Systematic Review and Meta-Analysis of Gallstone-Disease Treatment Outcomes Between Cholecystectomy and Relatively Conservative Approaches

2021 ◽  
Author(s):  
Bhavani Shankara Bagepally ◽  
Madhumitha Haridoss ◽  
Akhil Sasidharan ◽  
Kayala Venkata Jagadeesh
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Disease Treatment

scholarly journals Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy

2021 ◽  
Vol 8 (1) ◽  
pp. e000675
Author(s):  
Bhavani Shankara Bagepally ◽  
Madhumitha Haridoss ◽  
Akhil Sasidharan ◽  
Kayala Venkata Jagadeesh ◽  
Nikhil Kumar Oswal
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Conservative Management ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Biliary Complications ◽  
Number Needed To Treat ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Risk Ratios

BackgroundThe effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy.AimsTo synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness.DesignWe systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm.ResultsOf the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50–100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25–100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000).ConclusionsEarly cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management.PROSPERO registration number2020 CRD42020192612.

scholarly journals Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sanju Gautam ◽  
Nipun Shrestha ◽  
Sweta Mahato ◽  
Tuan P. A. Nguyen ◽  
Shiva Raj Mishra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sri Lanka ◽  
Treatment Failure ◽  
South Asia ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Tb Treatment ◽  
Effect Model ◽  
Pooled Prevalence ◽  
The Impact

AbstractThe escalating burden of diabetes is increasing the risk of contracting tuberculosis (TB) and has a pervasive impact on TB treatment outcomes. Therefore, we conducted this systematic review and meta-analysis to examine the burden of diabetes among TB patients and assess its impact on TB treatment in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). PubMed, Excerpta Medica Database (EMBASE), and CINAHL databases were systematically searched for observational (cross-sectional, case–control and cohort) studies that reported prevalence of diabetes in TB patients and published between 1 January 1980 and 30 July 2020. A random-effect model for computing the pooled prevalence of diabetes and a fixed-effect model for assessing its impact on TB treatment were used. The review was registered with PROSPERO number CRD42020167896. Of the 3463 identified studies, a total of 74 studies (47 studies from India, 10 from Pakistan, four from Nepal and two from both Bangladesh and Sri-Lanka) were included in this systematic review: 65 studies for the prevalence of diabetes among TB patients and nine studies for the impact of diabetes on TB treatment outcomes. The pooled prevalence of diabetes in TB patients was 21% (95% CI 18.0, 23.0; I2 98.3%), varying from 11% in Bangladesh to 24% in Sri-Lanka. The prevalence was higher in studies having a sample size less than 300 (23%, 95% CI 18.0, 27.0), studies conducted in adults (21%, 95% CI 18.0, 23.0) and countries with high TB burden (21%, 95% CI 19.0, 24.0). Publication bias was detected based on the graphic asymmetry of the funnel plot and Egger’s test (p < 0.001). Compared with non-diabetic TB patients, patients with TB and diabetes were associated with higher odds of mortality (Odds Ratio (OR) 1.7; 95% CI 1.2, 2.51; I2 19.4%) and treatment failure (OR 1.7; 95% CI 1.1, 2.4; I2 49.6%), but not associated with Multi-drug resistant TB (OR 1.0; 95% CI 0.6, 1.7; I2 40.7%). This study found a high burden of diabetes among TB patients in South Asia. Patients with TB-diabetes were at higher risk of treatment failure and mortality compared to TB alone. Screening for diabetes among TB patients along with planning and implementation of preventive and curative strategies for both TB and diabetes are urgently needed.

scholarly journals Treatment outcomes of visceral leishmaniasis in Ethiopia from 2001 to 2017: a systematic review and meta-analysis

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Eyob Alemayehu Gebreyohannes ◽  
Akshaya Srikanth Bhagvathula ◽  
Tadesse Melaku Abegaz ◽  
Mohammed Assen Seid
Keyword(s):  
Systematic Review ◽  
Visceral Leishmaniasis ◽  
Treatment Outcomes ◽  
Meta Analysis

Metastatic acral melanoma treatment outcomes: a systematic review and meta-analysis

2021 ◽  
Vol 31 (5) ◽  
pp. 482-486
Author(s):  
Kenneth K. Cho ◽  
Anne E. Cust ◽  
Yun Megan Foo ◽  
Georgina V. Long ◽  
Alexander M. Menzies ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Acral Melanoma ◽  
Melanoma Treatment

Treatment outcomes of bumetanide continuous infusion: A systematic review and meta‐analysis

Nephrology ◽  
2020 ◽  
Vol 25 (10) ◽  
pp. 744-748
Author(s):  
Panupong Hansrivijit ◽  
Chol Techorueangwiwat ◽  
Resha Khanal ◽  
Christina T. Dimech ◽  
Charat Thongprayoon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Infusion ◽  
Treatment Outcomes ◽  
Meta Analysis

scholarly journals Clinical Impact of Pretreatment Human Immunodeficiency Virus Drug Resistance in People Initiating Nonnucleoside Reverse Transcriptase Inhibitor–Containing Antiretroviral Therapy: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Silvia Bertagnolio ◽  
Lucas Hermans ◽  
Michael R Jordan ◽  
Santiago Avila-Rios ◽  
Collins Iwuji ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Immunodeficiency Virus ◽  
Drug Resistance ◽  
Reverse Transcriptase ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Transcriptase Inhibitor ◽  
Nonnucleoside Reverse Transcriptase Inhibitor ◽  
Immunodeficiency Virus ◽  
Reverse Transcriptase Inhibitor

Abstract Background Increased access to antiretroviral therapy (ART) has resulted in rising levels of pretreatment human immunodeficiency virus drug resistance (PDR). This is the first systematic review and meta-analysis to assess the impact of PDR on treatment outcomes among people initiating nonnucleoside reverse transcriptase inhibitor (NNRTI)–based ART, including the combination of efavirenz (EFV), tenofovir (TDF), and lamivudine or emtricitabine (XTC). Methods We systematically reviewed studies and conference proceedings comparing treatment outcomes in populations initiating NNRTI-based ART with and without PDR. We conducted subgroup analyses by regimen: (1) NNRTIs + 2 nucleoside reverse transcriptase inhibitors (NRTIs), (2) EFV + 2 NRTIs, or (3) EFV/TDF/XTC; by population (children vs adults); and by definition of resistance (PDR vs NNRTI PDR). Results Among 6197 studies screened, 32 were analyzed (31 441 patients). We found that individuals with PDR initiating NNRTIs across all the subgroups had increased risk of virological failure compared to those without PDR. Risk of acquisition of new resistance mutations and ART switch was also higher in people with PDR. Conclusions This review shows poorer treatment outcomes in the presence of PDR, supporting the World Health Organization’s recommendation to avoid using NNRTIs in countries where levels of PDR are high.

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