Cochrane Db Syst Rev
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Bronchiolitis is a serious, potentially life-threatening respiratory illness commonly affecting young babies. It is most often caused by Respiratory Syncytial Virus (RSV). The diagnosis is usually made on clinical grounds (especially tachypnoea and wheezing in a child less than two years of age). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia. Despite this, they are used at rates of 34 to 99% in uncomplicated cases. ⋯ This review found no evidence to support the use of antibiotics for bronchiolitis. This results needs to be treated with caution given only one RCT justified inclusion. It is unlikely that simple RCTs of antibiotics against placebo for bronchiolitis will be undertaken in future. Research to identify a possible small subgroup of patients presenting with bronchiolitis-like symptoms who may benefit from antibiotics may be justified. Otherwise, research may be better focussed on determining the reasons for clinicians to use antibiotics so readily for bronchiolitis, and ways of reducing their anxiety, and therefore their use of antibiotics for bronchiolitis.
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Cochrane Db Syst Rev · Jan 2007
ReviewProbiotics for non-alcoholic fatty liver disease and/or steatohepatitis.
Non-alcoholic fatty liver disease comprises a spectrum of diseases ranging from simple steatosis to non-alcoholic steatohepatitis, fibrosis, and cirrhosis. Probiotics have been proposed as a treatment option because of their modulating effect on the gut flora that could influence the gut-liver axis. ⋯ The lack of randomised clinical trials makes it impossible to support or refute probiotics for patients with non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.
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Cochrane Db Syst Rev · Jan 2007
ReviewH1-antihistamines for the treatment of anaphylaxis with and without shock.
Anaphylaxis is an acute systemic allergic reaction, which can be life-threatening. H1-antihistamines are commonly used as an adjuvant therapy in the treatment of anaphylaxis. ⋯ Based on this review, we are unable to make any recommendations for clinical practice. Randomized controlled trials are needed, although these are likely to prove challenging to design and execute.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisInhaled corticosteroids during acute bronchiolitis in the prevention of post-bronchiolitic wheezing.
Acute bronchiolitis in infants and young children is associated with long-term airway disease also known as post-bronchiolitic wheezing. Two major hypotheses have been proposed to explain the association between bronchiolitis and PBW. The first hypothesis considers bronchiolitis to be the first manifestation of recurrent wheezing in infants and children who are susceptible to obstructive airway disease. The second hypothesis suggests that the infection and concomitant inflammatory reaction in the acute phase leads to airway epithelium injury resulting in long-term obstructive airway disease. In line with the latter hypothesis, corticosteroids may have a beneficial effect on the prevention of post-bronchiolitic wheezing. ⋯ This review does not demonstrate an effect of inhaled corticosteroids given during the acute phase of bronchiolitis in the prevention of post-bronchiolitic wheezing. The small number of included participants and the inability to pool all clinical outcomes precludes us from making strong recommendations.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisAntioxidant supplements for non-alcoholic fatty liver disease and/or steatohepatitis.
Non-alcoholic fatty liver disease (NAFLD) is characterised by fatty deposition in the hepatocytes of patients with minimal or no alcohol intake and without other known cause. NAFLD includes a wide spectrum of histologic abnormalities ranging from hepatic steatosis to non-alcoholic steatohepatitis (NASH), or even cirrhosis. Antioxidant supplements, therefore, could potentially protect cellular structures against oxidative stress and the resulting lipid peroxidation. ⋯ There is insufficient data to either support or refute the use of antioxidant supplements for patients with NAFLD. It may be advisable to carry out large prospective randomised clinical trials on this topic.