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PloS One 2023To assess the benefits and harms of cannabinoids in participants with pain. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To assess the benefits and harms of cannabinoids in participants with pain.
DESIGN
Systematic review of randomised clinical trials with meta-analysis, Trial Sequential Analysis, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
DATA SOURCES
The Cochrane Library, MEDLINE, Embase, Science Citation Index, and BIOSIS.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Published and unpublished randomised clinical trials comparing cannabinoids versus placebo in participants with any type of pain.
MAIN OUTCOME MEASURES
All-cause mortality, pain, adverse events, quality of life, cannabinoid dependence, psychosis, and quality of sleep.
RESULTS
We included 65 randomised placebo-controlled clinical trials enrolling 7017 participants. Fifty-nine of the trials and all outcome results were at high risk of bias. Meta-analysis and Trial Sequential Analysis showed no evidence of a difference between cannabinoids versus placebo on all-cause mortality (RR 1.20; 98% CI 0.85 to 1.67; P = 0.22). Meta-analyses and Trial Sequential Analysis showed that cannabinoids neither reduced acute pain (mean difference numerical rating scale (NRS) 0.52; 98% CI -0.40 to 1.43; P = 0.19) or cancer pain (mean difference NRS -0.13; 98% CI -0.33 to 0.06; P = 0.1) nor improved quality of life (mean difference -1.38; 98% CI -11.81 to 9.04; P = 0.33). Meta-analyses and Trial Sequential Analysis showed that cannabinoids reduced chronic pain (mean difference NRS -0.43; 98% CI -0.72 to -0.15; P = 0.0004) and improved quality of sleep (mean difference -0.42; 95% CI -0.65 to -0.20; P = 0.0003). However, both effect sizes were below our predefined minimal important differences. Meta-analysis and Trial Sequential Analysis indicated that cannabinoids increased the risk of non-serious adverse events (RR 1.20; 95% CI 1.15 to 1.25; P < 0.001) but not serious adverse events (RR 1.18; 98% CI 0.95 to 1.45; P = 0.07). None of the included trials reported on cannabinoid dependence or psychosis.
CONCLUSIONS
Cannabinoids reduced chronic pain and improved quality of sleep, but the effect sizes are of questionable importance. Cannabinoids had no effects on acute pain or cancer pain and increased the risks of non-serious adverse events. The harmful effects of cannabinoids for pain seem to outweigh the potential benefits.
Topics: Humans; Acute Pain; Cancer Pain; Chronic Pain; Quality of Life; Cannabinoids; Analgesics; Sleep; Sleep Quality; Placebos
PubMed: 36716312
DOI: 10.1371/journal.pone.0267420 -
Obesity Reviews : An Official Journal... Jun 2016We performed a systematic review and meta-analysis of the effects of obesity ± overweight and weight loss on the corrected QT interval (QTc) and QT or QTc... (Meta-Analysis)
Meta-Analysis Review
We performed a systematic review and meta-analysis of the effects of obesity ± overweight and weight loss on the corrected QT interval (QTc) and QT or QTc dispersion (indices of ventricular repolarization). Mean difference for both QTc and QT or QTc dispersion with 95% confidence intervals (CIs) was calculated comparing obese ± overweight subjects and normal weight controls and QTc and QT or QTc dispersion before and after weight loss from diet ± exercise or bariatric surgery. A total of 22 studies fulfilled the selection criteria. Compared with normal weight controls, there was a significantly longer QTc in obese ± overweight subjects (mean difference of 21.74 msec, 95% CI: 18.76 to 22.32) and significantly longer QT or QTc dispersion (mean difference of 15.17 msec, 95% CI: 13.59 to 16.74). Weight loss was associated with a significant decrease in QTc (mean difference -25.77 msec, 95% CI: -28.33-23.21) and QT or QTc dispersion (mean difference of -13.46 msec, 95% CI: -15.60 to -11.32 in obese ± overweight subjects. Thus, obesity ± overweight is associated with significant prolongation of QTc and QT or QTC dispersion. Weight loss in obese ± overweight subjects produces significant decreases in these variables. © 2016 World Obesity.
Topics: Arrhythmias, Cardiac; Bariatric Surgery; Diet; Electrocardiography; Exercise; Heart Ventricles; Humans; Obesity; Overweight; Ventricular Dysfunction; Weight Loss
PubMed: 26956255
DOI: 10.1111/obr.12390 -
American Journal of Obstetrics &... Nov 2022Recent randomized controlled trials have demonstrated an association between uterine closure technique at the time of cesarean delivery and short- and long-term... (Review)
Review
OBJECTIVE
Recent randomized controlled trials have demonstrated an association between uterine closure technique at the time of cesarean delivery and short- and long-term operative outcomes with varied results. This systematic review and meta-analysis aimed to examine types of suture material used for cesarean delivery.
