scholarly journals Current Thoughts on the Treatment of Malassezia in Canine Otitis Externa

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Mary Fraser
Keyword(s):  
Otitis Externa ◽  
Current Knowledge ◽  
Chelating Agent ◽  
Controlled Trials ◽  
Double Blind ◽  
Malassezia Pachydermatis ◽  
Pubmed Database ◽  
Significant Difference ◽  
Randomised Controlled

<p>Otitis externa is a commonly diagnosed disorder of canine patients (Rosser, 2004) and can be caused by a number of different factors including infection, allergy, foreign bodies and breed/ear conformation. Malassezia pachydermatis is a yeast which is found as a commensal on canine skin, but may also contribute to the development and perpetuation of the condition.</p><p>The aim of this paper was to assess current knowledge and approaches to the treatment of M. pachydermatis when found to be present in cases of canine otitis externa.</p><p>A literature search was carried out using PubMed database. Search terms Malassezia, dogs / canine, otitis and therapy/treatment/therapeutics were utilised. This identified 26 results from 2005 - 2015. Examination of these papers focussed the review to 11 papers that were clinically relevant. The excluded papers were either concerned with laboratory storage/growth of M. pachydermatis, did not include therapy of the condition, or focussed on other skin conditions.</p><p>Of the 11 papers deemed relevant to this study, only three were double blind, randomised controlled trials (Rougier et al, 2005, Bensignor &amp; Grandemange, 2006, Hensel et al, 2009); one paper was a review of current literature relating to dermatology, including otitis externa (Bond, 2010) and the remainder were focussed on in vitro work with M. pachydermatis.</p><p>Many different therapeutics were used, namely thiabendazole, amphotericin B, itraconazole, ketoconazole, clotrimazole, miconazole, nystatin, chelating agents and various ear cleaners.</p><p>Within the controlled trials, a chelating agent was shown to improve therapeutic effectiveness of topical medication, combination therapy (antifungal, antibacterial and anti-inflammatory agents) was more effective than antifungal agent alone and no significant difference was noted when comparing combination therapies. A clear difference was found between different ear cleaners.</p><p>This review highlights the variety of different medications that can be used in the treatment of Malassezia otitis externa and the need for a greater number of robust clinical trials.</p><p>Find out more about <a href="http://www.girlingandfraser.co.uk/page4.htm" target="_blank">Mary</a>.</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

scholarly journals Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis

2011 ◽  
Vol 198 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Corrado Barbui ◽  
Andrea Cipriani ◽  
Vikram Patel ◽  
José L. Ayuso-Mateos ◽  
Mark van Ommeren
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Outcome Data ◽  
Allocation Concealment ◽  
Controlled Trials ◽  
Minor Depression ◽  
Double Blind ◽  
Significant Difference ◽  
Study Heterogeneity ◽  
Randomised Controlled

BackgroundDepression is a common condition that has been frequently treated with psychotropics.AimsTo review systematically the evidence of efficacy and acceptability of antidepressant and benzodiazepine treatments for patients with minor depression.MethodA systematic review and meta-analysis of double-blind randomised controlled trials comparing antidepressants or benzodiazepines v. placebo in adults with minor depression. Data were obtained from MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Controlled Trials Register and pharmaceutical company websites. Risk of bias was assessed for the generation of the allocation sequence, allocation concealment, masking, incomplete outcome data, and sponsorship bias.ResultsSix studies met inclusion criteria. Three studies compared paroxetine with placebo; fluoxetine, amitriptyline and isocarboxazid were studied in one study each. No studies compared benzodiazepines with placebo. In terms of failures to respond to treatment (6 studies, 234 patients treated with antidepressants and 234 with placebo) no significant difference between antidepressants and placebo was found (relative risk (RR) 0.94, 95% CI 0.81–1.08). In terms of acceptability, data extracted from two studies (93 patients treated with antidepressants and 93 with placebo) showed no statistically significant difference between antidepressants and placebo (RR = 1.06, 95% CI 0.65–1.73). There was no statistically significant between-study heterogeneity for any of the reported analyses.ConclusionsThere is evidence showing there is unlikely to be a clinically important advantage for antidepressants over placebo in individuals with minor depression. For benzodiazepines, no evidence is available, and thus it is not possible to determine their potential therapeutic role in this condition.

