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The Cochrane Database of Systematic... Oct 2011Diarrhoeal disorders and acute respiratory infections (ARIs), especially pneumonia, are the most common causes of death in low-income countries. Studies evaluating the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diarrhoeal disorders and acute respiratory infections (ARIs), especially pneumonia, are the most common causes of death in low-income countries. Studies evaluating the impact of zinc supplementation as an adjunct in the management of pneumonia are limited and have shown variable results.
OBJECTIVES
To evaluate zinc supplementation, as an adjunct to antibiotics, in the treatment (clinical recovery) of pneumonia in children aged two to 59 months.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), which contains the Cochrane Acute Respiratory Infections (ARI) Group's and the Cochrane Infectious Diseases Group's Specialised Registers, MEDLINE (1950 to March week 2, 2011), EMBASE (1974 to March 2011), CINAHL (1981 to March 2011), LILACS (1985 to March 2011), AMED (1985 to March 2011), CAB Abstracts (1910 to March 2011) and Web of Science (2000 to March 2011).
SELECTION CRITERIA
Randomised control trials (RCTs) evaluating supplementation of zinc as an adjunct to antibiotics for pneumonia in children aged two to 59 months.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial eligibility and screened all available titles and abstracts for inclusion. If the relevance could not be ascertained by screening the title and abstract, we retrieved and reviewed the full text of the article.
MAIN RESULTS
We included four trials in which 3267 children aged two to 35 months participated. Analysis showed that zinc supplementation in addition to standard antibiotic therapy in children with severe and non-severe pneumonia failed to show a statistically significant effect on clinical recovery (risk ratio (RR) 1.02; 95% confidence interval (CI) 0.93 to 1.11). Similary, zinc supplementation in children with severe pneumonia, as an adjunct to standard antibiotic therapy, did not show a statistically significant effect on clinical recovery measured as resolution of tachypnoea (respiratory rate > 50 breaths per minute) (RR 1.13; 95% CI 0.82 to 1.57) and cessation of chest indrawing (RR 1.08; 95% CI 0.88 to 1.31) as compared to the control group. Zinc supplementation in children with severe pneumonia also showed a non-significant effect on the duration of hospitalization stay as compared to the control (RR 1.04; 95% CI 0.89 to 1.22).
AUTHORS' CONCLUSIONS
Evidence provided in this review is insufficient to recommend the use of zinc as an adjunct to standard antibiotic therapy for pneumonia in children aged two to 35 months.
Topics: Anti-Bacterial Agents; Child, Preschool; Dietary Supplements; Humans; Infant; Length of Stay; Pneumonia; Randomized Controlled Trials as Topic; Recovery of Function; Respiratory Rate; Zinc; Zinc Sulfate
PubMed: 21975768
DOI: 10.1002/14651858.CD007368.pub2 -
The Cochrane Database of Systematic... Dec 2010Pneumonia is a leading cause of morbidity and mortality in children younger than five years of age. Most deaths occur during infancy and in low-income countries. Daily... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pneumonia is a leading cause of morbidity and mortality in children younger than five years of age. Most deaths occur during infancy and in low-income countries. Daily regimens of zinc have been reported to prevent acute lower respiratory tract infection and reduce child mortality.
OBJECTIVES
To evaluate the effectiveness of zinc supplementation in the prevention of pneumonia in children aged two to 59 months.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to January Week 2, 2010), EMBASE (1974 to January 2010) and LILACS (1985 to January 2010).
SELECTION CRITERIA
Randomised controlled trials (RCTs) evaluating supplementation of zinc for the prevention of pneumonia in children aged 2 to 59 months of age.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data.
MAIN RESULTS
We included six trials and 7850 participants in the meta-analysis. Analysis showed that zinc supplementation reduced the incidence of pneumonia by 13% (risk ratio (RR) 0.87; 95% confidence interval (CI) 0.81 to 0.94, fixed-effect, six studies) and prevalence of pneumonia by 41% (RR 0.59; 95% CI 0.35 to 0.99, random-effects, one study). On subgroup analysis, we found that zinc reduced the incidence of pneumonia defined by specific clinical criteria by 21% (i.e. confirmation by chest examination or chest radiograph) (RR 0.79; 95% CI 0.0.71 to 0.88, fixed-effect, four studies, n = 4591) but had no effect on lower specificity pneumonia case definition (i.e. age specific fast breathing with or without lower chest indrawing) (RR 0.95; 95% CI 0.86 to 1.06, fixed-effect, four studies, n = 3259).
