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Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for adults with early (stage 1 to 3) non-diabetic chronic kidney disease
CONCLUSIONS: There is currently insufficient evidence to determine the effectiveness of ACEi or ARB in patients with stage 1 to 3 CKD who do not have DM. The available evidence is overall of very low certainty and high risk of bias. We have identified an area of large uncertainty for a group of patients who account for most of those diagnosed as having CKD.PMID:37466151 | DOI:10.1002/14651858.CD007751.pub3
Source: Cochrane Database of Systematic Reviews - July 19, 2023 Category: General Medicine Authors: Tess E Cooper Claris Teng David J Tunnicliffe Brydee A Cashmore Giovanni Fm Strippoli Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack
CONCLUSIONS: Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular...
Source: Cochrane Database of Systematic Reviews - January 10, 2023 Category: General Medicine Authors: Jia Liu Lu-Ning Wang Source Type: research

Marine-derived n-3 fatty acids therapy for stroke
CONCLUSIONS: We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-certainty evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention. Studies assessing functional outcome might consider starting the intervention as early as possible after the event, as well as using standardised, clinically relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and m...
Source: Cochrane Database of Systematic Reviews - June 29, 2022 Category: General Medicine Authors: Celia Gabriela Alvarez Campano Mary Joan Macleod Lorna Aucott Frank Thies Source Type: research

Patches of different types for carotid patch angioplasty.
CONCLUSIONS: The number of outcome events is too small to allow conclusions, and more trial data are required to establish whether any differences do exist. Nevertheless, there is little to no difference in effect on perioperative and long-term ipsilateral stroke between vein and any synthetic patch material. Some evidence indicates that other synthetic patches (e.g. PTFE) may be superior to Dacron grafts in terms of perioperative stroke and TIA rates, and both early and late arterial re-stenosis and occlusion. Pseudoaneurysm formation may be more common after use of a vein patch than after use of a synthetic patch. Bovin...
Source: Cochrane Database of Systematic Reviews - February 18, 2021 Category: General Medicine Authors: Orrapin S, Benyakorn T, Howard DP, Siribumrungwong B, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke.
CONCLUSIONS: There is evidence of very low to moderate quality on the effectiveness of tDCS versus control (sham intervention or any other intervention) for improving ADL outcomes after stroke. However, the results did not persist in a sensitivity analyses including only trials with proper allocation concealment. Evidence of low to high quality suggests that there is no effect of tDCS on arm function and leg function, muscle strength, and cognitive abilities in people after stroke. Evidence of very low quality suggests that there is an effect on hemispatial neglect. There was moderate-quality evidence that adverse events...
Source: Cochrane Database of Systematic Reviews - November 11, 2020 Category: General Medicine Authors: Elsner B, Kugler J, Pohl M, Mehrholz J Tags: Cochrane Database Syst Rev Source Type: research

Cerebrolysin for acute ischaemic stroke.
CONCLUSIONS: Moderate-quality evidence indicates that Cerebrolysin probably has little or no beneficial effect on preventing all-cause death in acute ischaemic stroke, or on the total number of people with serious adverse events. Moderate-quality evidence also indicates a potential increase in non-fatal serious adverse events with Cerebrolysin use. PMID: 32662068 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - July 13, 2020 Category: General Medicine Authors: Ziganshina LE, Abakumova T, Hoyle CH Tags: Cochrane Database Syst Rev Source Type: research

Transcranial Doppler sonography for detecting stenosis or occlusion of intracranial arteries in people with acute ischaemic stroke.
CONCLUSIONS: This review provides evidence that TCD or TCCD, administered by professionals with adequate experience and skills, can provide useful diagnostic information for detecting stenosis or occlusion of intracranial vessels in people with acute ischaemic stroke, or guide the request for more invasive vascular neuroimaging, especially where CT or MR-based vascular imaging are not immediately available. More studies are needed to confirm or refute the results of this review in a larger sample of stroke patients, to verify the role of contrast medium and to evaluate the clinical advantage of the use of ultrasound. ...
Source: Cochrane Database of Systematic Reviews - February 18, 2020 Category: General Medicine Authors: Mattioni A, Cenciarelli S, Eusebi P, Brazzelli M, Mazzoli T, Del Sette M, Gandolfo C, Marinoni M, Finocchi C, Saia V, Ricci S Tags: Cochrane Database Syst Rev Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack.
CONCLUSIONS: Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular...
Source: Cochrane Database of Systematic Reviews - October 8, 2019 Category: General Medicine Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Marine-derived n-3 fatty acids therapy for stroke.
CONCLUSIONS: We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention.Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of ad...
Source: Cochrane Database of Systematic Reviews - June 25, 2019 Category: General Medicine Authors: Alvarez Campano CG, Macleod MJ, Aucott L, Thies F Tags: Cochrane Database Syst Rev Source Type: research

Stem cell transplantation for ischemic stroke.
CONCLUSIONS: Overall, in participants with ischemic stroke, stem cell transplantation was associated with a reduced neurological impairment, but not with a better functional outcome. No obvious safety concerns were raised. However, these conclusions came mostly from small RCTs with high risk of bias, and the certainty of the evidence ranged from low to very low. More well-designed trials are needed. PMID: 31055832 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 4, 2019 Category: General Medicine Authors: Boncoraglio GB, Ranieri M, Bersano A, Parati EA, Del Giovane C Tags: Cochrane Database Syst Rev Source Type: research

Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack.
CONCLUSIONS: In the field, CPSS had consistently the highest sensitivity and, therefore, should be preferred to other scales. Further evidence is needed to determine its absolute accuracy and whether alternatives scales, such as MASS and ROSIER, which might have comparable sensitivity but higher specificity, should be used instead, to achieve better overall accuracy. In the ER, ROSIER should be the test of choice, as it was evaluated in more studies than FAST and showed consistently high sensitivity. In a cohort of 100 people of whom 62 have stroke/TIA, the test will miss on average seven people with stroke/TIA (ranging fr...
Source: Cochrane Database of Systematic Reviews - April 8, 2019 Category: General Medicine Authors: Zhelev Z, Walker G, Henschke N, Fridhandler J, Yip S Tags: Cochrane Database Syst Rev Source Type: research

Gamma aminobutyric acid (GABA) receptor agonists for acute stroke.
CONCLUSIONS: This review provides moderate-quality evidence that fails to support the use of GABA receptor agonists (chlormethiazole or diazepam) for the treatment of people with acute stroke. More well-designed RCTs with large samples of participants with total anterior circulation syndrome are required to determine if there are benefits for this subgroup. Somnolence and rhinitis are frequent adverse events related to chlormethiazole. PMID: 30376593 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 30, 2018 Category: General Medicine Authors: Liu J, Zhang J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Remote ischaemic conditioning for preventing and treating ischaemic stroke.
CONCLUSIONS: We found low-quality evidence that RIC may reduce the risk of recurrent stroke in participants with intracerebral artery stenosis and reduce stroke severity in participants undergoing carotid stenting, but it may increase death or dependence in participants with acute ischaemic stroke who are undergoing intravenous thrombolysis. However, there is considerable uncertainty about these conclusions because of the small number of studies and low quality of the evidence. PMID: 29974450 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 5, 2018 Category: General Medicine Authors: Zhao W, Zhang J, Sadowsky MG, Meng R, Ding Y, Ji X Tags: Cochrane Database Syst Rev Source Type: research

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