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Frontiers in Pediatrics 2024The purpose of this study is to evaluate the efficacy of Vitamin A (VitA) as an adjuvant therapy for pediatric Pneumonia (MPP) through meta-analysis, and to investigate... (Review)
Review
OBJECTIVE
The purpose of this study is to evaluate the efficacy of Vitamin A (VitA) as an adjuvant therapy for pediatric Pneumonia (MPP) through meta-analysis, and to investigate its impact on inflammation levels (IL-6, IL-10), in order to explore the role of VitA in pediatric MPP.
METHODS
Using a systematic literature search method, relevant research literature is searched, and RCT studies that meet the requirements are selected based on preset inclusion and exclusion criteria. Then, a quality evaluation was conducted on the included literature, and meta-analysis was used to calculate the combined effect values of mortality rate, hospital stay, lung rale disappearance time, cough duration, fever duration, IL-6 and IL-10 levels, and heterogeneity analysis was conducted. The levels of IL-6 and IL-10 represent the inflammatory levels in pediatric MPP patients, and exploring their changes has significant implications for the anti-inflammatory effect of treatment.
RESULTS
A total of 10 RCT studies were included, with a total sample size of 1,485, including 750 cases in the control group and 735 cases in the observation group. The meta-analysis results of this study showed that there was a significant difference in the total clinical efficacy of using VitA adjuvant therapy compared to the control group without VitA [OR = 3.07, 95%CI = (2.81, 4.27)], < 0.05. However, there was no significant difference in the adverse reaction rate between the use of VitA as an adjuvant therapy and the control without VitA [OR = 1.17, 95%CI = (0.61, 2.27)], > 0.05. At the same time, the hospitalization time [MSD = -0.86, 95% CI = (-1.61, -0.21)], lung rale disappearance time [MSD = -0.78, 95%CI = (-1.19,-0.51)], cough duration [MSD = -1.07, 95%CI = (-1.41, -0.71)], and fever duration [MSD = -0.47, 95%CI = (-0.72, -0.23)] using VitA as an adjuvant treatment were obviously lower. In addition, the meta-analysis outcomes also showed that the use of VitA adjuvant therapy can significantly reduce IL-6 [MSD = -1.07, 95%CI = (-1.81, -0.27)] and IL-10 [MSD = -0.13, 95%CI = (-0.31, 0.12)] levels. This indicates that the application of VitA in pediatric MPP also has the effect of reducing inflammatory response.
CONCLUSION
Based on the meta-analysis results, VitA adjuvant therapy can significantly improve the clinical symptoms of pediatric MPP patients, shorten hospitalization time, promote the disappearance of lung rales, and alleviate cough and fever symptoms. In addition, VitA adjuvant therapy can effectively reduce inflammation levels, indicating its potential role in inhibiting inflammatory responses. In clinical practice, VitA adjuvant therapy for pediatric MPP can be promoted as a potential treatment option.
PubMed: 38859981
DOI: 10.3389/fped.2024.1345458 -
Korean Circulation Journal Apr 2024The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) may depend on renal function, and this raises theoretical concern over its effects on cardiovascular...
Cardiovascular Outcomes of Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Systematic Review and Updated Meta-Analysis.
BACKGROUND AND OBJECTIVES
The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) may depend on renal function, and this raises theoretical concern over its effects on cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD).
METHODS
This systematic review and updated meta-analysis of randomized controlled trials (RCTs) compared cardiovascular outcomes of patients with T2DM and CKD treated with SGLT2i to placebo. PubMed, Embase, and Cochrane were systematically searched. Prespecified subgroup analyses were performed in strata of estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m² and 45 to 59 mL/min/1.73 m².
RESULTS
Nine RCTs comprising 29,146 patients were selected. Average follow-up ranged from 0.75 to 4.2 years. SGLT2i were shown to reduce the risk of all-cause mortality (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79-0.97; p=0.01), the composite of cardiovascular mortality or hospitalizations for heart failure (HHF: HR, 0.71; 95% CI, 0.65-0.78; p<0.001), cardiovascular mortality (HR, 0.86; 95% CI, 0.76-0.98; p=0.02), HHF (HR, 0.62; 95% CI, 0.55-0.71; p<0.001), major adverse cardiovascular events (HR, 0.85; 95% CI, 0.77-0.94; p=0.002), stroke (HR, 0.76; 95% CI, 0.59-0.97; p=0.03), and myocardial infarction (HR, 0.78; 95% CI, 0.67-0.91; p=0.001). These findings were consistent over strata of eGFR, albeit with a lower incidence of stroke in patients treated with SGLT2i with eGFR <45 mL/min/1.73 m² (p-value for interaction=0.04).
