Background/Objectives: Prophylactic antibiotics (PAB) are being still widely used for treatment of acute pancreatitis (AP) despite trials showing no firm evidence of efficacy. We aimed to evaluate effects of PAB for AP in a meta-analysis and the need for further research by trial sequential analysis (TSA). Methods: Medline, Scopus and Web of Science were searched for randomized clinical trials. Primary outcomes were all infections and mortality. Secondary outcomes comprised infected pancreatic necrosis (IPN), specific infections, organ failure, surgical interventions, and length of hospital stay. Results: Twenty-one trials with 1383 pts were included. PAB were received by 703 pts, while 680 were controls. Mortality was similar with RR 0.85 (95% CI 0.66–1.10). Infections were significantly reduced (RR 0.60; 95% CI 0.49–0.74), mainly due to decreased risk of sepsis (RR 0.43; 95% CI 0.25–0.73) and urinary tract infections (RR 0.46; 95% CI 0.25–0.86). No significant reduction for IPN was shown (RR 0.81; 95% CI 0.63–1.04). Length of hospital stay was diminished by MD −6.65 (95% CI −8.86 to −4.43) days. TSA for all infections showed that the cumulative Z score crossed both conventional and monitoring boundaries at 526 pts from a heterogeneity-corrected required information size of 1113 pts based on a 40% incidence of infections in the control group, RRR of 30%, alpha 5%, beta 20%, and heterogeneity 56%. Conclusions: PABs decrease the rate of infections in AP, mainly due to RRR of extra-pancreatic infections, requiring no further research. No significant effect is shown on IPN and mortality, although firmer evidence is needed.
Sažetak. Cochrane kolaboracija međunarodna je i neprofitna organizacija čiji je temeljni cilj promicanje medicine temeljene na dokazima (engl. Evidence based medicine; EBM) te stvaranje i širenje pouzdanih, visokokvalitetnih dokaza o intervencijskim i dijagnostičkim postupcima u zdravstvenoj zaštiti. Archibald Cochrane bio je škotski liječnik i jedan od idejnih začetnika medicine temeljene na dokazima, u čiju je čast organizacija dobila ime. Organizacija je osnovana 1993. godine u Oxfordu (UK) pod vodstvom sira Iaina Chalmersa. Danas Cochrane kolaboracija okuplja više od 40 tisuća suradnika i volontera iz više od 130 zemalja. Cochrane kolaboracija sastoji se od nekoliko različitih radnih skupina, koje podržavaju rad organizacije. Glavni proizvod Cochrane kolaboracije je baza sustavnih pregleda (engl. Cochrane Database of Systematic Reviews; CDSR) koja predstavlja glavni dio knjižnice Cochrane (engl. Cochrane Library). Knjižnica Cochrane sadrži različite vrste visokokvalitetnih, neovisnih dokaza za donošenje odluka u zdravstvu. Svakodnevni razvoj Cochrane kolaboracije očituje se povećanjem broja Cochrane sustavnih pregleda te broja suradnika. Cochrane kolaboracija ima nekoliko ciljeva za budućnost, među kojima se ističu želja da se visokokvalitetni dokazi učine dostupnima svakome diljem svijeta te etabliranje kolaboracije kao glavnog zagovornika zdravstvene zaštite temeljene na dokazima.Ključne riječi: Archibald Cochrane; Cochrane kolaboracija; Iain Chalmers; medicina temeljena na dokazima Abstract. Cochrane Collaboration is an international and non-profit organization whose main goal is to promote Evidence-Based Medicine (EBM) and to create and disseminate reliable, high-quality evidence on interventional and diagnostic procedures in the health care. Archibald Cochrane was a Scottish physician and one of the founders of evidence-based medicine. The organization was named after him, in his honour. The organization was founded in 1993 in Oxford (UK), under the leadership of Sir Iain Chalmers. Nowadays, Cochrane Collaboration brings together over 40 000 associates and volunteers from more than 130 countries. Cochrane Collaboration consists of several different working groups, which support the organization. The main product of Cochrane Collaboration is the Cochrane Database of Systematic Reviews (CDSR), which is the main part of the Cochrane Library. The Cochrane Library contains various types of high-quality, independent evidence for decision-making in healthcare. The daily development of Cochrane Collaboration is concentrated on the increase of the number of Cochrane systematic reviews and the number of collaborators. Cochrane Collaboration has several goals for the future, including a desire to make high-quality evidence available to anyone around the world and to establish collaboration as the main evidence-based health advocate.
Cilj: Ciljevi ove studije su istražiti ima li omjer serumskih vrijednosti RANKL/OPG bolje prognostičke vrijednosti uspoređen s razinom iPTH-a u serumu te ispitati ovise li razine OPG-a i RANKL-a u serumu o terapiji vitaminom D. Ispitanici i metode: Istraživanje je obuhvatilo 120 pacijenata iz Kliničkog bolničkog centra Rijeka, Hrvatska. Pacijenti su podijeljeni u dvije skupine; skupina pacijenata na hemodijalizi (HD) i skupina primatelja bubrežnog transplantata. Primatelji transplantata bubrega uključeni su u trenutku transplantacije te praćeni 12 mjeseci nakon transplantacije. Rezultati: Prema rezultatima ovog istraživanja, serumske razine RANKL/OPG u skupini pacijenata na hemodijalizi koji su imali iPTH > 33 pmol/l i iPTH < 11 pmol/l bile su značajno veće u odnosu na one koji su imali iPTH 11 – 33 pmol/l. Također, razine RANKL/OPG u skupini primatelja bubrežnog transplantata koji su imali iPTH > 33 pmol/l i iPTH < 11 pmol/l bile su značajno veće, u usporedbi s onima koji su imali iPTH 11 – 33 pmol/l. Pacijenti na hemodijalizi i primatelji bubrežnog transplantata na terapiji vitaminom D imali su značajno više razine OPG-a u serumu i značajno nižu razinu sRANKL-a, od ispitanika bez terapije vitaminom D. Zaključak: Rezultati ovog istraživanja ukazuju na povoljan učinak vitamina D u prevenciji gubitka koštane mase kod pacijenata na hemodijalizi i kod primatelja bubrežnog transplantata. Omjer serumske razine RANKL/OPG korelira s vrijednostima iPTH-a, ali ostaje nejasno zašto je omjer RANKL/OPG nizak u umjereno povišenim vrijednostima iPTH-a te su potrebna dodatna istraživanja kako bismo dobili odgovor na ovo pitanje.
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