-
Frontiers in Neuroscience 2023Post-stroke constipation (PSC) is a common complication of strokes that seriously affects the recovery and quality of life of patients, and effective treatments are...
BACKGROUND AND OBJECTIVE
Post-stroke constipation (PSC) is a common complication of strokes that seriously affects the recovery and quality of life of patients, and effective treatments are needed. Acupuncture is a viable treatment option, but current evidence is insufficient to support its efficacy and safety. This study aims to evaluate the efficacy and safety of acupuncture in the treatment of PSC.
METHODS
A systematic search of eight databases was conducted to identify PSC-related randomized clinical trials from the inception of each database through May 2023. Methodological quality assessment was conducted by RoB 2.0, meta-analysis was conducted by RevMan 5.3 and Stata 15.1, and evidence quality was evaluated by GRADE. Moreover, reporting quality of acupuncture interventions was assessed using the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA).
RESULTS
Thirty RCTs involving 2,220 patients were identified. We found that acupuncture was superior to conventional treatment (CT) in improving total responder rate [risk ratio (): 1.16, 95% confidence interval (CI): 1.09 to 1.25, < 0.0001], decreasing constipation symptom scores [standardized mean difference (): -0.65, 95% CI: -0.83 to -0.46, < 0.00001], increasing serum P substance (SP) levels (: 1.92, 95% CI: 0.47 to 3.36, = 0.009), reducing the time to first bowel movement (BM) (: -1.19, 95% CI: -2.13 to -0.25, = 0.01), and lowing serum vasoactive intestinal peptide (VIP) levels (: -2.11, 95% CI: -3.83 to -0.38, = 0.02). Furthermore, acupuncture plus CT was superior regarding total responder rate (: 1.26, 95% CI: 1.17 to 1.35, < 0.00001), serum SP levels (: 2.00, 95% CI: 1.65-2.35, < 0.00001), time to first BM (: -2.08, 95% CI: -2.44 to -1.71, < 0.00001), and serum VIP levels (: -1.71, 95% CI: -2.24 to -1.18, < 0.00001). However, regarding Bristol Stool Scale (BSS) score, acupuncture plus CT was superior to CT (: -2.48, 95% CI: -3.22 to -1.73, < 0.00001), while there was no statistically significant difference between acupuncture and CT (: 0.28, 95% CI: -0.02 to 0.58, = 0.07). Acupuncture causes fewer AEs than CT (: 0.13, 95% CI: 0.06 to 0.26, < 0.00001), though there was no statistically significant difference between acupuncture plus CT vs. CT (: 1.30, 95% CI: 0.60 to 2.84, = 0.51).
CONCLUSION
Acupuncture may be an effective and safe therapy for PSC. However, given the inferior quality of clinical data, additional well-designed RCTs are required to confirm these findings.
PubMed: 37822350
DOI: 10.3389/fnins.2023.1275452 -
Annals of Medicine and Surgery (2012) Oct 2023Portal hypertension, a major complication of chronic liver disease, often leads to life-threatening variceal bleeding, managed effectively with vasoactive drugs like... (Review)
Review
BACKGROUND
Portal hypertension, a major complication of chronic liver disease, often leads to life-threatening variceal bleeding, managed effectively with vasoactive drugs like terlipressin. However, the most optimal method of terlipressin administration, continuous versus intermittent infusion, remains a subject of debate, necessitating this systematic review and meta-analysis for evidence-based decision-making in managing this critical condition.
METHODS
This systematic review and meta-analysis adhered to the PRISMA standards and explored multiple databases until 6 April 2023, such as MEDLINE through PubMed, Scopus, Web of Science, and CENTRAL. Independent reviewers selected randomized controlled trials (RCTs) that met specific inclusion criteria. After assessing study quality and extracting necessary data, statistical analysis was performed using Review Manager (RevMan), with results presented as risk ratios (RR) or mean differences.
RESULTS
Five RCTs (=395 patients) were included. The continuous terlipressin group had a significantly lower risk of rebleeding (RR=0.43, =0.0004) and treatment failure (RR=0.22, =0.02) and fewer total adverse effects (RR=0.52, <0.00001) compared to the intermittent group. However, there were no significant differences between the two groups in mean arterial pressure (=0.26), length of hospital stays (=0.78), and mortality rates (=0.65).
CONCLUSION
This study provides robust evidence suggesting that continuous terlipressin infusion may be superior to intermittent infusions in reducing the risk of rebleeding, treatment failure, and adverse effects in patients with portal hypertension. However, further large-scale, high-quality RCTs are required to confirm these findings and to investigate the potential benefits of continuous terlipressin infusion on mortality and hospital stays.
PubMed: 37811089
DOI: 10.1097/MS9.0000000000001261 -
The Journal of Infection Sep 2023The optimisation of the use of β-lactam antibiotics (BLA) via prolonged infusions in life-threatening complications such as febrile neutropenia (FN) is still... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The optimisation of the use of β-lactam antibiotics (BLA) via prolonged infusions in life-threatening complications such as febrile neutropenia (FN) is still controversial. This systematic review and meta-analysis aim to evaluate the efficacy of this strategy in onco-haematological patients with FN.
METHODS
A systematic search was performed of PubMed, Web of Science, Cochrane, EMBASE, World Health Organization, and ClinicalTrials.gov, from database inception until December 2022. The search included randomised controlled trials (RCTs) and observational studies that compared prolonged vs short-term infusions of the same BLA. The primary outcome was all-cause mortality. Secondary outcomes were defervescence, requirement of vasoactive drugs, length of hospital stay and adverse events. Pooled risk ratios were calculated using random effects models.
RESULTS
Five studies were included, comprising 691 episodes of FN, mainly in haematological patients. Prolonged infusion was not associated with a reduction in all-cause mortality (pRR 0.83; 95% confidence interval 0.47-1.48). Nor differences were found in secondary outcomes.
CONCLUSIONS
The limited data available did not show significant differences in terms of all-cause mortality or significant secondary outcomes in patients with FN receiving BLA in prolonged vs. short-term infusion. High-quality RCTs are needed to determine whether there are subgroups of FN patients who would benefit from prolonged BLA infusion.
Topics: Humans; Anti-Bacterial Agents; Monobactams; Febrile Neutropenia
PubMed: 37423503
DOI: 10.1016/j.jinf.2023.06.023 -
International Wound Journal Aug 2023Sepsis is a potentially lethal condition that occurs when the body's response to infection damages tissue and organs. The production of inflammatory mediators typically... (Meta-Analysis)
Meta-Analysis
Sepsis is a potentially lethal condition that occurs when the body's response to infection damages tissue and organs. The production of inflammatory mediators typically assists in defending the body against infection; however, an overreaction to inflammation can cause coagulation problems, vascular endothelial damage, and organ hypoperfusion. Blood purification methods, such as plasmapheresis, can effectively remove inflammatory mediators from plasma. The purpose of this meta-analysis was to explore the efficacy of plasma exchange for sepsis treatment as noted in recent studies. The authors searched the Pubmed (Medline), Cochrane Central Register of Controlled Trials (The Cochrane Library), Embase (Ovid), and Scopus databases and included controlled clinical studies that compared plasmapheresis or plasma filtration with conventional treatment in patients with severe sepsis. The Newcastle-Ottawa Scale literature quality assessment tool was used to assess the risk of bias. The primary study outcome was all-cause mortality. The random effects model was adopted for conducting the meta-analysis. Among the 1013 records found, the study included 5 trials, all of which carried a low risk of bias. The use of plasmapheresis was associated with a longer stay in the intensive care unit (odds ratio [OR], 0.85, 95% confidence interval [CI], 0.39-1.32, heterogeneity [I ] = 0%), a significant reduction in all-cause mortality (OR, 0.54, 95% CI, 0.33-0.89, I = 70%), and reduced mortality (OR, 0.29, 95% CI, 0.13-0.67, I = 0%) in adults; the results for children differed from this (OR, 0.79, 95% CI, 0.36-1.72, I = 89%). Four trials reported no adverse events; one trial reported an adverse event related to plasma exchange, including an instance of hypotension in one patient. Plasmapheresis appeared to be an effective treatment for patients suffering from sepsis. A large number of additional randomised controlled trials are needed to confirm this finding.
Topics: Humans; Plasma Exchange; Sepsis; Treatment Outcome; Controlled Clinical Trials as Topic
PubMed: 36717980
DOI: 10.1111/iwj.14059