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BACKGROUND: Eradication of Helicobacter pylori infection is challenging. We aimed to determine the optimal first-line H. pylori treatments at global and regional levels. METHODS: We searched Embase, PubMed, Cochrane CENTRAL, Web of Science, Scopus, WHO ICTRP, ClinicalTrials.gov, and ISRCTN registry, for randomized controlled trials published during 2011-2020. Utilizing a network meta-analysis in a Bayesian framework, success rates of 23 regimens were compared. The effect size was standardized risk ratio (RR) with 95% credible interval (CrI). Pooled eradication rate (ER) with 95% CrI was also reported for top combinations. The reference regimen was 7-day clarithromycin-based triple therapy. RESULTS: This review identified 121 trials comprising 34,759 participants. Globally, 14-day levofloxacin-based sequential therapy was the most efficient (RR: 1.43; 95% CrI, 1.26-1.59) with low certainty of evidence, followed by modified bismuth-containing quadruple therapy (proton pump inhibitor+bismuth compounds+clarithromycin+amoxicillin) for 10 days (RR: 1.35; 95% CrI, 1.22-1.48) and 14 days (RR: 1.27; 95% CrI, 1.12-1.42), and 14-day hybrid therapy (RR: 1.27; 95% CrI, 1.19-1.36). The corresponding ERs were 98.7% (95% CrI, 86.9-100.0), 93.2% (95% CrI, 84.2-100.0), 87.6% (95% CrI, 82.1-93.8), and 87.6% (95% CrI, 77.3-98.0), respectively. Continentally, the most effective combinations were: 10-day clarithromycin-based sequential therapy [(RR: 1.21; 95% CrI, 1.02-1.42), (ER: 89.5%, 95% CrI, 75.5-100.0)] for Africa, 14-day levofloxacin-based sequential therapy [(RR: 1.41; 95%CrI, 1.27-1.58), (ER: 98.7%, 95% CrI, 88.9-100.0)] for Asia, and 14-day clarithromycin-based triple therapy [(RR: 1.58; 95% CrI, 1.25-2.04), (ER: 94.8%; 95% CrI, 75.0-100.0)] for Europe. For Northern America, no sufficient data were found for network meta-analysis. In South America, none of the combinations were superior to the reference regimen. CONCLUSION: Although results of this network meta-analysis revealed optimal combinations for empiric therapy, the treatment preference would be based on the local pattern of antibacterial resistance, when the necessary information exists.
Assuntos
Infecções por Helicobacter , Helicobacter pylori , Amoxicilina , Antibacterianos/uso terapêutico , Teorema de Bayes , Claritromicina/uso terapêutico , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Humanos , Metanálise em Rede , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
Buildings can have varying heating and cooling set points to take advantage of favorable environmental conditions and low time-of-use rates. To optimize temperature scheduling and energy planning, building energy managements need reliable building thermal models and efficient estimation methods to accurately estimate space heating and cooling supply (or power demand) over a certain period (e.g., 24 h). This accurate estimation capability is vital for performing temperature control strategies. Therefore, the present study used resistor-capacitor (RC) models and unscented Kalman filter (UKF) integrated with nonlinear least square (NLS) to develop a method for precisely estimating heating and cooling supply to control zone temperature. To evaluate the capability of the method, two case studies are conducted. The first case study involves a made-up simple RC model, while the second case study uses monitored data from a single detached house in different scenarios. The capability of the method is evaluated by applying the estimated heating and cooling supply to the RC thermal model and simulated zone temperatures. Then, assess whether the controlled zone's temperature meets the expected temperature or not. The performance evaluation shows that the developed method can accurately estimate the heating and cooling supply, validating its applicability to temperature control objectives. Practical Application: This research provides a valuable contribution to modern building industry professionals by offering a precise method for estimating heating and cooling supply for temperature control in buildings. By equipping practitioners with an effective tool to optimize energy management, this study addresses a critical aspect of building performance. The practical case studies demonstrate the versatility and applicability of this approach in real-world scenarios. In a world increasingly prioritizing energy efficiency and sustainability, this research empowers professionals to make informed decisions, enhance building performance, and contribute to a greener and more sustainable future, all within a concise and actionable framework.