DATA SOURCES
Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid, and ClinicalTrials.gov were searched from inception of each database to October 2021.
STUDY ELIGIBILITY CRITERIA
All randomized controlled trials that compared types of suture materials used for hysterotomy closure during low-transverse cesarean delivery at ≥24 weeks' gestation and examined maternal outcomes were included for this review. The primary outcome was estimated blood loss. Secondary outcomes included additional surgical complications.
METHODS
Results were summarized as mean difference or risk ratio with associated 95% confidence intervals. The quality of studies was evaluated with the Cochrane Handbook for Systematic Reviews of Interventions for judging risk of bias. Heterogeneity was measured using I-squared (Higgins I).
RESULTS
This review included 7 randomized controlled trials, of which 3 compared multifilament with barbed suture (136 vs 136 participants), 3 compared multifilament with conventional monofilament suture (245 vs 244 participants), and 1 trial compared multifilament with chromic suture (4590 vs 4595 participants). Primary analysis showed no difference in estimated blood loss between the multifilament and the barbed suture group (mean difference, 46.2 mL; 95% confidence interval, -13.6 to 105.9), nor in change in hemoglobin concentration between the multifilament and the conventional monofilament group (mean difference, -0.1%; 95% confidence interval, -0.5 to 0.3). Secondary outcomes showed a reduction in operative time with barbed vs multifilament suture (mean difference, 1.9 minutes; 95% confidence interval, 0.03-3.8). Analysis also demonstrated an increased uterine scar thickness with use of conventional monofilament vs multifilament suture (mean difference, -1.05 mm; 95% confidence interval, -1.9 to -0.2).
CONCLUSION
This meta-analysis does not support a specific type of suture material for uterine closure at cesarean delivery because of insufficient data. Although barbed suture was associated with an overall decrease in operative time, and use of conventional monofilament suture was associated with an increase in uterine scar thickness, the clinical utility of these differences is not clear. Further adequate randomized controlled trials are warranted for evaluation of different suture materials for hysterotomy closure.
PubMed: 35995367
DOI: 10.1016/j.ajogmf.2022.100726 -
Critical Reviews in Food Science and... Jul 2016To assess the prevalence and mean intensity of anisakids in seafood caught in the Mediterranean Sea, focusing on fish species at risk of being raw-consumed. (Meta-Analysis)
Meta-Analysis Review
Prevalence and Mean Intensity of Anisakidae Parasite in Seafood Caught in the Mediterranean Sea Focusing on Fish Species at Risk of Being Raw-consumed. A Meta Analysis and Systematic Review.
OBJECTIVE
To assess the prevalence and mean intensity of anisakids in seafood caught in the Mediterranean Sea, focusing on fish species at risk of being raw-consumed.
DESIGN
Systematic review and meta-analysis of studies published from 1960-2012.
STUDY SELECTION
Main criteria for the inclusion of studies were as follows: Findings of anisakid larvae, in both muscles and viscera; fish species for human consumption caught in the Mediterranean Sea; prevalence and mean intensity data for each species; and sample size equal to or more than 40 fishes.
RESULTS
Twelve studies were identified. Among these, four studies considered the following three fish species that are often consumed raw or preserved lightly, or not cooked thoroughly: anchovy, pilchard, and Atlantic mackerel.
DATA SYNTHESIS
All pooled analyses were based on the random-effect model. Anisakids prevalence in fish muscle was 0.64% (P < 0.0001), in viscera it was 1.34% (P < 0.0001), and overall prevalence was 0.95% (P < 0.0001). Mean intensity in muscle was 2.31 (P = 0.0083), in viscera it was 1.55 (P = 0.0174), and overall it was 1.81 (P < 0.0005). Heterogeneity indices (I(2)) were significantly high with the exception of viscera mean intensity.
CONCLUSIONS
Anchovy, pilchard, and Atlantic mackerel have a low prevalence and mean intensity of anisakidae larvae in both viscera and muscles. Mean Intensity was also low.
Topics: Animals; Anisakiasis; Anisakis; Fishes; Food Handling; Hot Temperature; Humans; Larva; Mediterranean Sea; Muscles; Seafood; Species Specificity; Viscera
PubMed: 25807208
DOI: 10.1080/10408398.2012.755947 -
JAMA Network Open Jul 2023Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is not usually offered because of skepticism about long-term clinical benefits. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is not usually offered because of skepticism about long-term clinical benefits.
