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Vaccines Sep 2021This systematic review and meta-analysis was conducted to compare the safety and efficacy of 2019 novel coronavirus disease (COVID-19) vaccines according to vaccine... (Review)
Review
This systematic review and meta-analysis was conducted to compare the safety and efficacy of 2019 novel coronavirus disease (COVID-19) vaccines according to vaccine platform and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection severity. Articles published between 24 January 2020 and 30 May 2021 were retrieved via a PubMed and EMBASE search. A total of 12 reports on phase-3 clinical trials and observational studies of COVID-19 vaccines were included in the review. In terms of vaccine safety, mRNA vaccines showed more relevance to serious adverse events than viral vector and inactivated vaccines, but no solid evidence indicated that COVID-19 vaccines directly caused serious adverse events. Serious metabolic, musculoskeletal, immune-system, and renal disorders were more common among inactivated vaccine recipients, and serious gastrointestinal complications and infections were more common among viral vector and inactivated vaccine recipients. The occurrence of serious vessel disorders was more frequent in mRNA vaccines. In terms of efficacy, two mRNA vaccine doses conferred a lesser risk of SARS-COV-2 infection (odds ratio: 0.05; 95% confidence interval: 0.02-0.13) than did vaccination with viral vector and inactivated vaccines. All vaccines protected more against symptomatic than asymptomatic cases (risk ratio, 0.11 vs. 0.34), but reduced the risk of severe SARS-COV-2 infection. The COVID-19 vaccines assessed in this study are sufficiently safe and effective. The results indicate that two mRNA vaccine doses prevent SARS-COV-2 infection most effectively, but further research is needed due to the high degree of heterogeneity among studies in this sample. Interventions should be implemented continuously to reduce the risks of infection after one vaccine dose and asymptomatic infection.
PubMed: 34579226
DOI: 10.3390/vaccines9090989 -
PloS One 2015HPV is the most prevalent sexually transmitted infection and its effect in cancer induction is well documented. HPV infections are mostly asymptomatic, but it is unclear... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
HPV is the most prevalent sexually transmitted infection and its effect in cancer induction is well documented. HPV infections are mostly asymptomatic, but it is unclear whether HPV infections can result in alterations of reproductive health.
OBJECTIVE
To determine the relationship between human papillomavirus infections and reproductive health in both men and women.
METHODS
A systematic literature review was performed in PubMed and ScienceDirect data bases from January 1994 through August 2014.
RESULTS
HPV infections are shown to be significantly associated to many adverse effects in the reproductive function. These adverse effects were reported in different levels from cells production to pregnancy and may be related to the infecting genotype.
CONCLUSIONS
It appears from this study that HPV detection and genotyping could be of great value in infertility diagnosis at least in idiopathic infertility cases. Like for the risk of carcinogenesis, another classification of HPV regarding the risk of fertility alteration may be considered after deep investigations.
Topics: Abortion, Spontaneous; Female; Fertility; Fertilization in Vitro; Humans; Infertility, Female; Male; Papillomaviridae; Papillomavirus Infections; Pregnancy; Reproductive Health; Semen; Semen Analysis; Sexually Transmitted Diseases
PubMed: 25992782
DOI: 10.1371/journal.pone.0126936 -
Transplant Infectious Disease : An... Oct 2011Urinary tract infection (UTI) is the most common bacterial infection in renal transplant recipients. To date there are no guidelines on antibiotic prophylaxis for UTI in... (Meta-Analysis)
Meta-Analysis Review
Urinary tract infection (UTI) is the most common bacterial infection in renal transplant recipients. To date there are no guidelines on antibiotic prophylaxis for UTI in this population. We conducted a systematic review and meta-analysis of randomized controlled trials comparing antibiotic prophylaxis vs. placebo, no intervention, or different antibiotics, all beginning postoperatively and continued for at least 1 month during the first 6 months post transplantation. The search included CENTRAL, PubMed, LILACS, and relevant conference abstracts up to August 2009. The primary outcome was graft loss. Six trials were included in this review, including 545 patients. No significant difference was seen in graft loss (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.91-1.81). Prophylaxis lowered the risk for developing sepsis with bacteremia by 87% (RR 0.13, 95% CI 0.02-0.7) and the risk for developing bacteriuria (symptomatic or asymptomatic) by 60% (RR 0.41, 95% CI 0.31-0.56; 3 trials). Symptomatic UTI and pyelonephritis were not reported. No significant reduction was found in all-cause mortality and adverse events rates; conflicting results were reported for the development of resistant bacteria. Very few trials assessed the efficacy of prophylaxis for UTI following renal transplantation. Prophylaxis reduced bacteriuria and sepsis with bacteremia; effects on graft survival could not be demonstrated.
