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Too few trials or too few reported trials?
(Springer Science and Business Media LLC, 2018-10)
VITERI GARCIA, ANDRES ALEJANDRO
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Nicholas J. DeVito
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Ben Goldacre
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Vasodilators for women undergoing fertility treatment
(Wiley, 2018-10-12)
Rosa B Gutarra-Vilchez
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Xavier Bonfill Cosp
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Demián Glujovsky
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VITERI GARCIA, ANDRES ALEJANDRO
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Fernando M. Runzer-Colmenares
Background: The rate of successful pregnancies brought to term has barely increased since the first assisted reproductive technology (ART) technique became available. Research suggests that vasodilators may increase endometrial receptivity, thicken the endometrium, and favour uterine relaxation, all of which could improve the chances of successful assisted pregnancy. Objectives: To evaluate the effectiveness and safety of vasodilators in women undergoing fertility treatment. Search methods: We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, three other databases, and two clinical trial registries in April 2024, with no language or date restrictions. We also searched grey literature sources and checked the reference lists of relevant articles. Selection criteria: We included randomised controlled trials (RCTs) comparing vasodilators (alone or combined with other treatments) versus placebo or no treatment or versus other agents in women undergoing fertility treatment. Data collection and analysis: Two review authors independently selected studies, assessed risk of bias, extracted data, and calculated risk ratios (RRs). We combined study data using a fixed-effect model and assessed evidence certainty using the GRADE approach. Our primary outcomes were live birth or ongoing pregnancy and vasodilator side effects. Our secondary outcomes were clinical pregnancy, endometrial thickness, multiple gestation, miscarriage, and ectopic pregnancy. Main results: We included 45 studies with a total of 4404 women. The included studies compared a vasodilator versus a placebo or no treatment (40 RCTs), vasodilators plus another agent versus placebo or no treatment (3 RCTs) or versus oestrogens (3 RCTs). The mean length of follow-up was 15.45 weeks. Overall, the certainty of evidence was very low to moderate. The main limitations were imprecision (low number of events and participants) and risk of bias (lack of blinding in studies that reported subjective outcomes). Vasodilators versus placebo or no treatment. Vasodilators may result in little to no difference in rates of live birth or ongoing pregnancy compared with placebo or no treatment (RR 1.21, 95% CI 0.93 to 1.58; I² = 0%; 6 RCTs, 740 women; low-certainty evidence), but probably increase overall rates of side effects (RR 2.14, 95% CI 1.55 to 2.98; I² = 0%; 7 RCTs, 668 women; moderate-certainty evidence). The evidence suggests that 246 per 1000 women achieve live birth or ongoing pregnancy with a placebo or no treatment, and 229 to 389 per 1000 will do so using vasodilators. Vasodilators compared with placebo or no treatment likely increase rates of clinical pregnancy (RR 1.45, 95% CI 1.28 to 1.64; I² = 22%; 25 RCTs, 2506 women; moderate-certainty evidence). Vasodilators compared with placebo or no treatment probably have little or no effect on rates of multiple gestation or birth (RR 1.37, 95% CI 0.73 to 2.55; I² = 0%; 7 RCTs, 763 women; moderate-certainty evidence), miscarriage (RR 1.01, 95% CI 0.59 to 1.74; I² = 0%; 8 RCTs; 829 women; moderate-certainty evidence), and ectopic pregnancy (RR 1.25, 95% CI 0.34 to 4.59; I² = 0%; 4 RCTs, 543 women; moderate-certainty evidence). Most studies found a beneficial effect of vasodilators for endometrial thickness, but the reported effect estimates varied (I² = 93%), from a mean difference of 0.47 mm higher (95% CI 0.90 mm lower to 1. 84 mm higher) to 1.94 mm higher (95% CI 1.37 higher to 2.51 mm higher), and the evidence was very uncertain. Hence, we are unsure how to interpret these results. Vasodilators versus oestrogens. Vasodilators compared with oestrogens may have little or no effect on rates of live birth or ongoing pregnancy (RR 0.83, 95% CI 0.30 to 1.33; 1 RCT, 44 women, low-certainty evidence). The evidence is very uncertain regarding the effect of sildenafil compared with oestrogens on clinical pregnancy rates (RR 0.99, 95% CI 0.71 to 1.38; I² = 59%; 3 RCTs, 262 women; very low-certainty evidence), endometrial thickness (RR 1.90, 95 CI 1.15 to 3.13; 1 RCT, 120 women; very low-certainty evidence) and miscarriage rates (RR 0.50, 95% CI 0.05 to 5.12; 1 RCT, 44 women; very low-certainty evidence). Authors' conclusions: Among women undergoing fertility treatment, there may be little or no difference in the rate of live birth or ongoing pregnancy in those who receive vasodilators compared with those who receive a placebo or no treatment, and compared with those who receive oestrogens. Compared with placebo or no treatment, vasodilators likely increase rates of clinical pregnancy, but probably also increase overall rates of side effects. The evidence on clinical pregnancy with vasodilators versus oestrogens is very uncertain, and we found no evidence on overall side effects for the comparison of vasodilators versus oestrogens. We are unsure about the effect of vasodilators versus placebo or no treatment and versus oestrogens on endometrial thickness. Vasodilators versus placebo or no treatment probably have little or no effect on multiple gestation or birth, miscarriage, and ectopic pregnancy. Future studies should be adequately randomised and powered to ensure a more accurate evaluation of each treatment, with live births as a primary outcome.
