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Nutrients Jul 2021Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease... (Meta-Analysis)
Meta-Analysis
Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85-0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85-0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94-0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94-0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Cardiovascular Diseases; Diet; Eating; Fatty Acids, Omega-3; Female; Fishes; Heart Disease Risk Factors; Humans; Male; Middle Aged; Prospective Studies; Seafood; Young Adult
PubMed: 34371852
DOI: 10.3390/nu13072342 -
JBI Evidence Synthesis Aug 2020The objective of this review was to evaluate the effects of preoperative intrathecal morphine (ITM) in addition to patient-controlled analgesia with morphine (PCAM)... (Meta-Analysis)
Meta-Analysis
Effect of intrathecal morphine plus patient-controlled analgesia with morphine versus patient-controlled analgesia with morphine alone on total morphine dose 24 hours post-surgery: a systematic review.
OBJECTIVE
The objective of this review was to evaluate the effects of preoperative intrathecal morphine (ITM) in addition to patient-controlled analgesia with morphine (PCAM) versus PCAM without preoperative ITM on total morphine dose in the first 24 hours postoperatively in adult patients undergoing abdominal or thoracic surgery.
INTRODUCTION
Postoperative pain is a significant problem for patients undergoing major abdominal and thoracic surgery. Intrathecal morphine can reduce postoperative pain and reduce intravenous (IV) morphine requirements during the first 24 hours after surgery; however, the amount of IV morphine dose reduction achieved has not been well established. This knowledge could help anesthesia providers determine if ITM is an appropriate analgesic option for patients.
INCLUSION CRITERIA
This review included studies with participants 18 years of age or older receiving general anesthesia for abdominal or thoracic surgery. Studies were included that used the intervention of preoperative ITM in addition to PCAM versus PCAM without preoperative ITM. Total morphine dose in milligrams during the first 24 hours after surgery was the outcome of interest.
METHODS
A search of PubMed and CINAHL was conducted for studies published between January 1984 and October 2018 using the key terms intrathecal, morphine, postoperative, pain, patient-controlled analgesia and general anesthesia. Index terms and keywords from identified articles were used to search CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov, Ovid MEDLINE, ProQuest Dissertations and Theses/Nursing and Allied Health Databases, and Scopus. The reference lists of articles that underwent critical appraisal were searched for additional studies. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Randomized Controlled Trials. Two independent reviewers assessed each selected article. Study results were pooled in statistical meta-analysis using the JBI System for the Unified Management, Assessment and Review of Information, and two studies were described in narrative form. Differences in IV morphine dose between the ITM plus PCAM and PCAM alone groups were calculated to produce the weighted mean difference (WMD) utilizing a 95% confidence interval (CI). Heterogeneity was assessed using χ and I values. Subgroup analysis was conducted on two studies that included IV non-opioid analgesia in addition to ITM and PCAM for postoperative analgesia.
RESULTS
Seven RCTs with a total sample size of 352 patients were included in this review. Five studies that evaluated postoperative total morphine dose in milligrams with and without preoperative ITM were included for statistical meta-analysis, with 277 participants from four countries. Total morphine dose was significantly reduced in patients who received ITM (WMD = -24.44 mg, 95% CI -28.70 to -20.18 mg) compared to PCAM without ITM. Subgroup analysis of two studies involving 112 participants using IV acetaminophen in addition to ITM and PCAM indicated no additional benefit after ITM was already administered (WMD = -25.93, 95% CI -32.05 to -19.80 mg). Two studies with 75 participants were described narratively because total morphine dose was reported as median rather than mean values.
CONCLUSIONS
In this review, ITM provided a significant decrease in overall total morphine dose during the first 24 hours after surgery in abdominal surgery patients. The addition of IV non-opioids to the postoperative analgesia protocol showed no additional reduction in postoperative IV morphine dose between groups.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42018100613.
Topics: Adolescent; Adult; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Analgesics, Opioid; Humans; Morphine; Pain, Postoperative
PubMed: 32898361
DOI: 10.11124/JBISRIR-D-19-00199 -
Andrologia Dec 2020To assess the comparative efficacy and safety of drug treatments for premature ejaculation. A systemic review and Bayesian network meta-analysis were executed on... (Meta-Analysis)
Meta-Analysis
To assess the comparative efficacy and safety of drug treatments for premature ejaculation. A systemic review and Bayesian network meta-analysis were executed on randomised controlled trials of drug interventions for premature ejaculation. Intravaginal ejaculation latency time and related adverse effects were outcome measures. A total of 44 RCTs with 11,008 patients were included in our NMA. In therapy <8 weeks, the ranking of drug efficacy was topical creams >selective serotonin reuptake inhibitor (SSRI)+ phosphodiesterase 5 inhibitor (PDE5i) > PDE5i > sertraline > clomipramine > paroxetine > dapoxetine 60 milligram (mg) > dapoxetine 30 mg > fluoxetine>citalopram > duloxetine>placebo. In therapy ≥ 8 weeks, the ranking of drug efficacy was SSRI + PDE5i > topical creams > paroxetine > tramadol > PDE5i > fluoxetine > dapoxetine 60 mg > dapoxetine 30 mg > clomipramine>citalopram > placebo. For total adverse events, clomipramine, dapoxetine 30 mg, dapoxetine 60 mg, paroxetine, PDE5i, SSRI + PDE5i and tramadol had a higher risk than placebo. In conclusion, in ≥8 weeks of therapy, the drug combination of SSRI + PDE5i was the most effective PE therapy. In <8 weeks of therapy, the efficacy of local anaesthetics was best. All drug treatments were ranked better than placebo. In general, drugs with better effects had more obvious side effects.
Topics: Bayes Theorem; Ejaculation; Humans; Male; Network Meta-Analysis; Pharmaceutical Preparations; Premature Ejaculation; Selective Serotonin Reuptake Inhibitors; Treatment Outcome
PubMed: 32892379
DOI: 10.1111/and.13806