-
Journal of Obstetrics and Gynaecology... Feb 2024The current meta-analysis was designed to investigate the impact of Hyoscine N-butyl bromide (HBB) rectal on labour duration and the rate of cervical dilatation by... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The current meta-analysis was designed to investigate the impact of Hyoscine N-butyl bromide (HBB) rectal on labour duration and the rate of cervical dilatation by consolidating the available data.
METHODS
The search of Medline through the PubMed interface, Scopus, ScienceDirect, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed for original articles concerning the effects of HBB rectal on the duration of labour published prior to 26 June 2023. Search terms were based on Medical Subject Headings without time and language restrictions. They included: Hyoscine, Scopolamine, HBB, Buscopan, Buscolysin, Buscapine, rectal, suppository, childbirth, delivery, active phase, second stage, cervical dilatation, labour, labour, and duration of labour. The Comprehensive Meta-Analysis V3 software was used for all analyses.
RESULTS
Five randomized control trials and 1 non-randomized study involving 1310 women were included in the systematic review. Two studies were excluded from the meta-analysis because of heterogeneous interventions and a lack of mean and SD results. The results determined that HBB rectal administration significantly decreased the duration of the active phase (pooled mean difference -193.893; 95% CI -229.173 to -158.613, P < 0.001; I squares = 90.097%) and second stage of labour (pooled mean difference -2.911; 95% CI -5.486 to -0.336, P = 0.027; I squares = 90.097%). Also, the cervical dilatation rate in the active phase of labour was 0.981 cm/h higher than in the control group (I = 0.0%; P < 0.001).
CONCLUSION
This meta-analysis found that HBB rectal administration shortened the active labour phase and second stage and increased the rate of cervix dilatation; consequently, it can be used as a cost-effective intervention for low-risk pregnant women during labour. However, our findings also suggest that more robust clinical trials are required to generate evidence and confirm the use of HBB during labour for clinical practice guidelines.
Topics: Pregnancy; Female; Humans; Butylscopolammonium Bromide; Labor Stage, First; Scopolamine; Labor, Obstetric; Randomized Controlled Trials as Topic; Hydrocarbons, Brominated
PubMed: 37993100
DOI: 10.1016/j.jogc.2023.102292 -
Pancreatology : Official Journal of the... Feb 2024Non-steroidal anti-inflammatory drugs (NSAIDs) are the most studied chemoprophylaxis for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). While... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most studied chemoprophylaxis for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). While previous systematic reviews have shown NSAIDs reduce PEP, their impact on moderate to severe PEP (MSPEP) is unclear. We conducted a systematic review and meta-analysis to understand the impact of NSAIDs on MSPEP among patients who developed PEP. We later surveyed physicians' understanding of that impact.
DESIGN
A systematic search for randomized trials using NSAIDs for PEP prevention was conducted. Pooled-prevalence and Odds-ratio of PEP, MSPEP were compared between treated vs. control groups. Analysis was performed using R software. Random-effects model was used for all variables. Physicians were surveyed via email before and after reviewing our results.
RESULTS
7688 patients in 25 trials were included. PEP was significantly reduced to 0.598 (95%CI, 0.47-0.76) in the NSAIDs group. Overall burden of MSPEP was reduced among all patients undergoing ERCP: OR 0.59 (95%CI, 0.42-0.83). However, NSAIDs didn't affect the proportion of MSPEP among those who developed PEP (p = 0.658). Rectal Indomethacin and diclofenac reduced PEP but not MSPEP. Efficacy didn't vary by risk, timing of administration, or bias-risk. Survey revealed a change in the impression of the effect of NSAIDs on MSPEP after reviewing our results.
CONCLUSIONS
Rectal diclofenac or indomethacin before or after ERCP reduce the overall burden of MSPEP by reducing the pool of PEP from which it can arise. However, the proportion of MSPEP among patients who developed PEP is unaffected. Therefore, NSAIDs prevent initiation of PEP, but do not affect severity among those that develop PEP. Alternative modalities are needed to reduce MSPEP among patients who develop PEP.
Topics: Humans; Diclofenac; Cholangiopancreatography, Endoscopic Retrograde; Administration, Rectal; Anti-Inflammatory Agents, Non-Steroidal; Indomethacin; Pancreatitis
PubMed: 37981523
DOI: 10.1016/j.pan.2023.11.003 -
Critical Care Medicine Nov 2023Fever is frequently an early indicator of infection and often requires rigorous diagnostic evaluation.
RATIONALE
Fever is frequently an early indicator of infection and often requires rigorous diagnostic evaluation.
OBJECTIVES
This is an update of the 2008 Infectious Diseases Society of America and Society (IDSA) and Society of Critical Care Medicine (SCCM) guideline for the evaluation of new-onset fever in adult ICU patients without severe immunocompromise, now using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.
PANEL DESIGN
The SCCM and IDSA convened a taskforce to update the 2008 version of the guideline for the evaluation of new fever in critically ill adult patients, which included expert clinicians as well as methodologists from the Guidelines in Intensive Care, Development and Evaluation Group. The guidelines committee consisted of 12 experts in critical care, infectious diseases, clinical microbiology, organ transplantation, public health, clinical research, and health policy and administration. All task force members followed all conflict-of-interest procedures as documented in the American College of Critical Care Medicine/SCCM Standard Operating Procedures Manual and the IDSA. There was no industry input or funding to produce this guideline.
