To evaluate the evidence about the safety and efficacy of tramadol in pain relief during diagnostic outpatient hysteroscopy (OH).
Systematic review and meta-analysis of randomized controlled trials.
...Not applicable.
Patients undergoing diagnostic OH received tramadol versus those who were administered placebo.
Electronic databases were searched using the following MeSH terms (tramadol OR opioids OR opioid OR narcotic OR narcotics) AND (hysteroscopy OR hysteroscopic).
Pain assessed by visual analogue scale (VAS) during OH, immediately and 30 minutes after the procedure.
One hundred thirteen studies were identified of which four randomized clinical trials were deemed eligible for this review (tramadol: n = 209; placebo: n = 209). The pooled estimate showed that tramadol significantly reduced VAS during procedure than placebo (weighted mean difference WMD = −1.33; 95% confidence interval CI −1.78 to −0.88, I2 = 3%, P = .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD = −1.05; 95% CI −1.49 to −0.61, I2= 0, P = .84) and 30 minutes after (WMD = −0.98; 95% CI −1.30 to −0.65, I2 = 0, P = .88).
This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH.
Eficacia y seguridad del tramadol en el alivio del dolor durante la histeroscopia diagnóstica ambulatoria: revisión sistemática y metaanálisis de ensayos controlados aleatorizados
Evaluar la evidencia sobre la seguridad y la eficacia de tramadol en el alivio del dolor durante la histeroscopia diagnóstica ambulatoria (HSC).
Revisión sistemática y metaanálisis de ensayos controlados aleatorizados.
No aplicable.
Pacientes sometidos a una HSC diagnóstica que recibieron tramadol frente a los que recibieron placebo.
Se realizaron búsquedas en las bases de datos electrónicas utilizando los siguientes términos de MeSH (tramadol O opioides O opioides O narcóticos) E (histeroscopia O histeroscópico).
El dolor evaluado por la escala analógica visual (VAS) durante la HSC, inmediatamente y 30 minutos después del procedimiento.
Se identificaron ciento trece estudios, de los cuales cuatro ensayos clínicos aleatorizados se consideraron elegibles para esta revisión (tramadol: n = 209; placebo: n = 209). La estimación combinada mostró que el tramadol redujo significativamente el VAS durante el procedimiento comparado con el placebo (diferencia de medias ponderada DMP = -1.33; intervalo de confianza del 95% IC 1.78 a -0.88, I2 = 3%, P = 0.36). Además, el tramadol redujo significativamente el VAS inmediatamente después del procedimiento (DMP = - 1,05; IC del 95%: -1,49 a - 0,61, I2 = 0, P = 0.84) y 30 minutos después (WMD = - 0,98; IC del 95%: -1,30 a -0,65, I2 = 0, P = 0.88).
Este metanálisis sugiere que el tramadol es seguro, eficaz y brinda resultados favorables para reducir el dolor durante la HSC diagnóstica.
Background: Perineal trauma is a common problem that may affect women during vaginal delivery; this trauma can be either spontaneous (tear) or intentional (episiotomy). When repair of perineal trauma ...is required, adequate analgesics must be obtained. Topical products as lidocaine-prilocaine (EMLA) cream is one of the suggested methods, but still there is lack of evidence with regard to its efficacy and safety.
Objective: The aim of this review is to assess the evidence of utilizing EMLA cream in comparison to local perineal infiltration anesthesia for pain control during perineal repair after vaginal delivery.
Data sources: Medline, Embase, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov and the Cochrane Library were searched electronically from January 2006 to May 2018 for studies investigating the effect of lidocaine-prilocaine cream in relieving pain during repair of perineal trauma.
Methods of study selection: All randomized controlled trials assessing effect of lidocaine-prilocaine cream versus local infiltration anesthesia in relieving pain during repair of perineal trauma were considered for this meta-analysis. Fifteen studies were identified of which four studies deemed eligible for this review. Quality and risk of bias assessment was performed for all studies.
Data extraction: Two researchers independently extracted the data from the individual articles and entered into RevMan software. The weighted mean difference (WMD) and 95% confidence interval (CI) was calculated. Statistical heterogeneity between studies was assessed by the Higgins chi-square and (I
2
) statistics. When heterogeneity was significant, a random-effects model was used for meta-analysis. Otherwise, the fixed effect meta-analysis was used when there was no significant heterogeneity.
Results: Pooled analysis of result in "pain score" was insignificant between the two groups (WMD −1.11; 95% CI (−2.55 to 0.33); p = .13). Furthermore, the use of additional analgesia showed no statistically significant difference between the two groups (WMD 1.34; 95% CI (0.66-2.71), p = .42). Regarding patient satisfaction, an overall analysis of three studies showed significant results favoring EMLA cream group users (WMD 4.65; 95% CI (1.96-11.03), p = .0005). The pooled analysis of the outcome "duration of repair" showed the significantly shorter duration of repair in EMLA cream users (n = 92) than local infiltration anesthesia (n = 95) (1.72 min; 95% CI (−2.76 to −0.67), p = .001).