AUTHORS' CONCLUSIONS
Zinc supplementation in children is associated with a reduction in the incidence and prevalence of pneumonia, the leading cause of death in children.
Topics: Child, Preschool; Gluconates; Humans; Infant; Pneumonia; Randomized Controlled Trials as Topic; Zinc Acetate; Zinc Compounds; Zinc Sulfate
PubMed: 21154362
DOI: 10.1002/14651858.CD005978.pub2 -
Supportive Care in Cancer : Official... Aug 2010The purpose was to review relevant scientific papers written since 1989 which focused on the prevalence and management of dysgeusia as an oral side effect of cancer... (Review)
Review
PURPOSE
The purpose was to review relevant scientific papers written since 1989 which focused on the prevalence and management of dysgeusia as an oral side effect of cancer treatment.
METHODS
Our literature search was limited to English language papers published between 1990 and 2008. A total of 30 papers were reviewed; the results of 26 of these papers were included in the present systematic review. A structured assessment form was used by two reviewers for each paper. Studies were weighted as to the quality of the study design, and treatment recommendations were based on the relative strength of each paper.
RESULTS
A wide range in reported prevalence of dysgeusia was identified with the weighted prevalence from 56-76%, depending on the type of cancer treatment. Attempts to prevent dysgeusia through the prophylactic use of zinc sulfate or amifostine have been of limited benefit. Nutritional counseling may be helpful to some patients in minimizing the symptoms of dysgeusia.
CONCLUSIONS
Dysgeusia is a common oral side effect of cancer therapy (radiotherapy, chemotherapy, or combined modality therapy) and often impacts negatively on quality of life. From the current literature, there does not appear to be a predictable way of preventing or treating dysgeusia.
Topics: Amifostine; Dysgeusia; Humans; Neoplasms; Prevalence; Quality of Life; Zinc Sulfate
PubMed: 20495984
DOI: 10.1007/s00520-010-0902-1 -
The Cochrane Database of Systematic... Feb 2010Otitis media (inflammation of the middle ear, usually caused by infection) affects people of all ages, but is particularly common in young children. Around 164 million... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Otitis media (inflammation of the middle ear, usually caused by infection) affects people of all ages, but is particularly common in young children. Around 164 million people worldwide have long-term hearing loss caused by this condition, 90% of them in low-income countries. Because zinc supplements prevent pneumonia in disadvantaged children, we wondered whether they prevent otitis media.
OBJECTIVES
To evaluate whether zinc supplements prevent otitis media in adults and children of different ages.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2) which includes the Acute Respiratory Infection Groups' Specialised Register; MEDLINE (1950 to June Week 1 2009); and EMBASE (1974 to June 2009).
SELECTION CRITERIA
Randomised, placebo-controlled trials of zinc supplements given at least once a week for at least a month for preventing otitis media.
DATA COLLECTION AND ANALYSIS
Two review authors assessed the eligibility and methodological quality of the included trials, extracted and analysed data and wrote the review. We summarised results using risk ratios or rate ratios for dichotomous data and mean differences for continuous data. We combined trial results where appropriate.
MAIN RESULTS
We identified 12 trials for inclusion, 10 of which contributed outcomes data. In trials of healthy children living in low-income communities, two trials did not demonstrate a significant difference between the zinc supplemented and placebo groups in the numbers of participants experiencing an episode of definite otitis media during follow up (3191 participants), while another trial showed a significantly lower incidence rate of otitis media in the zinc group (rate ratio 0.69, 95% confidence interval (CI) 0.61 to 0.79, n = 1621). A small trial of 39 infants undergoing treatment for severe malnutrition suggested a benefit of zinc on the mean number of episodes of otitis media (mean difference -1.12 episodes, 95% CI -2.21 to -0.03). Zinc supplements did not seem to cause any serious adverse events, but a small minority of children were reported to have vomited shortly after ingestion of the supplements.
