Objective: To assess the effectiveness and tolerability of the 23 mg tablet donepezil in patients with Alzheimer’s disease (AD) using meta-analysis of randomized controlled trials. Methods: Major healthcare databases were searched from May to September 2016. Evaluation of relevant trials, assessment of risk of bias, collection and analyses of data were performed. Results: A total of 1,774 adult participants with AD were pooled from the two trials included. Pooled data showed that after 24 weeks of treatment, no significant difference was noted between Donepezil 23 mg/day and Donepezil 10 mg/day in terms of cognitive function (1.06 SIB points [-0.13, 2.26]; 1704 participants) and in terms of global clinical assessment (-0.02 CIBIC+ points [-0.13, 0.09]; 1705 participants). The participants who took the higher dose were at higher risk to experience “any adverse event” than those who received the lower dose (1.17 RR [1.09, 1.26]; 1785 participants). Conclusion Current evidences do not support the routine use of Donepezil 23 mg tablet for the improvement of cognitive function and global clinical status of patients with AD. The higher dose is also marked with an increased incidence of adverse events compared to the lower dose.
Meta-analysis

Meta-Analysis as Topic

No abstract available.
Meta-Analysis as Topic

I. Introduction of film-coating technique; II. Materials: films, pigments and solvents; III. Equipment: Modified coater, Fluidized-bed coater; IV. Formulating solution: Formulating, Calculating amount of solution; V. Types of film: Protective film, Bowel dissoluble film, longer releasing film; IV. Film coating technique using water instead of organic solvent; VII. Testing quality of film coat: Testing polymer and formula, Testing protective, bowel dissoluble and longer releasing film.
Pharmaceutical Preparations ; Meta-Analysis

Background: Dexamethasone, an anti-inflammatory drug, has an assumed analgesic effect when given epidurally, with less side effects5,7. Although numerous studies have evaluated dexamethasone, there is a paucity of studies assessing its intrapartum use. Objectives: To determine the effectiveness of epidural dexamethasone when used as an adjuvant for labor analgesia. Materials and Methods: A meta-analysis guided by the Cochrane handbook was performed. Articles were searched through PubMed, MEDLINE, CENTRAL, Google Scholar and ClinicalTrials.gov using search strategies such as keywords and MeSH terms. Cochrane version 2 risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality. Quantitative data were pooled and analyzed using Review Manager 5.4.1. Results: A total of five trials involving 309 women in labor were analyzed. The pooled mean difference showed prolonged duration of epidural analgesia on patients who received epidural dexamethasone; pooled risk ratio between the experimental and control group demonstrated no significant maternal adverse events such as nausea and vomiting, shivering, hypotension, and fever. Pooled risk ratio and mean difference also showed that epidural dexamethasone had no significant effect on the neonatal APGAR and neonatal umbilical pH. Conclusion Present data demonstrated the potential role of dexamethasone as an adjuvant to epidural solution during labor analgesia on providing local anesthetic dose sparing effect through prolongation of the duration of epidural analgesia, with limited maternal and neonatal adverse events. These results should be interpreted with caution before adopting this technique in routine clinical practice.
Dexamethasone ; Meta-Analysis

Background: Preterm birth is an important health concern in countries with limited resources and healthcare access. Topical therapy may be effective for improving outcomes in preterm neonates whose skin barriers are compromised due to immaturity. Objectives: To systematically review the topical VCO's effects in preterm infants on infection, mortality, and dermal maturity. Methodology: Systematic review and meta-analysis of RCTs of topical VCO in preterm infants were conducted. Databases included PubMed, Google Scholar, Clinical trials.gov, Trip, Cochrane Library, and HERDIN. The risk of bias was assessed by two authors independently. RR with 95% CI was used for the pooled estimate of dichotomous outcomes including infection prevention, mortality reduction, and skin irritation. Mean differences with 95% CI were used for the pooled estimate of weight loss and NSCS. Results: Of 110 records identified, 3 RCTs with 2440 patients were included. Prevention of infection had a trend toward VCO (RR = 0.90, [95% CI: 0.64, 1.27] while the results for mortality reduction were inconclusive (RR = 0.45, [95% CI: 0.06, 3.38]. NSC scores showed a beneficial trend toward VCO (RR = -0.03, [95% CI: -0.16, 0.09]. Both secondary outcomes of skin irritation and weight loss had inconclusive results. Conclusions This review showed the lack of evidence of the effectiveness of topical VCO in improving various outcomes in premature infants. The effects on infection prevention and dermal maturation were favorable. However, its effects on preventing mortality, skin irritation, and weight loss were inconclusive.
Meta-Analysis ; Infections ; Mortality

Background: Fibromyalgia is a difficult-to-treat chronic musculoskeletal pain and tenderness syndrome. It is considered due to augmented pain processing in central nervous system. Interest in antiepileptic drugs, included pregabalin, for treatment of fibromyalgia is currently growing. This study aimed to investigate the effectiveness of pregabalin for fibromyalgia. Methods: We conducted the study according to the meta-analysis PRISMA guideline. Relevant randomized controlled trials (RCTs) were identified from a search of PubMed and Cochrane databases. Quality of selected studies was assessed using Jadad score for randomized placebo-controlled trials (RCT). Primary outcome was pain score reduction (30% and 50% reduction) and secondary outcome was patient global impression of change. Statistical analysis was performed using Review Manager 5.3. Results: Six international, multicenter, high-quality RCTs with 8-15 weeks duration of treatment met inclusion criteria. Four studies used different fixed dose (300 mg/d, 450 mg/d, 600mg/d) and 2 studies used titrated dose in evaluating the efficacy of pregabalin. There was statistically significant benefit of pregabalin over placebo in mean pain score reduction [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.56-2.10 p < 0.00001 in fixed dose pregabalin 30% pain reduction; OR 2.06 95% CI 1.66-2.56 p < 0.00001 in fixed dose pregabalin 50% pain reduction; OR 1.53 95% CI 1.10-2.13 p 0.01 in titrated dose pregabalin 30% pain reduction; OR 1.80 95% CI 1.12-2.88 p 0.01 in titrated dose pregabalin 50% pain reduction]. Pregabalin also demonstrated significantly better patient global impression of change than placebo. No heterogeneity was seen in most groups. No publication bias was observed. Conclusion Our study showed pregabalin monotherapy was effective for pain treatment associated with fibromyalgia. Further studies with longer treatment duration are needed to confirm the long-term effectiveness of pregabalin for fibromyalgia treatment.
Fibromyalgia ; Pregabalin ; Meta-Analysis

Aims: This meta-analysis aims to synthesize available evidence from published studies on the effectiveness of parental non-pharmacologic smoking cessation programs which aim to reduce children's exposure to secondhand smoke.

Methodology: A database search using The Cochrane Library, PubMed®, Medline, Embase, and Google Scholar, was done by the investigators. This study included 20 randomized controlled trials published up to 2020. Pooled estimates of risk ratio (RR) for quit rates were computed using the random effects model.

Results: Overall, the quit rate among those who underwent parental smoking cessation was 13.4% while the quit rate for controls was 11.9%. The pooled RR demonstrated that the parental smoking cessation program was significantly associated with higher quit rates (RR = 1.22, 95%CI = 1.01 to 1.46, p-value = 0.04). The studies demonstrated moderate heterogeneity only (I2 = 54%). Among studies published prior to year 2000, no significant difference was observed between parental smoking cessation program and control (RR = 1.02, 95% CI = 0.62 to 1.70, p-value = 0.93). On the other hand, the pooled RR demonstrated that among studies published after 2020, parental smoking cessation program was significantly associated with higher quit rates (RR = 1.27, 95%CI = 1.03 to 1.56, p-value <0.0001). Among studies with self-help interventions, parental smoking cessation program has no additional benefit on quit rates (RR = 1.20, 95%CI = 0.94 to 1.58, p-value = 0.14). Among studies with biofeedback intervention also, no significant difference was observed (RR = 1.27, 95% CI = 0.86 to 1.89, p-value = 0.23).

Conclusions: This meta-analysis demonstrated sufficient evidence that non-pharmacologic interventions for parental smoking cessation are effective.

Background: Schizophrenia is a pervasive, chronic mental disorder that negatively impacts the biological, socioeconomic and family well being of the patient. Active involvement of family members and other significant individuals appears to benefit overall management. Objective: To determine the effectiveness of family-focused intervention in improving symptoms of schizophrenia. Methods: The authors searched for eligible clinical trials in the PubMed, Cochrane Central Register of Controlled Trials, Research Gate, Google Scholar and grey literature databases. Participants should be patients diagnosed to have schizophrenia and interventions should involve the family or be labeled as ‘family therapy.’ The primary outcome considered was symptom improvement based on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes included quality of life, family functioning and subjective experience of the treatment process. The authors used the RevMan 5.4 software for data analysis. Bias, subgroup and sensitivity analyses were performed. Strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Results: A total of 1,794 trials were initially identified, of which three publications were included in the review. Two studies used psychosocial approaches whereas one used cognitive behavioral therapy in conjunction with family intervention. Meta-analysis revealed the studies to be heterogeneous based on p values <0.10 and I2 >50%. Subgroup analysis by type of intervention showed no difference between the intervention and control groups, although there was a positive trend in favor of psychosocial intervention for improvement in PANSS score. Family-based intervention had a significant positive effect on quality of life. Conclusion Family-based interventions are effective in the management of schizophrenia, helping to improve quality of life, potentially reducing symptom burden and serving as an adjunct to health institution-based management.
schizophrenia ; meta-analysis

Introduction: Intralesional purified protein derivative (PPD) is an affordable therapeutic option that has been studied for cutaneous warts. However, the lack of good evidence precludes its widespread use. Objective: To determine the efficacy and safety of intralesional PPD in the treatment of cutaneous warts. Methods: A systematic search for controlled clinical trials comparing intralesional PPD and placebo or any conventional therapy was conducted using electronic databases. The included studies were assessed for risk of bias, and data such as clearance rate of target and distant lesions, recurrence rate, and adverse events were extracted. Analysis was done through RevMan v5.3. Results: Four controlled clinical trials composed of 205 patients were included. All of the studies compared intralesional PPD to placebo as comparator. Intralesional PPD had a significantly higher clearance rate of target wart (RR=0.43[0.22,0.84], P=0.01) and a significantly higher clearance rate of distant lesions (RR=0.59[0.41,0.85], P=0.005) as compared to placebo. However, there was no significant difference in the recurrence rate (RR=0 [-0.07,0.07], P=0.98). Adverse events reported were only considered minor. Conclusion Intralesional PPD is an effective and safe treatment option for cutaneous warts. However, more well-structured RCTs with longer follow-up period and those comparing it with conventional treatment are needed to further support its use.
Warts ; Meta-Analysis ; Tuberculin