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The Cochrane Database of Systematic... Sep 2018Almost 358,000 women die each year in childbirth, mainly in low-income countries. More than half of all maternal deaths occur within 24 hours of giving birth; severe... (Review)
Review
BACKGROUND
Almost 358,000 women die each year in childbirth, mainly in low-income countries. More than half of all maternal deaths occur within 24 hours of giving birth; severe bleeding in the postpartum period is the single most important cause. Depending on the rate of blood loss and other factors, such as pre-existing anaemia, untreated postpartum haemorrhage (PPH) can lead to hypovolaemic shock, multi-organ dysfunction, and maternal death, within two to six hours.This review investigated different methods for estimating blood loss. The most common method of measuring blood loss during the third stage of labour is visual estimation, during which the birth attendant makes a quantitative or semi-quantitative estimate of the amount of blood lost. In direct blood collection, all blood lost during the third stage of labour (except for the placenta and membranes) is contained in a disposable, funnelled, plastic collector bag, which is attached to a plastic sheet, and placed under the woman's buttocks. When the bleeding stops, there are two options: the bag can be weighed (also called gravimetric technique), or the bag can be calibrated, allowing for a direct measurement. A more precise measurement of blood loss is haemoglobin concentration (Hb) in venous blood sampling and spectrophotometry. With the dye dilution technique, a known quantity of dye is injected into the vein and its plasmatic concentration is monitored after the uterus stops bleeding. Using nuclear medicine, a radioactive tracer is injected, and its concentration is monitored after the uterus stops bleeding. Although hypothetically, these advanced methods could provide a better quantification of blood loss, they are difficult to perform and are not accessible in most settings.
OBJECTIVES
To evaluate the effect of alternative methods to estimate blood loss during the third stage of labour, to help healthcare providers reduce the adverse consequences of postpartum haemorrhage after vaginal birth.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register (2 February 2018), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP; 21 March 2018), and reference lists of retrieved studies.
SELECTION CRITERIA
All randomised trials, including cluster-randomised trials, evaluating methods for estimating blood loss after vaginal birth.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy.
MAIN RESULTS
The search retrieved 62 reports in total. Of these, we assessed 12 reports in full, corresponding to six trials. We included three trials and excluded one; two trials are ongoing.The included trials were conducted in hospital settings. Two trials were conducted in India; the third trial was a large cluster-randomised trial, which took place in 13 European countries. Overall, we judged the included trials to be at a low risk of bias. One study evaluated the use of calibrated drapes versus visual estimation, another evaluated the use of calibrated drapes versus the gravimetric technique (weight of blood-soaked materials), therefore, we were unable to pool the data from the two studies. The third study did not measure any of the outcomes of interest, so did not contribute data to the analyses.Direct measurement using calibrated drapes versus visual estimationOne cluster-randomised controlled trial in 13 western European countries, with over 25,000 women, examined this comparison.The trial did not report on postpartum anaemia (defined as Hb lower than 9 mg/dL), blood loss greater than 500 mL, or maternal infection.Moderate-quality evidence suggests there is probably little or no difference between groups in: severe morbidity (coagulopathy, organ failure, intensive care unit admission; adjusted risk ratio (RR) 0.82, 95% confidence interval (CI) 0.48 to 1.39); the risk of blood transfusion (adjusted RR 0.82, 95% CI 0.46 to 1.46); the use of plasma expanders (adjusted RR 0.77, 95% CI 0.42 to 1.42); and the use of therapeutic uterotonics (adjusted RR 0.87, 95% CI 0.42 to 1.76).Direct measurement using calibrated drapes (Excellent BRASSS-V Drape™) versus gravimetric techniqueOne randomised controlled trial in India, with 900 women, examined this comparison.The trial did not report on postpartum anaemia (defined as Hb lower than 9 mg/dL), severe morbidity, or maternal infection.High-quality evidence showed that using calibrated drapes improved the detection of blood loss greater than 500 mL when compared with the gravimetric technique (RR 1.86, 95% CI 1.11 to 3.11). Low-quality evidence suggests there may be little or no difference in the risk of blood transfusion between the two groups (RR 1.00, 95% CI 0.06 to 15.94), or in the use of plasma expanders, reported as intravenous fluids given for PPH treatment (RR 0.67; 95% CI 0.19 to 2.35). High-quality evidence showed little or no difference in the use of therapeutic uterotonics (RR 1.01, 95% CI 0.90 to 1.13), but the use of therapeutic uterotonics was extremely high in both arms of the study (57% and 56%).
