Role of Probiotics in Patients with Allergic Rhinitis: A Systematic Review of Systematic Reviews

Abstract Introduction Allergic rhinitis (AR) is estimated to affect up to 30% of the world population. With the rise in cases, newer treatment modalities have been explored. Probiotics have shown to reduce symptoms of AR and improve quality of life. A few systematic reviews have been published aiming to assess the role of probiotics in AR. Objectives To consolidate the recent evidence with an overview of systematic reviews by extracting data regarding subjective outcomes (from quality of life questionnaires, the Total Nasal Symptom Score, the Total Ocular Symptom Score, the Daily Total Symptom Score, the incidence of AR, and the Rhinitis Total Symptom Score) and objective outcomes (levels of antigen-specific immunoglobulin E [IgE], total IgE, interleukin 10 [IL-10], interferon gamma [IFNG], eosinophil, and the T helper 1/T helper 2 [Th1/Th2] ratio). Data Synthesis We conducted a literature search on the PubMed, EBSCO CINAHL, EBSCO Dentistry & Oral Sciences Source, and Cochrane Library up to April 14, 2020. The qualitative assessment was performed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool. A total of 419 titles were screened, and 3 systematic reviews met our eligibility criteria. Probiotics in the treatment of AR have been shown to improve quality of life, the total nasal and ocular symptom scores, the daily total symptom scores and Th1/Th2 ratio. No difference was ascertained for rhinitis total symptom score, and the rates of antigen-specific IgE, total IgE, IL-10, INFG and eosinophil. Conclusion The present review showed that there is considerable evidence that probiotics are useful in the treatment of AR. Further randomized trials targeting the limitations of the currently-available evidence can help ascertain the usefulness of probiotics in cases of AR.

Role of Probiotics in Patients with Allergic Rhinitis: A Systematic Review of Systematic Reviews.

Introduction Allergic rhinitis (AR) is estimated to affect up to 30% of the world population. With the rise in cases, newer treatment modalities have been explored. Probiotics have shown to reduce symptoms of AR and improve quality of life. A few systematic reviews have been published aiming to assess the role of probiotics in AR. Objectives To consolidate the recent evidence with an overview of systematic reviews by extracting data regarding subjective outcomes (from quality of life questionnaires, the Total Nasal Symptom Score, the Total Ocular Symptom Score, the Daily Total Symptom Score, the incidence of AR, and the Rhinitis Total Symptom Score) and objective outcomes (levels of antigen-specific immunoglobulin E [IgE], total IgE, interleukin 10 [IL-10], interferon gamma [IFNG], eosinophil, and the T helper 1/T helper 2 [Th1/Th2] ratio). Data Synthesis We conducted a literature search on the PubMed, EBSCO CINAHL, EBSCO Dentistry & Oral Sciences Source, and Cochrane Library up to April 14, 2020. The qualitative assessment was performed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool. A total of 419 titles were screened, and 3 systematic reviews met our eligibility criteria. Probiotics in the treatment of AR have been shown to improve quality of life, the total nasal and ocular symptom scores, the daily total symptom scores and Th1/Th2 ratio. No difference was ascertained for rhinitis total symptom score, and the rates of antigen-specific IgE, total IgE, IL-10, INFG and eosinophil. Conclusion The present review showed that there is considerable evidence that probiotics are useful in the treatment of AR. Further randomized trials targeting the limitations of the currently-available evidence can help ascertain the usefulness of probiotics in cases of AR.

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review.

BACKGROUND: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. METHODS: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. RESULTS: Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. CONCLUSION: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.

Optimum Degree of Head Elevation/Reverse Trendelenburg Position for Sinus Surgery: Systematic Review.

