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Evidence-based Complementary and... 2019Xiyanping injection (XYP) is a well-known Chinese medicinal preparation reputed as a most effective alternative to antibiotics. XYP has been widely used in combination... (Review)
Review
BACKGROUND
Xiyanping injection (XYP) is a well-known Chinese medicinal preparation reputed as a most effective alternative to antibiotics. XYP has been widely used in combination therapies to treat various infectious diseases, among which XYP plus azithromycin (AZM) chemotherapy is often used for the treatment of pneumonia in pediatric patients (p-MPP) in China.
OBJECTIVE
The present study just aimed to confirm whether XYP can improve the clinical efficacy and safety of AZM chemotherapy for p-MPP by performing meta-analysis and systematic review.
METHODS
A meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The randomized controlled trials (RCTs) concerning XYP plus AZM chemotherapy for p-MPP were selected, for which the main outcomes included overall response rate (ORR), antipyretic time, cough disappearance time, lung wet Rales disappearance time, hospitalization duration, and adverse drug reactions (ADRs). Based on the data extracted, the meta-analysis was conducted by using a standard data extraction form.
RESULTS
Nine RCTs involving 963 patients were included for meta-analysis. More concretely, the combination therapy showed the risk ratio (RR) and 95% confidence intervals (CI) of ORR and ADRs as (RR, 1.21 [95% CI, 1.15, 1.28]) and (RR, 0.37 [95% CI, 0.27, 0.51]), respectively. And other major outcomes were as follows: hospitalization durations (standard mean difference (SMD), -1.32 [95% CI, -1.48, -1.16]), antipyretic time (SMD, -1.26 [95% CI, -1.70, -0.83]), cough disappearance time (SMD, -1.07 [95% CI, -1.38, -0.75]), and the disappearance time of lung wet Rales (SMD, -0.83 [95% CI, -1.07, -0.60]). With statistically significant differences in various aspects, the combination therapy plus XYP displayed obvious advantages in contrast to AZM alone.
CONCLUSION
Overall, XYP might reduce the incidence of ADRs and significantly improve the clinical efficacy for p-MPP receiving AZM chemotherapy.
PubMed: 31558910
DOI: 10.1155/2019/2346583 -
Journal of Medical Microbiology Nov 2019is regarded as the important infectious agent of acute respiratory infections (ARIs) in the world. However, there is little knowledge about the prevalence of in Iran.... (Meta-Analysis)
Meta-Analysis
is regarded as the important infectious agent of acute respiratory infections (ARIs) in the world. However, there is little knowledge about the prevalence of in Iran. Therefore, the aim of this study was to investigate the prevalence of in Iran through a meta-analysis of included studies. A systematic search was done by using electronic databases from papers that were published by Iranian authors to the end of February 2019. Then, 12 publications, which met our inclusion criteria, were enrolled for data extraction and analysis by using the 'metaprop program' in stata version 14.0. The pooled prevalence of was 9 % (95 % confidence intervals: 5-16 %) ranging from 1 to 26 %. There was a significant heterogeneity among the 12 studies (X=128.29; <0.001; =91.43 %). The funnel plot for publication bias showed no evidence of asymmetry. The frequency of in Iran is comparable with other parts of the world. Although the overall prevalence of was low, awareness about the distribution of these agent is very important because of higher infection rates in susceptible groups. In addition, these results showed the rates of had variation based on location, type of infection and sample, gender and detection rate and there was evidence of publication bias.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Iran; Male; Middle Aged; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Prevalence; Respiratory Tract Infections; Young Adult
PubMed: 31524582
DOI: 10.1099/jmm.0.001079 -
Clinical Medicine Insights.... 2019is one of the primary cause of community-acquired pneumonia (CAP) worldwide. However, scant data are available on the prevalence of etiological organisms for CAP in...
BACKGROUND
is one of the primary cause of community-acquired pneumonia (CAP) worldwide. However, scant data are available on the prevalence of etiological organisms for CAP in adolescent and adult Indian population.