Efficacy of electronic cigarettes for tobacco smoking cessation: An adapted systematic review

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
T O'Dowd
Keyword(s):  
Smoking Cessation ◽  
Cohort Studies ◽  
Randomised Controlled Trials ◽  
Electronic Cigarettes ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Smoking Reduction ◽  
Significant Difference ◽  
Randomised Controlled

Abstract Background Worldwide smoking remains the leading cause of preventable morbidity and mortality. Electronic cigarettes (ECs) are increasingly used by tobacco smokers as an aid to smoking cessation; however, their efficacy remains uncertain. Methods Electronic databases, clinical trial registries and grey literature sources were searched. The aim was to examine randomised controlled trials or prospective cohort studies, published since the 2016 Cochrane review on this topic, that assessed the efficacy of ECs in achieving smoking cessation among current smokers. Results Two RCTs and five cohort studies, including a total of 16,460 participants, were eligible for inclusion. One RCT found sustained 1-year abstinence of 18.0% in the EC group versus 9.9% in the nicotine replacement therapy group (RR: 1.83; 95% CI 1.30 to 2.58; P &lt; 0.001). The second RCT did not find a statistically significant difference in abstinence rates between EC users and non-users (RR 0.71). Of the five included cohort studies, four reported statistically significant RRs. Two found a positive association (RRs of 1.45 and 1.84) between EC use and smoking cessation but two studies showed EC use was associated with reduced smoking cessation (RRs of 0.25 and 0.35). Due to significant heterogeneity between the studies the data were deemed unsuitable for pooling into a meta-analysis. All trials assessing smoking reduction reported higher rates of reduction among EC users. No serious adverse events were reported with EC use. Follow-up periods of included trials ranged from one to four years, with an average of 1.6 years. Conclusions There is limited, low-quality evidence that ECs are an effective intervention for smoking cessation and smoking reduction. The overall quality of evidence is low as it is based on a small number of studies with inconsistent and imprecise results. Due to the short follow-up periods of the included trials, the long-term safety of ECs is unclear from this review. Key messages Limited evidence that electronic cigarettes are an effective smoking cessation intervention. Further well-designed randomised controlled trials are required to investigate the efficacy of ECs for smoking cessation.

Immediate versus wait-and-gradual discontinuation in antipsychotic switching: A meta-analysis

2020 ◽  
Vol 34 (8) ◽  
pp. 914-919
Author(s):  
Hiroyoshi Takeuchi ◽  
Gary Remington
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Outcome Data ◽  
Controlled Trials ◽  
Double Blind ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Meta Analyses ◽  
Switching Strategies

Introduction: In two previous meta-analyses of randomized controlled trials (RCTs) examining antipsychotic switching strategies in patients with schizophrenia, we showed no significant differences in any clinical outcomes between immediate versus gradual and gradual versus wait-and-gradual discontinuation of the pre-switch antipsychotic. In this report, we compared immediate versus wait-and-gradual antipsychotic discontinuation. Methods: We identified five RCTs examining immediate versus wait-and-gradual discontinuation of the pre-switch antipsychotic in antipsychotic switching involving patients with schizophrenia. However, no data were available from one RCT. The following clinical outcome data were extracted and meta-analyzed: study discontinuation, psychopathology, extrapyramidal symptoms, and treatment-emergent adverse events that were reported in two or more of the studies. Results: The meta-analysis included four RCTs involving 351 patients ( n=175 for immediate and n=176 for wait-and-gradual antipsychotic discontinuation). A significant difference was found in study discontinuation due to all causes ( n=4, n=351, risk ratio=1.58, 95% confidence interval 1.15–2.17, p=0.005, I2=0%) between the immediate and wait-and-gradual antipsychotic discontinuation groups, while there was no significant difference in any other clinical outcomes. The group difference in study discontinuation due to all causes remained significant for the studies adopting immediate antipsychotic initiation but not for the studies switching to ziprasidone. Conclusion: Findings suggest that wait-and-gradual antipsychotic discontinuation may be preferable when a more cautious antipsychotic switch is needed. However, further long-term, double-blind RCTs are needed to confirm the present findings.

