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The Cochrane Database of Systematic... Jul 2007Respiratory distress syndrome (RDS) is a significant cause of morbidity and mortality in preterm infants. RDS is caused by a deficiency, dysfunction, or inactivation of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Respiratory distress syndrome (RDS) is a significant cause of morbidity and mortality in preterm infants. RDS is caused by a deficiency, dysfunction, or inactivation of pulmonary surfactant. Numerous surfactants of either animal extract or synthetic design have been shown to improve outcomes. New surfactant preparations that include peptides or whole proteins that mimic endogenous surfactant protein have recently been developed and tested.
OBJECTIVES
To assess the effect of administration of synthetic surfactant containing surfactant protein mimics compared to animal derived surfactant extract on the risk of mortality, chronic lung disease, and other morbidities associated with prematurity in preterm infants at risk for or having RDS.
SEARCH STRATEGY
Standard search methods of the Cochrane Neonatal Review Group were used. The search included MEDLINE (1966 - May 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) in all languages. In addition, published abstracts of the Society of Pediatric Research were searched electronically. For abstract books that did not include key words, the search was limited to the relevant sections on pulmonary and neonatology. The bibliography cited in each publication was obtained and searched in order to identify additional relevant articles.
SELECTION CRITERIA
Randomized and quasi-randomized controlled clinical trials were considered for this review. Studies that enrolled preterm infants or low birth weight infants at risk for or having RDS who were treated with either a synthetic surfactant containing surfactant protein mimics or an animal-derived surfactant preparation were included for this review. Studies that either attempted to treat or prevent respiratory distress syndrome were included.
DATA COLLECTION AND ANALYSIS
Primary outcome measures, including mortality, chronic lung disease and multiple secondary outcome measures were abstracted by the reviewers. Statistical analysis was performed using Review Manager software. Categorical data was analyzed using relative risk, risk difference, and number needed to treat. 95% confidence intervals reported. A fixed effects model was used for the meta-analysis. Heterogeneity was assessed using the I-squared statistic.
MAIN RESULTS
Two studies were identified that compared protein containing synthetic surfactants to animal derived surfactant preparations. In a meta-analysis of these two studies, infants who received protein containing synthetic surfactant compared to animal derived surfactant extract did not demonstrate significantly different risks of prespecified primary outcomes: mortality at 36 weeks [typical RR 0.81 (95% CI 0.64, 1.03)], chronic lung disease at 36 weeks [typical RR 0.99 (95% CI 0.84, 1.18)], or the combined outcome of mortality or chronic lung disease at 36 weeks [typical RR 0.96 (95% CI 0.82, 1.12)]. There were also no differences in any of the secondary outcomes regarding complications of prematurity between the two surfactant groups with the exception of necrotizing enterocolitis. A decrease in the risk of necrotizing enterocolitis was noted in infants who received protein containing synthetic surfactants compared to animal derived surfactant extract [typical RR 0.60 (95% CI 0.42, 0.86)]. However, this was a secondary outcome in both of the primary studies and there was moderate heterogeneity between the studies.
AUTHORS' CONCLUSIONS
In two trials of protein containing synthetic surfactants compared to animal derived surfactant extract, no statistically different clinical differences in death and chronic lung disease were noted. Further well designed studies of adequate size and power will be needed to confirm and refine these findings.
Topics: 1,2-Dipalmitoylphosphatidylcholine; Animals; Biological Products; Drug Combinations; Fatty Alcohols; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Phosphatidylglycerols; Phospholipids; Proteins; Pulmonary Surfactant-Associated Proteins; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn
PubMed: 17636826
DOI: 10.1002/14651858.CD006069.pub2 -
The Cochrane Database of Systematic... 2003Alzheimer's disease sufferers have been found to have a lack of the enzyme responsible for converting choline into acetylcholine within the brain. Lecithin is a major... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alzheimer's disease sufferers have been found to have a lack of the enzyme responsible for converting choline into acetylcholine within the brain. Lecithin is a major dietary source of choline, so extra consumption may reduce the progression of dementia.
OBJECTIVES
To determine the efficacy of lecithin in the treatment of dementia or cognitive impairment.
SEARCH STRATEGY
The Cochrane Dementia and Cognitive Improvement Group's Specialized Register was searched on 15 May 2002 using the terms lecithin and phosphaditylcholine. This contains records from all major databases and many trials databases. Reference lists and relevant books have been examined.
SELECTION CRITERIA
All unconfounded, randomized trials comparing lecithin with placebo in a treatment period longer than one day, in patients with dementia of the Alzheimer type, vascular dementia, mixed vascular and Alzheimer's disease, unclassified or other dementia or unclassified cognitive impairment not fulfilling the criteria for dementia are eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Data were extracted by two independent reviewers and cross-checked. Meta-analyses were performed when more than one trial provided data on a comparable outcome on sufficiently similar patients. Random effects analyses were performed whenever heterogeneity between results appeared to be present. Standardised differences in mean outcome measures were used due do the use of different scales and periods of treatment. Odds ratios for dichotomous data were pooled using the Mantel-Haenszel or DerSimonian and Laird methods.
