Pharmacotherapies for Central Post-Stroke Pain: A Systematic Review and Network Meta-Analysis.

Background: Central post-stroke pain (CPSP) is a common condition. Several pharmacotherapies have been applied in practice. However, the comparative effectiveness among these pharmacotherapies is unknown. Aim: The aim of this study is to study the comparative effectiveness among differential pharmacotherapies for CPSP through a network meta-analysis. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception to 30 March 2022, without any language restriction. Two reviewers independently screened the retrieved articles, extracted data, and evaluated the risk of bias (RoB). The outcome of interest of the study was the change in the scores of pain intensity scales. We estimated standard mean differences (SMDs) between treatments and calculated corresponding 95% CIs. Results: Thirteen randomized controlled trials (529 participants) were included after a screen of 1774 articles. Compared with placebo, pamidronate (SMD -2.43, 95% CI -3.54 to -1.31; P - score = 0.93), prednisone (SMD -2.38, 95% CI -3.09 to -1.67; P - score = 0.92), levetiracetam (SMD -2.11, 95% CI -2.97 to -1.26; P - score = 0.87), lamotrigine (SMD -1.39, 95% CI -2.21 to -0.58; P - score = 0.73), etanercept (SMD -0.92, 95% CI -1.8 to -0.03; P - score = 0.59), and pregabalin (SMD -0.46, 95% CI -0.71 to -0.22; P - score = 0.41) had significantly better treatment effect. Pamidronate, prednisone, and levetiracetam ranked as the first three most effective treatments. In subgroup analyses, prednisone, levetiracetam, lamotrigine, and pregabalin were more effective than placebo as oral pharmacotherapies, while etanercept was more effective than placebo as injectable pharmacotherapy. Conclusions: Our study confirmed that pamidronate, prednisone, and guideline-recommended anticonvulsants were effective for reducing pain intensity for CPSP. Pamidronate and prednisone showed better effect than other pharmacotherapies, which warrants further investigation.

A retrospective analysis of clinical features and death factors of infants and young children with severe pneumonia / 中国小儿急救医学

Objective Through retrospective data analysis,we tried to further understand the epide-miological characteristics,clinical feature and death factors of infant and young children with severe pneumo-nia. Methods The study objects were inpatients( age between≥28 days and≤3 years) who were diagnosed severe pneumonia from 1 January,2011 to 31 December,2013 of the Chengdu Women′s and Children′s Cen-tral Hospital. We used retrospective case study to understand the epidemiology,clinical feature,death factors of infant and young children with severe pneumonia. And we used chi-square test and Logistic multivariate regression analysis to analyze the death factors of infants and young children with severe pneumonia. Results (1) Among 1 411 cases of severe pneumonia,the ratio of male and female was 1. 8∶1,and the ratio of urban and rural areas was 1∶3. 62. The proportion of less than 3 months old infant was 46. 00%. And 62. 93% infant and young children with severe pneumonia occurred in the spring and winter. (2) Average hospitalization time was (9. 99 ± 6. 27 ) days, longer than the hospitalization time of mild pneumonia patients. ( 3 ) A total of 64. 21% of infant and young children with severe pneumonia had basic diseases. (4)A total of 91. 99% of the infant and young children with severe pneumonia had complications. (5) The most common etiology of infant and young children with severe pneumonia was bacteria,the second was virus. (6) In all cases,there were 44 cases died. The mortality of infant and young children with severe pneumonia was 3. 12%. And 72. 73% of the death cases were infants less than 3 months old. (7) The results of Logistic multiple regression analysis showed that there were significant differences in age, congenital heart diseases, repeating infection history, multiple drug-resistant strains infection, surgical history, multiple organ dysfunction, internal environment disorder. Conclusion Infant and young children with severe pneumonia have the following characteristics:most of them occurred in the winter and spring, and come from rural more than from the city. The smaller the age, the incidence of a disease is higher,and the mortality is higher. Most of infant and young children with severe pneu-monia have basic diseases. Most of the infant and young children with severe pneumonia have complications. If having one of the following high-risk factors:less than 3 months old,congenital heart diseases,repeating infec-tion history,multiple drug-resistant strains infection,surgical history,multiple organ dysfunction,internal envi-ronment disorder,the infant with severe pneumonia should be intensively monitored and actively treated.