BACKGROUND: This review aims to evaluate the effect of Reverse Trendelenburg Position (RTP) on bleeding and Boezaart score and to determine the optimum degree of head elevation through a systematic review and meta-analysis.Methodology: We conducted a systematic review according to PRISMA guidelines and a literature search was performed on PubMed, Web of Science, Cochrane, Dental and Oral Science, Google scholar and Clinicaltrials.gov and included randomized controlled trials (RCTs) in English language only. We extracted all relevant data and conducted quality assessment using Cochrane risk of Bias tool (Version 2). We also performed quality assessment of the outcomes using GRADE. Meta-analysis for all the outcomes using conducted on RevMan version 5.3. RESULTS: The search identified 629 articles and three RCTs that met our inclusion criteria. Two were included in the meta-analysis. A total of 124 patients were assessed for bleeding during sinus surgery and there was a significant reduction in total blood loss in RTP (10-15°) when compared to horizontal position by 134 ml (Mean Difference (MD): -134.23; 95% confidence interval (CI): -184.13 to -67.27). RTP also had a significant reduction in bleeding per minute by 1.07 ml/min (MD: -1.07; 95%CI: (-1.69 to -0.44), while the Boezaart score was significantly lower in the RTP group (MD: -0.69; 95%CI: -0.94 to -0.43) when compared to horizontal position. CONCLUSION: Though with limited evidence RTP for ESS reduces total blood loss, blood loss per minute and improves visualization. Further studies are needed to assess the actual impact and optimal degree of head elevation.

Accuracy of lung ultrasound and chest X-rays in diagnosing acute pulmonary oedema in patients presenting with acute dyspnoea in emergency department.

To determine the diagnostic accuracy of lung ultrasound and chest X-ray in diagnosing Acute Pulmonary Oedema in patients presenting with acute dyspnoea in emergency department, a study was conducted at the emergency department of Shifa International Hospital, Islamabad, from July 31, 2018 to January 31, 2019. A total of 225 patients presenting with dyspnoea and satisfying the inclusion criteria were assessed through clinical examination, lung ultrasound (LUS) and chest X-ray. The results of chest X-ray and lung ultrasound were compared with clinical diagnosis. The study revealed sensitivity of chest X-ray and LUS (60.16% versus 91.05%), specificity (66.67% versus 91.18%), positive predictive value (68.52% versus 92.56%) and the negative predictive values (58.12% versus 89.42%) respectively. The present study revealed that the LUS has better accuracy than chest X-ray for diagnosis of acute pulmonary oedema.

Knowledge and attitudes of Pakistani intensive care unit nurses regarding oral care delivery to mechanically ventilated patients.

OBJECTIVE: To assess the knowledge and attitudes of intensive care unit nurses regarding oral care delivery to mechanically ventilated patients. METHODS: The cross-sectional study was conducted from January to July 2018 across four hospitals in the twin cities of Rawalpindi and Islamabad, Pakistan. Data was obtained from randomly selected nurses with the help of a 14-item self-reporting questionnaire. Data was analysed using SPSS 23. RESULTS: Out of 81 nurses, 76(93.8%) were female, and 47(58%) had experience up to 10 years. When the participants were asked if disease can be transmitted from other patients, 23(28.4%) said it was likely, 22(27.2%) said it was most likely and 16(19.8%) said they did not know. When asked if the disease can be transmitted from the aspiration of contaminated secretions from the oropharynx, 32(39.5%) nurses said it was likely, 31(38.3%) said it was not likely and 9(11.1%) did not know. Knowledge level was significantly associated with level of education (p<0.05). In terms of attitude, 54(66.7%) nurses disagreed that there were more important tasks to do for unstable patients than oral care, indicating a good attitude. CONCLUSIONS: Knowledge and attitude among the subjects were found to be good regarding oral care delivery to mechanically ventilated patients.

Knowledge and attitude of health workers regarding catheter-associated urinary tract infection in tertiary care hospitals, Pakistan.

OBJECTIVE: To assess the knowledge and attitude of house officers, residents, specialists and nurses regarding urinary catheterisation and catheter-associated urinary tract infection in tertiary care hospitals. METHODS: The cross-sectional study was conducted from February to July 2018 at 9 hospitals in Rawalpindi and Islamabad, Pakistan, and comprised doctors and nurses. Data were collected using an interviewer-administered questionnaire. Knowledge and attitude regarding urinary catheterisation were compared between doctors and nurses. Data was analysed using SPSS 23. RESULTS: Of the768 individuals approached, 485(63%) agreed to participate. Of them, 358(74%) were doctors and 127(26%) were nurses. Among the doctors, 261(73%) were house officers, 58(16%) residents and 39(11%) specialists. When asked if avoiding catheter kinking was an effective way to prevent CAUTI, 194(54.19%) doctors got it correct as opposed to 102(80.31%) nurses. When the doctors and nurses were asked if the catheter should be removed whenever it is convenient for healthcare personnel, 354(98.88) doctors and 112(88.18) nurses gave the correct answer (p=0.041). CONCLUSIONS: There was reasonable knowledge and attitude among nurses and doctors towards urinary catheterisation and preventive measures related to catheter-associated urinary tract infection.