CONCLUSIONS
Compared with a placebo, patients with T2DM and CKD treated with SGLT2i experience a reduction in all-cause mortality, cardiovascular mortality, and HHF.
TRIAL REGISTRATION
PROSPERO Identifier: CRD42023401081.
PubMed: 38859642
DOI: 10.4070/kcj.2023.0241 -
European Review For Medical and... May 2024Periimplantitis (PI) is a complex multifactorial chronic disease caused by interactions between bacteria, host immune-inflammatory responses, and genetic or... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Periimplantitis (PI) is a complex multifactorial chronic disease caused by interactions between bacteria, host immune-inflammatory responses, and genetic or environmental factors that modify buccal eutrophism. In daily clinical practice, an increase in the prevalence of PI (8%) determined the need to establish the PI causes and set optimal therapeutic strategies. The interleukin family (IL-1), a group of cytokines, triggers and perpetuates peri-implantitis. Therefore, they could be used as biomarkers for diagnosis and treatment. This systematic review aimed to analyze the correlation between IL-1 allelic polymorphism (IL-1A -889, IL-1β -511, IL-1β +3954) and the PI disease.
MATERIALS AND METHODS
Selected databases were PubMed, Scopus, and Cochrane Library. The search strategy included the following terms: "dental implants"; "periimplantitis"; "interleukin-IL-1"; "polymorphism"; "perimplant bone loss". Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A meta-analysis was conducted on five of 40 review articles. p-values, confidence intervals (CI), and Odds ratios (OR) were assessed. In 4 articles, the p-value was lower than 0.05, confirming the statistical significance of the result.
RESULTS
The prevalence of the selected studies reported the existence of a causal association between polymorphisms of IL-1 and the onset of peri-implantitis, especially for IL-1 allelic variants associated with further polymorphic genes encoding for IL-6, tumor necrosis factor-alpha (TNF-α), matrix metalloproteinases (MMP)-8, IL-1Na, IL-8, IL-18, osteopontin (OPN). In addition, the presence of the IL-1 polymorphism and PI is particularly higher in smokers, diabetes, and autoimmune disease patients.
CONCLUSIONS
The detection of salivary biomarkers is, therefore, a diagnostic tool with a high potential to intercept the PI early and act with appropriate and non-invasive treatment. Due to the continued technological innovation in biomarkers and diagnostic sciences, further studies are needed to investigate the role of these biochemical mediators. The results of studies and the recent technological innovation in biomarkers and diagnostic sciences will allow further research to investigate the role of these biochemical mediators.
Topics: Humans; Peri-Implantitis; Polymorphism, Genetic; Interleukin-1; Dental Implants
PubMed: 38856132
DOI: 10.26355/eurrev_202405_36293 -
Cureus May 2024Cervical intervertebral disc herniation is a common condition and most often presents as neck or upper limb pain causing varying levels of disability and dysfunction.... (Review)
Review
Cervical intervertebral disc herniation is a common condition and most often presents as neck or upper limb pain causing varying levels of disability and dysfunction. Percutaneous injection of ozone into the intradiscal space is a novel and minimally invasive technique for managing this condition and can be an effective alternative to surgical management. A literature search was done using the keywords ozone disc nucleolysis of cervical intervertebral lesions, and five studies were selected based on the inclusion and exclusion criteria. Meta-analysis was performed to determine safety, effectiveness, and symptomatic relief (determined based on the visual analog scale (VAS)) with the publication bias being removed. Subjects treated with ozone therapy showed significant reduction (p < 0.0001) in VAS score as compared to baseline VAS score with a standardized mean difference of 2.78 (95% CI = 1.48 to 4.07; Z value = 4.20). Ozone nucleolysis is a minimally invasive, relatively safe, and optimally effective treatment option for reducing the pain related to cervical disc. Intradiscal ozone therapy can be considered an alternative treatment modality, and well-designed, randomized clinical trials are required to confirm the long-term superiority of ozone therapy against other treatment modalities available for cervical disc herniation.