Should the duration of head bandaging be reduced after pinnaplasty? A systematic review

2014 ◽  
Vol 128 (11) ◽  
pp. 948-951 ◽  
Author(s):  
A E L McMurran ◽  
I Khan ◽  
S Mohamad ◽  
M Shakeel ◽  
H Kubba
Keyword(s):  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Case Series ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
National Library ◽  
Significant Difference ◽  
Randomised Controlled ◽  
The Cochrane Library

AbstractBackground:It is common practice to use head bandages for 7–10 days following pinnaplasty. However, head bandages are often troublesome for patients and can lead to serious complications.Method:A systematic review was performed to evaluate the use of head bandages after pinnaplasty. A search of Medline, Embase (Ovid) and CINAHL (EBSCO collections), the Cochrane Library, Pubmed (US National Library of Medicine) and Google Scholar identified 34 related articles. Of these, 14 were deemed relevant and 2 randomised controlled trials, 1 cohort study, 3 case series and 1 literature review met the inclusion criteria.Results:The two randomised controlled trials show no statistically significant difference in complications when a head bandage was used for the standard 7–10 days, for 24 hours or not at all. The three case series show that using a head bandage for 24 hours or not at all are safe alternatives. The review article recommended that when head bandages are applied after pinnaplasty it should be for the shortest duration possible.Conclusion:Based on the available evidence, not using a head bandage at all or using one for a maximum of 24 hours following pinnaplasty is recommended.

Depression and cardiovascular disease: does antidepressant treatment improve cardiac outcome?

2007 ◽  
Vol 24 (4) ◽  
pp. 156-158 ◽  
Author(s):  
Damien Gallagher
Keyword(s):  
Cardiovascular Disease ◽  
Randomised Controlled Trials ◽  
Antidepressant Treatment ◽  
Future Research ◽  
Controlled Trials ◽  
Medline Search ◽  
Reference Sections ◽  
Significant Difference ◽  
Cardiac Outcome ◽  
Randomised Controlled

AbstractObjective: The association between depression and cardiovascular disease has been well documented but the nature of this relationship continues to be defined. Given the accumulation of epidemiological evidence linking these diseases a number of interventional studies have been undertaken to assess the issue of whether antidepressant treatment in depressed patients with cardiovascular disease improves cardiac outcome. The objective of this paper is to review recent randomised controlled trials on this topic and to explore the implications that these may have for future research in this area.Method: This review is derived from a MEDLINE search using the search terms ‘depressive disorder’ and ‘cardiovascular diseases’. Only randomised controlled trials published in English with clearly defined methods and interventions are included here. Reference sections from the articles were used to identify additional relevant studies.Results: A small number of high quality trials were uncovered which indicated mixed results in terms of the treatment of depression in cardiovascular disease. None indicated a statistically significant difference in cardiac outcome.Conclusions: It is not possible at this time to recommend treatment for depression to reduce cardiovascular risk. However depression remains prevalent in patients with cardiovascular disease and is a treatable cause of morbidity in its own right.

A phase II, randomized, double blind comparison of calcium aluminosilicate clay (CASAD) versus placebo (dibasic calcium carbonate) for the prevention of diarrhea in patients (pts) with metastatic colorectal cancer (mCRC) treated with irinotecan (I).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3600-3600
Author(s):  
Bryan K. Kee ◽  
Rebecca Slack ◽  
Todd S. Crocenzi ◽  
Lucas Wong ◽  
Benjamin Esparaz ◽  
...  
Keyword(s):  
Phase Ii ◽  
Performance Status ◽  
Symptom Burden ◽  
Active Metabolites ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Significance Level ◽  
Significant Difference ◽  
Grade 3

