Summary
Postoperative sore throat has a negative impact on patient satisfaction and recovery. Benzydamine hydrochloride is a non‐steroidal anti‐inflammatory drug available for topical use. We ...performed a systematic review and meta‐analysis to assess the efficacy and safety of topical application of benzydamine to prevent postoperative sore throat in adults undergoing elective surgery under general anaesthesia. We searched PubMed, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials to identify relevant randomised controlled trials and pooled the data using a random effects model. The primary outcomes were the incidence and severity of sore throat 24 h after surgery/extubation, and adverse events. The quality of evidence was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) criteria. Thirteen randomised controlled trials involving 1842 patients were included. Compared with control patients who did not receive analgesia, benzydamine was associated with a decreased incidence of postoperative sore throat, with a risk ratio (95%CI) of 0.31 (0.20–0.47), but not with significantly reduced severity, the standardised mean difference (95%CI) being −0.27 (−0.63 to 0.08). There were no significant adverse events related to benzydamine. Benzydamine was also associated with a reduced incidence of postoperative sore throat when compared with lidocaine, with a risk ratio (95%CI) of 0.18 (0.07–0.43). We judged the evidence for the outcome ‘incidence of postoperative sore throat’ as high quality.
Summary
Postoperative sore throat negatively affects patient satisfaction and recovery. Numerous randomised trials have tested the efficacy of corticosteroids applied to tracheal tubes to prevent ...postoperative sore throat. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Wanfang Database, and the China Academic Journal Network Publishing Database from inception to 7 December 2017. We included randomised controlled trials that assessed the efficacy and safety of corticosteroids applied to tracheal tubes, compared either with non‐analgesic controls and analgesic agents, in adults undergoing elective surgery under general anaesthesia. We pooled the data using a random‐effects model and assessed the risk of random error by applying trial sequential analysis. Our primary outcomes were postoperative sore throat 24 h after surgery/extubation, and adverse events. The evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We included 20 randomised controlled trials involving 2200 patients. Compared with non‐analgesic controls, corticosteroids applied to tracheal tubes were associated with a reduced incidence of postoperative sore throat, risk ratio (95%CI) 0.39 (0.32–0.49) (18 trials, 1506 patients). Two randomised trials reported no adverse events. Compared with lidocaine, corticosteroids applied to tracheal tubes were associated with reduced incidence of postoperative sore throat, risk ratio (95%CI) 0.42 (0.35–0.51) (nine trials, 706 patients). Trial sequential analyses suggested the presence of firm evidence that corticosteroids applied to tracheal tubes were superior both to non‐analgesic controls and lidocaine, in preventing postoperative sore throat. Evidence for postoperative sore throat for both comparisons was assessed as high quality. Only two trials sought adverse events; none were recorded.
Atypical femoral fracture with bisphosphonate use Yano, Y; Kuriyama, A; Yano, Y ...
QJM : An International Journal of Medicine,
2020-Nov-01, 2020-11-01, 20201101, Volume:
113, Issue:
11
Journal Article
Background
Most studies on the dietary habits and overweight status of men aged 20–49 years have been cross‐sectional, with longitudinal studies being scarce. One‐quarter of Japanese men aged ...20–49 years skip breakfast or have dinner within 2 h of bedtime (late dinner); therefore, the effects of these eating habits on men's increasing body weight need to be determined.
Methods
We conducted a retrospective cohort study using health check‐up data provided from several health insurance societies in Japan. Participants comprised 45 524 men employees aged 20–49 years who were followed up for 3 years. The primary outcome investigated was body mass index (BMI) ≥25 kg m−2. We conducted a multivariable logistic regression analysis and calculated the odds ratios for skipping breakfast and late dinner, as well as baseline age, body mass index, smoking status, eating speed, snack‐eating status, alcohol drinking frequency, physical activity, sleep habits, and the interaction between skipping breakfast and late dinner.
Results
Of the participants, 17 706 (38.8%) skipped breakfast and 25 987 (57.1%) had a late dinner. At the 3‐year follow‐up, 5093 (11.2%) had a BMI ≥25 kg m−2. The odds ratios of men skipping breakfast and having a late dinner were 1.18 (95% confidence interval = 1.04–1.33) and 0.92 (95% confidence interval = 0.84–1.01), respectively. The interaction between these factors was nonsignificant.
Conclusions
We suggest that skipping breakfast among men aged 20–49 years was one predictor of being overweight; however, having dinner within 2 h of bedtime was not a predictor.
A diagnosis of Wernicke's encephalopathy (WE) is difficult. Transient hypotension has been reported as a rare complication of WE. We herein report a case of prolonged hypotension and dysuautonomia ...associated with WE in a 69-year-old man with underlying alcohol abuse. Without apparent etiology of shock, this patient remained hypotensive for 9 days, requiring a vasopressor, despite daily administration of thiamine 600 mg. Fluctuation of blood pressure caused by postural change and bradycardia in the presence of shock indicated that this patient had dysautonomia. This case hereby proposes a possible association between hypotension, dysautonomia and Wernicke's encephalopathy.
To comprehensively evaluate diagnostic algorithms for myocardial infarction using a high-sensitivity cardiac troponin I (hs-cTnI) assay.
We prospectively enrolled patients with suspected myocardial ...infarction without ST-segment elevation from nine emergency departments in Japan. The diagnostic algorithms evaluated: (i) based on hs-cTnI alone, such as the European Society of Cardiology (ESC) 0/1-h or 0/2-h and High-STEACS pathways; or (ii) used medical history and physical findings, such as the ADAPT, EDACS, HEART, and GRACE pathways. We evaluated the negative predictive value (NPV), sensitivity as safety measures, and proportion of patients classified as low or high-risk as an efficiency measure for a primary outcome of type 1 myocardial infarction or cardiac death within 30 days.
We included 437 patients, and the hs-cTnI was collected at 0 and 1 hours in 407 patients and at 0 and 2 hours in 394. The primary outcome occurred in 8.1% (33/407) and 6.9% (27/394) of patients, respectively. All the algorithms classified low-risk patients without missing those with the primary outcome, except for the GRACE pathway. The hs-cTnI-based algorithms classified more patients as low-risk: the ESC 0/1-h 45.7%; the ESC 0/2-h 50.5%; the High-STEACS pathway 68.5%, than those using history and physical findings (15-30%). The High-STEACS pathway ruled out more patients (20.5%) by hs-cTnI measurement at 0 hours than the ESC 0/1-h and 0/2-h algorithms (7.4%).
The hs-cTnI algorithms, especially the High-STEACS pathway, had excellent safety performance for the early diagnosis of myocardial infarction and offered the greatest improvement in efficiency.
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