9 research outputs found
Treatment of partial thickness hand burn injuries in children with combination of silver foam dressing and zinc-hyaluronic gel
No full textNoninvasive ventilation improves the outcome in patients with pneumonia-associated respiratory failure: Systematic review and meta-analysis
No full textNoninvasive ventilation (NIV) is beneficial in exacerbations of chronic obstructive pulmonary disease (COPD), but its effectiveness in pneumonia-associated respiratory failure is still controversial. In the current meta-analysis, we aimed to investigate whether the use of NIV before intubation in pneumonia improves the mortality and intubation rates of respiratory failure as compared to no use of NIV in adults.We searched three databases from inception to December 2019. We included studies, in which pneumonia patients were randomized initially into either NIV-treated or non-NIV-treated groups. Five full-text publications, including 121 patients, reported eligible data for statistical analysis.With NIV the overall hospital mortality rate seemed lower in patients with pneumonia-associated respiratory failure, but this was not significant [odds ratio (OR) = 0.39; 95% confidence interval (CI): 0.13-1.14; P = 0.085]. In the intensive care unit, the mortality was significantly lower when NIV was applied compared to no NIV treatment (OR = 0.22; 95% CI: 0.07-0.75; P = 0.015). NIV also decreased mortality compared to no NIV in patient groups, which did not exclude patients with COPD (OR = 0.25; 95% CI: 0.08-0.74; P = 0.013). The need for intubation was significantly reduced in NIV-treated patients (OR = 0.22; 95% CI: 0.09-0.53; P = 0.001), which effect was more prominent in pneumonia patient groups not excluding patients with pre-existing COPD (OR = 0.13; 95% CI: 0.03-0.46; P = 0.002).NIV markedly decreases the death rate in the intensive care unit and reduces the need for intubation in patients with pneumonia-associated respiratory failure. The beneficial effects of NIV seem more pronounced in populations that include patients with COPD. Our findings suggest that NIV should be considered in the therapeutic guidelines of pneumonia, given that future clinical trials confirm the results of our meta-analysis.All data and materials generated during the current study are available from the corresponding author on reasonable request
Hyperthermia induced by transient receptor potential vanilloid-1 (TRPV1) antagonists in human clinical trials: Insights from mathematical modeling and meta-analysis
No full textAntagonists of the transient receptor potential vanilloid-1 (TRPV1) channel alter body temperature (Tb) in laboratory animals and humans: most cause hyperthermia; some produce hypothermia; and yet others have no effect. TRPV1 can be activated by capsaicin (CAP), protons (low pH), and heat. First-generation (polymodal) TRPV1 antagonists potently block all three TRPV1 activation modes. Second-generation (mode-selective) TRPV1 antagonists potently block channel activation by CAP, but exert different effects (e.g., potentiation, no effect, or low-potency inhibition) in the proton mode, heat mode, or both. Based on our earlier studies in rats, only one mode of TRPV1 activation - by protons - is involved in thermoregulatory responses to TRPV1 antagonists. In rats, compounds that potently block, potentiate, or have no effect on proton activation cause hyperthermia, hypothermia, or no effect on Tb, respectively. A Tb response occurs when a TRPV1 antagonist blocks (in case of hyperthermia) or potentiates (hypothermia) the tonic TRPV1 activation by protons somewhere in the trunk, perhaps in muscles, and - via the acido-antithermogenic and acido-antivasoconstrictor reflexes - modulates thermogenesis and skin vasoconstriction. In this work, we used a mathematical model to analyze Tb data from human clinical trials of TRPV1 antagonists. The analysis suggests that, in humans, the hyperthermic effect depends on the antagonist's potency to block TRPV1 activation not only by protons, but also by heat, while the CAP activation mode is uninvolved. Whereas in rats TRPV1 drives thermoeffectors by mediating pH signals from the trunk, but not Tb signals, our analysis suggests that TRPV1 mediates both pH and thermal signals driving thermoregulation in humans. Hence, in humans (but not in rats), TRPV1 is likely to serve as a thermosensor of the thermoregulation system. We also conducted a meta-analysis of Tb data from human trials and found that polymodal TRPV1 antagonists (ABT-102, AZD1386, and V116517) increase Tb, whereas the mode-selective blocker NEO6860 does not. Several strategies of harnessing the thermoregulatory effects of TRPV1 antagonists in humans are discussed
Systemic antibiotic prophylaxis does not affect infectious complications in 1 pediatric burn injury: a meta-analysis
No full textIn pediatric burns the use of systemic antibiotic prophylaxis is a standard procedure in some burn centers, though its beneficial effect on the infectious complications is debated. The present meta-analysis aimed at determining whether systemic antibiotic prophylaxis prevents infectious complications in pediatric patients with burn injuries. We searched the PubMed, EMBASE, and Cochrane Library databases from inception to August 2019. We included 6 studies, in which event rates of infectious complications were reported in children with burn injuries receiving or not receiving systemic antibiotic prophylaxis. We found that the overall odds ratio (OR) of developing an infection (including local and systemic) was not different between the groups (OR = 1.35; 95% CI, 0.44, 4.18). The chances for systemic infectious complications alone were also not different between antibiotic-treated and non-treated patients (OR = 0.74; 95% CI, 0.38, 1.45). Based on the age, affected total body surface area, and country income level, we did not find any subgroup that benefited from the prophylaxis. Our findings provide quantitative evidence for the inefficacy of systemic antibiotic prophylaxis in preventing infections in pediatric burns. To validate our conclusion, multinational, randomized trials in a diverse population of children with burn injuries are warranted
Flow chart of study selection and inclusion.
No full textFlow chart of study selection and inclusion.</p
Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis - Fig 3
No full textForest plot of the odds ratios (ORs) for all infectious complications in pediatric patients of 0–10 years (top) and 0–16 years (bottom) with burn injuries who received versus those who did not receive systemic antibiotic prophylaxis.</p
Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis - Fig 5
No full textForest plot of the odds ratios (ORs) for all infectious complications in pediatric patients with burn injuries who received versus those who did not receive systemic antibiotic prophylaxis in country subgroups of high income (top) and middle income (bottom).</p
Forest plot of the odds ratios (ORs) for systemic and local subgroups of infectious complications in pediatric patients with burn injuries who received systemic antibiotic prophylaxis compared to those who did not.
No full textHere, and in Figs 3–5, black circles represent the OR for each study, while the left and right horizontal arms of the circles indicate the corresponding 95% confidence intervals (CI) for the OR. The size of the gray box is proportional to the sample size of the study; bigger box represents larger sample size, thus bigger relative weight of the study, and vice versa. The diamonds represent the average OR calculated from the ORs of the individual studies in a subgroup (top and middle) and in all studies (bottom). The left and right vertices of the diamonds represent the 95% CI of the average ORs. The vertical dashed line is determined by the low and top vertices of the bottom diamond and indicates the value of the average OR of all studies in the forest plot. An OR lesser than 1 indicates that the use of systemic antibiotic prophylaxis decreased the chance for infectious complications, whereas an OR higher than 1 indicates an increased chance for infections in the antibiotic-treated children.</p
Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis - Fig 4
No full textForest plot of the odds ratios (ORs) for all infectious complications in pediatric patients with burn injuries who received versus those who did not receive systemic antibiotic prophylaxis in subgroups of less than 20% (top) and more than 20% (bottom) mean extent of injury as related to the total body surface area (TBSA).</p