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BACKGROUND: Irritable bowel syndrome (IBS) is a common and potential disabling functional gastrointestinal disorder. Studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Existing systematic reviews have addressed only the levels of anxiety or depression in patients with IBS. AIM: To investigate systematically the prevalence of anxiety or depression in IBS patients METHODS: A literature search was conducted using the related keywords from the bibliographic databases of Embase, PubMed, Scopus, Web of Science and POPLINE published until 1 January 2019 with no language restriction. Studies reporting the prevalence of anxiety/depressive symptoms/disorders in adult (≥15 years) IBS patients were evaluated. The pooled prevalence, odds ratio (OR) and 95% CI were calculated using stata software. RESULTS: A total of 14 926 articles were initially screened, and finally 73 papers were included. The prevalence rates of anxiety symptoms and disorders in IBS patients were 39.1% (95% CI: 32.4-45.8) and 23% (95% CI: 17.2-28.8) respectively. The ORs for anxiety symptoms and disorders in IBS patients compared with healthy subjects were 3.11 (95% CI: 2.43-3.98) and 2.52 (95% CI: 1.99-3.20) respectively. The prevalence estimates of depressive symptoms and disorders in IBS patients were 28.8% (95% CI: 23.6-34) and 23.3% (95% CI: 17.2-29.4) respectively. The ORs for depressive symptoms and disorders in IBS patients compared to healthy subjects were 3.04 (95% CI: 2.37-3.91) and 2.72 (95% CI: 2.45-3.02) respectively. CONCLUSION: Patients with IBS have a three-fold increased odds of either anxiety or depression, compared to healthy subjects.
Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Síndrome do Intestino Irritável/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/complicações , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Depressão/complicações , Transtorno Depressivo/complicações , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Síndrome do Intestino Irritável/complicações , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Adulto JovemRESUMO
A systematic review and meta-analysis was conducted on the prevalence of osteoporosis in the Eastern Mediterranean Region. The overall pooled prevalence of osteoporosis was 24.4%. The prevalence has increased significantly over the recent years. The highest pooled prevalence was in Saudi Arabia (32.7%), and the lowest was in Kuwait (15.1%). PURPOSE: To conduct a systematic review and meta-analysis on the prevalence of osteoporosis in the Eastern Mediterranean Region (EMR), as defined by the World Health Organization. METHODS: We included all observational studies reporting the prevalence of osteoporosis among general population. We searched literatures from the databases of PubMed, Scopus, Web of Science, and Index Medicus for the EMR published between January 2000 and December 2017 with no restriction of language. Two reviewers independently contributed in study selection and data extraction. STATA software was used for analyzing the collected data. RESULTS: A total of 1692 citations were retrieved. After excluding the irrelevant articles, 36 eligible studies were included. The overall pooled prevalence rate of osteoporosis in the EMR on 31,593 participants was 24.4% (95% confidence interval [CI], 20.4-28.4). Based on femoral densitometry, the prevalence of osteoporosis was 16.8% (95% CI, 9.5-24.2), and based on spinal densitometry, it was 24.3% (95% CI, 19.4-29.2). The pooled prevalence in males was 20.5% (95% CI, 10.5-30.5), compared with 24.4% (95% CI, 20.2-28.6) in females. The prevalence rate was significantly higher in 2007-2015 (32.7%; 95% CI, 25.1-40.3) than in 2000-2006 (19.8%; 95% CI, 12.5-27). CONCLUSIONS: Our findings indicate a considerable prevalence of osteoporosis among the people of the EMR. The prevalence has increased during recent years, showing that osteoporosis is becoming a critical health problem in this region. Prevention and control measures need to be implemented by health service authorities.
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Osteoporose/epidemiologia , Feminino , Humanos , Kuweit/epidemiologia , Masculino , Região do Mediterrâneo/epidemiologia , Estudos Observacionais como Assunto , Prevalência , Arábia Saudita/epidemiologiaRESUMO
BACKGROUND: Striking prevalence of Helicobacter pylori infection has been convoluted with considerable resistance to various antibiotics worldwide. Although many eradication regimens have been introduced as the first-line therapies against H pylori, lack of appropriate multiple comparison studies makes hard to implement such results to the clinical practice. This project attempts to utilize a comprehensive network meta-analysis to pool the results of clinical trial comparing various first-line eradication therapies simultaneously in different continents. METHODS: We will include all randomized controlled trials assessing the first-line regimens for treatment of H pylori published in last 10 years. We will search the databases of PubMed, EMBASE, Scopus, Web of Science and Cochrane Central Register of Controlled Trials, International Standard Randomised Controlled Trial Number registry, World Health Organisation International Clinical Trials Registry Platform, and ClinicalTrials.gov for randomized controlled trials published since January 2009 without language limitation. The primary and secondary outcomes will be H pylori eradication rate and adverse events, respectively. Subgroup analyses will be conducted for different continents. Two reviewers will independently contribute in study selection and data extraction. For evaluating quality of studies, Cochrane Collaboration tool score will be used. We will conduct network meta-analysis for treatment comparisons using STATA software version 13. RESULTS: These findings will be submitted to a peer-reviewed journal for publication. CONCLUSION: Our results will provide the guidance for clinicians in deferent regions to select the best possible therapeutic regimen for treatment of H pylori infected patients. REGISTRATION NUMBER: This systematic review and network meta-analysis has been registered in the PROSPERO International Prospective Register of Systematic Reviews, with registration number CRD42017077061.