Page 1. The Open Women's Health Journal, 2009, 3, 11-15 11 1874-2912/09 2009 Bentham Open Op... more Page 1. The Open Women's Health Journal, 2009, 3, 11-15 11 1874-2912/09 2009 Bentham Open Open Access IVF Outcomes with Either Highly Purified FSH vs. Recombinant FSH in Down-Regulated Normogonadotrophic ...
Nonnutritive sweetener (NNS) consumption is increasing among children, yet its long-term health i... more Nonnutritive sweetener (NNS) consumption is increasing among children, yet its long-term health impact is unclear, particularly when exposure occurs during early life. To synthesize evidence from prospective studies evaluating the association of early-life NNS exposure and long-term metabolic health. Medline, Embase, and Cochrane Library (inception to July 2015). We aimed to include randomized controlled trials (RCTs) evaluating NNS-based interventions and prospective cohort studies reporting NNS exposure among pregnant women, infants, or children (<12 years of age), with a minimum study duration of 6 months. The primary outcome was BMI; secondary outcomes included growth velocity, overweight/obesity, adiposity, and adverse metabolic effects. Study quality and risk of bias were evaluated using validated assessment tools. We identified 6 eligible cohort studies and 2 RCTs (n = 15 641 children). Half of the cohorts reported increasing weight gain or fat mass accumulation with increasing NNS intake, and pooled data from 2 cohorts showed a significant correlation with BMI gain (weighted mean correlation 0.023, 95% confidence interval 0.006 to 0.041). RCTs reported contradictory effects on weight change in children receiving NNSs. No eligible studies evaluated prenatal or infant NNS exposure. Meta-analysis was limited because of the small number of eligible studies and heterogeneity of populations and outcomes. There is limited and inconsistent evidence of the long-term metabolic effects of NNS exposure during gestation, infancy, and childhood. Further research is needed to inform recommendations for the use of NNSs in this sensitive population.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 10, 2016
Surfactant is the principle treatment of respiratory distress syndrome, but the ideal method of i... more Surfactant is the principle treatment of respiratory distress syndrome, but the ideal method of its administration remains controversial. The intubation, surfactant administration and extubation (InSurE) method is proven to work but is invasive. The objective of this systematic review is to evaluate the efficacy and safety of the modalities of surfactant administration. We searched MEDLINE, EMBASE and CENTRAL (inception to December 2015) for randomized trials comparing new modalities with InSurE method. The primary outcome was mortality and development of bronchopulmonary dysplasia (BPD). We screened 1837 citations and identified five unique trials were included; all were of unclear risk of bias. Four trials (400 infants) compared endotracheal catheters with InSurE, and one trial (70 infants) compared laryngeal masks (LMA) with InSurE. There was no significant difference between using endotracheal catheters compared with InSurE regarding infant mortality (risk ratio 1.05, 95% CI 0.5...
JPEN. Journal of parenteral and enteral nutrition, Jan 8, 2015
The efficacy of enteral nutrition (EN) for maintaining remission in patients with inactive Crohn&... more The efficacy of enteral nutrition (EN) for maintaining remission in patients with inactive Crohn's disease (CD) is unclear. The aim of this article was to systematically identify, review, and critically appraise the evidence on efficacy of EN in maintaining medically induced remission in CD. Several databases were searched from inception to April 2015 for relevant citations of published randomized controlled trials and nonrandomized cohort studies. Two reviewers independently selected studies for inclusion and assessed study quality and risk of bias. The primary outcome was relapse rate in patients with inactive CD who have been in medically induced remission and subsequently started or maintained on EN. Twelve studies (1169 patients, including 95 children) fulfilled the inclusion criteria. As the included studies were significantly heterogeneous, a meta-analysis was not performed. Eleven studies showed that EN was either better than, or as effective as, the comparator in mainta...
Conflicting evidence exists regarding the benefits of physical activity for long-term blood gluco... more Conflicting evidence exists regarding the benefits of physical activity for long-term blood glucose control in adults with type 1 diabetes (T1D). The object of this systematic review was to determine the effects of physical activity on long-term blood glucose control in T1D adults. PubMed/Medline, Embase, CENTRAL, SPORTdiscus, Global Health and ICTRP were searched up to October 2013 for randomized trials of aerobic or resistance exercise training in T1D adults. Exercises had to be performed at least twice weekly for a minimum of two months. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included cardiorespiratory fitness and insulin dose. Six randomized trials were identified (323 adults); sample sizes ranged from n=6 to n=148 participants receiving the intervention. Five trials had an unknown risk of bias; one trial was deemed to be at high risk of bias. Exercise frequency varied from twice weekly to daily, with intensities (50-90% VO2peak), and session durations (20-120 min) varying widely. Four trials reported HbA1c, which decreased with exercise training (mean difference [MD] -0.78% (-9 mmol/mol), 95% CI -1.14 (-13 mmol/mol) to -0.41 (-5 mmol/mol); p<0.0001; I(2) 0%) compared with controls. Exercise training improved cardiorespiratory fitness by 3.45 ml/kg/min (95% CI 0.59 to 6.31, p=0.02, I(2) 0%) compared with controls. One trial reported an effect on insulin dose (MD -0.4U/kg, 95% CI -0.53 to -0.27, p<0.00001) compared to controls. There are currently insufficient well-designed studies to ascertain the true effect of exercise training on HbA1c in individuals with T1D, but current results are promising.
BACKGROUND: Pain management is integral to the management of hip fracture.PURPOSE: To review the ... more BACKGROUND: Pain management is integral to the management of hip fracture.PURPOSE: To review the benefits and harms of pharmacologic and nonpharmacologic interventions for managing pain after hip fracture.DATA SOURCES: 25 electronic databases (January 1990 to December 2010), gray literature, trial registries, and reference lists, with no language restrictions.STUDY SELECTION: Multiple reviewers independently and in duplicate screened 9357 citations to identify randomized, controlled trials (RCTs); nonrandomized, controlled trials (non-RCTs); and cohort studies of pain management techniques in older adults after acute hip fracture.DATA EXTRACTION: Independent, duplicate data extraction and quality assessment were conducted, with discrepancies resolved by consensus or a third reviewer. Data extracted included study characteristics, inclusion and exclusion criteria, participant characteristics, interventions, and outcomes.DATA SYNTHESIS: 83 unique studies (64 RCTs, 5 non-RCTs, and 14 cohort studies) were included that addressed nerve blockade (n = 32), spinal anesthesia (n = 30), systemic analgesia (n = 3), traction (n = 11), multimodal pain management (n = 2), neurostimulation (n = 2), rehabilitation (n = 1), and complementary and alternative medicine (n = 2). Overall, moderate evidence suggests that nerve blockades are effective for relieving acute pain and reducing delirium. Low-level evidence suggests that preoperative traction does not reduce acute pain. Evidence was insufficient on the benefits and harms of most interventions, including spinal anesthesia, systemic analgesia, multimodal pain management, acupressure, relaxation therapy, transcutaneous electrical neurostimulation, and physical therapy regimens, in managing acute pain.LIMITATIONS: No studies evaluated outcomes of chronic pain or exclusively examined participants from nursing homes or with cognitive impairment. Systemic analgesics (narcotics, nonsteroidal anti-inflammatory drugs) were understudied during the search period.CONCLUSION: Nerve blockade seems to be effective in reducing acute pain after hip fracture. Sparse data preclude firm conclusions about the relative benefits or harms of many other pain management interventions for patients with hip fracture.PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
A systematic review of PDE-5 inhibitors for erectile dysfunction was performed to evaluate the ut... more A systematic review of PDE-5 inhibitors for erectile dysfunction was performed to evaluate the utility of quantitative methods for identifying and exploring the influence of bias and study quality on pooled outcomes from meta-analyses. We included 123 randomized controlled trials (RCTs). Methodological quality was poorly reported. All three drugs appeared highly effective. Indirect adjusted analyses showed no differences between the three drugs. Funnel plots and statistical tests showed no evidence of small-study effects for sildenafil whereas there was evidence of such bias for tadalafil and vardenafil. Adjustment for missing studies using trim and fill techniques did not alter the pooled estimates substantially. The exclusion of previous sildenafil nonresponders was associated with larger treatment effects for tadalafil. This investigation was hampered by poor reporting of methodological quality, a low number of studies, heterogeneity and large effect sizes. Despite such limitations, a comprehensive assessment of biases should be a routine in systematic reviews.
Debate continues about the comparative benefits and harms of first-generation antipsychotics (FGA... more Debate continues about the comparative benefits and harms of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) in treating schizophrenia. To compare the effects of FGAs with those of SGAs in the treatment of adults aged 18 to 64 years with schizophrenia and related psychosis on illness symptoms, diabetes mellitus, mortality,tardive dyskinesia, and a major metabolic syndrome. English-language studies from 10 electronic databases to March 2012, reference lists of relevant articles, and gray literature. Randomized trials for efficacy and cohort studies at least 2 years in duration for adverse events. Two independent reviewers extracted data from 114 studies involving 22 comparisons and graded the strength of evidence for primary outcomes as insufficient, low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation approach. Few differences of clinical importance were found for core illness symptoms; lack of precision in effect estimates precluded firm conclusions for many comparisons. Moderate-strength evidence showed a clinically important benefit of haloperidol over olanzapine for improving positive symptoms, but the benefit was scale-dependent: It was seen when the Scale for the Assessment of Positive Symptoms was used but not when the Positive and Negative Syndrome Scale (PANSS) was used. Moderate-strength evidence showed a clinically important benefit of olanzapine over haloperidol in improving negative symptoms when the PANSS and the Scale for the Assessment of Negative Symptoms were used. Low-strength evidence showed no difference in mortality for chlorpromazine verus clozapine or haloperidol versus aripiprazole,increased incidence of the metabolic syndrome for olanzapine versus haloperidol (risk differences, 2% and 22%), and higher incidence of tardive dyskinesia for chlorpromazine versus clozapine (risk differences, 5% and 9%). Evidence was insufficient to draw conclusions for diabetes mellitus. All studies had high or unclear risk of bias. Length of study follow-up was often too brief to adequately measure adverse events. Medication comparisons, dosage, and outcome measurement were heterogenous for head-to-head comparisons. Selective patient populations limit generalizability. Clear benefits of FGAs versus SGAs for treating schizophrenia remain inconclusive because of variation in assessing outcomes and lack of clinically important differences for most comparisons. The strength of evidence on safety for major medical events is low or insufficient. Agency for Healthcare Research and Quality.
BACKGROUND: The aims of this study were to find an ultrasonically echogenic material to study the... more BACKGROUND: The aims of this study were to find an ultrasonically echogenic material to study the uterine activity, and to test whether closing the vaginal speculum on the cervix prevents the displacement of the injected material. METHODS: A concentrated sperm suspension was used as an ultrasonically visible material. Forty-five women undergoing intrauterine insemination were randomized into: open speculum group (n
ABSTRACT Objective: The objective of our study was to review the efficacy and safety of atosiban ... more ABSTRACT Objective: The objective of our study was to review the efficacy and safety of atosiban and nifedipine using both direct and indirect evidence. Data sources: We performed electronic (e.g. MEDLINE, EMBASE, CENTRAL) and hand searches (last search August 2011) to identify randomized controlled trials (RCTs) comparing atosiban with nifedipine directly, or either drug with betamimetics, in order to allow for indirect analyses. Methods of study selection: A review was conducted of published, unpublished, and ongoing RCTs comparing atosiban with nifedipine directly, or either drug with betamimetics, in pregnant women under threat of preterm labor. Tabulation, integration, and results: Data were extracted for an intention-to-treat analysis, and meta-analysis was performed using a random-effects model. Data from direct and indirect evidence were combined using inverse variance. Four RCTs were identified that compared atosiban with nifedipine, with another 31 RCTs comparing either drug with betamimetics. Data for the majority of outcomes were unavailable. When evidence was available, the meta-analysis showed that there were no clear differences in the significant effects exerted by the two drugs. All safety outcomes were in favor of atosiban: there were lower incidences of adverse drug reactions, flushing, gastrointestinal tract upset, hypotension, palpitation, and tachycardia in women prescribed atosiban, with the exception of nausea, which was more frequent in such women. On combining direct and indirect evidence, we also identified a higher probability of treatment failure within 7 days of initiation of treatment (birth or alternative tocolytic therapy) and higher incidence of headache in women receiving nifedipine. Conclusion: Both drugs seem to have a similar positive effect on prolongation of pregnancy; however, the safety profile of atosiban is considerably better.
... Ahmed Kamal, MD Ibrahim Fahmy, MD Ragaa Mansour, MD, Ph.D. Ahmed Abou-Setta, MD Gamal Serour,... more ... Ahmed Kamal, MD Ibrahim Fahmy, MD Ragaa Mansour, MD, Ph.D. Ahmed Abou-Setta, MD Gamal Serour, MD Mohamed Aboulghar, MD ... Hum Reprod 1998;13(12):3390-3. 9. Fahmy I, Mansour R, Aboulghar M, Serour G, Kamal A, Tawab NA, et al. ...
Page 1. The Open Women's Health Journal, 2009, 3, 11-15 11 1874-2912/09 2009 Bentham Open Op... more Page 1. The Open Women's Health Journal, 2009, 3, 11-15 11 1874-2912/09 2009 Bentham Open Open Access IVF Outcomes with Either Highly Purified FSH vs. Recombinant FSH in Down-Regulated Normogonadotrophic ...
Nonnutritive sweetener (NNS) consumption is increasing among children, yet its long-term health i... more Nonnutritive sweetener (NNS) consumption is increasing among children, yet its long-term health impact is unclear, particularly when exposure occurs during early life. To synthesize evidence from prospective studies evaluating the association of early-life NNS exposure and long-term metabolic health. Medline, Embase, and Cochrane Library (inception to July 2015). We aimed to include randomized controlled trials (RCTs) evaluating NNS-based interventions and prospective cohort studies reporting NNS exposure among pregnant women, infants, or children (<12 years of age), with a minimum study duration of 6 months. The primary outcome was BMI; secondary outcomes included growth velocity, overweight/obesity, adiposity, and adverse metabolic effects. Study quality and risk of bias were evaluated using validated assessment tools. We identified 6 eligible cohort studies and 2 RCTs (n = 15 641 children). Half of the cohorts reported increasing weight gain or fat mass accumulation with increasing NNS intake, and pooled data from 2 cohorts showed a significant correlation with BMI gain (weighted mean correlation 0.023, 95% confidence interval 0.006 to 0.041). RCTs reported contradictory effects on weight change in children receiving NNSs. No eligible studies evaluated prenatal or infant NNS exposure. Meta-analysis was limited because of the small number of eligible studies and heterogeneity of populations and outcomes. There is limited and inconsistent evidence of the long-term metabolic effects of NNS exposure during gestation, infancy, and childhood. Further research is needed to inform recommendations for the use of NNSs in this sensitive population.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 10, 2016
Surfactant is the principle treatment of respiratory distress syndrome, but the ideal method of i... more Surfactant is the principle treatment of respiratory distress syndrome, but the ideal method of its administration remains controversial. The intubation, surfactant administration and extubation (InSurE) method is proven to work but is invasive. The objective of this systematic review is to evaluate the efficacy and safety of the modalities of surfactant administration. We searched MEDLINE, EMBASE and CENTRAL (inception to December 2015) for randomized trials comparing new modalities with InSurE method. The primary outcome was mortality and development of bronchopulmonary dysplasia (BPD). We screened 1837 citations and identified five unique trials were included; all were of unclear risk of bias. Four trials (400 infants) compared endotracheal catheters with InSurE, and one trial (70 infants) compared laryngeal masks (LMA) with InSurE. There was no significant difference between using endotracheal catheters compared with InSurE regarding infant mortality (risk ratio 1.05, 95% CI 0.5...
JPEN. Journal of parenteral and enteral nutrition, Jan 8, 2015
The efficacy of enteral nutrition (EN) for maintaining remission in patients with inactive Crohn&... more The efficacy of enteral nutrition (EN) for maintaining remission in patients with inactive Crohn's disease (CD) is unclear. The aim of this article was to systematically identify, review, and critically appraise the evidence on efficacy of EN in maintaining medically induced remission in CD. Several databases were searched from inception to April 2015 for relevant citations of published randomized controlled trials and nonrandomized cohort studies. Two reviewers independently selected studies for inclusion and assessed study quality and risk of bias. The primary outcome was relapse rate in patients with inactive CD who have been in medically induced remission and subsequently started or maintained on EN. Twelve studies (1169 patients, including 95 children) fulfilled the inclusion criteria. As the included studies were significantly heterogeneous, a meta-analysis was not performed. Eleven studies showed that EN was either better than, or as effective as, the comparator in mainta...
Conflicting evidence exists regarding the benefits of physical activity for long-term blood gluco... more Conflicting evidence exists regarding the benefits of physical activity for long-term blood glucose control in adults with type 1 diabetes (T1D). The object of this systematic review was to determine the effects of physical activity on long-term blood glucose control in T1D adults. PubMed/Medline, Embase, CENTRAL, SPORTdiscus, Global Health and ICTRP were searched up to October 2013 for randomized trials of aerobic or resistance exercise training in T1D adults. Exercises had to be performed at least twice weekly for a minimum of two months. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included cardiorespiratory fitness and insulin dose. Six randomized trials were identified (323 adults); sample sizes ranged from n=6 to n=148 participants receiving the intervention. Five trials had an unknown risk of bias; one trial was deemed to be at high risk of bias. Exercise frequency varied from twice weekly to daily, with intensities (50-90% VO2peak), and session durations (20-120 min) varying widely. Four trials reported HbA1c, which decreased with exercise training (mean difference [MD] -0.78% (-9 mmol/mol), 95% CI -1.14 (-13 mmol/mol) to -0.41 (-5 mmol/mol); p<0.0001; I(2) 0%) compared with controls. Exercise training improved cardiorespiratory fitness by 3.45 ml/kg/min (95% CI 0.59 to 6.31, p=0.02, I(2) 0%) compared with controls. One trial reported an effect on insulin dose (MD -0.4U/kg, 95% CI -0.53 to -0.27, p<0.00001) compared to controls. There are currently insufficient well-designed studies to ascertain the true effect of exercise training on HbA1c in individuals with T1D, but current results are promising.
BACKGROUND: Pain management is integral to the management of hip fracture.PURPOSE: To review the ... more BACKGROUND: Pain management is integral to the management of hip fracture.PURPOSE: To review the benefits and harms of pharmacologic and nonpharmacologic interventions for managing pain after hip fracture.DATA SOURCES: 25 electronic databases (January 1990 to December 2010), gray literature, trial registries, and reference lists, with no language restrictions.STUDY SELECTION: Multiple reviewers independently and in duplicate screened 9357 citations to identify randomized, controlled trials (RCTs); nonrandomized, controlled trials (non-RCTs); and cohort studies of pain management techniques in older adults after acute hip fracture.DATA EXTRACTION: Independent, duplicate data extraction and quality assessment were conducted, with discrepancies resolved by consensus or a third reviewer. Data extracted included study characteristics, inclusion and exclusion criteria, participant characteristics, interventions, and outcomes.DATA SYNTHESIS: 83 unique studies (64 RCTs, 5 non-RCTs, and 14 cohort studies) were included that addressed nerve blockade (n = 32), spinal anesthesia (n = 30), systemic analgesia (n = 3), traction (n = 11), multimodal pain management (n = 2), neurostimulation (n = 2), rehabilitation (n = 1), and complementary and alternative medicine (n = 2). Overall, moderate evidence suggests that nerve blockades are effective for relieving acute pain and reducing delirium. Low-level evidence suggests that preoperative traction does not reduce acute pain. Evidence was insufficient on the benefits and harms of most interventions, including spinal anesthesia, systemic analgesia, multimodal pain management, acupressure, relaxation therapy, transcutaneous electrical neurostimulation, and physical therapy regimens, in managing acute pain.LIMITATIONS: No studies evaluated outcomes of chronic pain or exclusively examined participants from nursing homes or with cognitive impairment. Systemic analgesics (narcotics, nonsteroidal anti-inflammatory drugs) were understudied during the search period.CONCLUSION: Nerve blockade seems to be effective in reducing acute pain after hip fracture. Sparse data preclude firm conclusions about the relative benefits or harms of many other pain management interventions for patients with hip fracture.PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
A systematic review of PDE-5 inhibitors for erectile dysfunction was performed to evaluate the ut... more A systematic review of PDE-5 inhibitors for erectile dysfunction was performed to evaluate the utility of quantitative methods for identifying and exploring the influence of bias and study quality on pooled outcomes from meta-analyses. We included 123 randomized controlled trials (RCTs). Methodological quality was poorly reported. All three drugs appeared highly effective. Indirect adjusted analyses showed no differences between the three drugs. Funnel plots and statistical tests showed no evidence of small-study effects for sildenafil whereas there was evidence of such bias for tadalafil and vardenafil. Adjustment for missing studies using trim and fill techniques did not alter the pooled estimates substantially. The exclusion of previous sildenafil nonresponders was associated with larger treatment effects for tadalafil. This investigation was hampered by poor reporting of methodological quality, a low number of studies, heterogeneity and large effect sizes. Despite such limitations, a comprehensive assessment of biases should be a routine in systematic reviews.
