strategy. (Comparative Study)
Comparative Study Meta-Analysis Review
Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials.
INTRODUCTION
Although guidelines emphasize that the provision of enteral nutrition (EN) should be as close as the patient's needs, prospective studies question this strategy.
OBJECTIVE
To compare the effect of two EN strategies (underfeeding versus full-feeding) on ICU and overall mortality (hospital mortality or 60-day mortality) and length of stay (LOS), duration of mechanical ventilation (MV), infectious complications, and gastrointestional tolerability in ICU patients.
METHODS
Random effects meta-analysis of randomized controlled trials (RCT). Our search covered MEDLINE, EMBASE, SCOPUS and CENTRAL databases until May 2015. Underfeeding was assigned into to two different groups according to the level of energy intake achieved (moderate feeding 46-72% and trophic feeding 16-25%) for subgroup analysis.
RESULTS
Five RCTs were included among the 904 studies retrieved (n=2432 patients). No difference was found in overall mortality when all five studies were combined. In the subgroup analysis, moderate feeding (three studies) showed lower mortality compared with full-feeding (RR 0.82;95%CI,0.68-0.98;I2 0% p=0.59 for heterogeneity). No differences were found for ICU mortality, ICU and hospital LOS, duration of MV, and infectious complications. Underfeeding showed lower occurrence of GI signs and symptoms except for aspiration and abdominal distention.
CONCLUSIONS
This meta-analysis found no differences in ICU and overall mortality, ICU and hospital LOS, duration of MV, and infectious complications between underfeeding and full-feeding. The subgroup analysis showed lower overall mortality among patients receiving moderate underfeeding. This result should be cautiously interpreted due to the limitations of the small number of studies analyzed and their methodology.
Topics: Critical Illness; Enteral Nutrition; Hospital Mortality; Humans; Length of Stay; Randomized Controlled Trials as Topic; Respiratory Insufficiency
PubMed: 28244768
DOI: 10.20960/nh.443 -
Pediatric Surgery International Mar 2021Delayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Delayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of early enteral nutrition after intestinal surgery in adults. This systematic review and meta-analysis evaluates whether early enteral feeding (EEF) is beneficial in children who underwent intestinal anastomosis.
METHODS
MEDLINE, PubMed, the Cochrane Library, and Web of Science databases were searched for RCTs that addressed the effect of EEF in children (younger than 18 years old) undergoing intestinal anastomosis. EEF was defined as starting enteral feeding before the 3rd postoperative day. Studies were selected based on predetermined inclusion and exclusion criteria. A meta-analysis was performed using RevMan 5.3 to estimate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).
RESULTS
Four RCT studies met the inclusion criteria, comprising 97 cases with EEF and 89 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = - 2.80; 95% CI - 3.11 to - 2.49; p < 0.00001). Postoperative anastomotic leak rate was unchanged between EEF and DEF groups (OR = 0.86; 95% CI 0.17-4.46; p = 0.86). The EEF group had a shorter length of hospital stay (MD = - 3.38; 95% CI - 4.29 to - 2.48; p < 0.00001), earlier time to bowel movement return (MD = - 0.57; 95% CI - 0.79 to - 0.35; p < 0.00001), lower incidence of surgical infection (OR = 0.27; 95% CI 0.08-0.90; p = 0.03), and faster tolerance of full enteral feeding (MD = - 2.00; 95% CI - 3.01 to - 2.79; p < 0.00001). Incidence of fever (OR = 0.37; 95% CI 0.10-1.31; p = 0.12), emesis, and abdominal distention (OR = 0.63; 95% CI 0.13-3.16; p = 0.58) were not different between the two groups.
CONCLUSIONS
Early enteral feeding after intestinal anastomosis in children does not increase the risk of postoperative anastomotic leak, fever, emesis, and abdominal distention. However, early enteral feeding is beneficial as it promotes the return of bowel function, reduces the length of hospital stay and the incidence of surgical infection in comparison to delayed enteral feeding.
Topics: Adolescent; Adult; Anastomosis, Surgical; Anastomotic Leak; Child; Digestive System Surgical Procedures; Enteral Nutrition; Humans; Intestines; Length of Stay; Pediatrics; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Time Factors
PubMed: 33595685
DOI: 10.1007/s00383-020-04830-w -
Vector Borne and Zoonotic Diseases... Apr 2022Bubonic plague classically manifests as a painful, swollen superficial lymph node (bubo) that is readily apparent on physical examination. However, patients...
Bubonic plague classically manifests as a painful, swollen superficial lymph node (bubo) that is readily apparent on physical examination. However, patients occasionally present with buboes formed in deep lymph nodes, which are difficult to detect and can lead to delays in diagnosis and treatment. To better characterize this phenomenon, we conducted a review of the published literature to identify reports of occult buboes among patients with plague. Articles were identified from two sources: a systematic review on plague treatment, and a search of the PubMed Central database. Articles were eligible if they described a patient with plague who had (1) no evidence of lymphadenopathy on examination; and (2) at least one bubo discovered during surgery or autopsy. Six patients with occult buboes were identified among 5120 articles screened. The majority were male ( = 4/6) and three were <15 years of age. Fever ( = 6/6), leukocytosis ( = 5/6), and abdominal pain or distention ( = 4/6) were the most common signs and symptoms. Initial diagnoses included other bacterial infections, appendicitis, or acute abdomen. Four patients received at least one antimicrobial effective against ; however, some experienced delayed treatment due to late diagnosis of plague. Occult buboes were discovered in retroperitoneal ( = 2), inguinal/femoral ( = 2), mesenteric ( = 2), axillary ( = 1), and mediastinal ( = 1) regions. Four of the six patients died. Patients with occult buboes experienced delays in the diagnosis of plague and a high fatality rate. Clinicians in plague-endemic areas should consider the presence of occult buboes among patients with compatible symptoms and exposure history.
Topics: Animals; Autopsy; Female; Fever; Male; Plague; Strigiformes; Yersinia pestis
PubMed: 35404104
DOI: 10.1089/vbz.2022.0012