3600 Background: CASAD is a naturally occurring calcium montmorrilonite clay that serves as a cation exchange absorbent. One of the active metabolites of Irinotecan is SN-38, which is adsorbed by CASAD in vitro. The study hypothesis was that oral CASAD would reduce the rate of grade 3/4 diarrhea in mCRC patients treated with irinotecan. Methods: The study is a multicenter, prospective, randomized, double blinded placebo-controlled phase II trial. One hundred patients receiving I-based chemotherapy were randomized equally between CASAD (1000 mg po 4x daily) and placebo in order to have 75% power to detect a difference in the proportions of patients with grade 3/4 diarrhea within 6 weeks at a 1-sided 5% significance level. We also compared symptom burden using the MDASI questionnaire summed over the 13 symptom items for weeks 0, 3, 5, and 6. Results: Between 5/2009 and 5/2012, 100 patients were randomized in a 1:1 ratio between study arms. Median age 57 yrs, 54% male, 74% Non-Hispanic White, 93% performance status 0 or 1. Serious diarrhea was less frequent than expected based upon prior studies with Irinotecan. In evaluable patients, no significant difference in the rate of G3/4 diarrhea was seen (the primary endpoint): CASAD arm: 7/43 pts (16%), Placebo arm: 3/32 pts (9%), p=0.70. The rate of any diarrhea among all pts was also similar: CASAD arm 64% vs. Placebo arm 70%. The rate of study dropout was 14% in CASAD and 38% for placebo (p=0.01; 2-sided). No differences were found in symptom burden or individual symptom items or serious adverse events. Conclusions: Compared with placebo, CASAD use was safe but ineffective in preventing diarrhea in mCRC patients treated with irinotecan-containing chemotherapy regimens. There were no favorable or unfavorable signals in terms of the patient experience related to symptoms, but there were significantly more dropouts in the placebo arm. Future CASAD trials are focused on active treatment of diarrhea. Clinical trial information: NCT00748215.

Telehealth for the management of blood pressure in patients with chronic kidney disease: A systematic review

2017 ◽  
Vol 25 (2) ◽  
pp. 80-92 ◽  
Author(s):  
Li Luo ◽  
Meiqin Ye ◽  
Jiaowang Tan ◽  
Qiong Huang ◽  
Xindong Qin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Dialysis Patients ◽  
Significant Difference ◽  
Randomised Controlled

Background Most patients with chronic kidney disease (CKD) fail to achieve blood pressure (BP) management as recommended. Meanwhile, the effects of promising intervention and telehealth on BP control in CKD patients remain unclear. We aimed to evaluate the efficacy of telehealth for BP in CKD non-dialysis patients. Methods Databases including MEDLINE, EMBASE, CENTRAL, CNKI, Wanfang, VIP and CBM were systematically searched for randomised controlled trials or quasi-randomised controlled trials on telehealth for BP control of CKD3-5 non-dialysis patients. We analysed systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), serum creatinine, and estimated glomerular filtration rate (eGFR) with a fixed-effects model. Results Three studies, with total 680 subjects, were included in our systematic review and two were included for meta-analysis. Pooled estimates showed decreased SBP (pooled mean difference (MD), −5.10; 95% confidence interval (CI), −11.34, 1.14; p > 0.05, p = 0.11), increased DBP (pooled MD, 0.45; 95% CI, −4.24, 5.13; p > 0.05, p = 0.85), decreased serum creatinine (pooled MD, −0.38; 95% CI, −0.83, 0.07; p > 0.05, p = 0.10) and maintained eGFR (pooled MD, 4.72; 95% CI, −1.85, 11.29; p > 0.05, p = 0.16) in the telehealth group. There was no significant difference from the control group. MAP (MD, 0.6; 95% CI, −6.61, 7.81; p > 0.05, p = 0.87) and BP control rate ( p > 0.05, p = 0.8), respectively, shown in two studies also demonstrated no statistical significance in the telehealth group. Conclusions There was no statistically significant evidence to support the superiority of telehealth for BP management in CKD patients. This suggests further studies with improved study design and optimised intervention are needed in the future.

