ABSTRACT
Background: the co-administration of ketamine and propofol [CoKP] is thought to maximize the beneficial profile of each medication, while minimizing the respective adverse effects of each medication
Objective: our objective was to compare adverse events between ketamine monotherapy [KM] and CoKP for procedural sedation and analgesia [PSA] in a pediatric emergency department [ED]
Methods: this was a prospective, randomized, single-blinded, controlled trial of KM vs. CoKP in patients between 3 and 21 years of age. The attending physician administered either ketamine 1 mg/kg i.v. or ketamine 0.5 mg/kg and propofol 0.5 mg/kg i.v. The physician could administer up to three additional doses of ketamine [0.5 mg/kg/dose] or ketamine/propofol [0.25 mg/kg/dose of each]. Adverse events [e.g., respiratory events, cardiovascular events, unpleasant emergence reactions] were recorded. Secondary outcomes included efficacy, recovery time, and satisfaction scores
Results: thirty-two patients were randomized to KM and 29 patients were randomized to CoKP. There was no difference in adverse events or type of adverse event, except nausea was more common in the KM group. Efficacy of PSA was higher in the KM group [99%] compared to the CoKP group [90%]. Median recovery time was the same
Conclusions: we found no significant differences in adverse events between the KM and CoKP groups. While CoKP is a reasonable choice for pediatric PSA, our study did not demonstrate an advantage of this combination over KM
ABSTRACT
Purpose: to assess whether Helicobacter pylori [H. pylori] eradication therapy benefits patients with functional dyspepsia [FD]
Methods: randomized controlled trials [RCTs] examining the efficacy and safety of H. pylori eradication therapy for patients with functional dyspepsia published in English [till November 2016] were recognized by searching PubMed, EMBASE, and The Cochrane Library. Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed as a pooled risk ratio [RR] or a standard mean difference [SMD]. All data were analyzed with Review Manager 5.3 and Stata 12.0
Results: this analysis involved 15 RCTs with a total of 3567 patients with FD. These studies were used to assess the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR was 1.26 [95%CI: 1.10-1.40, P < 0.0001]. H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at >/= 1 year [RR = 1.27; 95%CI: 1.13-1.41, P < 0.0001] but not during short-term follow-up at < 1 year [RR = 1.26; 95%CI: 0.83-1.92, P = 0.27]. Four studies showed no benefit of H. pylori eradication therapy on quality of life with an SMD of -0.01 [95%CI: -0.09 to 0.07, P = 0.74]. Four studies demonstrated that H. pylori eradication therapy reduced the development of peptic ulcer disease compared to no eradication therapy [RR = 0.34; 95%CI: 0.17-0.67, P = 0.002]. Three studies showed that H. pylori eradication therapy increased the likelihood of treatment-related side effects compared to no eradication therapy [RR = 1.87; 95%CI: 1.08-3.47, P = 0.02]. Ten studies demonstrated that patients who received H. pylori eradication therapy were more likely to obtain histologic resolution of chronic gastritis compared to those who did not receive eradication therapy [RR = 7.05; 95%CI: 3.59-13.74, P < 0.00001]
Conclusion: the decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment