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Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in preterm infants: a network meta-analysis
CONCLUSIONS: Prophylactic indomethacin probably results in a small reduction in severe IVH and moderate reduction in mortality and surgical PDA closure (moderate-certainty), may result in a small increase in CLD (low-certainty) and results in trivial differences in NEC (high-certainty), gastrointestinal perforation (moderate-certainty) and cerebral palsy (low-certainty). Prophylactic ibuprofen probably results in a small reduction in severe IVH and moderate reduction in surgical PDA closure (moderate-certainty), may result in a moderate reduction in mortality (low-certainty) and trivial differences in CLD (low-certainty) a...
Source: Cochrane Database of Systematic Reviews - April 1, 2022 Category: General Medicine Authors: Souvik Mitra Courtney E Gardner Abigale MacLellan Tim Disher Danielle M Styranko Marsha Campbell-Yeo Stefan Kuhle Bradley C Johnston Jon Dorling Source Type: research

Paracetamol Intake and Hematologic Malignancies: A Meta-Analysis of Observational Studies
J Clin Med. 2021 May 30;10(11):2429. doi: 10.3390/jcm10112429.ABSTRACTHematologic malignancies cause more than half a million deaths every year worldwide. Analgesics were suggested as chemopreventive agents for several cancers but so far, results from individual studies about the relationship between paracetamol (acetaminophen) use and hematologic malignancies are conflicting. Therefore, we decided to perform a systematic review and meta-analysis. We retrieved studies published in any language by systematically searching Medline, Embase, Conference Proceedings Citation Index, Open Access Theses and Dissertations, and the f...
Source: Clinical Lymphoma and Myeloma - June 2, 2021 Category: Cancer & Oncology Authors: Jes ús Prego-Domínguez Bahi Takkouche Source Type: research

N-acetylcysteine for non-paracetamol (acetaminophen)-related acute liver failure.
CONCLUSIONS: The available evidence is inconclusive regarding the effect of N-acetylcysteine compared with placebo or no N-acetylcysteine, as an adjunct to usual care, on mortality or transplant rate in non-paracetamol-induced acute liver failure. Current evidence does not support the guideline suggestion to use N-acetylcysteine in adults with non-paracetamol-related acute liver failure, nor the rising use observed in clinical practice. The uncertainty based on current scanty evidence warrants additional randomised clinical trials with non-paracetamol-related acute liver failure evaluating N-acetylcysteine versus placebo, ...
Source: Cochrane Database of Systematic Reviews - December 9, 2020 Category: General Medicine Authors: Siu JT, Nguyen T, Turgeon RD Tags: Cochrane Database Syst Rev Source Type: research

Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants.
CONCLUSIONS: Moderate-quality evidence according to GRADE suggests that paracetamol is as effective as ibuprofen; low-quality evidence suggests paracetamol to be more effective than placebo or no intervention; and low-quality evidence suggests paracetamol as effective as indomethacin in closing a PDA. There was no difference in neurodevelopmental outcome in children exposed to paracetamol compared to ibuprofen; however the quality of evidence is low and comes from only one study. In view of concerns raised regarding neurodevelopmental outcomes following prenatal and postnatal exposure to paracetamol, long-term follow-up to...
Source: Cochrane Database of Systematic Reviews - January 26, 2020 Category: General Medicine Authors: Ohlsson A, Shah PS Tags: Cochrane Database Syst Rev Source Type: research

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns.
CONCLUSIONS: The paucity and low quality of existing data do not provide sufficient evidence to establish the role of paracetamol in reducing the effects of painful procedures in neonates. Paracetamol given after assisted vaginal birth may increase the response to later painful exposures. Paracetamol may reduce the total need for morphine following major surgery, and for this aspect of paracetamol use, further research is needed. PMID: 31985830 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - January 26, 2020 Category: General Medicine Authors: Ohlsson A, Shah PS Tags: Cochrane Database Syst Rev Source Type: research

Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants.
CONCLUSIONS: Moderate-quality evidence according to GRADE suggests that paracetamol is as effective as ibuprofen; low-quality evidence suggests paracetamol to be more effective than placebo or no intervention; and low-quality evidence suggests paracetamol as effective as indomethacin in closing a PDA. There was no difference in neurodevelopmental outcome in children exposed to paracetamol compared to ibuprofen; however the quality of evidence is low and comes from only one study. In view of concerns raised regarding neurodevelopmental outcomes following prenatal and postnatal exposure to paracetamol, long-term follow-up to...
Source: Cochrane Database of Systematic Reviews - April 6, 2018 Category: General Medicine Authors: Ohlsson A, Shah PS Tags: Cochrane Database Syst Rev Source Type: research

Osmotic therapies added to antibiotics for acute bacterial meningitis.
CONCLUSIONS: Glycerol was the only osmotic therapy evaluated, and data from trials to date have not demonstrated an effect on death. Glycerol may reduce neurological deficiency and deafness. PMID: 29405037 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - February 6, 2018 Category: General Medicine Authors: Wall EC, Ajdukiewicz KM, Bergman H, Heyderman RS, Garner P Tags: Cochrane Database Syst Rev Source Type: research

LITFL Review 308
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 308th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week This week’s ERCast chats with Ashley Liebig about 3 things we can do to improve our overall...
Source: Life in the Fast Lane - November 19, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs

Effectiveness and safety of treatments used for the management of patent ductus arteriosus (PDA) in preterm infants: a protocol for a systematic review and network meta-analysis
Introduction Management of patent ductus arteriosus (PDA) in preterm infants is one of the most controversial topics in neonatal medicine. The availability of different pharmacotherapeutic options often poses a practical challenge to the practising neonatologist as to which one to choose as a therapeutic option. Our objectives are to determine the relative merits of the available pharmacotherapeutic options for the management of PDA. Methods and Analysis We will conduct a systematic review of all randomised controlled trials evaluating the use of intravenous or oral: indomethacin, ibuprofen and acetaminophen for the treat...
Source: BMJ Open - July 24, 2016 Category: Journals (General) Authors: Mitra, S., Florez, I. D., Tamayo, M. E., Aune, D., Mbuagbaw, L., Veroniki, A.-A., Thabane, L. Tags: Open access, Intensive care, Paediatrics, Pharmacology and therapeutics Protocol Source Type: research

Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis
Conclusions Efficacy and safety of paracetamol appear to be comparable with those of ibuprofen. These results should be interpreted with caution, taking into account the non-optimal quality of the studies analysed and the limited number of neonates treated with paracetamol so far.
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 18, 2016 Category: Perinatology & Neonatology Authors: Terrin, G., Conte, F., Oncel, M. Y., Scipione, A., McNamara, P. J., Simons, S., Sinha, R., Erdeve, O., Tekgunduz, K. S., Dogan, M., Kessel, I., Hammerman, C., Nadir, E., Yurttutan, S., Jasani, B., Alan, S., Manguso, F., De Curtis, M. Tags: Clinical trials (epidemiology), Congenital heart disease, Screening (epidemiology), Screening (public health) Original articles Source Type: research

LITFL Review 185
Welcome to the 185th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Incredible reenactment videos of the Elaine Bromiley case, “a routine operation that went horribly awry.” From EMCrit, where Nicholas Chrimes’s videos show how things go wrong and how they can go right. [AS]   The Best of #...
Source: Life in the Fast Lane - June 7, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs