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Rhinology Feb 2022Although the role of human papillomavirus (HPV) in sinonasal inverted papilloma (SNIP) has been investigated, the link between HPV infection and SNIP recurrence remains... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although the role of human papillomavirus (HPV) in sinonasal inverted papilloma (SNIP) has been investigated, the link between HPV infection and SNIP recurrence remains controversial. This meta-analysis aimed to investigate the association between HPV infection and recurrence of SNIP.
METHODS
The PubMed, Web of Science, Google Scholar, and Cochrane Library databases were searched (until 16 June 2021) to collect all relevant articles. The pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using the fixed effects model. In addition, subgroup analysis, assessment of publication bias, and sensitivity analyses were performed.
RESULTS
Fourteen eligible articles, including 592 patients with SNIP, were included in this study. Pooled analysis revealed that HPV-positive cases exhibited a significantly higher OR of tumour recurrence than HPV-negative counterparts). A significant association between HPV infection and tumour recurrence remained stable in subgroup analyses according to the publication year of the studies.
CONCLUSIONS
Our meta-analysis demonstrates that HPV infection is significantly associated with the recurrence of SNIP, suggesting the pathological role of HPV in SNIP. These results suggest that HPV infection should be considered in the management of SNIP.
Topics: Humans; Nose Neoplasms; Papilloma, Inverted; Papillomaviridae; Papillomavirus Infections; Paranasal Sinus Neoplasms
PubMed: 34941974
DOI: 10.4193/Rhin21.255 -
The Cochrane Database of Systematic... Dec 2021Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in white populations. Distal intestinal obstruction syndrome (DIOS) is an important... (Review)
Review
BACKGROUND
Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in white populations. Distal intestinal obstruction syndrome (DIOS) is an important morbidity in cystic fibrosis. It is the result of the accumulation of viscid faecal material within the bowel which combines with thick, sticky mucus produced in the intestines of people with cystic fibrosis. The intestine may be completely blocked (complete DIOS) or only partially blocked (incomplete DIOS). Once a diagnosis of DIOS has been made, the goal of therapy is to relieve the acute complete or incomplete faecal obstruction and ultimately prevent the need for surgical intervention.
OBJECTIVES
This review aimed to evaluate the effectiveness and safety of different treatment regimens for the treatment of DIOS (complete and incomplete) in children and adults with cystic fibrosis.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of search: 09 September 2021. We also searched online trial registries. Date of last search: 12 October 2021.
SELECTION CRITERIA
Randomised controlled trials, quasi-randomised controlled trials (including cross-over trials (to be judged on an individual basis)) comparing the use of laxative agents or surgery for treating DIOS in children, young people and adults with cystic fibrosis to each other, placebo or no intervention.
DATA COLLECTION AND ANALYSIS
Two authors independently screened papers, extracted trial details and assessed for risk of bias. The authors assessed the quality of evidence using GRADE.
MAIN RESULTS
There was one trial with 20 participants (16 females) included in the review. The mean age of participants was 13.1 years. The trial was a double-blinded, randomised cross-over trial which had a duration of 12 months in total and compared high-dose and low-dose pancreatic enzyme therapy. As only the abstract of the trial was available, the overall risk of bias was judged to be unclear. The trial did not address either of our primary outcomes (time until resolution of DIOS and treatment failure rate), but reported episodes of acute DIOS, presence of abdominal mass and abdominal pain. There were no numerical data available for these outcomes, but the authors stated that there was no difference between treatment with high-dose or low-dose pancreatic enzymes. The overall certainty of the evidence was found to be very low.
AUTHORS' CONCLUSIONS
There is a clear lack of evidence for the treatment of DIOS in people with cystic fibrosis. The included abstract did not address our primary outcome measures and did not provide numerical data for the two secondary outcomes it did address. Therefore, we cannot justify the use of high-dose pancreatic enzymes for treating DIOS, nor can we comment on the efficacy and safety of other laxative agents. From our findings, it is clear that more randomised controlled trials need to be conducted in this area.