Predictors of prolonged mechanical ventilation in patients admitted to intensive care units: A systematic review.

OBJECTIVE: Although intensive care medicine has evidenced a significant growth in recent decades, the number of patients requiring prolonged mechanical ventilation (PMV) still represents a considerable burden on health-care expenditure. The prediction of the need for PMV seems to provide a plausible cost-effective intervention. The objective of this study is to systematically review the predictors of the need for PMV of adult patients admitted to intensive care units (ICUs) due to medical and surgical needs. METHODS: We conducted a systematic search on three online databases (PubMed, Embase, and MEDLINE) till February 20, 2019. The search process employed several combinations of specific keywords and Boolean operators. RESULTS: A total of 15 articles were included in the study. Based on pooling the outcomes of odds ratios (ORs) and their respective 95% confidence intervals (CIs) as reported from logistic regression analyses, the pooled PMV incidence in 8220 patients (69.59% males) was 17.67 cases per 100 ICU admissions (95% CI 13.69-21.65). We could not conduct a meta-analysis of ORs and 95% CIs due to the significant heterogeneity observed between the included studies (P < 0.001, I2 = 97%). Pre-operative/preadmission kidney dysfunction and chronic obstructive pulmonary disease were the most significant independent predictors of the need for PMV. Following cardiac surgeries, repeated or emergency surgery, prolonged cardiopulmonary bypass time, and the need for blood transfusion were predictors of the need for PMV. CONCLUSION: Within the study limitations, several predictors were identified, which could be further investigated using a unified PMV definition. Successful prediction of the need for PMV would assist clinicians in identifying and adjusting a "weaning strategy" as well as improving patient care to reduce morbidity. Furthermore, establishing specialized weaning units could be warranted based on PMV incidence and prediction in the local settings.

Assessment of Academic Motivation Level of Undergraduate Medical Students of Azad Kashmir, Pakistan.

Objective To assess the academic motivation level of undergraduate medical students of Azad Kashmir, Pakistan. Methods A total of 378 Poonch Medical College (PMC) students were included in this cross-sectional study. The academic motivation scores of the study subjects were measured using a 28-item, five-point Academic Motivation Scale (AMS) questionnaire originally developed by Deci and Ryan (1985). The tool was checked for internal consistency and was interviewer-administered. Motivation level was quantitatively presented and compared across gender and medical years. Results The highest mean motivation score (4.04 ± 2.71) was observed for the statement "Because this will help me make a better choice regarding my career orientation." The following statements showed a statistically significantly higher mean motivation level in females as compared to males: "Because eventually, it will enable me to enter the job market in a field that I like" (p .008) and "for the pleasure that I experience when I read interesting authors" (p .001). But for the statement, "I once had good reasons for going to college; however, now I wonder whether I should continue," males showed a higher motivation level (p. 0.19). A statistically significant difference in mean motivation level was seen across medical years for the following statements: "For the intense feelings I experience when I am communicating my own ideas to others," "For the pleasure that I experience when I read interesting authors," "Because this will help me make a better choice regarding my career orientation," "For the satisfaction I feel when I am in the process of accomplishing difficult academic activities," and "Because I want to show myself that I can succeed in my studies" (p-value <.05). Conclusion This study analyzed mean motivation scores for all AMS questions. The study identified that the most common motivational factor for pursuing medical education was because the students thought this will help them make a better choice regarding their career orientation.

Bicarbonate Therapy for Critically Ill Patients with Metabolic Acidosis: A Systematic Review.

The management of acid-base disorders always calls for precise diagnosis and treatment of the underlying disease. Sometimes additional means are necessary to combat systemic acidity itself. In this systematic review, we discuss the concept and some specific aspects of bicarbonate therapy for critically ill patients with metabolic acidosis (i.e., patients with blood pH < 7.35). We conducted a systematic literature review of three online databases (PubMed, Google Scholar, and Cochrane) in November 2018 to validate usage of bicarbonate therapy for critically ill patients with metabolic acidosis. Twelve trials and case series were included in the final analysis, from which we assessed population, intervention, comparison, and outcome data. The current literature suggests limited benefit from bicarbonate therapy for patients with severe metabolic acidosis (pH < 7.1 and bicarbonate < 6 mEq/L). However, bicarbonate therapy does yield improvement in survival for patients with accompanying acute kidney injury.