Topics: Anti-Bacterial Agents; Humans; Kidney Transplantation; Urinary Tract Infections
PubMed: 21521435
DOI: 10.1111/j.1399-3062.2011.00644.x -
American Journal of Therapeutics 2017Asymptomatic candiduria is a common finding in hospitalized patients. Its management modalities are still a matter of debate. Urinary catheter should be removed or... (Comparative Study)
Comparative Study Meta-Analysis Review
Asymptomatic candiduria is a common finding in hospitalized patients. Its management modalities are still a matter of debate. Urinary catheter should be removed or replaced in all cases. In the current meta-analysis, we aimed to compare 2 different strategies in term of candida clearance from the urinary tract: Systemic fluconazole versus conservative management. A systematic search was performed in Pubmed, Web of science, and Cochrane Library database by 2 investigators. Three studies were included (421 patients). Data were extracted and the quality of each study was assessed. Systemic fluconazole was associated with a significantly higher short-term clearance of the funguria after 14 days of treatment [odds ratio = 0.43; confidence interval (CI) 95% (0.26-0.65)]. No significant heterogeneity was found among the included studies (Q statistic test = 0.38; I = 0). In conclusion, fluconazole significantly hasten short-term candida clearance from the urinary tract.
Topics: Administration, Intravenous; Administration, Oral; Adult; Antifungal Agents; Asymptomatic Infections; Candida; Candidiasis; Conservative Treatment; Fluconazole; Humans; Treatment Outcome; Urinary Tract Infections
PubMed: 26938755
DOI: 10.1097/MJT.0000000000000403 -
European Urology Dec 2017People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with antibiotics risking adverse effects and antimicrobial resistance. We performed a... (Meta-Analysis)
Meta-Analysis Review
Benefits and Harms of Treatment of Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis by the European Association of Urology Urological Infection Guidelines Panel.
UNLABELLED
People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with antibiotics risking adverse effects and antimicrobial resistance. We performed a systematic review to determine any benefits and harms of treating ABU in particular patient groups. Relevant databases were searched and eligible trials were assessed for risk-of-bias and Grading of Recommendations, Assessment, Development and Education quality. Where possible, a meta-analysis of extracted data was performed or a narrative synthesis of the evidence was presented. After screening 3626 articles, 50 studies involving 7088 patients were included. Overall, quality of evidence ranged from very low to low. There was no evidence of benefit for patients with no risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalised patients, patients with renal transplants, or patients prior to joint replacement, and treatment was harmful for patients with recurrent urinary tract infection (UTI). Treatment of ABU resulted in a lower risk of postoperative UTI after transurethral resection surgery. In pregnant women, we found evidence that treatment of ABU decreased risk of symptomatic UTI, low birthweight, and preterm delivery. ABU should be treated prior to transurethral resection surgery. In addition, current evidence also suggests that ABU treatment is required in pregnant women, although the results of a recent trial have challenged this view.
PATIENT SUMMARY
We reviewed available scientific studies to see if people with bacteria in their urine but without symptoms of urinary tract infection should be treated with antibiotics to eliminate bacteria. For most people, treatment was not beneficial and may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and those about to undergo urological surgery.
Topics: Anti-Bacterial Agents; Asymptomatic Infections; Bacteriuria; Humans; Risk Assessment
PubMed: 28754533
DOI: 10.1016/j.eururo.2017.07.014 -
JAMA Otolaryngology-- Head & Neck... Nov 2023Head and neck cancers (HNCs) are often diagnosed at advanced clinical stages during their symptomatic phase, leading to a reduced treatment window and poor survival....
IMPORTANCE
Head and neck cancers (HNCs) are often diagnosed at advanced clinical stages during their symptomatic phase, leading to a reduced treatment window and poor survival. Screening programs have been suggested as a mitigation strategy.
OBJECTIVE
To examine the effectiveness of current HNC screening programs in improving diagnosis and survival in adults.
EVIDENCE REVIEW
This Preferred Reporting Items for Systematic Reviews and Meta-analyses-guided systematic review involved use of peer-reviewed, English-language journal articles identified from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials between January 1, 2001, and July 15, 2022. Snowballing was applied to retrieve more studies. Eligible articles were original clinical trials and observational studies presenting a universal or risk-targeted screening program of primary HNC in the adult population. Reporting quality was assessed using the JBI's critical appraisal tools.
FINDINGS
Database searches yielded 3646 unique citations with an additional 8 studies found via snowballing. Five reviewers assessed the full text of 106 studies. Sixteen articles were ultimately included in the review, involving 4.7 million adults (34.1%-100% male; median age, 30-59 years). Fifteen studies were based in Asia and 1 in Europe (Portugal). Five reported data from randomized clinical trials. An oral inspection conducted once or once every 2 to 3 years was described in 11 studies for screening oral cancer, while multistep screening involving Epstein-Barr virus serologic testing for nasopharyngeal carcinoma delivered every 1 to 4 years was presented in 5. In 4 trials and 6 observational studies, screening significantly increased the detection of localized (stage I/II) tumor or was associated with an increased proportion of diagnoses, respectively, regardless of the population and cancer subsites. Universal screening of asymptomatic adults improved 3- to 5-year overall survival but did not increase cancer-specific survival in 4 trials. Targeted screening improved overall and cancer-specific survival or was associated with improved survival outcomes in 2 trials and 2 observational studies, respectively. Studies had low to medium risks of bias.
CONCLUSIONS AND RELEVANCE
Evidence from the existing literature suggests that a risk-targeted screening program for oral and nasopharyngeal cancers could improve diagnosis and patient survival. Screening adherence, societal cost-effectiveness, and optimal risk stratification of such a program warrant future research, especially in low-incidence settings outside Asia.
Topics: Adult; Humans; Male; Middle Aged; Female; Epstein-Barr Virus Infections; Early Detection of Cancer; Herpesvirus 4, Human; Head and Neck Neoplasms; Mouth Neoplasms
PubMed: 37796524
DOI: 10.1001/jamaoto.2023.3010 -
Malaria Journal Dec 2022In the last decade Plasmodium knowlesi has been detected in humans throughout South East Asia. The highest risk groups for this infection are males, adults and those... (Review)
Review
BACKGROUND
In the last decade Plasmodium knowlesi has been detected in humans throughout South East Asia. The highest risk groups for this infection are males, adults and those performing forest-related work. Furthermore, asymptomatic cases of P. knowlesi malaria have been reported including among women and children.
METHODS
Pubmed, Scopus and the Web of Science databases for literature describing asymptomatic P. knowlesi malaria published between 2010 and 2020 were searched. A systematic literature review was conducted to identify studies reporting the prevalence and incidence of laboratory confirmed asymptomatic P. knowlesi cases in humans, their clinical and demographic characteristics, and methods used to diagnose these cases.
RESULTS
By analysing over 102 papers, thirteen were eligible for this review. Asymptomatic P. knowlesi infections have been detected in 0.03%-4.0% of the population depending on region, and infections have been described in children as young as 2 years old. Various different diagnostic methods were used to detect P. knowlesi cases and there were differing definitions of asymptomatic cases in these studies. The literature indicates that regionally-differing immune-related mechanisms may play a part on the prevalence of asymptomatic P. knowlesi.
CONCLUSION
Differing epidemiological characteristics of asymptomatic P. knowlesi malaria in different regions reinforces the need to further investigate disease transmission mechanics. Effective public health responses to changes in P. knowlesi epidemiology require proactive intervention and multisectoral collaboration.
Topics: Child; Humans; Female; Child, Preschool; Plasmodium knowlesi; Communicable Diseases, Emerging
PubMed: 36474243
DOI: 10.1186/s12936-022-04339-8 -
The Cochrane Database of Systematic... Nov 2015Nasopharyngeal cancer is endemic in a few well-defined populations. The prognosis for advanced nasopharyngeal cancer is poor, but early-stage disease is curable and a... (Review)
Review
BACKGROUND
Nasopharyngeal cancer is endemic in a few well-defined populations. The prognosis for advanced nasopharyngeal cancer is poor, but early-stage disease is curable and a high survival rate can be achieved. Screening for early-stage disease could lead to improved outcomes. Epstein-Barr virus (EBV) serology and nasopharyngoscopy are most commonly used for screening. The efficacy and true benefit of screening remain uncertain due to potential selection, lead-time and length-time biases.
OBJECTIVES
To determine the effectiveness of screening of asymptomatic individuals by EBV serology and/or nasopharyngoscopy in reducing the mortality of nasopharyngeal cancer compared to no screening. To assess the impact of screening for nasopharyngeal cancer on incidence, survival, adverse effects, cost-effectiveness and quality of life.
SEARCH METHODS
The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 6); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 6 July 2015.
SELECTION CRITERIA
Randomised controlled trials (RCT) and controlled clinical trials (CCT) evaluating screening for nasopharyngeal cancer versus no screening. Randomisation either by clusters or individuals was acceptable.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by The Cochrane Collaboration. Our primary outcome measure was nasopharyngeal cancer-specific mortality. Secondary outcomes were incidence of nasopharyngeal cancer by stage and histopathological classification at diagnosis, survival (two-year, three-year, five-year and 10-year), harms of screening (physical and psychosocial), quality of life (via validated tools such as the SF-36 and patient satisfaction), cost-effectiveness and all-cause mortality.