Scopus© Citations 2
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Effects of Exposure to Cola-Based Soft Drink on Bleaching Effectiveness and Tooth Sensitivity of In-Office Bleaching: A Blind Clinical Trial
(Informa UK Limited, 2019-12)
Viviane Hass
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Stephanye Tavares Carvalhal
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Suellen Nogueira Linares Lima
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VITERI GARCIA, ANDRES ALEJANDRO
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Etevaldo Matos Maia Filho
Scopus© Citations 13
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Effect of mouthwashes on the integrity of composite resin and resin modified glass ionomer: In vitro study
(Medicina Oral, S.L., 2019)
A. Armas-Vega
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P Casanova-Obando
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MF Taboada-Alvear
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JE Aldas-Ramirez
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N Montero-Oleas
Scopus© Citations 11
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GRADE-Based Recommendations for Surgical Repair of Nonruptured Abdominal Aortic Aneurysm
(SAGE Publications, 2019-04-08)
Margarita Posso
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M. Jesús Quintana
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Sergi Bellmunt
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Laura Martínez García
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José R. Escudero
<jats:p> The objective of this study was to provide evidence-based recommendations for endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for patients with a nonruptured abdominal aortic aneurysm (AAA). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Both low- and high surgical risk patients treated with EVAR showed decreased 30-day mortality, but the low-risk group had no differences in 4-year mortality. Compared with friendly anatomy, patients with hostile anatomy had an increased risk of type I endoleak. Young patients may prefer OSR. Endovascular aneurysm repair was not cost-effective in Europe. Four conditional recommendations were formulated: (1) OSR for low-risk patients up to 80 years old, (2) EVAR for low-risk patients older than 80 years, (3) EVAR for high-risk patients as long as is anatomically feasible, and (4) OSR in patients in whom it is not anatomically feasible to perform EVAR. Based on GRADE criteria, either OSR or EVAR can be suggested to patients with nonruptured AAA taking into account their surgical risk, hostile anatomy, and age. Given the weakness of the recommendations, personal preferences are determinant. </jats:p>
Scopus© Citations 6
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Selective removal compared to complete removal for deep carious lesions
(Medwave Estudios Limitada, 2020-01-31)
Francisca Verdugo-Paiva
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Paula Zambrano-Achig
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SIMANCAS RACINES, DANIEL ALEJANDRO
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VITERI GARCIA, ANDRES ALEJANDRO
Scopus© Citations 6
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Knowledge translation: Cochrane, Wikipedia and students’ initiatives
(Medwave Estudios Limitada, 2020-03-31)
Nahir Aucar
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VITERI GARCIA, ANDRES ALEJANDRO
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Juan Víctor Ariel Franco
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SIMANCAS RACINES, DANIEL ALEJANDRO
Scopus© Citations 2
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Therapeutic use of cannabis and cannabinoids: an evidence mapping and appraisal of systematic reviews
(Springer Science and Business Media LLC, 2020-01-15)
Nadia Montero-Oleas
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Ingrid Arevalo-Rodriguez
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Solange Nuñez-González
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VITERI GARCIA, ANDRES ALEJANDRO
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SIMANCAS RACINES, DANIEL ALEJANDRO
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Although cannabis and cannabinoids are widely used with therapeutic purposes, their claimed efficacy is highly controversial. For this reason, medical cannabis use is a broad field of research that is rapidly expanding. Our objectives are to identify, characterize, appraise, and organize the current available evidence surrounding therapeutic use of cannabis and cannabinoids, using evidence maps.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We searched PubMed, EMBASE, The Cochrane Library and CINAHL, to identify systematic reviews (SRs) published from their inception up to December 2017. Two authors assessed eligibility and extracted data independently. We assessed methodological quality of the included SRs using the AMSTAR tool. To illustrate the extent of use of medical cannabis, we organized the results according to identified PICO questions using bubble plots corresponding to different clinical scenarios.