AUTHORS' CONCLUSIONS
Evidence on whether zinc supplementation can reduce the incidence of otitis media in healthy children under the age of five years living in low- and middle-income countries is mixed. There is some evidence of benefit in children being treated for marasmus, but this is based on one small trial and should therefore be treated with caution.
Topics: Child, Preschool; Chlorides; Developing Countries; Dietary Supplements; Female; Gluconates; Humans; Infant; Male; Otitis Media; Randomized Controlled Trials as Topic; Trace Elements; Zinc Acetate; Zinc Compounds; Zinc Sulfate
PubMed: 20166086
DOI: 10.1002/14651858.CD006639.pub2 -
The Cochrane Database of Systematic... Jan 2010Sickle cell disease is an inherited disorder of hemoglobin, resulting in abnormal red blood cells. These are rigid and may block blood vessels leading to acute painful... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sickle cell disease is an inherited disorder of hemoglobin, resulting in abnormal red blood cells. These are rigid and may block blood vessels leading to acute painful crises and other complications. Recent research has focused on therapies to rehydrate the sickled cells by reducing the loss of water and ions from them. Little is known about the effectiveness and safety of such drugs.
OBJECTIVES
To assess the relative risks and benefits of drugs to rehydrate sickled red blood cells.
SEARCH STRATEGY
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register.Last search of the Group's Trials Register: 22 May 2009.
SELECTION CRITERIA
Randomized or quasi-randomized controlled trials of drugs to rehydrate sickled red blood cells compared to placebo or an alternative treatment.
DATA COLLECTION AND ANALYSIS
Both authors independently selected studies for inclusion, assessed study quality and extracted data.
MAIN RESULTS
Of the 47 studies identified, two met the inclusion criteria. The first study tested the effectiveness of zinc sulphate to prevent sickle cell-related crises in a total of 145 participants and showed a significant reduction in painful crises over one and a half years, mean difference -2.83 (95% confidence interval -3.51 to -2.15). However, analysis was restricted due to limited statistical data. Changes to red cell parameters and blood counts were inconsistent. No serious adverse events were noted in the study.The second study was a Phase II dose-finding study of senicapoc (Gardos channel blocker) compared to placebo. Compared to the placebo group the high dose senicapoc showed significant improvement in change in hemoglobin level, number and proportion of dense red blood cells, red blood cell count and indices and hematocrit. The results with low-dose senicapoc were similar to the high-dose senicapoc group but of lesser magnitude. There was no difference in the frequency of painful crises between the three groups. A subsequent Phase III study had to be stopped prematurely due to lack of reduction in the number of painful crisis.
AUTHORS' CONCLUSIONS
While the results of zinc for reducing sickle-related crises are encouraging, larger and longer-term multicentre studies are needed to evaluate the effectiveness of this therapy for people with sickle cell disease.Though the phase II study of senicapoc showed that the drug improved red cell survival, depending on dose, this did not lead to fewer painful crises; a subsequent phase III study was terminated prematurely for this reason.
Topics: Acetamides; Anemia, Sickle Cell; Antisickling Agents; Dehydration; Erythrocyte Aging; Erythrocytes; Humans; Randomized Controlled Trials as Topic; Trityl Compounds; Zinc Sulfate
PubMed: 20091545
DOI: 10.1002/14651858.CD003426.pub3 -
BMJ Clinical Evidence Sep 2009Warts are caused by the human papillomavirus (HPV), of which there are over 100 types, which probably infects the skin via areas of minimal trauma. Risk factors include... (Review)
Review
INTRODUCTION
Warts are caused by the human papillomavirus (HPV), of which there are over 100 types, which probably infects the skin via areas of minimal trauma. Risk factors include use of communal showers, occupational handling of meat, and immunosuppression. In immunocompetent people, warts are harmless and resolve as a result of natural immunity within months or years.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for warts (non-genital)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic, review we present information relating to the effectiveness and safety of the following interventions: intralesional bleomycin; cimetidine; contact immunotherapy; cryotherapy; duct tape occlusion; formaldehyde, glutaraldehyde; homeopathy; photodynamic treatment; pulsed dye laser; surgical procedures; topical salicylic acid; and zinc sulphate.