OBJECTIVE
To assess the association of successful CTO-PCI with quality of life by analyzing the relevant domains of the Seattle Angina Questionnaire (SAQ).
DATA SOURCES
PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane databases were searched to identify randomized trials and observational studies specifically addressing quality of life domains of SAQ from January 2010 to June 2022.
STUDY SELECTION
Studies included reporting SAQ metrics such as angina frequency, physical limitation, and quality of life, before and after CTO-PCI.
DATA EXTRACTION AND SYNTHESIS
The present study was performed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements, in which fixed-effect or random-effect models with generic inverse-variance weighting depending on statistical homogeneity were applied. Data were extracted by 3 independent reviewers.
OUTCOMES AND MEASURES
The primary outcome was angina frequency; physical limitation and quality of life were assessed as secondary outcomes.
RESULTS
Seven prospective randomized or observational studies (2500 patients) were included, with a mean (SD) participant age of 61.2 (2.1) years. CTO-PCI was associated with significantly improved quality-of-life metrics during a mean (SD) follow-up of 14.8 (16.3) months. In patients with successful procedures, angina episodes became less frequent (mean [SD] difference for SAQ angina frequency of 12.9 [3.1] survey points [95% CI, 7.1-19.8 survey points]; standardized mean difference was 0.54 [95% CI, 0.21-0.92]; P = .002; I2 = 86.4%) and they experienced less physical activity limitation (mean [SD] difference for SAQ physical limitation of 9.7 [6.2] survey points [95% CI, 3.5-16.2 survey points]; standardized mean difference was 0.42 [95% CI, 0.24-0.55]; P < .001; I2 = 20.9%), and greater quality-of-life domain (mean [SD] difference for SAQ quality of life of 14.9 [3.5] survey points [95% CI, 7.7-22.5 survey points]; standardized mean difference was 0.41 [95% CI, 0.25-0.61]; P < .001; I2 = 58.8%) compared with patients with optimal medical therapy or failed procedure. Furthermore, follow-up duration (point estimate, 0.03; 95% CI, 0.01-0.04; P = .01) was associated with a significant decrease in angina frequency in meta-regression analysis.
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis examining quality of life following CTO-PCI, successful procedures were associated with improved quality-of-life parameters compared with patients on optimal medical therapy or after failed CTO-PCI. These findings suggest support for using PCI to treat CTOs in symptomatic patients unresponsive to medical treatment.
Topics: Humans; Middle Aged; Quality of Life; Percutaneous Coronary Intervention; Prospective Studies; Treatment Outcome; Coronary Occlusion; Angina Pectoris
PubMed: 37471086
DOI: 10.1001/jamanetworkopen.2023.24522 -
Scientific Reports Dec 2022Anemia is a common, treatable condition in patients with aneurysmal subarachnoid hemorrhage (SAH) and has been associated with poor outcome. As there are still no... (Meta-Analysis)
Meta-Analysis
Anemia is a common, treatable condition in patients with aneurysmal subarachnoid hemorrhage (SAH) and has been associated with poor outcome. As there are still no guidelines for anemia management after aneurysm rupture, we aimed to identify outcome-relevant severity of anemia in SAH. We systematically searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library for publications before Oct 23rd, 2022, reporting on anemia in SAH patients. The presence and severity of anemia were assessed according to the reported hemoglobin values and/or institutional thresholds for red blood cells transfusion (RBCT). Out of 1863 original records, 40 full-text articles with a total of 14,701 patients treated between 1996 and 2020 were included in the final analysis (mean 445.48 patients per study). A substantial portion of patients developed anemia during SAH (mean pooled prevalence 40.76%, range 28.3-82.6%). RBCT was administered in a third of the cases (mean 32.07%, range 7.8-88.6%), with institutional threshold varying from 7.00 to 10.00 g/dL (mean 8.5 g/dL). Anemia at the onset of SAH showed no impact on SAH outcome. In contrast, even slight anemia (nadir hemoglobin < 11.0-11.5 g/dL) occurring during SAH was associated with the risk of cerebral infarction and poor outcome at discharge and follow-up. The strongest association with SAH outcome was observed for nadir hemoglobin values ranging between 9.0 and 10.0 g/dL. The effect of anemia on SAH mortality was marginal. The development of anemia during SAH is associated with the risk of cerebral infarction and poor outcome at discharge and follow-up. Outcome-relevant severity of post-SAH anemia begins at hemoglobin levels clearly above the thresholds commonly set for RBCT. Our findings underline the need for further studies to define the optimal management of anemia in SAH patients.
Topics: Humans; Subarachnoid Hemorrhage; Anemia; Erythrocyte Transfusion; Aneurysm, Ruptured; Cerebral Infarction
PubMed: 36456587
DOI: 10.1038/s41598-022-24591-x -
Cureus Aug 2023Deep brain stimulation (DBS) is extensively used to treat motor and non-motor symptoms in Parkinson's disease (PD). The aim of this study was to investigate the... (Review)
Review
Deep brain stimulation (DBS) is extensively used to treat motor and non-motor symptoms in Parkinson's disease (PD). The aim of this study was to investigate the difference between subthalamic (STN) and globus pallidus internus (GPi) DBS on mood and quality of life with reference to minimal clinically important differences (MCID). A systematic literature search for articles published until November 2022 yielded 14 studies meeting the eligibility criteria, with a total of 1,088 patients undergoing STN (n=571) or GPi (n=517) stimulation. Baseline patient and clinical characteristics were comparable between the two groups. Results showed that GPi stimulation demonstrated a greater reduction in the Beck depression inventory (mean difference (MD)=1.68) than STN stimulation (MD=0.84). Hospital anxiety and depression scale showed a 2.69- and 3.48-point decrease by the GPi group in the depression and anxiety categories, respectively. The summary index (SI) of the PD questionnaire depicted a greater improvement in the GPi group from baseline (mean=41.01, 95% CI 34.89, 47.13) to follow-up (mean=30.85, 95% CI 22.08, 39.63) when compared to the STN group (baseline mean=42.43, 95% CI 34.50, 50.37; follow-up mean=34.21, 95% CI 25.43, 42.99). The emotions category also demonstrated a similar trend. However, STN stimulation showed greater reductions in motor symptoms and medication than GPi stimulation. This meta-analysis demonstrated that GPi stimulation seems to offer an advantage over STN stimulation in improving mood and quality of life in PD, but those effects must be further validated by larger studies.
PubMed: 37753046
DOI: 10.7759/cureus.44177 -
Surgery Aug 2022A systematic review and network meta-analysis was performed to compare outcomes after living donor right hepatectomy via the following techniques: conventional open... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A systematic review and network meta-analysis was performed to compare outcomes after living donor right hepatectomy via the following techniques: conventional open (Open), mini-laparotomy (Minilap), hybrid (Hybrid), totally laparoscopic (Lap), and robotic living donor right hepatectomy (Robotic).
METHODS
PubMed, EMBASE, Cochrane, and Scopus were searched from inception to August 2021 for comparative studies of patients who underwent living donor right hepatectomy.
RESULTS
Nineteen studies comprising 2,261 patients were included. Operation time was longer in Lap versus Minilap and Open (mean difference 65.09 min, 95% confidence interval 3.40-126.78 and mean difference 34.81 minutes, 95% confidence interval 1.84-67.78), and in Robotic versus Hybrid, Lap, Minilap, and Open (mean difference 144.72 minutes, 95% confidence interval 89.84-199.59, mean difference 113.24 minutes, 95% confidence interval 53.28-173.20, mean difference 178.33 minutes, 95% confidence interval 105.58-251.08 and mean difference 148.05 minutes, 95% confidence interval 97.35-198.74, respectively). Minilap and Open were associated with higher blood loss compared to Lap (mean difference 258.67 mL, 95% confidence interval 107.00-410.33 and mean difference 314.11 mL, 95% confidence interval 143.84-484.37) and Robotic (mean difference 205.60 mL, 95% confidence interval 45.92-365.28 and mean difference 261.04 mL, 95% confidence interval 84.26-437.82). Open was associated with more overall complications compared to Minilap (odds ratio 2.60, 95% confidence interval 1.11-6.08). Recipient biliary complication rate was higher in Minilap and Open versus Hybrid (odds ratio 3.91, 95% confidence interval 1.13-13.55 and odds ratio 11.42, 95% confidence interval 2.27-57.49), and lower in Open versus Minilap (OR 0.07, 95% confidence interval 0.01-0.34).
CONCLUSION
Minimally invasive donor right hepatectomy via the various techniques is safe and feasible when performed in high-volume centers, with no major differences in donor complication rates and comparable recipient outcomes once surgeons have mounted the learning curve.
