Research Outputs
Comparative efficacy and safety of Clozapine vs. Quetiapine in schizophrenia and related disorders: An updated systematic review
Schizophrenia poses a significant burden on global health systems and societies. Atypical antipsychotics like clozapine and quetiapine have been shown to be effective in schizophrenia treatment. The most recent head-to-head systematic review comparing clozapine and quetiapine was conducted over a decade ago, and its findings remained inconclusive due to the limited number of high-quality, adequately powered trials. An updated synthesis is therefore warranted. A systematic search was carried out in the Cochrane Schizophrenia Group's Study-Based Register of Trials to identify all double-blind, randomized controlled trials comparing clozapine with quetiapine in schizophrenia and related disorders in terms of efficacy and safety. Risk ratios were calculated and mean differences for binary and continuous outcomes respectively, were assessed using the random effects model. Risk of bias was assessed for included studies and a Summary of findings table created using the GRADE approach. One short-term study involving 63 adults with first-episode schizophrenia fulfill the inclusion criteria, where the overall risk of bias was unclear due to missing reports. No significant differences were observed in global state, relapse, metabolic effects, and general mental state. Clozapine was associated with more somnolence, hypersalivation, and constipation. Other adverse effects and early discontinuation did not significantly differ. Clozapine and quetiapine appear to have similar efficacy in schizophrenia treatment with distinct adverse effect profiles. More high-quality RCTs are needed to confirm efficacy equivalence and clarify safety differences between clozapine and quetiapine, providing the robust evidence required to support safer and more appropriate prescribing practices.
Mortality in critically III elderly individuals receiving mechanical ventilation
BACKGROUND: Previous studies that evaluated mortality in elderly subjects who received mechanical ventilation had conflicting results. The aim of this systematic review was to evaluate the effects of age on mortality. METHODS: A number of medical literature databases and the references listed (from 1974 to May 2015) were searched for studies that compared 2 different age groups. The primary outcome was mortality in subjects ages > 65 y. The severity scores, ICU and hospital lengths of stay, and the presence of ventilator-associated pneumonia were secondary outcomes. Finally, mortality in the subjects with ARDS and of cutoff ages 70 and 80 y was assessed by subgroup analysis. Evidence quality was assessed by the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria score. RESULTS: Of the 5,182 articles identified, 21 were included. Subjects ages > 65 y had higher mortalities (odds ratio [OR] 1.80, 95% CI 1.56 –2.08; I2 _ 71%). APACHE (Acute Physiology and Chronic Health Evaluation) II revealed intergroup differences (mean difference 3.07, 95% CI 2.52–3.61; I2 _ 0%), whereas neither the ICU nor hospital length of stay (mean difference 1.27, 95% CI _0.82 to 3.36, I2 _ 82%, and mean difference 1.29, 95% CI _0.71 to 3.29, I2 _ 0%, respectively) nor the groups in the 2 studies that assessed ventilator-associated pneumonia exhibited any difference. Subgroup analysis revealed a higher mortality in the older subjects, in the subjects with ARDS (OR 1.76, 95% CI 1.30 –2.36; I2 _ 0%) and in the subjects ages 70 and 80 y (OR 1.78, 95% CI 1.51–2.10, I2 _ 71%; and OR 1.96, 95% CI 1.81–2.13, I2 _ 0%, respectively). The quality of associated evidence was low or very low. CONCLUSIONS: Although low-quality evidence was available, we conclude that age is associated with a greater mortality in critical subjects who were receiving mechanical ventilation.
Treatments for non-small cell lung cancer: A systematic quality assessment of clinical practice guidelines
Aim: To evaluate the methodological quality of clinical practice guidelines (CPGs) on treatments for non-small cell lung cancer (NSCLC). Methods: We searched MEDLINE, CPG developer websites, lung cancer societies, and oncology organizations to identify CPGs providing recommendations on treatments for NSCLC. The methodological quality for each CPG was determined independently by three appraisers using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument. Results: Twenty-two CPGs met the eligibility criteria. The median scores per AGREE II domain were: scope and purpose 90.7% (64.8–100%), stakeholder involvement 76.9% (27.8–96.3%); rigor of development 80.9% (27.1–92.4%); clarity of presentation 89.8% (50–100%); applicability 46.5% (12.5–87.5%); and editorial independence 91.7% (27.8–100%). Most of the CPGs (54.5%) were rated as “recommended with modifcations” for clinical use. Conclusions: Overall, the methodological quality of CPGs proving recommendations on the management of NSCLC is moderate, but there is still room for improvement in their development and implementation.
Clozapine versus quetiapine for people with schizophrenia
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the clinical effects and safety of clozapine compared with quetiapine in the treatment of schizophrenia and related disorders.
Drugs for preventing lung cancer in healthy people
Background: This is the second update of this Cochrane Review. Some studies have suggested a protective effect of antioxidant nutrients and higher dietary levels of fruits and vegetables on lung cancer. Objectives: To determine whether vitamins and minerals and other potential agents, alone or in combination, reduce lung cancer incidence and lung cancer mortality in healthy populations. Search methods: We searched CENTRAL, MEDLINE and Embase from 1974 to May 2019 and screened references included in published studies and reviews. Selection criteria: We included randomised controlled trials (RCTs) comparing vitamins or mineral supplements with placebo, administered to healthy people with the aim of preventing lung cancer.
Use of Antibiotics in Dental Implant Surgery: A Decision Based on Evidence from Systematic Review
Todavía se mantiene el integorrante acerca de si las infecciones postoperatorias y el fracaso de los implantes se pueden reducir con el uso de antibióticos. Especialmente, cuando su uso rutinario puede causar efectos adversos y puede contribuir al desarrollo de bacterias resistentes a los antibióticos. Por otra parte, no hay consenso en cuanto al régimen de dosificación apropiado de antibióticos para prevenir la infección bacteriana en los implantes dentales. Para determinar la efectividad de los diferentes regímenes de antibióticos destinados a prevenir la infección temprana después de la colocación del implante, se llevó a cabo una revisión sistemática de todos los estudios pertinentes sobre el uso de antibióticos para la cirugía del implante dental. También fueron analizados grupos de pacientes en los que se colocaron implantes sin el uso de antibióticos. Los resultados iniciales demostraron la existencia de infección postoperatoria y el fracaso del implante debido a la infección. De 164 artículos revisados, 11 cumplieron con los criterios de selección, representando un total de 9.472 implantes colocados. Estudios asociados con el uso de antibióticos postoperatorios mostraron una menor incidencia de infección temprana (regímenes postoperatorios 0%, regímenes pre y postoperatoria 0,22% y 0,53%, a largo y corto plazo, respectivamente (P= 0,275)). En cuanto al fracaso debido a la infección, no se encontraron diferencias entre los grupos (p= 0,249). Se observó una tendencia a favor del uso de antibióticos para prevenir infecciones postoperatorias tempranas. Nuevos estudios deben llevarse a cabo con el fin de proporcionar directrices clínicas, basadas en la evidencia, para el uso de antibióticos en la colocación del implante dental.