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, I
= 3%, P = .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD = -1.05; 95% CI -1.49 to -0.61, I
= 0, P = .84) and 30 minutes after (WMD = -0.98; 95% CI -1.30 to -0.65, I
= 0, P = .88).
This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH.
Background
Cough assist devices play an important role with patients in the intensive care unit (ICU), particularly those with neuromuscular diseases which had abnormal muscle tone. It was previously ...thought to be the main technique for improving cough efficacy, which aids in weaning from mechanical ventilation and improves patient outcomes. So, we selected randomly the odd numbers from Abo El-Reesh hospital records, and 30 children of both sexes with pneumonia were selected, aged from 6 months to 3 years, who were selected from intensive care unit: fifteen children were the control group, who received the selected physical therapy program (postural drainage, percussion and resist diaphragm), and another fifteen children were the study group, who received previous physical therapy program, which was selected, and cough assist device.
Results
This study revealed the effect of cough assist device on blood gasses and the period of mechanical ventilator on children with pneumonia and general hypotonia. There was a significant decrease in pH, PaCO
2
, and HCO
3
post treatment compared with that pretreatment in the study and control groups (
p
< 0.05). The percentage of decrease in pH, PaCO
2
, and HCO
3
in study group A were 0.4, 38.26, and 30.28% respectively while that in the control group were 0.4, 32.56, and 25.48% for pH, PaCO
2
, and HCO
3
respectively. There was a significant increase in PaO
2
post treatment compared with that pretreatment in the study and control groups (
p
< 0.001). The percentage of increase in PaO
2
in the study group was 32.13% and that in control group was 30.09%. There was no significant difference in pH, PaCO
2
, and HCO
3
between both groups pre-treatment (
p
˃ 0.05). Also, there was no significant difference between groups post treatment (
p
˃ 0.05). The median (IQR) period of mechanical ventilation in the study group was 5 (7, 4) days while that in control group was 8 (18, 5) days. There was a significant decrease in period of mechanical ventilator of the study group compared with that of control group (
p
= 0.03).
Conclusion
The cough assist device and physical therapy program were selected for children in the intensive care unit which have the same effect on arterial blood gasses as they optimize pH, PO
2
, PCO
2
, and HCO
3
, but the cough assist device helps in accelerating weaning of mechanical ventilator so as decrease the period of mechanical ventilator.
Background
Pioglitazone’s role in the induction of atheroma regression in diabetics was suggested by several RCT. The aim of our study was to evaluate this role through a systematic review of all RCT ...conducted on this subject.
Methods
Literature was searched for relevant studies. We included all RCT that compared pioglitazone versus other antidiabetic agents. Mean differences of either AV or CIMT, HbA1C, HDL, and LDL between the two groups were used to assess the effect of pioglitazone versus alternative therapies.
Results
Six RCT were included with a total of 1180 patients. Pioglitazone was significantly superior to glimepiride and gliclazide in improving IMT. No significant difference was observed in overall AV, HbA1C, and LDL.
Conclusion
The latter findings confirm that anti-atheroma action of pioglitazone is not achieved through its antiglycemic or antidyslipidemia effects, but probably through a DNA-mediated effect, and may lead to its repurposing for reversal of organ fibrosis.
Purpose
Droxidopa has been approved for the treatment of neurogenic orthostatic hypotension (NOH) under the US Food and Drug Administration accelerated approval program, which warrants confirmatory ...evidence on long-term efficacy of droxidopa. Hereby, we synthesize evidence from published randomized controlled trials (RCTs) about the safety and efficacy of droxidopa for patients with neurogenic orthostatic hypotension.
Methods
A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central was conducted using relevant keywords. Records were screened for eligible studies and data were extracted and synthesized using Review Manager version 5.3 for Windows. Subgroup analysis and sensitivity analysis were conducted to investigate long-term durability of droxidopa against placebo.
Results
Four RCTs with a total of 485 patients (droxidopa,
n
= 246; placebo,
n
= 239) were eligible for the final analysis. The mean difference (MD) of change in the main outcomes from baseline to endpoint favored droxidopa than placebo Orthostatic Hypotension Questionnaire (OHQ) MD −0.61,
P
= 0.004; dizziness/lightheadedness score MD −0.83,
P
= 0.008; and standing systolic blood pressure (SBP) MD 4.09,
P
= 0.03. The efficacy of droxidopa decreased gradually after 2 weeks, and its statistical significance was lost after 8 weeks (OHQ score MD −0.18,
P
= 0.61; dizziness/lightheadedness score MD −0.71,
P
= 0.11; and standing SBP MD 2.96,
P
= 0.29). None of the adverse events were significantly higher in the case of droxidopa compared to placebo.
Conclusion
Droxidopa is a safe and effective drug for the short-term management of NOH symptoms. However, current evidence is insufficient to confirm the efficacy of droxidopa for long-term use. Therefore, further studies with increased sample size are needed.
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