PubMed: 38854278
DOI: 10.7759/cureus.59855 -
Cureus May 2024Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) represents a minimally invasive alternative to traditional open thyroidectomy (OT). The objective... (Review)
Review
Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) represents a minimally invasive alternative to traditional open thyroidectomy (OT). The objective of this systematic review and meta-analysis was to comprehensively analyze and compare postoperative pain outcomes between conventional open thyroidectomy (COT) and TOETVA. We conducted a systematic search across multiple databases, including PubMed, Medline, Elton B. Stephens Company (EBSCO), and Google Scholar, to identify cohorts and randomized trials comparing postoperative pain outcomes between patients undergoing transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) and those undergoing conventional thyroidectomy. The search period spanned from the earliest available article up to January 15, 2022. Keywords such as "scarless thyroidectomy," "endoscopic transoral via vestibular thyroidectomy," "conventional thyroidectomy," "transcervical thyroidectomy," "postoperative pain," and "visual analog pain score" were utilized to retrieve relevant studies. A total of 1,291 patients from 11 studies were included in our analysis, with 10 studies originating from Asia and one from Europe. Among these studies, seven were prospective, while four were retrospective. The primary outcome measure was postoperative pain. Various statistical tests were also performed for data analysis, including the Chi-square and random effects model. The Newcastle Ottawa Scale was used to assess the quality of studies. There was no significant statistical difference observed between the endoscopic transoral vestibular route and the conventional cervical approach in terms of visual analog scale (VAS) score, with an odds ratio of -0.37 and a 95% confidence interval ranging from -0.9 to 0.17. The overall effect had a P-value of 0.18. However, substantial heterogeneity was noted, with an I2 value for heterogeneity of 98% and a P-value for heterogeneity of less than 0.001. The Chi-square value was calculated as 364.02, and the main difference was 9. In comparison, TOETVA exhibited lower pain levels on the first day post-operation compared to conventional thyroidectomy, with an odds ratio of -1.36 and a 95% confidence interval ranging from -2.65 to -0.06. Transoral endoscopic thyroidectomy via the vestibular approach demonstrated superior outcomes compared to conventional thyroidectomy in terms of postoperative pain management on the first day following surgery. However, when considering overall pain management throughout the recovery period, no significant difference was observed between the two approaches. More extensive studies evaluating pain levels on the day of surgery and controlling for analgesic interventions are warranted.
PubMed: 38854204
DOI: 10.7759/cureus.59998 -
Cureus May 2024Forensic anthropology and forensic medicine both have been fascinating fields that deal with mandibular characteristics and sex determination. Researchers may determine... (Review)
Review
Forensic anthropology and forensic medicine both have been fascinating fields that deal with mandibular characteristics and sex determination. Researchers may determine an individual's biological sex with amazing precision by examining the size, shape, and proportions of the mandible. This information is useful for anthropological studies and criminal investigations. This systematic review aims to evaluate the consistency and validity of using mandibles as a method for gender determination across different populations. A systematic search was conducted in PubMed, Web of Science, and Scopus databases. Further, a manual search was carried out to find additional studies. Mandibular parameters and other relevant data about research were extracted from the included studies. Random effects meta-analysis was carried out for four parameters. A total of nine studies were included in the systematic review out of 76 initial search results. All studies were in vitro. Nine studies were included in the qualitative analysis, whereas only seven studies were included in the meta-analysis. A total of 2385 individuals (1193 male and 1192 female) were evaluated in the included studies. The parameters assessed were as follows: minimum ramus breadth (MiRB), maximum ramus breadth (MaRB), projective ramus height (PRH), bigonial width (BGW), gonial angle (GA), and antegonial angle (AGA). Meta-analysis was conducted for four parameters out of six. For the two parameters, meta-analysis was not conducted as only one study was evaluated. Meta-analyses of PRH obtained a high degree of heterogeneity (99%), mean difference (MD) of 4.06 mm, and p-value of p=0.09. Meta-analysis of BGW obtained 93% heterogeneity, MD of 9.03 mm, and p=0.0007. Meta-analysis of GA showed 99% heterogeneity, MD of 3.44 mm, and p=0.66. Meta-analysis of AGA obtained a low heterogeneity of 30%, MD of -0.77 mm, and p=0.23. The parameter, BGW, can be considered a useful tool in identifying sex. The parameters, PRH, GA, and AGA, cannot be preferred as a reliable tool in identifying the sex of an individual in forensic contexts.
