ABSTRACT
Ivermectin is an antiparasitic used in human medicine and veterinary medicine. Moreover, its use intensified in Brazil during the pandemic as an early treatment for COVID-19. Bearing in mind that drugs enter the environment via different pathways, ecotoxicological studies are essential to understanding the effects of these compounds on biota. The aim of this study was to perform a bibliometric analysis of the ecotoxicological effects of ivermectin. Searches were conducted using different English, Portuguese and Spanish descriptors in different databases within the 2010-2021 time window. The papers found were subjected to inclusion and exclusion criteria and subsequently studied. Fourteen publications, with records going all the way back to 2012, were assessed. According to their type, most papers were classified as original studies and revealed that the predominant test organisms were flies. In terms of subject areas, the studies fell within the fields of Environmental Science, Toxicology, Molecular Biochemistry, Pharmacology and Pharmacy and Multidisciplinary Chemistry. In all of the papers studied, there was a case of association of researchers from different countries as well as a predominance of English manuscripts. Word cloud analysis based on the keywords highlighted a concern with the impacts of this antiparasitic on the biota present in manure. As a result of the survey conducted, environmental monitoring of this substance and the performance of experiments that contemplate the current situation of occurrence of this drug in different environmental matrices are recommended.
ABSTRACT
Background: Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable. Objective: To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic. Design: We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined. Data sources: MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019. Review methods: Two of us independently screened titles and s to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions). Results: We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0–41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9–44.8%] v 34.5% [95% CI, 30.6–38.5%];P = 0.005). Conclusions: Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine. PROSPERO registration: CRD42020149712 (April 2020). © 2022, College of Intensive Care Medicine. All rights reserved.