AUTHORS' CONCLUSIONS
Overall, the evidence in this review is insufficient to support the use of one method over another for blood loss estimation after vaginal birth. In general, the quality of evidence for our predefined outcomes ranged from low to high quality, with downgrading decisions due to imprecision. The included trials did not report on many of our primary and secondary outcomes.In trials that evaluate methods for estimating blood loss during vaginal birth, we believe it is important to measure their impact on clinical maternal and neonatal outcomes, along with their diagnostic accuracy. This body of knowledge needs further, well designed, appropriately powered, randomised controlled trials that correlate blood loss with relevant clinical outcomes, such as those listed in this review.
Topics: Blood Specimen Collection; Blood Transfusion; Female; Humans; Labor Stage, Third; Oxytocics; Plasma Substitutes; Postpartum Hemorrhage; Pregnancy; Randomized Controlled Trials as Topic; Surgical Drapes
PubMed: 30211952
DOI: 10.1002/14651858.CD010980.pub2 -
Acta Dermato-venereologica Jan 2024Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to... (Meta-Analysis)
Meta-Analysis
Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to compare reported measures of efficacy of lasers and energy-based devices in clinical trials in preventing surgical scar formation in a systematic review and network meta-analyses. Five electronic databases, PubMed, Scopus, Embase, ClinicalTrials.gov, and the Cochrane Library, were searched to retrieve relevant articles. The search was limited to randomized controlled trials that reported on clinical outcomes of surgical scars with treatment initiation no later than 6 months after surgery and a follow-up period of at least 3 months. A total of 18 randomized controlled trials involving 482 participants and 671 postsurgical wounds were included in the network meta-analyses. The results showed that the most efficacious treatments were achieved using low-level laser therapy) (weighted mean difference -3.78; 95% confidence interval (95% CI) -6.32, -1.24) and pulsed dye laser (weighted mean difference -2.46; 95% CI -4.53, -0.38). Nevertheless, low-level laser therapy and pulsed dye laser demonstrated comparable outcomes in surgical scar minimization (weighted mean difference -1.32, 95% CI -3.53, 0.89). The findings of this network meta-analyses suggest that low-level laser therapy and pulsed dye laser are both effective treatments for minimization of scar formation following primary closure of surgical wounds with comparable treatment outcomes.
Topics: Humans; Network Meta-Analysis; Cicatrix; Lasers, Dye; Databases, Factual; Low-Level Light Therapy
PubMed: 38189223
DOI: 10.2340/actadv.v104.18477 -
Complementary Therapies in Medicine Jun 2023Liver conditions are major burdens upon health systems around the world. Turmeric /curcumin is believed to possess therapeutic features in ameliorating various metabolic... (Meta-Analysis)
Meta-Analysis Review
Effects of curcumin/turmeric supplementation on liver function in adults: A GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials.
INTRODUCTION
Liver conditions are major burdens upon health systems around the world. Turmeric /curcumin is believed to possess therapeutic features in ameliorating various metabolic disorders. In this systematic review and meta-analysis of the randomized controlled trials (RCTs), we examined the effect of turmeric/curcumin supplementation on some liver function tests (LFTs).
METHODS
We comprehensively searched online databases (i.e. PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar) from inception up to October 2022. Final outcomes included aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Weighted mean differences (WMDs) were reported. In case of between-study heterogeneity, subgroup analysis was conducted. Non-linear dose-response analysis was carried out to detect the potential effect of dosage and duration. The registration code is CRD42022374871.
RESULTS
Thirty-one RCTs were included in the meta-analysis. Turmeric/curcumin supplementation significantly reduced blood levels of ALT (WMD = -4.09 U/L; 95 % CI = -6.49, -1.70) and AST (WMD = -3.81 U/L; 95 % CI = -5.71, -1.91), but not GGT (WMD: -12.78 U/L; 95 % CI: -28.20, 2.64). These improvements, though statistically significant, do not ensure clinical effectiveness.
CONCLUSION
It seems that turmeric/curcumin supplementation might be effective in improving AST and ALT levels. However, further clinical trials are needed to examine its effect on GGT. Quality of the evidence across the studies was low for AST and ALT and very low for GGT. Therefore, more studies with high quality are needed to assess this intervention on hepatic health.
Topics: Humans; Adult; Curcumin; Curcuma; Randomized Controlled Trials as Topic; Liver; gamma-Glutamyltransferase; Dietary Supplements
PubMed: 37178581
DOI: 10.1016/j.ctim.2023.102952 -
Complementary Therapies in Medicine Sep 2021Although previous studies have examined the impact of curcumin supplementation on cytokine levels in patients with autoimmune disorders, we were unable to find a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although previous studies have examined the impact of curcumin supplementation on cytokine levels in patients with autoimmune disorders, we were unable to find a systematic review of the effect of curcumin supplementation on inflammatory biomarkers such as CRP and ESR in patients with rheumatoid arthritis or ulcerative colitis; therefore we conducted this systematic review and meta-analysis.
METHODS
Relevant studies published from inception to December 2020 were systematically searched through the PubMed, SCOPUS, and google scholar databases. We conducted our systematic review and meta-analysis according to the 2020 PRISMA guidelines. The quality of the papers were assessed by using the Cochrane Collaboration's risk of bias tool. Included studies were randomized clinical trials on the effects of supplementation with curcumin or its derivative on inflammatory factors in patients with rheumatoid arthritis and ulcerative colitis. Pooled effect sizes were calculated using a random-effects model and reported as the weighted mean difference (WMD) and 95 % CI.
RESULTS
In all, six studies met the inclusion criteria for this study. Curcumin supplementation in doses of 250-1500 mg/day over 8-12 weeks was observed to be associated with decreases in CRP and ESR in adult patients with rheumatoid arthritis and ulcerative colitis in comparison with the control group (WMD: -0.42; 95 % CI: -0.59, -0.26, I = 94.3 %; WMD: -55.96; 95 % CI: -93.74, -18.17, I = 99.7 %, respectively). Significant findings were also observed based on subgroup analyses by the study sample size, duration, participants' age, curcumin dosage, and type of disease.
CONCLUSIONS
Curcumin supplementation was associated with significant reductions in levels of CRP and ESR in patients with rheumatoid arthritis and ulcerative colitis. Earlier studies reported curcumin as a safe complementary therapy for several diseases. However, a handful of studies were found on the effect of curcumin on autoimmune diseases despite our comprehensive search. Further studies are therefore warranted in this area.
Topics: Adult; Arthritis, Rheumatoid; Biomarkers; Colitis, Ulcerative; Curcumin; Dietary Supplements; Humans; Randomized Controlled Trials as Topic
PubMed: 34478838
DOI: 10.1016/j.ctim.2021.102773 -
The International Journal of Medical... Feb 2023Indocyanine green fluorescence (ICG-F) stains hepatic tumours and delineates vascular and biliary structures in real-time. We detail the efficacy of ICG-F in robotic... (Review)
Review
BACKGROUND
Indocyanine green fluorescence (ICG-F) stains hepatic tumours and delineates vascular and biliary structures in real-time. We detail the efficacy of ICG-F in robotic hepatobiliary surgery.
METHODS
PubMed, EMBASE, Web of Science, and Cochrane Central were searched for original articles and meta-analyses detailing the outcomes of ICG-F in robotic hepatobiliary surgery.
RESULTS
214 abstracts were reviewed; 16 studies are presented. One single-institution study reported ICG-F in robotic right hepatectomy reduced postoperative bile leakage (0% vs. 12%, p = 0.023), R1 resection (0% vs. 16%, p = 0.019), and readmission (p = 0.023) without prolonging operative time (288 vs. 272 min, p = 0.778). Improved visualisation aided in attainment of R0 resection in partial hepatectomies and radical gallbladder adenocarcinoma resections. Fewer ICG-F-aided robotic cholecystectomies were converted to open procedure compared to laparoscopic cholecystectomies (2.1% vs. 8.9%, p = 0.03; 0.15% vs. 2.6%, p < 0.001).
CONCLUSIONS
ICG-F improves clinical outcomes in robotic hepatobiliary surgery without prolonging operative time. There is an opportunity to standardise ICG administration protocols, especially for hepatectomies.
Topics: Humans; Indocyanine Green; Robotic Surgical Procedures; Fluorescence; Coloring Agents; Hepatectomy
PubMed: 36417426
DOI: 10.1002/rcs.2485 -
BJU International Jan 2017To profile the contemporary risks of occupational bladder in the UK, as this is a common malignancy that arises through occupational carcinogen exposure. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To profile the contemporary risks of occupational bladder in the UK, as this is a common malignancy that arises through occupational carcinogen exposure.