scholarly journals A double-blind, randomised, controlled trial of protein supplementation to enhance exercise capacity in COPD during pulmonary rehabilitation: a pilot study

2021 ◽  
pp. 00077-2021
Author(s):  
Abdulelah M. Aldhahir ◽  
Yousef S. Aldabayan ◽  
Jaber S. Alqahtani ◽  
Heidi A. Ridsdale ◽  
Colette Smith ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Protein Supplementation ◽  
High Protein ◽  
Double Blind ◽  
Meaningful Improvement ◽  
Significant Difference ◽  
Randomised Controlled

BackgroundPulmonary rehabilitation (PR) is a cost-effective management strategy in chronic obstructive pulmonary disease (COPD) which improves exercise performance and health-related quality of life. Nutritional supplementation may counter malnutrition and enhance PR outcomes but rigorous evidence is absent. We aimed to investigate the effect of high protein-supplementation (Fortisip Compact Protein, FCP) during PR on exercise capacity.MethodsA double-blind randomised controlled trial comparing FCP with preOp (a carbohydrate control supplement) in COPD patients participating in a PR programme. Participants consumed the supplement twice a day during PR and attended twice-weekly PR sessions, with pre- and post-PR measurements including the incremental shuttle walk test (ISWT) at 6-weeks as the primary outcome. Participants’ experience using supplements was assessed.ResultsSixty-eight patients were recruited; (FCP: 36 and control: 32). The trial was stopped early due to COVID-19. Although statistical significance was not reached, there was the suggestion of a clinically meaningful difference in ISWT at 6 weeks favouring the intervention group (intervention: 342 m±149; n=22 versus control: 305 m±148; n=22, p=0.1). Individuals who achieved an improvement in ISWT had larger mid-thigh circumference at baseline (responder: 62 cm±4 versus non-responder: 55 cm±6; p=0.006). 79% were satisfied with the taste and 43% would continue taking the FCP.ConclusionAlthough the data did not demonstrate a statistically significant difference in ISWT, high protein supplementation in COPD during PR may result in a clinically meaningful improvement in exercise capacity and was acceptable to patients. Large, adequately powered studies are justified.

scholarly journals Recurrence Kinetics after Laparoscopic versus Open Surgery in Colon Cancer. A Meta-Analysis

2021 ◽  
Vol 10 (18) ◽  
pp. 4163
Author(s):  
Ross Lilley ◽  
Evangeline Chan ◽  
Nicklaus Ng ◽  
Amber Orr ◽  
Marcin Szostok ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Biology ◽  
Randomised Controlled Trials ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Curative Treatment ◽  
Controlled Trials ◽  
Open Approach ◽  
Significant Difference ◽  
Randomised Controlled

Background: Colorectal cancer (CRC) is a leading cause of mortality worldwide and in the UK. Surgical resection is the main curative treatment modality available and using a laparoscopic vs. an open approach may have a direct influence on the inflammatory response, influencing cancer biology and potentially the recurrence kinetics by promoting cancer growth. Methods: This systematic review aims to compare laparoscopic with open surgery for the treatment of colon cancer with a specific focus on the moment of the recurrence. We included randomised controlled trials in intended curative surgery for colon cancer in adults. Interventions: Studies investigating laparoscopic vs. open resection as an intended curative treatment for patients with confirmed carcinoma of the colon. The two co-primary outcomes were the time to recurrence and the overall survival (OS) and disease-free survival (DFS) at three and five years. Meta-analyses were done on the mean differences. Results: After selection, we reviewed ten randomised controlled trials. Most of the trials did not display a statistically significant difference in either DFS or OS at three or at five years when comparing laparoscopic to open surgery. Groups did not differ for the OS and DFS, especially regarding the time needed to observe the median recurrence rate. The quality of evidence (GRADE) was moderate to very low. Conclusion: We observed no difference in the recurrence kinetics, OS or DFS at three or five years when comparing laparoscopic to open surgery in colon cancer.

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