OBJECTIVE
We performed a systematic review and meta-analysis to determine the contribution of in the causation of CAP in Indian patients aged 12 years or above.
METHODOLOGY
We performed a systematic search of both indexed and non-indexed publications using PubMed, databases of National Institute of Science Communication and Information Resources (NISCAIR), Annotated Bibliography of Indian Medicine (ABIM), Google Scholar, and hand search including cross-references using key terms 'community acquired pneumonia AND India'. All studies, published between January 1990 and January 2017, that evaluated Indian patients aged above 12 years with a confirmed diagnosis of CAP were eligible for inclusion. Our search retrieved a total of 182 studies, of which only 17 and 12 qualified for inclusion in the systematic review of all etiological organisms, and meta-analysis of , respectively.
RESULTS
A total of 1435 patients met the inclusion criteria. The pooled proportion of patients with infection was 19% (95% confidence interval [CI]: 12%-26%; I = 94.5% where I represents heterogeneity, < .01). Other major etiological agents are (15.5% [1.1%-35.5%]), (10.5% [1.6%-24.0%]), and (7.3% [2.5%-23.8%]).
CONCLUSIONS
Analysis found approximately a one-fifth proportion of adult Indian patients of CAP with infection, suggesting it as a leading organism for causing CAP compared with other etiological organisms.
PubMed: 31391784
DOI: 10.1177/1179548419862790 -
Journal of the American Academy of... Sep 2019Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants.
BACKGROUND
Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants.
OBJECTIVE
To investigate the triggers, clinical manifestations, and treatment of pediatric EM.
METHODS
Systematic literature review of pediatric EM.
RESULTS
After full-text article review, we included 113 articles, representing 580 patients. The mean age was 5.6 years, ranging 0.1-17 years. Infectious agents were the main triggers: herpes simplex virus (HSV) in 104 patients (17.9%) and Mycoplasma pneumoniae in 91 patients (15.7%). In total, 140 cases (24.1%) were drug-related and 89 cases (15.3%) had other triggers, such as vaccines (19 patients, 3.2%). In total, 229 patients had EM major (39.5%). Treatment was supportive care only (180 patients, 31.1%), systemic corticosteroids (115 patients, 19.8%), antivirals (85 patients, 14.6%), and antibiotics (66 patients, 11.3%), mostly macrolides (45 patients, 7.7%). Long-term sequelae were rare (1.3%). Pediatric EM was reported in 19 infants (3.2%). The main trigger was vaccination (9 patients). Infantile EM was EM major in 2 cases and EM minor in 17. Infants were less prone to develop EM major than older children (P < .01). Pediatric EM was recurrent in 83 cases (14.3%), which was triggered by HSV in 36 patients (61%). Recurrence affected older children.
LIMITATIONS
Potential confusion between Steven Johnson syndrome and EM major in addition to publication bias.
CONCLUSION
Pediatric EM is a rare disease, mainly triggered by infections. This condition can affect all mucosal surfaces, most commonly the oral mucosae. The diagnosis is clinical, and management relies on supportive care. Vaccines are a particular trigger in infants. Recurrent cases are most commonly linked to HSV. Dermatologists and pediatricians should be aware of this potentially recurrent and severe condition.
Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Antiviral Agents; Child; Child, Preschool; Diagnosis, Differential; Drug Eruptions; Erythema Multiforme; Glucocorticoids; Herpes Simplex; Humans; Infant; Mouth Mucosa; Palliative Care; Pneumonia, Mycoplasma; Rare Diseases; Recurrence; Severity of Illness Index; Vaccination
PubMed: 31331726
DOI: 10.1016/j.jaad.2019.02.057 -
Journal of Veterinary Internal Medicine Sep 2019The pathogenic role of mycoplasmas in the lower respiratory tract (LRT) of dogs is debated, because mycoplasmas can be isolated from both healthy and sick dogs. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The pathogenic role of mycoplasmas in the lower respiratory tract (LRT) of dogs is debated, because mycoplasmas can be isolated from both healthy and sick dogs.
OBJECTIVES
To critically assess available data from controlled observational studies on the role of 4 mycoplasma species in LRT disease of dogs.
DESIGN
Systematic review and meta-analyses.
METHODS
Seven electronic databases were searched for relevant publications. Risk of bias was assessed by the Newcastle-Ottawa Scale. Meta-analyses, stratified by mycoplasmal species, were performed using a random effects Bayesian model with noninformative priors to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the association between Mycoplasma cynos, Mycoplasma canis, Mycoplasma spumans, and Mycoplasma edwardii and LRT disease in dogs.
RESULTS
Five studies were included from 1201 references identified. All studies dealt with M. cynos, whereas 3 dealt with the other mycoplasma species. A significant association was found between M. cynos and LRT disease (Bayesian OR, 3.60; CI, 1.31-10.29). Conversely, M. canis, M. spumans, and M. edwardii were not significantly associated with LRT signs (Bayesian OR, 1.06; CI, 0.10-14.63; Bayesian OR, 3.40; CI, 0.16-54.27; and Bayesian OR, 1.04; CI, 0.05-23.54, respectively).
CONCLUSIONS AND CLINICAL IMPORTANCE
Results support a pathogenic role of M. cynos and a commensal role of M. canis and M. edwardii in LRT in dogs. Although the association was not significant based on the CI, the point estimate of the Bayesian OR was relatively high for M. spumans, making its role less clear. Mycoplasma cynos-specific polymerase chain reaction should be considered on samples from dogs with LRT.
Topics: Animals; Dog Diseases; Dogs; Mycoplasma; Mycoplasma Infections; Respiratory Tract Infections
PubMed: 31297880
DOI: 10.1111/jvim.15568 -
Medicine Apr 2019Several clinical studies have reported that inflammation factors (IF) are associated with Mycoplasma pneumoniae in children. However, no study systematically... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several clinical studies have reported that inflammation factors (IF) are associated with Mycoplasma pneumoniae in children. However, no study systematically investigated the association between IF and M pneumoniae in pediatric population. Thus, this study will explore the association between IF and pediatric M pneumoniae systematically.
METHODS
This study will search following databases of PUBMED, PsycINFO, Scopus, Cochrane Library, EMBASE, Web of Science, and Chinese Biomedical Literature Database from inception to the February 28, 2019 without any language limitations. We will cover clinical studies of M pneumoniae that report associations between IF and M pneumoniae. In addition, reference lists of relevant studies will also be identified to avoid missing any eligible studies. Two investigators will independently screen and select studies, and will assess the methodological quality for each study, which is evaluated by using Newcastle Ottawa Scale. Any disagreements will be settled down through discussion with a third investigator until consensus is reached.
RESULTS
This study will explore the associations between IF and M pneumoniae by assessing the changes of IF, such as interleukin (IL)-4, IL-5, IL-6, IL-10, IL-13, and IL-17 at different stages of M pneumoniae.
CONCLUSION
The findings of this study may provide most recent evidence for the associations between IF and M pneumoniae in pediatric populations.
ETHICS AND DISSEMINATION
Ethical approval is not needed in this study, because no individual patient data will be utilized in this study. The findings of this study are expected to be published at peer-reviewed journal or will be presented at professional conference.
PROSPERO REGISTRATION NUMBER
PROSPERO CRD42019125359.
Topics: Child; Humans; Inflammation; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Research Design
PubMed: 30985670
DOI: 10.1097/MD.0000000000015118 -
Journal of Clinical Laboratory Analysis Jun 2019Mycoplasma pneumoniae (M pneumoniae) is a common human etiology of respiratory infections. Nuclear acid sequence-based amplification (NASBA) shows good value for the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mycoplasma pneumoniae (M pneumoniae) is a common human etiology of respiratory infections. Nuclear acid sequence-based amplification (NASBA) shows good value for the detection of M pneumoniae that surpasses PCR. However, the optimal detection technology still remains to be identified. The purpose of this meta-analysis was to systematically evaluate the overall accuracy of NASBA for diagnosing M pneumoniae infections.
METHODS
The databases PubMed, Cochrane Library, Google Scholar, CNKI, Wang Fang, and Baidu Scholar were comprehensively searched from their initiation date to December 2017 for NASBA in the diagnosis of M pneumoniae infection. Meta-DiSc 1.4 statistical software was used to evaluate the sensitivity (SEN), specificity (SPE), negative likelihood ratio (-LR), positive likelihood ratio (+LR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC). RevMan 5.2 statistical software was used for quality evaluation of the included articles. Publication bias was evaluated by funnel plot.
RESULTS
Six articles with high quality, including 10 studies, were finally included in this meta-analysis. The combined statistics results for the diagnosis of M pneumoniae infection by NASBA were 0.77 (SEN, 95% CI: 0.71 to 0.82); 0.98 (SPE, 95% CI: 0.98 to 0.99); 0.22 (-LR, 95% CI: 0.13 to 0.39); 50.38 (+ LR, 95% CI: 21.85 to 116.17); 292.72 (DOR, 95% CI: 95.02 to 901.75); and 0.9875 (the area under the curve of SROC).
CONCLUSION
Nuclear acid sequence-based amplification is a reliable technique to diagnose M pneumoniae infection. However, whether it can replace PCR and serology need to be further studied.
Topics: Humans; Mycoplasma pneumoniae; Odds Ratio; Pneumonia, Mycoplasma; ROC Curve; Self-Sustained Sequence Replication; Sensitivity and Specificity
PubMed: 30843291
DOI: 10.1002/jcla.22879 -
BMC Infectious Diseases Feb 2019A novel method, termed loop-mediated isothermal amplification (LAMP), was developed by Notomi et al. (2000). Individually published results have been reported that this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A novel method, termed loop-mediated isothermal amplification (LAMP), was developed by Notomi et al. (2000). Individually published results have been reported that this technology has been successfully applied to the detection of a variety of pathogens. However, the overall diagnostic accuracy of LAMP for Mycoplasma pneumoniae (MP) remains unclear. A meta-analysis was therefore performed to review the accuracy of LAMP for Mycoplasma pneumoniae.
METHODS
Cochrane Library and PubMed were systematically searched and checked for studies using LAMP for detecting mycoplasma pneumoniae. We used PCR as a reference standard to evaluate the quality of the studies eligible for inclusion in the meta-analysis. Then, the data from the studies were extracted by two independent assessors. Meta-DiSc 1.4 software was utilized to test the heterogeneity of sensitivity (SEN), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnosis odds ratio (DOR). The pooled analysis results were plotted, and the summary receiver operating characteristic (SROC) curve was plotted by calculating the area under the curve (AUC). Generated pooled summary estimates (95% CIs) were calculated for the overall accuracy, and a bivariate meta-regression model was used for the meta-analysis.
RESULTS
Seven studies with nine fourfold tables were included in this meta-analysis. The pooled SEN and SPE for diagnosing Mycoplasma pneumoniae were 0.90 (95% CI: 0.87-0.93) and 0.98 (95% CI: 0.96-0.99), respectively. The PLR was 31.25 (95% CI: 14.83-65.87), NLR 0.10 (95% CI: 0.05-0.22), DOR 399.32 (95% CI: 172.01-927.00), and AUC 0.9892.
CONCLUSIONS
In conclusion, compared with PCR, LAMP is a valuable alternative method for Mycoplasma pneumoniae diagnosis in clinic with high sensitivity and specificity. However, more evidence is required to confirm that LAMP can fully replace other methods in the clinical diagnosis of MP.
Topics: Area Under Curve; Humans; Mycoplasma pneumoniae; Nucleic Acid Amplification Techniques; Odds Ratio; Pneumonia, Mycoplasma; ROC Curve; Sensitivity and Specificity
PubMed: 30782134
DOI: 10.1186/s12879-019-3799-4 -
Canadian Respiratory Journal 2018pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children. The objective of this study was to explore potential changes in levels of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children. The objective of this study was to explore potential changes in levels of serum tumor necrosis factor- (TNF-) and interferon- (IFN-) associated with pediatric MPP.
METHODS
This protocol has been registered (PROSPERO 2017: CRD42017077979). A literature search was performed in October 2017 using PubMed, Embase, the Cochrane Library, and other Chinese medical databases to identify studies. The meta-analysis was performed using Review Manager 5.3 software. Random-effect models were used to estimate mean differences (MDs) and 95% confidence intervals (CIs) of cytokine levels.
RESULTS
Twelve studies were included in the meta-analysis, encompassing 2,422 children with MPP and 454 healthy control children. Serum TNF- levels were significantly higher in children with MPP compared with healthy children (MD = 22.5, 95% CI = 13.78-31.22, < 0.00001), and there was significant heterogeneity across studies ( = 100%, < 0.00001). Subgroup analyses showed no evidence for a difference in serum TNF- levels between children with refractory and nonrefractory MPP. Serum IFN- levels did not significantly differ in children with MPP compared with healthy children (MD = 4.83, 95% CI = -3.27-12.93, =0.24).
CONCLUSIONS
Our meta-analysis showed that serum TNF- and IFN- levels were significantly elevated and unchanged, respectively, in pediatric MPP. Because infection by different pathogens has variable effects on serum TNF- and IFN- levels, the finding could be helpful in developing novel diagnostic methods.
Topics: Child; Humans; Interferon-gamma; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Tumor Necrosis Factor-alpha
PubMed: 30275916
DOI: 10.1155/2018/8354892 -
Antimicrobial Agents and Chemotherapy Sep 2018The duration of therapy for community-acquired pneumonia (CAP) remains undefined. We sought to investigate whether short-course antibiotic treatment for CAP is... (Meta-Analysis)
Meta-Analysis
The duration of therapy for community-acquired pneumonia (CAP) remains undefined. We sought to investigate whether short-course antibiotic treatment for CAP is associated with favorable clinical outcomes in adult patients. We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for studies comparing the effectiveness and safety between treatment regimens administered for ≤6 days and ≥7 days. We defined treatment for ≤6 days as short-course treatment and treatment for ≥7 days as long-course treatment. Twenty-one clinical trials (4,861 clinically evaluable patients) were included, and 19 out of 21 trials were randomized. Clinical cure was similar between the compared groups (4,069 patients, risk ratio [RR] = 0.99 [95% confidence interval {CI}, 0.97 to 1.01]), irrespective of patient setting (RR = 0.98 [95% CI, 0.96 to 1.00] for the outpatient setting and RR = 1.00 [95% CI, 0.92 to 1.09] for the inpatient setting) or severity of pneumonia (RR = 1.05 [95% CI, 0.96 to 1.14]). Also, relapses were similar between the short- and long-course treatment groups (1,923 patients, RR = 0.67 [95% CI, 0.30 to 1.46]). Short-course treatment was associated with fewer serious adverse events (1,923 patients, RR = 0.73 [95% CI, 0.55 to 0.97]) and, importantly, resulted in lower mortality than long-course treatment (2,802 patients, RR = 0.52 [95% CI, 0.33 to 0.82]). In CAP, short-course antibiotic treatment (≤6 days) is as effective as and potentially superior to, in terms of mortality and serious adverse events, longer-course treatment.
Topics: Adult; Anti-Bacterial Agents; Clinical Trials as Topic; Community-Acquired Infections; Humans; Pneumonia; Randomized Controlled Trials as Topic
PubMed: 29987137
DOI: 10.1128/AAC.00635-18