Articles: treatment.
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J Neurosurg Anesthesiol · Feb 2025
Safety and Efficacy of Neuroprotective Agents as Adjunctive Therapies for Reperfusion in the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
There is still no clear evidence of the efficacy of the application of neuroprotective agents (NPAs) for acute ischemic stroke (AIS) patients receiving reperfusion therapies. This meta-analysis aimed to determine the effects of NPAs versus placebo on functional and safety outcomes as an adjunctive treatment to intravenous thrombolysis (IVT) or endovascular therapy (EVT) in AIS patients. The primary outcome was neurological functional independence, as evaluated by the proportion of patients whose modified Rankin Scale scores were 0 to 2 at 90 days after treatment. ⋯ The application of NPAs was associated with greater odds of functional independence (odds ratio [OR]: 1.28; 95% CI: 1.12 to 1.46; P < 0.001; I2 = 0.0%) within 90 days. However, subgroup analysis of reperfusion therapy type (IVT, EVT, or both) revealed that only the EVT subgroup showed a significant association between NPAs or placebo and functional independence at 90 days (EVT group, OR: 1.43; 95% CI: 1.05 to 1.94; P = 0.022; I2 = 0.0%; IVT group, OR: 1.51; 95% CI: 0.93 to 2.46; P = 0.099; I2 = 39.8%; IVT plus EVT group, OR: 1.17; 95% CI: 0.94 to 1.45; P = 0.157; I2 = 16.0%). This meta-analysis revealed that NPAs could increase the possibility of AIS patients undergoing reperfusion therapies achieving functional independence within 90 days of onset; however, with the limited number of studies on each drug, further evidence is still needed to demonstrate the efficacy of each individual agent as an adjunctive therapy for different means of reperfusion.
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Treatment programs designed to enhance recovery after caesarean delivery include multimodal analgesia to ensure optimal analgesia while reducing exposure to systemic opioids. Evidence for the effectiveness of continuous wound infiltration with local anaesthetic after unplanned caesarean delivery is needed. ⋯ We failed to show that continuous ropivacaine wound infiltration was noninferior to epidural morphine in providing analgesia after unplanned caesarean delivery. Because of a significant rate of technical failures, continuous wound infiltration should only be considered when neuraxial morphine is contraindicated.
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The treatment of acute uncomplicated diverticulitis (UD) with antibiotics remains common despite substantial evidence supporting the non-inferiority of nonantibiotic outpatient management. In the past 15 years, there have been two landmark randomized-controlled clinical trials, follow-up studies, and numerous retrospective studies that have supported the non-inferiority of nonantibiotic management of UD. Multiple medical societies including the American Gastroenterological Association and the American College of Physicians recommend using antibiotics selectively rather than routinely in UD. We aim to raise physician awareness of the latest guideline recommendations through our article, potentially improving antibiotic stewardship and reducing related healthcare costs.