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 44 SRs published between 2001 and 2017 were included in this evidence mapping with data from 158 individual studies. We extracted 96 PICO questions in the following medical conditions: multiple sclerosis, movement disorders (e.g. Tourette Syndrome, Parkinson Disease), psychiatry conditions, Alzheimer disease, epilepsy, acute and chronic pain, cancer, neuropathic pain, symptoms related to cancer (e.g. emesis and anorexia related with chemotherapy), rheumatic disorders, HIV-related symptoms, glaucoma, and COPD. The evidence about these conditions is heterogeneous regarding the conclusions and the quality of the individual primary studies. The quality of the SRs was moderate to high according to AMSTAR scores.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Evidence on medical uses of cannabis is broad. However, due to methodological limitations, conclusions were weak in most of the assessed comparisons. Evidence mapping methodology is useful to perform an overview of available research, since it is possible to systematically describe the extent and distribution of evidence, and to organize scattered data.</jats:p> </jats:sec>
Scopus© Citations 64
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Prevalence and incidence of dental caries associated with the effect of tooth brushing and fluoride varnishing in scholars at Galapagos Islands, Ecuador: Protocol of the EESO-Gal study
(Medwave Estudios Limitada, 2020-07-31)
VITERI GARCIA, ANDRES ALEJANDRO
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Parise Vasco Juan Marcos
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María José Cabrera-Dávila
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María Christel Zambrano-Bonilla
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Ingrid Ordonez-Romero
Scopus© Citations 8
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Drug treatments for covid-19: living systematic review and network meta-analysis
(BMJ, 2020-07-30)
Reed AC Siemieniuk
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Jessica J Bartoszko
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Dena Zeraatkar
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Elena Kum
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Anila Qasim
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>To compare the effects of treatments for coronavirus disease 2019 (covid-19).</jats:p> </jats:sec> <jats:sec> <jats:title>Design</jats:title> <jats:p>Living systematic review and network meta-analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Data sources</jats:title> <jats:p>WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2021 and six additional Chinese databases up to 20 February 2021. Studies identified as of 1 December 2021 were included in the analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Study selection</jats:title> <jats:p>Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>463 trials enrolling 166 581 patients were included; 267 (57.7%) trials and 89 814 (53.9%) patients are new from the previous iteration; 265 (57.2%) trials evaluating treatments with at least 100 patients or 20 events met the threshold for inclusion in the analyses. Compared with standard care, three drugs reduced mortality in patients with mostly severe disease with at least moderate certainty: systemic corticosteroids (risk difference 23 fewer per 1000 patients, 95% credible interval 40 fewer to 7 fewer, moderate certainty), interleukin-6 receptor antagonists when given with corticosteroids (23 fewer per 1000, 36 fewer to 7 fewer, moderate certainty), and Janus kinase inhibitors (44 fewer per 1000, 64 fewer to 20 fewer, high certainty). Compared with standard care, two drugs probably reduce hospital admission in patients with non-severe disease: nirmatrelvir/ritonavir (36 fewer per 1000, 41 fewer to 26 fewer, moderate certainty) and molnupiravir (19 fewer per 1000, 29 fewer to 5 fewer, moderate certainty). Remdesivir may reduce hospital admission (29 fewer per 1000, 40 fewer to 6 fewer, low certainty). Only molnupiravir had at least moderate quality evidence of a reduction in time to symptom resolution (3.3 days fewer, 4.8 fewer to 1.6 fewer, moderate certainty); several others showed a possible benefit. Several drugs may increase the risk of adverse effects leading to drug discontinuation; hydroxychloroquine probably increases the risk of mechanical ventilation (moderate certainty).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Corticosteroids, interleukin-6 receptor antagonists, and Janus kinase inhibitors probably reduce mortality and confer other important benefits in patients with severe covid-19. Molnupiravir and nirmatrelvir/ritonavir probably reduce admission to hospital in patients with non-severe covid-19.</jats:p> </jats:sec> <jats:sec> <jats:title>Systematic review registration</jats:title> <jats:p>This review was not registered. The protocol is publicly available in the supplementary material.</jats:p> </jats:sec> <jats:sec> <jats:title>Readers’ note</jats:title> <jats:p> This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This is the fifth version of the original article published on 30 July 2020 ( <jats:italic>BMJ</jats:italic> 2020;370:m2980), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity. </jats:p> </jats:sec>
Scopus© Citations 679

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