Topics: Administration, Oral; Bandages; Bleomycin; Cimetidine; Cryosurgery; Cryotherapy; Humans; Warts; Zinc Sulfate
PubMed: 21726478
DOI: No ID Found -
Clinical and Experimental Dermatology Jan 2009Many interventions have been described for inherited epidermolysis bullosa (EB), but it is unclear which are beneficial. (Review)
Review
BACKGROUND
Many interventions have been described for inherited epidermolysis bullosa (EB), but it is unclear which are beneficial.
AIMS
A systematic review of randomized controlled trials (RCTs) was performed to inform practice and highlight research gaps.
METHODS
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and the Cochrane Skin Group specialist library, from inception until 1 April 2007, were searched. Primary outcomes were healing of lesions or prevention of new lesions. Trials were assessed for quality of reporting and data were extracted.
RESULTS
Five randomized double-blind placebo-controlled crossover studies were identified (n = 102). Two studies assessed oral tetracyclines in EB simplex (EBS). In one study (n = 12), 4/6 patients improved and 2/6 deteriorated on a dose of 1500 mg of tetracycline daily; only two patients completed the study. In the second study (n = 21), 6/18 and 7/18 improved on oxytetracycline 1 g and placebo, respectively. Two RCTs assessed topical interventions for EBS: aluminium chloride hexahydrate solution 20% (n = 23) and bufexamac cream 5% (n = 8). Neither showed a benefit over placebo. One RCT of 36 patients with recessive dystrophic EB compared phenytoin with placebo and failed to show any difference in mean lesion counts (difference = 0, 95% CI -11 to 4).
CONCLUSIONS
There is no reliable trial evidence for interventions in inherited EB. In future, it may be that gene treatment becomes the best treatment approach for these diseases.
Topics: Administration, Oral; Administration, Topical; Aluminum Chloride; Aluminum Compounds; Anti-Inflammatory Agents, Non-Steroidal; Astringents; Bufexamac; Chlorides; Cross-Over Studies; Epidermolysis Bullosa; Humans; Randomized Controlled Trials as Topic; Tetracyclines; Treatment Failure
PubMed: 18828848
DOI: 10.1111/j.1365-2230.2008.02789.x -
The Cochrane Database of Systematic... Oct 2007Sickle cell disease is an inherited disorder of haemoglobin, which results in abnormal red blood cells. These can deform and cause blockages in blood vessels, leading to... (Review)
Review
BACKGROUND
Sickle cell disease is an inherited disorder of haemoglobin, which results in abnormal red blood cells. These can deform and cause blockages in blood vessels, leading to acute crises such as pain; stroke and splenic sequestration; and chronic organ and tissue damage. Recently research has begun to focus on therapies which prevent the red blood cells deforming by reducing the loss of water and ions from the cells. However, little is known about the effectiveness and safety of such drugs.
OBJECTIVES
To assess the relative risks and benefits of drugs which aim to prevent sickle cell-related crises by reducing red blood cell dehydration.
SEARCH STRATEGY
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of the most recent search of the Group's Haemoglobinopathies Trials Register: November 2006.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials of drugs which aim to prevent sickle cell crises by reducing red cell dehydration, compared to placebo or an alternative treatment.
DATA COLLECTION AND ANALYSIS
Both authors independently selected studies for inclusion, assessed study quality and extracted data from the included studies.
MAIN RESULTS
Of the 39 studies identified, one met the inclusion criteria. This study tested the effectiveness of zinc sulphate to prevent sickle cell-related crises in a total of 145 participants and showed a significant reduction in the total number of pain, haemolytic, aplastic and sequestration crises over one and a half years, WMD -2.83 (95% CI -3.51 to -2.15). However, our analysis was limited by non-reporting of standard deviations for some data. Changes to red cell parameters and blood counts were inconsistent. No serious adverse events were noted in the study.
AUTHORS' CONCLUSIONS
While the results of zinc for reducing sickle-related crises are encouraging, larger and longer-term multicentre studies over a number of years are needed to evaluate the effectiveness of this therapy for people with sickle cell disease.