MATERIALS AND METHODS
A systematic review using PubMed, Medline, Embase and Web of Science was performed in March 2016. We selected reports of British workers in which bladder cancer or occupation were the main focus, with sufficient cases or with confidence intervals (CIs). We used the most recent data in populations with multiple reports. We combined odds ratios and risk ratios (RRs) to provide pooled RRs of incidence and disease-specific mortality (DSM). We tested for heterogeneity and publication bias. We extracted bladder cancer mortality from Office of National Statistics death certificates. We compered across regions and with our meta-analysis.
RESULTS
We identified 25 articles reporting risks in 702 941 persons. Meta-analysis revealed significantly increased incidence for 12/37 and DSM for five of 37 occupational classes. Three classes had reduced bladder cancer risks. The greatest risk of bladder cancer incidence occurred in chemical process (RR 1.87, 95% CI 1.50-2.34), rubber (RR 1.82, 95% CI 1.4-2.38), and dye workers (RR 1.8, 95% CI 1.07-3.04). The greatest risk of DSM occurred in electrical (RR 1.49, 95% CI 1.19-1.87) and chemical process workers (RR 1.35, 95% CI 1.09-1.68). Bladder cancer mortality was higher in the North of England, probably reflecting smoking patterns and certain industries. Limitations include the lack of sufficient robust data, missing occupational tasks, and no adjustment for smoking.
CONCLUSION
Occupational bladder cancer occurs in many workplaces and the risks for incidence and DSM may differ. Regional differences may reflect changes in industry and smoking patterns. Relatively little is known about bladder cancer within British industry, suggesting official data underestimate the disease.
Topics: Humans; Occupational Diseases; Risk Assessment; Time Factors; United Kingdom; Urinary Bladder Neoplasms
PubMed: 27332981
DOI: 10.1111/bju.13561 -
Journal of Oral Biology and... 2023This systematic review and meta-analysis aimed to evaluate if bioceramic sealers had superior sealing properties to epoxy resin-based sealers. (Review)
Review
OBJECTIVE
This systematic review and meta-analysis aimed to evaluate if bioceramic sealers had superior sealing properties to epoxy resin-based sealers.
METHODOLOGY
A systematic search was performed in the following databases: MEDLINE Ovid (from 1946 onwards), Scopus, Google Scholar, EBSCO, and a hand search of references of included articles was also done. In vitro and ex vivo studies were included. Risk of bias was assessed, and quantitative synthesis was performed for microleakage measured using vertical dye penetration, horizontal dye penetration, and dentin-sealer gap. Summary effect was reported as Standardized Mean Difference with 95% CI. Subgroup analysis was performed based on the imaging modalities, the obturation techniques, and the file systems employed.
RESULTS
A total of 24 studies were included. Meta-analysis demonstrated no significant difference between the sealing ability of bioceramic sealer and epoxy resin-based sealer when measured using the microleakage tests [SMD -0.59(95%CI: 1.74,0.55)]. Subgroup analysis revealed no significant differences except when manual K-files were used. Heterogeneity was low when sub-group analysis was done.
CONCLUSION
Bioceramic sealers and epoxy resin-based sealers both exhibited comparable sealing ability.
PubMed: 36345495
DOI: 10.1016/j.jobcr.2022.10.006 -
World Journal of Gastroenterology Dec 2013To assess systematically the safety and efficacy of bile leakage test in liver resection. (Meta-Analysis)
Meta-Analysis Review
AIM
To assess systematically the safety and efficacy of bile leakage test in liver resection.
METHODS
Randomized controlled trials and controlled clinical trials involving the bile leakage test were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate postoperative bile leakage, intraoperative positive bile leakage, and complications. We used either the fixed-effects or random-effects model.
RESULTS
Eight studies involving a total of 1253 patients were included and they all involved the bile leakage test in liver resection. The bile leakage test group was associated with a significant reduction in bile leakage compared with the non-bile leakage test group (RR = 0.39, 95%CI: 0.23-0.67; I (2) = 3%). The white test had superiority for detection of intraoperative bile leakage compared with the saline solution test (RR = 2.38, 95%CI: 1.24-4.56, P = 0.009). No significant intergroup differences were observed in total number of complications, ileus, liver failure, intraperitoneal hemorrhage, pulmonary disorder, abdominal infection, and wound infection.
CONCLUSION
The bile leakage test reduced postoperative bile leakage and did not increase incidence of complications. Fat emulsion is the best choice of solution for the test.