METHODS
We conducted a systematic review for each population, intervention, comparison, and outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as best-practice statements.
RESULTS
The panel issued 12 recommendations and 9 best practice statements. The panel recommended using central temperature monitoring methods, including thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors when these devices are in place or accurate temperature measurements are critical for diagnosis and management. For patients without these devices in place, oral or rectal temperatures over other temperature measurement methods that are less reliable such as axillary or tympanic membrane temperatures, noninvasive temporal artery thermometers, or chemical dot thermometers were recommended. Imaging studies including ultrasonography were recommended in addition to microbiological evaluation using rapid diagnostic testing strategies. Biomarkers were recommended to assist in guiding the discontinuation of antimicrobial therapy. All recommendations issued were weak based on the quality of data.
CONCLUSIONS
The guidelines panel was able to formulate several recommendations for the evaluation of new fever in a critically ill adult patient, acknowledging that most recommendations were based on weak evidence. This highlights the need for the rapid advancement of research in all aspects of this issue-including better noninvasive methods to measure core body temperature, the use of diagnostic imaging, advances in microbiology including molecular testing, and the use of biomarkers.
Topics: Humans; Adult; Critical Illness; Fever; Critical Care; Intensive Care Units; Communicable Diseases; Biomarkers
PubMed: 37902340
DOI: 10.1097/CCM.0000000000006022 -
World Journal of Surgical Oncology Jul 2023To summarize the chemo-radio effect of metformin in rectal cancers with neoadjuvant chemoradiotherapy on pathological response, tumor regression grade (TRG), and T/N... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To summarize the chemo-radio effect of metformin in rectal cancers with neoadjuvant chemoradiotherapy on pathological response, tumor regression grade (TRG), and T/N downstaging.
METHODS
PubMed, MEDLINE, Embase, and Cochrane Database of collected reviews were searched up to June 30, 2022. This study conducted systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) sheet. Odds ratios (ORs) and confidence intervals (CIs) which calculated by random-effects models were displayed in forest plots. Newcastle-Ottawa scale was used to assess the risk of bias of the observational cohort studies.
RESULTS
This systematic review and meta-analysis comprised eight cohorts out of seven studies, with 2294 patients in total. We performed two-way comparison for metformin in diabetic patients vs (1) non-metformin drugs in diabetic patients and (2) nondiabetic patients. In diabetes patient studies, the metformin group had a significantly increased pathological response on TRG (OR: 3.28, CI: 2.01-5.35, I = 0%, p < 0.001) and T downstaging (OR: 2.14, CI: 1.24-3.67, I = 14%, p = 0.006) in comparison with a non-metformin group. When compared with nondiabetic patients, the pathological response on TRG (OR: 2.67, CI: 1.65-4.32, I = 43%, p < 0.001) and T downstaging (OR: 1.96, CI: 1.04-3.71, I = 66%, p = 0.04) were also higher in metformin group. The limitation was that no randomized controlled trials were available based on current literature review. Small sample sizes for diabetic metformin or non-metformin users in rectal cancer patients reduced the power of the study.
CONCLUSIONS
For patients with rectal cancer and treated with neoadjuvant chemoradiotherapy, metformin administration in diabetic patients increased the pathological response on tumor-regression grade and T downstaging. Further well-designed, high-quality randomized controlled trials are required to reveal the actual effect of metformin.
Topics: Humans; Metformin; Neoadjuvant Therapy; Chemoradiotherapy; Rectal Neoplasms; Diabetes Mellitus; Treatment Outcome
PubMed: 37491250
DOI: 10.1186/s12957-023-03087-6 -
The Journal of Infectious Diseases Aug 2023This study aims to comparatively analyze clinical features, treatment, and patient outcomes between the previous and the 2022 mpox (monkeypox) outbreaks. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aims to comparatively analyze clinical features, treatment, and patient outcomes between the previous and the 2022 mpox (monkeypox) outbreaks.
METHODS
Five bibliographic databases were searched for studies reporting clinical features, management, and patient outcomes of mpox. Systematic review and meta-analysis were performed.
RESULTS
In total, 73 studies were included in the systematic review, of which 33 studies were subjected to meta-analysis. Previous outbreaks substantially affected children, whereas the 2022 outbreak primarily affected male adults, of which 94.66% (95% confidence interval [CI], 88.03-98.95) were men who have sex with men. Furthermore, 72.47% (95% CI, 51.04-89.71) reported high-risk sexual activity and the overall human immunodeficiency virus (HIV) prevalence was 37.65% (95% CI, 30.09-45.50). Skin lesions remain the typical symptom; however, their anatomic distribution differed. Systemic manifestations were common, but rectal pain was unique to the 2022 outbreak. The estimated overall fatality during past outbreaks in Africa was 4.61% (95% CI, 2.39%-7.35%), whereas 6.34% (95% CI, 3.35%-10.10%) of patients from the 2022 outbreak required hospitalization. Antiviral treatment, in particular tecovirimat, has been prescribed for a subset of patients, but the efficacy remains inconclusive.
CONCLUSIONS
These findings are important for better understanding the disease and guiding adequate response to mpox outbreaks.
Topics: Adult; Child; Humans; Male; Female; Homosexuality, Male; Mpox (monkeypox); Sexual and Gender Minorities; Antiviral Agents; Disease Outbreaks; Pelvic Pain
PubMed: 36735342
DOI: 10.1093/infdis/jiad034