Topics: Abdominal Pain; Adolescent; Adult; Child; Cystic Fibrosis; Female; Humans; Intestinal Obstruction; Pancreas; Randomized Controlled Trials as Topic
PubMed: 34936086
DOI: 10.1002/14651858.CD012798.pub3 -
The Cochrane Database of Systematic... Dec 2021Cystic fibrosis (CF) is the most common, life-limiting, genetically inherited disease. It affects multiple organs, particularly the respiratory system. However,... (Review)
Review
BACKGROUND
Cystic fibrosis (CF) is the most common, life-limiting, genetically inherited disease. It affects multiple organs, particularly the respiratory system. However, gastrointestinal problems such as constipation and distal intestinal obstruction syndrome (DIOS) are also important and well-recognised complications in CF. They share similar symptoms e.g. bloating, abdominal pain, but are distinct conditions. Constipation occurs when there is gradual faecal impaction of the colon, but DIOS occurs when there is an accumulation of faeces and sticky mucus, forming a mass in the distal part of the small intestine. The mass may partially block the intestine (incomplete DIOS) or completely block the intestine (complete DIOS). Symptoms of DIOS can affect quality of life and other aspects of CF health, such as airway clearance, exercise, sleep and nutritional status. Treatment of constipation and prevention of complete bowel obstruction are required for gastrointestinal management in CF. However, many different strategies are used in clinical practice and there is a lack of consensus. The importance of this topic was highlighted in a recent research priority setting exercise by the James Lind Alliance.
OBJECTIVES
To evaluate the effectiveness and safety of laxative agents of differing types for preventing DIOS (complete and incomplete) in children and adults with CF.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of search: 09 September 2021. We also searched online trial registries. Date of last search: 12 October 2021.
SELECTION CRITERIA
Randomised and quasi-randomised controlled parallel trials comparing laxative therapy for preventing DIOS (including osmotic agents, stimulants, mucolytics and substances with more than one action) at any dose to placebo, no treatment or an alternative laxative therapy, in people of any age with pancreatic sufficient or insufficient CF and any stage of lung disease. Randomised cross-over trials were judged on an individual basis.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trials for inclusion, extracted outcome data and performed a risk of bias assessment for the included data. We judged the certainty of the evidence using GRADE criteria.
MAIN RESULTS
We included one cross-over trial (17 participants) with a duration of 12 months, in which participants were randomly allocated to either cisapride (a gastro-prokinetic agent) or placebo for six months each. The trial had an unclear risk of bias for most domains but had a high risk of reporting bias. Radiograph scores revealed no difference in occurrence of DIOS between cisapride and placebo (narrative report, no data provided). There were no adverse effects. Symptom scores were the only secondary outcome within the review that were reported. Total gastrointestinal symptom scores favoured cisapride with a statistically significant mean difference (MD) of -7.60 (95% confidence interval (CI) -14.73 to -0.47). There was no significant difference at six months between cisapride and placebo for abdominal distension, MD -0.90 (95% CI -2.39 to 0.59) or abdominal pain, MD -0.4 (95% CI -2.05 to 1.25). The global symptom scores (whether individuals felt better or worse) were reported in the paper to favour cisapride and be statistically significant (P < 0.05). We assessed the available data to be very low certainty. There was a great deal of missing data from the included trial and the investigators failed to report numerical data for many outcomes. The overall risk of bias of the trial was unclear and it had a high risk for reporting bias. There was also indirectness; the trial drug (cisapride) has since been removed from the market in several countries due to adverse effects, thus it has no current applicability for preventing DIOS. The included trial also had very few participants, which downgraded the certainty a further level for precision.
AUTHORS' CONCLUSIONS
There is an absence of evidence for interventions for the prevention of DIOS. As there was only one included trial, we could not perform a meta-analysis of the data. Furthermore, the included trial compared a prokinetic agent (cisapride) that is no longer licensed for use in a number of countries due to the risk of serious cardiac events, a finding that came to light after the trial was conducted. Therefore, the limited findings from the trial are not applicable in current clinical practice. Overall, a great deal more research needs to be undertaken on gastrointestinal complications in CF, as this is a very poorly studied area compared to respiratory complications in CF.
Topics: Cisapride; Constipation; Cystic Fibrosis; Humans; Intestinal Obstruction; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 34936085
DOI: 10.1002/14651858.CD012619.pub3 -
The Saudi Dental Journal Nov 2021Oral submucous fibrosis (OSMF) is one of the common oral potentially malignant disorders that can result in severe morbidity. Depending upon the stage of disease,... (Review)
Review
BACKGROUND
Oral submucous fibrosis (OSMF) is one of the common oral potentially malignant disorders that can result in severe morbidity. Depending upon the stage of disease, multiple management therapies exist which include medicinal and surgical approaches. Although the surgical approach is preferred in severe conditions, numerous studies have reported its post-surgical deteriorating outcomes including increased fibrotic changes. To reduce these post-surgical complications, Light amplification by stimulated emission of radiation (Laser) has been introduced and studied as a non-invasive technique to treat oral submucous fibrosis. However, there exists a lack of knowledge about 'which laser shows a better post-treatment outcome'. Accordingly, this review aims to answer this question.
MATERIALS AND METHODS
A systematic review of the published literature was performed using an electronic search in PubMed/Medline, Science Direct, Web of Science, Embase, J- STAGE, Google Scholar, and Scopus databases, from 1952 till 2019 using keywords like, 'Oral submucous fibrosis', 'Treatment', 'Laser', 'Trismus', ' Fibrosis', 'Surgical', 'Non-invasive', and 'Postoperative results'.
RESULTS
The search strategy revealed 20 relevant published studies in which laser had been used to treat 250 patients of OSMF. Effective results were found without any complications in all the cases after follow up.
CONCLUSION
Observing the current literature, it can be concluded that laser might be used as a potential non-invasive approach in the management of OSMF, however, large scale studies are required to investigate the efficacy and other effects of this technology
PubMed: 34803281
DOI: 10.1016/j.sdentj.2020.11.005 -
Clinics and Research in Hepatology and... Mar 2022Biofilm-producing bacteria are relatively resistant to antibiotics, as the penetration of antibiotics into the endopolysaccharide envelope is incomplete. N Acetyl... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Biofilm-producing bacteria are relatively resistant to antibiotics, as the penetration of antibiotics into the endopolysaccharide envelope is incomplete. N Acetyl cysteine (NAC) is known to destabilize the biofilms, as it cleaves the disulfide bonds of mucus glycoproteins, reducing the viscosity and thickness of mucus. This allows NAC to act synergistically with antibiotics for the eradication of H Pylori. The meta-analysis evaluates the evidence of the efficacy of adjuvant N acetyl cysteine (NAC) compared to standard therapies in the eradication of H. Pylori infections.
METHODS
We searched randomized clinical trials in MEDLINE, Cochrane Central Register of Clinical Trials (CENTRAL), EBSCO, Database of Abstracts of Reviews of Effects (DARE), and Google Scholar. We included trials comparing standard treatment protocols plus adjuvant NAC and the same regimen without NAC. These studies included adults with a diagnosis of Helicobacter pylori infection. Our primary outcome was the successful eradication of H. Pylori. The results were pooled using a random-effects model, and data were analyzed using RevMan 5.0 software. Cochrane collaboration's tool was used to assess the risk of bias. Publication bias and other inconsistencies were assessed. Sensitivity analyses and grading of evidence were performed.
FINDINGS
Eight studies, comprising 1167 patients, were included in the meta-analysis, the pooled outcomes of patients on adjuvant NAC+ standard eradication therapy noted an eradication rate of 76.1% (n=581) compared to the patients in standard eradication therapy with a rate of 72.18% (n=586), RR 1.17 [95% CI (0.99, 1.39); I2= 64%; p value=0.07]. Moderate to severe heterogeneity was noted. These pooled results show that adjuvant NAC plus standard treatment protocols are not superior to standard treatment protocols for H pylori eradication. Similar results were seen in the use of adjuvant NAC with 'currently used standard treatment protocols' (78.3% versus 76.3%, RR 1.08, [95% CI 0.94 to 1.25]; I2=55%; p=0.28; n= 829 patients], as well as in the treatment of naïve patients (79.8% versus 80.9%, RR 1.00[95% CI 0.87 to 1.15]; i2=27%; P=-0.98; n= 775 patients].
CONCLUSION
Adjuvant NAC plus standard treatment protocols are not superior to standard treatment protocols for H. pylori eradication. These findings are consistent with the use of adjuvant NAC with 'currently used standard treatment protocols' (clarithromycin-based triple therapies) and also with adjuvant NAC used in the treatment of naïve patients. We are moderately certain of these findings. Future studies could explore the use of NAC as a pretreatment before using the current standard therapies in the eradication of H. Pylori rather than NAC as adjuvant therapy.
FUNDING
None.