Topics: Anastomotic Leak; Bile Duct Diseases; Chi-Square Distribution; Diagnostic Techniques, Digestive System; Fat Emulsions, Intravenous; Hepatectomy; Humans; Indocyanine Green; Methylene Blue; Odds Ratio; Predictive Value of Tests
PubMed: 24363535
DOI: 10.3748/wjg.v19.i45.8420 -
BMJ (Clinical Research Ed.) Aug 2002To assess the evidence for the efficacy of local treatments for cutaneous warts. (Review)
Review
OBJECTIVE
To assess the evidence for the efficacy of local treatments for cutaneous warts.
METHODS
Systematic review of randomised controlled trials.
MAIN OUTCOMES MEASURES
Total clearance of warts and adverse effects such as irritation, pain, and blistering.
STUDY SELECTION
Randomised controlled trials of any local treatment for uncomplicated cutaneous warts. All published and unpublished material was considered, with no restriction on date or language.
RESULTS
50 included trials provided generally weak evidence because of poor methods and reporting. The best evidence was for topical treatments containing salicylic acid. Data pooled from six placebo controlled trials showed a cure rate of 75% (144 of 191) in cases compared with 48% (89 of 185) in controls (odds ratio 3.91, 95% confidence interval 2.40 to 6.36). Some evidence for the efficacy of contact immunotherapy was provided by two small trials comparing dinitrochlorobenzene with placebo. Evidence for the efficacy of cryotherapy was limited. No consistent evidence was found for the efficacy of intralesional bleomycin, and only limited evidence was found for the efficacy of topical fluorouracil, intralesional interferons, photodynamic therapy, and pulsed dye laser.
CONCLUSIONS
Reviewed trials of local treatments for cutaneous warts were highly variable in methods and quality, and there was a paucity of evidence from randomised, placebo controlled trials on which to base the rational use of the treatments. There is good evidence that topical treatments containing salicylic acid have a therapeutic effect and some evidence for the efficacy of dinitrochlorobenzene. Less evidence was found for the efficacy of all the other treatments reviewed, including cryotherapy.
Topics: Anti-Bacterial Agents; Antiviral Agents; Bleomycin; Cryotherapy; Dermatologic Agents; Humans; Immunotherapy; Interferons; Laser Therapy; Photochemotherapy; Randomized Controlled Trials as Topic; Salicylic Acid; Treatment Outcome; Warts
PubMed: 12202325
DOI: No ID Found -
Nutrition Reviews May 2022Hibiscus sabdariffa (hibiscus) has been proposed to affect cardiovascular risk factors. (Meta-Analysis)
Meta-Analysis
CONTEXT
Hibiscus sabdariffa (hibiscus) has been proposed to affect cardiovascular risk factors.
OBJECTIVE
To review the evidence for the effectiveness of hibiscus in modulating cardiovascular disease risk markers, compared with pharmacologic, nutritional, or placebo treatments.
DATA SOURCES
A systematic search of the Web of Science, Cochrane, Ovid (MEDLINE, Embase, AMED), and Scopus databases identified reports published up to June 2021 on randomized controlled trials using hibiscus as an intervention for lipid profiles, blood pressure (BP), and fasting plasma glucose levels in adult populations.
DATA EXTRACTION
Seventeen chronic trials were included. Quantitative data were examined using a random effects meta-analysis and meta-regression with trial sequential analysis to account for type I and type II errors.
DATA ANALYSIS
Hibiscus exerted stronger effects on systolic BP (-7.10 mmHg [95%CI, -13.00, -1.20]; I2 = 95%; P = 0.02) than placebo, with the magnitude of reduction greatest in those with elevated BP at baseline. Hibiscus induced reductions to BP similar to that resulting from medication (systolic BP reduction, 2.13 mmHg [95%CI, -2.81, 7.06], I2 = 91%, P = 0.40; diastolic BP reduction, 1.10 mmHg [95%CI, -1.55, 3.74], I2 = 91%, P = 0.42). Hibiscus also significantly lowered levels of low-density lipoprotein compared with other teas and placebo (-6.76 mg/dL [95%CI, -13.45, -0.07]; I2 = 64%; P = 0.05).
CONCLUSIONS
Regular consumption of hibiscus could confer reduced cardiovascular disease risk. More studies are warranted to establish an effective dose response and treatment duration.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration no. CRD42020167295.
Topics: Adult; Biomarkers; Blood Pressure; Cardiovascular Diseases; Hibiscus; Humans; Hypertension
PubMed: 34927694
DOI: 10.1093/nutrit/nuab104