Evaluation of the Therapeutic Effect of Antibiotics on Scrub Typhus: A Systematic Review and Network Meta-Analysis.

Background: To explore the efficacy and safety of drugs in patients with scrub typhus. Methods: For this systematic review and network meta-analysis, we searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, China National Knowledge Infrastructure (CNKI), and Wanfang data (WF) up to December 2021. All randomized controlled trials (RCTs) of antibiotics used to treat scrub typhus were included without language or date restrictions. The overall effectiveness was evaluated from 4 perspectives: cure rate (CR), defervescence time (DT), gastrointestinal symptoms-adverse events (GS-AD), and abnormal blood count-adverse events (ABC-AD). The quality of evidence was evaluated using the Cochrane Risk of Bias tool and GRADE system. Results: Sixteen studies involving 1,582 patients were included to evaluate 7 drugs, namely, azithromycin, doxycycline, chloramphenicol, tetracycline, rifampin, moxifloxacin, and telithromycin. In this network meta-analysis, rifampicin (82%) and chloramphenicol (65%) were more effective in terms of CR, and moxifloxacin (3%) from the quinolone family was the worst. Azithromycin caused the fewest events in terms of ABC-AD. No differences were found in this network meta-analysis (NMA) in terms of DT and GS-AD. Conclusions: Rifampicin was associated with the highest CR benefit and the lowest risk of DT when used to treat patients with scrub typhus, except in areas where tuberculosis (TB) was endemic. Azithromycin was found to be better in CR and was associated with a lower probability of GS-AD and ABC-AD; therefore, it may be considered to treat pregnant women and children. Moxifloxacin had a much lower CR than other drugs and is, therefore, not recommended for the management of scrub typhus. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021287837.

Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis.

BACKGROUND: As the etiology of chronic fatigue syndrome (CFS) is unclear and the treatment is still a big issue. There exists a wide range of literature about acupuncture and moxibustion (AM) for CFS in traditional Chinese medicine (TCM). But there are certain doubts as well in the effectiveness of its treatment due to the lack of a comprehensive and evidence-based medical proof to dispel the misgivings. Current study evaluated systematically the effectiveness of acupuncture and moxibustion treatments on CFS, and clarified the difference among them and Chinese herbal medicine, western medicine and sham-acupuncture. METHODS: We comprehensively reviewed literature including PubMed, EMBASE, Cochrane library, CBM (Chinese Biomedical Literature Database) and CNKI (China National Knowledge Infrastructure) up to May 2016, for RCT clinical research on CFS treated by acupuncture and moxibustion. Traditional direct meta-analysis was adopted to analyze the difference between AM and other treatments. Analysis was performed based on the treatment in experiment and control groups. Network meta-analysis was adopted to make comprehensive comparisons between any two kinds of treatments. The primary outcome was total effective rate, while relative risks (RR) and 95% confidence intervals (CI) were used as the final pooled statistics. RESULTS: A total of 31 randomized controlled trials (RCTs) were enrolled in analyses. In traditional direct meta-analysis, we found that in comparison to Chinese herbal medicine, CbAM (combined acupuncture and moxibustion, which meant two or more types of acupuncture and moxibustion were adopted) had a higher total effective rate (RR (95% CI), 1.17 (1.09 ~ 1.25)). Compared with Chinese herbal medicine, western medicine and sham-acupuncture, SAM (single acupuncture or single moxibustion) had a higher total effective rate, with RR (95% CI) of 1.22 (1.14 ~ 1.30), 1.51 (1.31-1.74), 5.90 (3.64-9.56). In addition, compared with SAM, CbAM had a higher total effective rate (RR (95% CI), 1.23 (1.12 ~ 1.36)). In network meta-analyses, similar results were recorded. Subsequently, we ranked all treatments from high to low effective rate and the order was CbAM, SAM, Chinese herbal medicine, western medicine and sham-acupuncture. CONCLUSIONS: In the treatment of CFS, CbAM and SAM may have better effect than other treatments. However, the included trials have relatively poor quality, hence high quality studies are needed to confirm our finding.

The efficacy and safety of Chinese herbal medicine, Rhodiola formulation in treating ischemic heart disease: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Rhodiola formulation is widely used in treating ischemic heart disease (IHD), angina pectoris in China. A number of clinical studies have reported and claimed that Rhodiola formulation can relieve the symptoms of IHD. This study provides the first Preferred Reporting Items for Systematic Reviews (PRISMA)-compliant systematic review to evaluate the efficacy and safety of Rhodiola formulation in treating ischemic heart disease either as a sole agent or in combination with routine western medicine (RWM). METHODS: Search strategy - PubMed, Science Direct, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Master Theses Full-text Database (CMTD), China Doctor Dissertations Full-text Database (CDMD), Wanfang Data (WF) databases were searched for all relevant studies on Rhodiola formulation that have been published in English and Chinese. The last search of all databases was performed on 31 January 2013. All randomized controlled trials (RCTs) of Rhodiola formulation for patients with IHD were included, and the quality of included RCTs was assessed with Cochrane risk of bias tool. The primary outcomes, including the effective size of symptomatic and electrocardiography (ECG) improvement were calculated as an odds ratio (OR) and 95% confidence intervals (CIs). Because of obvious heterogeneity in the studies with regard to herbal species, herbal formulations, treatment group medicines, control group medicines and outcome measurement, subgroup analysis and sensitivity analysis were performed to evaluate the effects of study characteristics of RCTs, including quality, the role of Rhodiola formulations in treatment group and the different control group medicines. RESULTS: A total of thirteen studies (n=1672) were included. most of included studies were found to be high risk of bias with low quality of methodology. The Rhodiola formulations used alone or in combination with RWM demonstrated a positive effect on both improvement of symptoms and ECG. For the subgroup analysis, the ORs of symptomatic improvement in Rhodiola formulations versus other Chinese herbal medicines (CHMs), Rhodiola formulations versus RWM, and Rhodiola formulations plus RWM versus RWM were 1.51, 2.64, 5.63, respectively. The ORs of symptomatic improvement for Rhodiola formulations versus other CHMs, Rhodiola formulations versus RWM, and Rhodiola formulations plus RWM versus RWM were 1.33, 3.11, 2.27, respectively. Overall, the effectiveness of Rhodiola formulations was higher compared to medicines in control groups, with statistically significant differences observed both in symptomatic improvement (OR=2.40, 95% CI: 1.57-3.66, P<0.0001) and ECG improvement (OR=1.48, 95% CI: 1.17-1.87, P<0.01). However, the sensitivity test indicated that overall effects of Rhodiola formulation versus other CHMs in ECG improvement were not stable (after removing the study by Yin, P=0.05); the differences of CHMs in the control group are a possible source of heterogeneity. CONCLUSION: Rhodiola formulations may have a positive effect on treating IHD alone and in combination with RWM. However, poor quality of methodology and heterogeneity of the included trials means that larger sample size, multi-center, placebo-controlled, double blind studies are needed.