MAIN RESULTS
Twelve randomized trials have been identified involving patients with Alzheimer's disease (265 patients), Parkinsonian dementia (21 patients) and subjective memory problems (90 patients). No trials reported any clear clinical benefit of lecithin for Alzheimer's disease or Parkinsonian dementia. Few trials contributed data to meta-analyses. The only statistically significant result was in favour of placebo for adverse events, based on one trial, which appears likely to be a spurious result. A dramatic result in favour of lecithin was obtained in a trial of subjects with subjective memory problems.
REVIEWER'S CONCLUSIONS
Evidence from randomized trials does not support the use of lecithin in the treatment of patients with dementia. A moderate effect cannot be ruled out, but results from the small trials to date do not indicate priority for a large randomized trial.
Topics: Alzheimer Disease; Cognition Disorders; Dementia; Humans; Phosphatidylcholines; Randomized Controlled Trials as Topic
PubMed: 12917896
DOI: 10.1002/14651858.CD001015 -
Clinical Infectious Diseases : An... Feb 2001To update the case-fatality rate (CFR) associated with invasive aspergillosis according to underlying conditions, site of infection, and antifungal therapy, data were... (Review)
Review
To update the case-fatality rate (CFR) associated with invasive aspergillosis according to underlying conditions, site of infection, and antifungal therapy, data were systematically reviewed and pooled from clinical trials, cohort or case-control studies, and case series of >/=10 patients with definite or probable aspergillosis. Subjects were 1941 patients described in studies published after 1995 that provided sufficient outcome data; cases included were identified by MEDLINE and EMBASE searches. The main outcome measure was the CFR. Fifty of 222 studies met the inclusion criteria. The overall CFR was 58%, and the CFR was highest for bone marrow transplant recipients (86.7%) and for patients with central nervous system or disseminated aspergillosis (88.1%). Amphotericin B deoxycholate and lipid formulations of amphotericin B failed to prevent death in one-half to two-thirds of patients. Mortality is high despite improvements in diagnosis and despite the advent of newer formulations of amphotericin B. Underlying patient conditions and the site of infection remain important prognostic factors.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Case-Control Studies; Central Nervous System Fungal Infections; Child; Child, Preschool; Clinical Trials as Topic; Cohort Studies; Drug Combinations; Female; Humans; MEDLINE; Male; Middle Aged; Neutropenia; Phosphatidylcholines; Phosphatidylglycerols; Prognosis
PubMed: 11170942
DOI: 10.1086/318483 -
Current Opinion in Obstetrics &... Feb 2000There has been growing interest in the possibility of screening for ovarian cancer. This article addresses papers published following a systematic review of all... (Review)
Review
There has been growing interest in the possibility of screening for ovarian cancer. This article addresses papers published following a systematic review of all prospective ovarian cancer screening studies since 1998. In the past year, new markers have been reported and previous strategies have been refined. A randomized controlled trial of ovarian cancer screening has shown a survival benefit in women who developed ovarian cancer in the screened group. Although the results do not justify ovarian cancer screening in the general population, the data support the need for a larger randomized trial powered to assess the impact of screening on mortality.
Topics: Biomarkers, Tumor; CA-125 Antigen; Clinical Trials as Topic; Female; Humans; Lysophospholipids; Mass Screening; Ovarian Neoplasms; Risk Factors; Ultrasonography
PubMed: 10752515
DOI: 10.1097/00001703-200002000-00007 -
The Cochrane Database of Systematic... 2000Alzheimer's disease sufferers have been found to have a lack of the enzyme responsible for converting choline into acetylcholine within the brain. Lecithin is a major... (Review)
Review
BACKGROUND
Alzheimer's disease sufferers have been found to have a lack of the enzyme responsible for converting choline into acetylcholine within the brain. Lecithin is a major dietary source of choline, so extra consumption may reduce the progression of dementia.
OBJECTIVES
To determine the efficacy of lecithin in the treatment of dementia or cognitive impairment.
SEARCH STRATEGY
The Cochrane Dementia and Cognitive Impairment Group Register of Clinical Trials has been searched, as have the electronic databases MEDLINE, EMBASE, Psychlit, ISI and Current Contents. Reference lists and relevant books have been examined.
SELECTION CRITERIA
All unconfounded, randomized trials comparing lecithin with placebo in a treatment period longer than one day, in patients with dementia of the Alzheimer type, vascular dementia, mixed vascular and Alzheimer's disease, unclassified or other dementia or unclassified cognitive impairment not fulfilling the criteria for dementia are eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Data were extracted by two independent reviewers and cross-checked. Meta-analyses were performed when more than one trial provided data on a comparable outcome on sufficiently similar patients. Random effects analyses were performed whenever heterogeneity between results appeared to be present. Standardised mean difference were used due do the use of different scales and periods of treatment. Odds ratios for dichotomous data were pooled using the Mantel-Haenszel or DerSimonian and Laird methods.