Conclusions: This meta-analysis suggests that topical lidocaine-prilocaine cream gives comparable results in reducing pain during perineal repair after vaginal delivery.
Nivolumab, a completely human programmed death-1 inhibitor antibody, was first approved by the Food and Drug Administration for patients with advanced malignant melanoma resistant to other modalities ...of treatment. In 2015, it received approval as the first line of treatment for malignant melanoma. We aimed to synthesize evidence from published randomized-controlled trials on the safety and efficacy of nivolumab, either alone or in combination with ipilimumab, in the management of advanced unresectable melanoma. We searched the following electronic databases: PubMed, Scopus, Web of Science, and Cochrane Central. The records retrieved were screened for eligibility. Time-to-event data were pooled as Hazard ratio using the generic inverse variance method and dichotomous data were pooled as relative risk (RR) in a random-effects model. We used Review Manager 5.3 software for windows. Four unique randomized-controlled trials (five reports) with a total of 1910 patients (nivolumab group, n=1207 and control group, n=703) were included. The overall effect estimate favored nivolumab plus ipilimumab versus ipilimumab alone in terms of the objective response rate RR: 3.58, 95% confidence interval (CI): 2.08-6.14, the complete response rate (RR: 5.93, 95% CI: 2.45-14.37), the partial response rate (RR: 2.80, 95% CI: 2.16-3.64), the stable disease rate (RR: 0.56, 95% CI: 0.41-0.76), and progression-free survival (hazard ratio: 0.67, 95% CI: 0.60-0.74). The pooled studies were homogenous. Similar results were obtained for nivolumab monotherapy versus chemotherapy comparison. Nivolumab alone or combined with ipilimumab significantly improved the overall and complete response rates compared with ipilimumab alone. In addition, nivolumab resulted in longer progression-free survival with a comparable safety profile.
Background: Colposcopy is an office gynecological procedure used for cervical evaluation in patients with abnormal cervical cytology. It is considered an important tool for early detection of cases ...of cervical cancer.
Objective: To evaluate the evidence from published randomized clinical trials (RCTs) about the efficacy of local anesthetics in pain relief during colposcopic-guided biopsy.
Data sources: Several electronic databases included MEDLINE, EMBASE, Cochrane Library, ISI and Scopus were searched using the relevant MeSH terms.
Methods of study selection: All RCTs assessing the effect of local anesthetics in relieving pain during colposcopy were considered for this meta-analysis. There were 1339 studies identified of which 11 studies deemed eligible for this review. We performed quality and risk of bias assessment for all included studies.
Data extraction: Three researchers independently extracted the data from the individual articles and entered it into RevMan software. The extracted outcomes included pain scores and the duration of the procedure.
Results: Eleven RCTs were included. Local anesthesia (LA) was associated with higher pain at speculum insertion than control (SMD = 0.23, 95% CI 0.03, 0.43). While, LA significantly reduced biopsy pain than control (SMD= -0.57, 95% CI -0.94, -0.20). The overall pooled estimate showed no significant difference between LA and control regarding postprocedural pain, pain on endocervical curettage, pain expectancy, and overall pain scores.
Conclusions: This meta-analysis suggests that local anesthetics are effective in pain relief during a colposcopic-guided biopsy; however there is no strong evidence to recommend its use in current practice.
RAF protein kinases are effectors of the GTP-bound form of small guanosine triphosphatase RAS and function by phosphorylating MEK. We showed here that the expression of ARAF activated RAS in a ...kinase-independent manner. Binding of ARAF to RAS displaced the GTPase-activating protein NF1 and antagonized NF1-mediated inhibition of RAS. This reduced ERK-dependent inhibition of RAS and increased RAS-GTP. By this mechanism, ARAF regulated the duration and consequences of RTK-induced RAS activation and supported the RAS output of RTK-dependent tumor cells. In human lung cancers with EGFR mutation, amplification of ARAF was associated with acquired resistance to EGFR inhibitors, which was overcome by combining EGFR inhibitors with an inhibitor of the protein tyrosine phosphatase SHP2 to enhance inhibition of nucleotide exchange and RAS activation.
The role of rifaximin in the prevention of Spontaneous Bacterial Peritonitis (SBP) is not well studied. The aim of this meta-analysis was to evaluate the role of rifaximin in the prevention of SBP.
A ...computerized literature search for relevant clinical trials was conducted during August 2017. Data on Frequency of SBP, the success rate of prevention of SBP, mortality rate, hepatorenal syndrome, septic shock, hepatic encephalopathy, and GIT bleeding were extracted and pooled as Risk Ratio (RR) with their 95% Confidence Interval (CI) in a meta-analysis model. Heterogeneity was assessed by Chi-square test.