Debate continues about the comparative benefits and harms of first-generation antipsychotics (FGA... more Debate continues about the comparative benefits and harms of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) in treating schizophrenia. To compare the effects of FGAs with those of SGAs in the treatment of adults aged 18 to 64 years with schizophrenia and related psychosis on illness symptoms, diabetes mellitus, mortality,tardive dyskinesia, and a major metabolic syndrome. English-language studies from 10 electronic databases to March 2012, reference lists of relevant articles, and gray literature. Randomized trials for efficacy and cohort studies at least 2 years in duration for adverse events. Two independent reviewers extracted data from 114 studies involving 22 comparisons and graded the strength of evidence for primary outcomes as insufficient, low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation approach. Few differences of clinical importance were found for core illness symptoms; lack of precision in effect estimates precluded firm conclusions for many comparisons. Moderate-strength evidence showed a clinically important benefit of haloperidol over olanzapine for improving positive symptoms, but the benefit was scale-dependent: It was seen when the Scale for the Assessment of Positive Symptoms was used but not when the Positive and Negative Syndrome Scale (PANSS) was used. Moderate-strength evidence showed a clinically important benefit of olanzapine over haloperidol in improving negative symptoms when the PANSS and the Scale for the Assessment of Negative Symptoms were used. Low-strength evidence showed no difference in mortality for chlorpromazine verus clozapine or haloperidol versus aripiprazole,increased incidence of the metabolic syndrome for olanzapine versus haloperidol (risk differences, 2% and 22%), and higher incidence of tardive dyskinesia for chlorpromazine versus clozapine (risk differences, 5% and 9%). Evidence was insufficient to draw conclusions for diabetes mellitus. All studies had high or unclear risk of bias. Length of study follow-up was often too brief to adequately measure adverse events. Medication comparisons, dosage, and outcome measurement were heterogenous for head-to-head comparisons. Selective patient populations limit generalizability. Clear benefits of FGAs versus SGAs for treating schizophrenia remain inconclusive because of variation in assessing outcomes and lack of clinically important differences for most comparisons. The strength of evidence on safety for major medical events is low or insufficient. Agency for Healthcare Research and Quality.
BACKGROUND: The aims of this study were to find an ultrasonically echogenic material to study the... more BACKGROUND: The aims of this study were to find an ultrasonically echogenic material to study the uterine activity, and to test whether closing the vaginal speculum on the cervix prevents the displacement of the injected material. METHODS: A concentrated sperm suspension was used as an ultrasonically visible material. Forty-five women undergoing intrauterine insemination were randomized into: open speculum group (n
ABSTRACT Objective: The objective of our study was to review the efficacy and safety of atosiban ... more ABSTRACT Objective: The objective of our study was to review the efficacy and safety of atosiban and nifedipine using both direct and indirect evidence. Data sources: We performed electronic (e.g. MEDLINE, EMBASE, CENTRAL) and hand searches (last search August 2011) to identify randomized controlled trials (RCTs) comparing atosiban with nifedipine directly, or either drug with betamimetics, in order to allow for indirect analyses. Methods of study selection: A review was conducted of published, unpublished, and ongoing RCTs comparing atosiban with nifedipine directly, or either drug with betamimetics, in pregnant women under threat of preterm labor. Tabulation, integration, and results: Data were extracted for an intention-to-treat analysis, and meta-analysis was performed using a random-effects model. Data from direct and indirect evidence were combined using inverse variance. Four RCTs were identified that compared atosiban with nifedipine, with another 31 RCTs comparing either drug with betamimetics. Data for the majority of outcomes were unavailable. When evidence was available, the meta-analysis showed that there were no clear differences in the significant effects exerted by the two drugs. All safety outcomes were in favor of atosiban: there were lower incidences of adverse drug reactions, flushing, gastrointestinal tract upset, hypotension, palpitation, and tachycardia in women prescribed atosiban, with the exception of nausea, which was more frequent in such women. On combining direct and indirect evidence, we also identified a higher probability of treatment failure within 7 days of initiation of treatment (birth or alternative tocolytic therapy) and higher incidence of headache in women receiving nifedipine. Conclusion: Both drugs seem to have a similar positive effect on prolongation of pregnancy; however, the safety profile of atosiban is considerably better.
... Ahmed Kamal, MD Ibrahim Fahmy, MD Ragaa Mansour, MD, Ph.D. Ahmed Abou-Setta, MD Gamal Serour,... more ... Ahmed Kamal, MD Ibrahim Fahmy, MD Ragaa Mansour, MD, Ph.D. Ahmed Abou-Setta, MD Gamal Serour, MD Mohamed Aboulghar, MD ... Hum Reprod 1998;13(12):3390-3. 9. Fahmy I, Mansour R, Aboulghar M, Serour G, Kamal A, Tawab NA, et al. ...
Uploads
Papers by Ahmed Abou-Setta