MAIN RESULTS
Twelve randomized trials have been identified involving patients with Alzheimer's disease (265 patients), Parkinsonian dementia (21 patients) and subjective memory problems (90 patients). No trials reported any clear clinical benefit of lecithin for Alzheimer's disease or Parkinsonian dementia. Few trials contributed data to meta-analyses. The only statistically significant result was in favour of placebo for adverse events, based on one trial, which appears likely to be a spurious result. A dramatic result in favour of lecithin was obtained in a trial of subjects with subjective memory problems.
REVIEWER'S CONCLUSIONS
Evidence from randomized trials does not support the use of lecithin in the treatment of patients with dementia. A moderate effect cannot be ruled out, but results from the small trials to date do not indicate priority for a large randomized trial.
Topics: Alzheimer Disease; Cognition Disorders; Dementia; Humans; Phosphatidylcholines; Randomized Controlled Trials as Topic
PubMed: 11034695
DOI: 10.1002/14651858.CD001015 -
The Cochrane Database of Systematic... 2000People with Alzheimer's disease have been found to have a relative lack of the enzyme responsible for converting choline into acetylcholine within the brain. Lecithin is... (Review)
Review
BACKGROUND
People with Alzheimer's disease have been found to have a relative lack of the enzyme responsible for converting choline into acetylcholine within the brain. Lecithin is a major dietary source of choline, so extra consumption may assist in the production of acetylcholine and reduce some of the symptoms of dementia.
OBJECTIVES
To determine the efficacy of lecithin in the treatment of dementia or cognitive impairment.
SEARCH STRATEGY
The Cochrane Dementia and Cognitive Impairment Group Register of Clinical Trials has been searched, as have the electronic databases MEDLINE, EMBASE, Psychlit, ISI and Current Contents. Reference lists and relevant books have been examined.
SELECTION CRITERIA
All unconfounded, randomised trials comparing lecithin with placebo in a treatment period longer than one day, in patients with dementia of the Alzheimer type, vascular dementia, mixed vascular and Alzheimer's disease, unclassified or other dementia or unclassified cognitive impairment not fulfilling the criteria for dementia are eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Data are extracted by two independent reviewers and cross checked. Meta-analyses are performed when more than one trial provide data on a comparable outcome on sufficiently similar patients. Random effects analyses are performed whenever heterogeneity between results appears to be present. Standardised mean difference are used due do the use of different scales and periods of treatment. Odds ratios for dichotomous data are pooled using the Mantel-Haenszel or DerSimonian and Laird methods.
MAIN RESULTS
Eleven randomised trials have been identified involving patients with Alzheimer's disease (265 patients) and Parkinsonian dementia (21 patients). No trials reported any clear clinical benefit of lecithin. Few trials contributed data to meta-analyses. The only statistically significant result was in favour of placebo for adverse events, based on one trial, which appears likely to be a spurious result.
REVIEWER'S CONCLUSIONS
Evidence from randomised trials does not support the use of lecithin in the treatment of patients with dementia or cognitive impairment. A moderate effect cannot be ruled out, but results from the small trials to date do not indicate priority for a large randomised trial.
Topics: Alzheimer Disease; Cognition Disorders; Dementia; Humans; Phosphatidylcholines
PubMed: 10796586
DOI: 10.1002/14651858.CD001015 -
Journal of the American Dental... Feb 2000The authors discuss the local pharmacotherapy for chronic orofacial neuropathic pain disorders such as neuropathies, neuromas and neuralgias. (Review)
Review
BACKGROUND
The authors discuss the local pharmacotherapy for chronic orofacial neuropathic pain disorders such as neuropathies, neuromas and neuralgias.
METHODS
The authors conducted a systematic literature review on this topic. The focus of the review involved the two most commonly applied medications for neuropathic disorders--local anesthetics and capsaicin. Other compounds such as nonsteroidal anti-inflammatory drugs, sympathomimetic agents, anticonvulsants and N-methyl-D-aspartate receptor antagonists also were reviewed. The medication delivery and retention methods appropriate for oral and perioral disease and pain control are described in this article.
RESULTS
There are an ever-increasing number of agents that can be used to help patients with neuropathic-based oral and perioral pain problems. Moreover, a clear advancement in the delivery of these medications is the development of a vehicle-carrier agent (pluronic lecithin organogel) that can penetrate the mucosa and cutaneous tissues and carry the active medication with it to the treatment site. The major caveat underlying these treatment strategies is that except for patient testimony and a few studies, there are limited empirical data on the efficacy of most of these new formulations, and additional research is clearly needed.
CONCLUSIONS
Because of their rapid onset and low side-effect profile, topical medications offer a distinct advantage over systemic administration for those orofacial disorders that are regional, near the surface and chronic and that demonstrate some response such as pain relief to topical or subcutaneous anesthetics.
CLINICAL IMPLICATIONS
Practicing dentists now have some new tools they can use to help manage patients who have a chronic nerve pain disorder in and around the mouth.
Topics: Administration, Topical; Analgesics; Anesthetics, Local; Capsaicin; Cranial Nerve Diseases; Cranial Nerve Neoplasms; Drug Carriers; Drug Delivery Systems; Facial Pain; Humans; Neuralgia; Neuroma; Phosphatidylcholines
PubMed: 10680386
DOI: 10.14219/jada.archive.2000.0146