Topics: Adult; Anti-Bacterial Agents; Clarithromycin; Cysteine; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Proton Pump Inhibitors; Randomized Controlled Trials as Topic
PubMed: 34775122
DOI: 10.1016/j.clinre.2021.101832 -
Italian Journal of Pediatrics Aug 2021Cystic fibrosis (CF) is a multisystem disorder, caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. These cause a reduced secretion of...
Cystic fibrosis (CF) is a multisystem disorder, caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. These cause a reduced secretion of chloride, a marked absorption of sodium and, therefore, of water, through the epithelium, resulting in the formation of thickened secretions in organs such as lung or pancreas. These viscous secretions lead to airway obstruction, chronic infection and inflammation resulting in progressive lung damage, bronchiectasis and eventual respiratory failure. Although the average life expectancy has increased over the last 30 years, lung disease is the most common cause of death in people with CF. For these reasons, the improvement of sputum clearance is a major therapeutic aim in CF and early initiation of airway clearance is widely recommended and implemented. Symptomatic mucolytic therapy today is mainly based on inhalation of DNase, hypertonic saline or mannitol, in combination with physiotherapy. Mucolytic agents break down the gel structure of mucus and therefore decrease its elasticity and viscosity, reducing the pulmonary exacerbation frequency and to improve and stabilize lung function. Nevertheless, high quality studies comparing these mucolytic drugs are still few, and the individual experiences of patients and caregivers explain the high variability of their use globally. This review will summarize the current knowledge on hypertonic saline in the treatment of CF lung disease. Furthermore, we report the real-world prescription of inhaled mucolytic agents in CF.
Topics: Administration, Inhalation; Cystic Fibrosis; Expectorants; Humans; Hyaluronic Acid; Nebulizers and Vaporizers; Saline Solution, Hypertonic
PubMed: 34362426
DOI: 10.1186/s13052-021-01117-1 -
Annals of Palliative Medicine Apr 2021Meta-analysis was used to evaluate the efficacy and safety of aspirin combined with letrozole in the treatment of polycystic ovary syndrome (PCOS). (Meta-Analysis)
Meta-Analysis
BACKGROUND
Meta-analysis was used to evaluate the efficacy and safety of aspirin combined with letrozole in the treatment of polycystic ovary syndrome (PCOS).
METHODS
Through comprehensive searches of the China Knowledge Network (CNKI), the VIP database (VIP), the Wanfang database, the China Biomedical Database (CBM), PubMed, EMBASE, and the Cochrane Library, the clinical randomized controlled trials (RCTs) published on aspirin combined with letrozole in the treatment of PCOS were collected. According to the inclusion and exclusion criteria, the included studies were screened and quality evaluated, and RevMan 5.3 software was used for meta-analysis.
RESULTS
A total of 10 RCTs and 948 patients with PCOS were included. Meta-analysis results showed that compared with letrozole monotherapy, aspirin combined with letrozole could significantly increase the thickness of the endometrium [MD=1.98, 95% CI: 1.63-2.34, P<0.00001], cervical mucus scores (MD =1.65, 95% CI: 1.32-1.98, P<0.00001), the ovulation rate (OR=3.50, 95% CI: 2.08-5.91, P<0.00001), the number of mature follicles (MD=0.65, 95% CI: 0.51-0.78, P<0.00001), and the pregnancy rate (OR=3.06, 95% CI: 2.28-4.12, P<0.00001), and significantly reduced the abortion rate (OR=0.20, 95% CI: 0.11-0.38, P<0.00001). There was no statistically significant difference in the incidence of adverse reactions between the 2 groups (OR=0.76, 95% CI: 0.44-1.32, P=0.33).
CONCLUSIONS
Aspirin combined with letrozole in the treatment of PCOS is safe and effective. Due to the limitations in the number and quality of the included studies, further verification with multi-center, large-sample, high-quality RCTs is still needed.
Topics: Aspirin; China; Female; Humans; Letrozole; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy
PubMed: 33966411
DOI: 10.21037/apm-21-606 -
Journal of Clinical Medicine Apr 2021Mucins are a family of glycosylated proteins which are the primary constituents of mucus and play a dynamic role in the regulation of the protective mucosal barriers... (Review)
Review
Mucins are a family of glycosylated proteins which are the primary constituents of mucus and play a dynamic role in the regulation of the protective mucosal barriers throughout the human body. Ulcerative colitis (UC) is an Inflammatory Bowel Disease (IBD) characterised by continuous inflammation of the inner layer of the large intestine, and in this systematic review we analyse currently available data to determine whether alterations exist in mucin activity in the colonic mucosa of UC patients. Database searches were conducted to identify studies published between 1990 and 2020 that assess the role of mucins in cohorts of UC patients, where biopsy specimens were resected for analysis and control groups were included for comparison. 5497 articles were initially identified and of these 14 studies were systematically selected for analysis, a further 2 articles were identified through citation chaining. Therefore, 16 studies were critically reviewed. 13 of these studies assessed the role of MUC2 in UC and the majority of articles indicated that alterations in MUC2 structure or synthesis had an impact on the colonic mucosa, although conflicting results were presented regarding MUC2 expression. This review highlights the importance of further research to enhance our understanding of mucin regulation in UC and summarises data that may inform future studies.
PubMed: 33946184
DOI: 10.3390/jcm10091935 -
Clinics (Sao Paulo, Brazil) 2021The risk factors of bronchiectasis in patients with chronic obstructive pulmonary disease have not yet been established. This systematic review and meta-analysis aimed... (Meta-Analysis)
Meta-Analysis
The risk factors of bronchiectasis in patients with chronic obstructive pulmonary disease have not yet been established. This systematic review and meta-analysis aimed to investigate and identify potential risk factors for patients with chronic obstructive pulmonary disease accompanied by bronchiectasis. We reviewed eight electronic journal databases from their inception to November 2019 for observational studies with no language restrictions. The Newcastle-Ottawa Scale was applied to evaluate the quality of the literature. Binary variables were pooled using odds ratios and continuous variables using the standardized mean difference with 95% confidence intervals. The confidence of evidence was assessed according to the grading of the recommendations assessment, development, and evaluation method. Eight case-control studies met the inclusion criteria. Tuberculosis history, smoking history, hospitalization stays, admissions in the past year, and duration of symptoms were considered risk factors. In addition, the ratio between the forced expiratory volume in 1s and forced vital capacity, the percentage of forced expiratory volume in 1s, the forced expiratory volume in 1s as a percentage of the predicted value, purulent sputum, purulent mucus sputum, positive sputum culture, Pseudomonas aeruginosa infection, arterial oxygen pressure, daily dyspnea, C-reactive protein, leukocytes, and the percentage of neutrophils were found to be closely related to bronchiectasis. However, these were not considered risk factors. The evidence of all outcomes was judged as "low" or "very low." Additional prospective studies are required to elucidate the underlying risk factors and identify effective preventive interventions.
Topics: Bronchiectasis; Forced Expiratory Volume; Humans; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Risk Factors
PubMed: 33886788
DOI: 10.6061/clinics/2021/e2420 -
Phytotherapy Research : PTR Sep 2021Viral infections of the lower respiratory tract are considered a public health problem. They affect millions of people worldwide, causing thousands of deaths, and are... (Meta-Analysis)
Meta-Analysis Review
Effectiveness of supplementation with quercetin-type flavonols for treatment of viral lower respiratory tract infections: Systematic review and meta-analysis of preclinical studies.
Viral infections of the lower respiratory tract are considered a public health problem. They affect millions of people worldwide, causing thousands of deaths, and are treated with expensive medicines, such as antivirals or palliative measures. In this study, we conducted a systematic review to describe the use of quercetin-type flavonols against lower respiratory tract viruses and discussed the preclinical impact of this approach on different signs and clinical mechanisms of infection. The systematic review was performed in PubMed/MEDLINE, Scopus, Scielo, and Biblioteca Virtual de Saúde (BVS). After the database search, 11 relevant studies were identified as eligible. The analysis of these studies showed evidence of antiviral activity of quercetin-type flavonols with significantly reduced mortality rate (M-H = 0.19, 95% CI: 0.05 to 0.65, p-value = 0.008) of infected animals and a reduction in the average viral load (IV = -1.93, 95% CI: -3.54 to -0.31, p-value = 0.02). Additionally, quercetin and its derivatives reduced the amount of proinflammatory cytokines, chemokines, reactive oxygen species, mucus production, and airway resistance in animals infected with a respiratory virus. Overall, supplementation with quercetin-type flavonols is a promising strategy for treating viral-induced lower respiratory tract infections.
Topics: Animals; Dietary Supplements; Flavonols; Humans; Quercetin; Respiratory Tract Infections; Virus Diseases
PubMed: 33864310
DOI: 10.1002/ptr.7122