PubMed: 38854199
DOI: 10.7759/cureus.59965 -
Turkish Journal of Obstetrics and... Jun 2024Endometriosis is a prevalent condition in women that causes pelvic pain and fertility issues due to the growth of endometrial tissue outside the uterus during menstrual...
Endometriosis is a prevalent condition in women that causes pelvic pain and fertility issues due to the growth of endometrial tissue outside the uterus during menstrual cycles. Steroid hormones play a crucial role in the development and growth of endometriosis lesions; therefore, researchers have investigated several effective drugs that target hormones for treating this disease. One such drug is bazedoxifene, but despite several animal studies, there has yet to be a comprehensive evaluation of their combined results. A systematic search was conducted across several databases (Embase, PubMed, Scopus, and Web of Sciences) to identify studies investigating the effectiveness of bazedoxifene in animal models of endometriosis. Meta-analysis was performed using the size of endometriosis implants before and after drug administration in the case and control groups, along with the p-value of the associations. Begg's and Egger's tests were used to assess publication bias. This study included four eligible studies consisting of 45 endometrial animal models and 35 control subjects. The meta-analysis showed that bazedoxifene significantly reduced the size of endometriosis implants in animal models compared with the control group (odds ratio: 0.122, 95% confidence interval: 0.050-0.298, p<0.001). Detailed investigation determined that there was no significant heterogeneity between the studies (I2=38.81, and p-value of the Q test=0.179). However, according to Egger's test, the study showed publication bias (p=0.035). This study found that bazedoxifene is a promising treatment option for endometriosis in animal models. However, more research on animals and humans is required to confirm these results.
PubMed: 38853494
DOI: 10.4274/tjod.galenos.2024.82610 -
Brazilian Journal of Anesthesiology... 2024Prior research has established the effectiveness of magnesium in relieving postoperative pain. This article aims to evaluate magnesium sulfate for perioperative... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prior research has established the effectiveness of magnesium in relieving postoperative pain. This article aims to evaluate magnesium sulfate for perioperative analgesia in adults undergoing general abdominal surgery under general anesthesia.
OBJECTIVE
The primary aim was to assess pain scores at 6 and 24 hours postoperatively in patients receiving magnesium sulfate vs. the control group. Secondary outcomes were postoperative opioid consumption, perioperative complications, and time to rescue analgesia.
METHODS
A comprehensive database search identified studies comparing magnesium sulfate with control in adults undergoing general anesthesia for general abdominal surgery. Using random-effects models, data were presented as mean ± Standard Deviation (SD) or Odds Ratios (OR) with corresponding 95% Confidence Intervals (95% CI). A two-sided p-value < 0.05 was considered statistically significant.
RESULTS
In total, 31 studies involving 1762 participants met the inclusion criteria. The magnesium group showed significantly lower postoperative pain scores at both early (within six hours) and late (up to 24 hours) time points compared to the control group. The early mean score was 3.1 ± 1.4 vs. 4.2 ± 2.3, and the late mean score was 2.3 ± 1.1 vs. 2.7 ± 1.5, resulting in an overall Mean Difference (MD) of -0.72; 95% CI -0.99, -0.44; p < 0.00001. The magnesium group was associated with lower rates of postoperative opioid consumption and shivering and had a longer time to first analgesia administration compared to the saline control group.
CONCLUSION
Magnesium sulfate administration was linked to reduced postoperative pain and opioid consumption following general abdominal surgery.
Topics: Humans; Pain, Postoperative; Magnesium Sulfate; Randomized Controlled Trials as Topic; Abdomen; Analgesics; Anesthesia, General; Analgesics, Opioid; Perioperative Care
PubMed: 38848810
DOI: 10.1016/j.bjane.2024.844524 -
PloS One 2024Evidence supports the benefits of hydroxyurea (HU) in adults with sickle cell disease (SCD), but reservations remain due to long-term concerns of fertility.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence supports the benefits of hydroxyurea (HU) in adults with sickle cell disease (SCD), but reservations remain due to long-term concerns of fertility. Retrospective analysis of clinical records of SCD patients (haemoglobin SS genotype) have identified gender-related differences in disease progression. This could inform risk stratification during SCD at diagnosis with the possibility to guide therapeutic decisions.