Six studies involving 973 patients were included in the final analysis. The pooled effect estimate showed that the rifaximin plus norfloxacin group had less incidence of SBP (RR 0.58, 95% CI0.37, 0.92, P=0.02) and hepatic encephalopathy (RR 0.38, 95% CI0.17, 0.84, P=0.02) than the norfloxacin-based regimen group. No significant difference between rifaximin and norfloxacin in terms of frequency of SBP and success rate of primary prevention of SBP (RR 0.49, 95% CI 0.24, 1.01, P=0.05; RR1.21, 95% CI 0.95, 1.55, P=0.13, respectively).
Based on our analysis, Rifaximin is a promising drug and appears to be a good alternative to norfloxacin in the prevention of SBP.
Background
Bone metastasis is reported to be associated with poor quality of life, and increased risk of hospitalization. We aim to synthesize evidence from published randomized controlled trials ...(RCTs) which compared the efficacy of denosumab versus bisphosphonates in patients with advanced cancers.
Methods
We searched for all published RCTs in the following electronic databases: PubMed, Scopus, Web of Science, and Cochrane Central. Retrieved records were screened for eligibility. Time-to-event data were pooled as hazard ratio (HR) using the generic inverse-variance method and dichotomous data were pooled as relative risk (RR) in a random-effect model. We used Review Manager 5.3 for windows.
Results
Six unique RCTs with a total of 7722 patients were included. Overall effect estimates favored denosumab group in comparison to intravenous (IV) bisphosphonates in the following terms: time to first skeletal-related events (HR 0.92, 95% CI 0.86, 0.98,
p
= 0.01), time to subsequent skeletal-related event (RR 0.92, 95% CI 0.86, 0.99,
p
= 0.03), and radiation to bone (RR 0.81, 95% CI 0.71, 0.92,
p
= 0.02). Denosumab group was associated with increased risk of grade 3 or 4 hypocalcaemia (RR 1.99, 95% CI 1.11, 3.54,
p
= 0.02) and reduced risk of renal impairment or toxicity (RR 0.75, 95% CI 0.61, 0.91,
p
= 0.003) in comparison to IV bisphosphonates group. Pooled studies were homogenous.
Conclusion
Denosumab showed a favorable significant impact on delaying the time to first skeletal-related event and reducing the incidence of radiation to the bone event in comparison to bisphosphonates, with similar efficacy regarding overall survival and time to disease progression. Further large-scale and long-term studies are needed to clarify the long-term efficacy and safety of both regimens.
Without clear evidence, selecting among the existing immunotherapeutic options for warts remains challenging.
Through network meta-analyses, we aimed to evaluate the comparative efficacy of different ...intralesional immunotherapeutic modalities.
We included randomized controlled trials comparing intralesional immunotherapeutic modalities to cryotherapy, placebo, or imiquimod. All outcomes were presented as odds ratios (ORs) with 95% confidence intervals. Both conventional and network meta-analyses (with a frequentist approach) were conducted on R software. The P-score was used to rank different treatments.
Network meta-analysis of 17 randomized controlled trials (1676 patients) showed that PPD (purified protein derivative vaccine, OR 39.56), MMR (measles, mumps, rubella vaccine, OR 17.46) and interferon β (OR 15.55) had the highest efficacy in terms of complete recovery at the primary site compared with placebo. Regarding complete recovery at the distant site, autoinoculation (OR 79.95), PPD (OR 42.95), and MMR (OR 15.39) were all statistically superior to placebo. According to the P-score, MMR was more effective than other modalities in reducing the recurrence rate at the same site.
Relatively small sample size in some comparisons and variability in baseline characteristics.
PPD and MMR were the most effective in achieving complete primary and distant recovery (along with autoinoculation for distant recovery) and reducing the recurrence rate at the same site compared with cryotherapy and other immunotherapeutic modalities.
JAK2, CALR, MPL and triple-negative mutational status has a direct impact on symptom severity and disease burden assessed by MPN10 score in myeloproliferative neoplasms (MPNs). Among 93 patients; ...median MPN10 score was 48 (5-76) in JAK2 mutants versus 25 (4-80) in JAK2 negative (p < .001); 22.5 (4-65) in CALR mutants versus 35 (5-80) in CALR negative (p < .050) and 21 (10-48) in triple negative versus 40 (4-80) in JAK2/CALR/MPL mutants (p < .001). At three years, progression free and overall survival of JAK2-positive versus JAK2-negative patients were 62% versus 100% (p < .001); 85% versus 100% (p = .011) and were 100% versus 78% (p = .067); 100% versus 92% (p = .197) in CALR-positive versus CALR-negative patients and 100% versus 75% (p = .004); 100% versus 90% (p = .015) in triple negative versus mutant patients, respectively. MPN10 score in association with driver gene mutations can be used as a predictor of survival in MPN patients.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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