Topics: Hepatectomy; Humans; Laparoscopy; Laparotomy; Length of Stay; Living Donors; Network Meta-Analysis; Operative Time; Postoperative Complications; Robotic Surgical Procedures
PubMed: 35644687
DOI: 10.1016/j.surg.2022.03.042 -
Annals of Clinical Microbiology and... Mar 2021Abnormal laboratory findings are common in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this systematic review was to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Abnormal laboratory findings are common in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this systematic review was to investigate the effect of the level of some laboratory factors (C-reactive protein (CRP), creatinine, leukocyte count, hemoglobin, and platelet count) on the severity and outcome of coronavirus disease 2019 (COVID-19).
METHODS
We searched PubMed, Web of Science, Scopus, and Google Scholar. We collected the articles published before May 26, 2020. We gathered the laboratory factors in groups of patients with COVID-19, and studied the relation between level of these factors with severity and outcome of the disease.
RESULTS
Mean CRP level, creatinine, hemoglobin, and the leukocytes count in the critically ill patients were significantly higher than those of the other groups (non-critical patients); mean CRP = 54.81 mg/l, mean creatinine = 86.82 μmol/l, mean hemoglobin = 144.05 g/l, and mean leukocyte count = 7.41 × 10. The lymphocyte count was higher in patients with mild/moderate disease (mean: 1.32 × 10) and in the invasive ventilation group (mean value of 0.72 × 10), but it was considerably lower than those of the other two groups. The results showed that the platelet count was higher in critically ill patients (mean value of 205.96 × 10). However, the amount was lower in the invasive ventilation group compared with the other groups (mean level = 185.67 × 10).
CONCLUSION
With increasing disease severity, the leukocyte count and the level of CRP increase significantly and the lymphocyte count decreases. There seems to be a significant relation between platelet level, hemoglobin, and creatinine level with severity of the disease. However, more studies are required to confirm this.
Topics: C-Reactive Protein; COVID-19; Creatinine; Hemoglobins; Humans; Laboratories; Leukocyte Count; Platelet Count; SARS-CoV-2; Severity of Illness Index
PubMed: 33726761
DOI: 10.1186/s12941-021-00420-3 -
Asia Pacific Journal of Clinical... 2022Evidence showed that intermittent fasting may have beneficial effects on metabolic syndrome. However, the results are controversial and indefinite. This study intends to... (Meta-Analysis)
Meta-Analysis
Effects of intermittent fasting on cardiometabolic risk factors in patients with metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials.
BACKGROUND AND OBJECTIVES
Evidence showed that intermittent fasting may have beneficial effects on metabolic syndrome. However, the results are controversial and indefinite. This study intends to investigate and assess the effects of intermittent fasting (IF) on cardiometabolic risk factors in patients with metabolic syndrome.
METHODS AND STUDY DESIGN
We searched PubMed, Web of Science, Embase, and Cochrane Library databases up to July 31, 2022. Primary outcomes included body mass index, fat mass, fat free mass, body weight, blood pressure, the homeostasis model assessment of insulin resistance (IR), fasting blood glucose, fasting insulin, and lipid profiles.
RESULTS
Of 4997 retrieved records, 6 met the inclusion criteria. The meta-analysis showed that IF can significantly reduce BMI (mean difference=-1.56 kg/m2, 95% CI: -2.62 to -0.51), fat mass (mean difference=-1.35%, 95% CI: -2.03 to -0.67), fat free mass (mean difference=-0.63%, 95% CI: -1.22 to -0.04), body weight (mean difference=-2.49 kg, 95% CI: -3.11 to -1.88), waist circumference (mean difference=-3.06 cm, 95% CI: -4.21 to -1.92), and HOMA-IR (mean difference=-0.62, 95% CI: -0.84 to -0.40) compared with non-fasting. However, no statistical difference was found in the SBP, DBP, TC, TG, LDL-C, HDL-C, fasting blood glucose, and fasting insulin comparing fasting and non-fasting group. Subgroup analyses suggested that study duration and sample size may be the source of heterogeneity for LDL-C. Sensitivity analysis indicated that our results are reliable and robust.
CONCLUSIONS
IF could be used for patients with metabolic syndrome. Further studies with a larger sample size are needed to verify the effectiveness and safety of IF in patients with metabolic syndrome.
Topics: Humans; Metabolic Syndrome; Blood Glucose; Cardiometabolic Risk Factors; Intermittent Fasting; Cholesterol, LDL; Randomized Controlled Trials as Topic; Body Weight; Insulin Resistance; Insulin
PubMed: 36576283
DOI: 10.6133/apjcn.202212_31(4).0008