METHODS
This systemic review and meta-analysis evaluated fertility parameters in both children (aged ≥ 6 years) and adults with SCD receiving HU therapy. Studies were sourced from PubMed and EMBASE from inception to July 2023. A total of 160 potentially relevant articles were identified.
RESULTS
Four studies were included that evaluated the effects of HU on sperm parameters in males. A further 4 studies assessed anti-mullerian hormone (AMH) levels and ovarian reserves in females. Differences from baseline values were used to identify compromised fertility. Amongst males, HU treatment negatively impacted the concentration of spermatozoa (MD = -15.48 million/mL; 95% CI: [-20.69, -10.26]; p< 0.001), which continued following treatment cessation (MD = -20.09 million/mL; 95% CI: [-38.78, -1.40]; P = 0.04). HU treatment also led to lower total sperm counts (MD = -105.87 million; 95% CI: [-140.61, -71.13]; P< 0.001) which persisted after treatment (MD = -53.05 million; 95% CI: [-104.96, -1.14]; P = 0.05). Sperm volume, initial forward motility and morphology were unaffected by HU treatment. In females, HU treatment decreased the mean AMH levels 1.83 (95% CI [1.42, 2.56]. A total of 18.2.% patients treated with HU showed reduced ovarian reserves.
INTERPRETATION & CONCLUSIONS
This systemic review and meta-analysis suggest that the use of HU for SCD impacts seminal fluid parameters in males and can diminish AMH levels and ovarian reserves in females.
Topics: Adult; Child; Female; Humans; Male; Anemia, Sickle Cell; Anti-Mullerian Hormone; Antisickling Agents; Fertility; Hydroxyurea; Ovarian Reserve; Sperm Count; Spermatozoa
PubMed: 38848387
DOI: 10.1371/journal.pone.0304241 -
Medicine Jun 2024Not all the breast lesions were mass-like, some were non-mass-like at ultrasonography. In these lesions, conventional ultrasonography had a high sensitivity but a low... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
Not all the breast lesions were mass-like, some were non-mass-like at ultrasonography. In these lesions, conventional ultrasonography had a high sensitivity but a low specificity. Sonoelastography can evaluate tissue stiffness to differentiate malignant masses from benign ones. Then what about the non-mass lesions? The aim of this study was to evaluate the current accuracy of sonoelastography in the breast non-mass lesions and compare the results with those of the American College of Radiology breast Imaging-Reporting and Data System (BI-RADS).
METHODS
An independent literature search of English medical databases, including PubMed, Web of Science, Embase & MEDLINE (Embase.com) and Cochrane Library, was performed by 2 researchers. The accuracy of sonoelastography was calculated and compared with those of BI-RADS.
RESULTS
Fourteen relevant studies including 1058 breast non-mass lesions were included. Sonoelastography showed a pooled sensitivity of 0.74 (95% CI: 0.70-0.78), specificity of 0.89 (95% CI: 0.85-0.91), diagnostic odds ratio (DOR) of 25.22 (95% CI: 17.71-35.92), and an area under the curve of 0.9042. Eight articles included both sonoelastography and BI-RADS. The pooled sensitivity, specificity, DOR and AUC were 0.69 versus 0.91 (P < .01), 0.90 versus 0.68 (P < .01), 19.65 versus 29.34 (P > .05), and 0.8685 versus 0.9327 (P > .05), respectively.
CONCLUSIONS
Sonoelastography has a higher specificity and a lower sensitivity for differential diagnosis between malignant and benign breast non-mass lesions compared with BI-RADS, although there were no differences in AUC between them.
Topics: Humans; Elasticity Imaging Techniques; Female; Ultrasonography, Mammary; Breast Neoplasms; Sensitivity and Specificity; Diagnosis, Differential; Breast; Breast Diseases
PubMed: 38847732
DOI: 10.1097/MD.0000000000038425