Topics: Anemia, Sickle Cell; Antisickling Agents; Dehydration; Erythrocytes; Humans; Piracetam; Randomized Controlled Trials as Topic; Zinc Sulfate
PubMed: 17943791
DOI: 10.1002/14651858.CD003426.pub2 -
Journal of the American Academy of... Aug 2007Cutaneous leishmaniasis (CL) is caused by different species of Leishmania and transmitted by the bite of infected sand flies. It is a health problem in many countries. (Review)
Review
BACKGROUND
Cutaneous leishmaniasis (CL) is caused by different species of Leishmania and transmitted by the bite of infected sand flies. It is a health problem in many countries.
OBJECTIVE
This study was performed to assess the evidence for the efficacy of different therapeutic modalities for acute Old World CL, which is usually caused by L major and L tropica.
METHODS
Evidence was reviewed according to the hierarchy of evidence. Because there have been no published systematic reviews on this topic to date, the primary source of evidence was individual randomized controlled trials (RCTs). Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated, and conclusions were based on the rated strength of published evidence.
RESULTS
In all, 50 RCTs met inclusion criteria consisting of 5515 patients in 119 study arms. Reviewed trials were highly variable in quality and methods and generally provide weak evidence for treatment of acute Old World CL.
LIMITATIONS
The quality of included studies was generally poor.
CONCLUSIONS
Well-designed randomized, double-blind, controlled trials should be designed and conducted to find better evidence for the treatment of acute Old World CL.
Topics: Administration, Topical; Antimony; Azoles; Cryotherapy; Humans; Leishmaniasis, Cutaneous; Paromomycin; Randomized Controlled Trials as Topic; Zinc Sulfate
PubMed: 17337090
DOI: 10.1016/j.jaad.2007.01.016 -
The Cochrane Database of Systematic... 2002Sickle cell disease is an inherited disorder of haemoglobin, which results in abnormal red blood cells. These can deform and cause blockages in blood vessels, leading to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sickle cell disease is an inherited disorder of haemoglobin, which results in abnormal red blood cells. These can deform and cause blockages in blood vessels, leading to acute crises such as pain, stroke and splenic sequestration, and chronic organ and tissue damage. Recently research has begun to focus on therapies which prevent the red blood cells deforming by reducing the loss of water and ions from the cells. However, little is known about the effectiveness and safety of such drugs.
OBJECTIVES
To assess the relative risks and benefits of drugs which aim to prevent sickle cell related crises by reducing red blood cell dehydration.
SEARCH STRATEGY
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group specialist register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings. Date of the most recent search of the Group's specialised register: December 2001.
SELECTION CRITERIA
All those randomised or quasi-randomised controlled trials of drugs which aim to prevent sickle cell crises by reducing red cell dehydration, compared to placebo or an alternative treatment.
DATA COLLECTION AND ANALYSIS
Both reviewers independently selected trials for inclusion, assessed trial quality and extracted data from the included studies.
MAIN RESULTS
Of the 27 trials identified, two met the inclusion criteria. The two trials tested the effectiveness of zinc sulphate and piracetam to prevent sickle cell related crises in a total of 246 patients. A reduction in pain crises was shown in the piracetam study over one year (weighted mean difference (WMD) -1.9 (95% CI -3.01, -0.79)), although blood counts were not significantly changed. The zinc trial showed a significant reduction in the total number of pain, haemolytic, aplastic and sequestration crises over one and a half years (WMD -2.83 (95% CI -3.51, -2.15)), but our analysis was limited by non-reporting of standard deviations for some data. Changes to red cell parameters and blood counts were inconsistent. No serious adverse events were noted in either trial.
REVIEWER'S CONCLUSIONS
While the results of both zinc and piracetam for reducing sickle related crises are encouraging, larger, and/or longer term multicentre trials over a number of years are needed to evaluate the effectiveness of these therapies for patients with sickle cell disease.
Topics: Anemia, Sickle Cell; Antisickling Agents; Dehydration; Erythrocytes; Humans; Piracetam; Randomized Controlled Trials as Topic; Zinc Sulfate
PubMed: 12519597
DOI: 10.1002/14651858.CD003426