MAIN RESULTS
We identified no trials that met the review inclusion criteria. We retrieved 31 full-text studies for further investigation following the search. However, none met the eligibility criteria for a RCT or CCT investigation on the efficacy of screening for nasopharyngeal cancer.
AUTHORS' CONCLUSIONS
No data from RCTs or CCTs are available to allow us to determine the efficacy of screening for nasopharyngeal cancer, or the cost-effectiveness and cost-benefit of a screening strategy. High-quality studies with long-term follow-up of mortality and cost-effectiveness are needed.
Topics: Asymptomatic Diseases; Carcinoma; Early Detection of Cancer; Endoscopy; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Humans; Mass Screening; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms
PubMed: 26544798
DOI: 10.1002/14651858.CD008423.pub2 -
The Journal of Urology Apr 2021The administration of antimicrobial prophylaxis for postoperative urinary tract infections following transurethral resection of bladder tumors is controversial. We aimed... (Meta-Analysis)
Meta-Analysis
PURPOSE
The administration of antimicrobial prophylaxis for postoperative urinary tract infections following transurethral resection of bladder tumors is controversial. We aimed to systematically review evidence on the potential effect of antimicrobial prophylaxis on postoperative urinary tract infections and asymptomatic bacteriuria.
MATERIALS AND METHODS
We conducted a systematic search in Embase®, Medline® and the Cochrane Central Register of Controlled Trials. Randomized controlled trials and nonrandomized controlled trials assessing the effect of any form of antimicrobial prophylaxis in patients with transurethral resection of bladder tumors on postoperative urinary tract infections or asymptomatic bacteriuria were included. Risk of bias was assessed using RoB 2.0 or the Newcastle-Ottawa Scale. Fixed and random effects meta-analyses were conducted. As a potential basis for a scoping review, we exploratorily searched Medline for risk factors for urinary tract infections after transurethral resection of bladder tumors. The protocol was registered on PROSPERO (CRD42019131733).
RESULTS
Of 986 screened publications, 7 studies with 1,725 participants were included; the reported effect sizes varied considerably. We found no significant effect of antimicrobial prophylaxis on urinary tract infections: the pooled odds ratio of the random effects model was 1.55 (95% CI 0.73-3.31). The random effects meta-analysis examining the effect of antimicrobial prophylaxis on asymptomatic bacteriuria showed an OR of 0.43 (0.18-1.04). Risk of bias was moderate. Our exploratory search identified 3 studies reporting age, preoperative pelvic radiation, preoperative hospital stay, duration of operation, tumor size, preoperative asymptomatic bacteriuria and pyuria as risk factors for urinary tract infections following transurethral resection of bladder tumors.
CONCLUSIONS
We observed insufficient evidence supporting routine antimicrobial prophylaxis in patients undergoing transurethral resection of bladder tumors for the prevention of postoperative urinary tract infections; our findings may inform harmonization of international guidelines.
Topics: Antibiotic Prophylaxis; Bacteriuria; Humans; Postoperative Complications; Urinary Bladder Neoplasms; Urinary Tract Infections
PubMed: 33284673
DOI: 10.1097/JU.0000000000001513 -
BMJ Clinical Evidence Jul 2008Infection with the human immunodeficiency virus (HIV) usually leads to 8-10 years of asymptomatic infection before immune function deteriorates and AIDS develops.... (Review)
Review
INTRODUCTION
Infection with the human immunodeficiency virus (HIV) usually leads to 8-10 years of asymptomatic infection before immune function deteriorates and AIDS develops. Without treatment, about 50% of infected people will die of AIDS over 10 years. With treatment, prognosis depends on age, CD4 cell count, and initial viral load.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions? What are the effects of different antiretroviral drug treatment regimens in HIV infection? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: combination treatments containing either CCR5 inhibitors or fusion inhibitors; early diagnosis and treatment of sexually transmitted diseases (STDs); early and delayed antiretroviral treatment using triple antiretroviral regimens; non-nucleoside reverse transcriptase inhibitor (NNRTI) based triple regimens; nucleoside reverse transcriptase inhibitor (NRTI) and protease inhibitor-based triple regimens (standard, and boosted); post-exposure prophylaxis in healthcare workers; and presumptive mass treatment of sexually transmitted diseases (STDs).
Topics: CD4 Lymphocyte Count; HIV Infections; Humans; Reverse Transcriptase Inhibitors
PubMed: 19445740
DOI: No ID Found