Background and objectivesNausea and vomiting during pregnancy (NVP) occur commonly. Possible harmful side-effects of conventional medicine to the fetus create the need for alternative options to relieve NVP. This systematic review (SR) investigated current evidence regarding orally administered ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy.MethodsA comprehensive electronic bibliographic database search was carried out. Randomized controlled trials (RCTs) of the efficacy of orally administered ginger, as treatment for NVP in pregnant women at any stage of pregnancy, published in English, were included. Two researchers independently extracted data and assessed trial quality. RevMan5 software (Cochrane Collaboration) was used for data analysis. p < 0.05 was considered statistically significant.ResultsTwelve RCTs involving 1278 pregnant women were included. Ginger significantly improved the symptoms of nausea when compared to placebo (MD 1.20, 95% CI 0.56-1.84, p = 0.0002, I2 = 0%). Ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI -0.03-1.46, p = 0.06, I2 = 71%). Subgroup analyses seemed to favor the lower daily dosage of <1500 mg ginger for nausea relief. Ginger did not pose a significant risk for spontaneous abortion compared to placebo (RR 3.14, 95% CI 0.65-15.11, p = 0.15; I2 = 0%), or to vitamin B6 (RR 0.49, 95% CI 0.17-1.42, p = 0.19, I2 = 40%). Similarly, ginger did not pose a significant risk for the side-effects of heartburn or drowsiness.ConclusionsThis review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and low quality of evidence). Ginger did not significantly affect vomiting episodes, nor pose a risk for side-effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from NVP.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42011001237.
less than 60 cases of erythropoietic porphyria have been described since the original report by Shultz in 1874. It is a congenital disease and is generally thought to be transmitted in a non sex‐linked recessive mode (Goldberg and Rimington, 1962, p. 49; Heilmeyer, Clotten, Kerp, Merker, Parra and Wetzel, 1964). All cases in whom a definitive statement was made regarding age of onset presented in childhood and no patient has survived to middle age (Goldberg and Rimington, 1962, p. 55). The first of the two cases described here is unusual in that the disease only manifested itself after the age of 50 Most patients with erythropoietic porphyria have a haemolytic anaemia (Goldberg and Rimington, 1962, p. 54). There is frequently a reticulocytosis and the serum bilirubin may be slightly raised. Urobilinogen and stercobilinogen excretion are increased. Erythrocyte survival has been studied in a few cases with equivocal results (London, West, Shemin and Rittenburg, 1950; Gray, Muir and Neuberger, 1950; Rosenthal, Lipton and Asrow, 1955; Canivet and Pernard‐Considére, 1958; Heilmeyer et al., 1964). In an attempt to elucidate the mechanism underlying the anaemia associated with this disease two cases of erythropoietic porphyria were studied using a combined radioactive iron and chromium technique to make detailed simultaneous measurements of red‐cell production and destruction.
Context: Gastroenteritis (GE) remains the second major cause of death in the most vulnerable of the world's populations. Potential treatments include the use of probiotics, with the yeast Saccharomyces boulardii being one such option. Objectives: The primary objective was to assess the efficacy and safety of Saccharomyces boulardii in the treatment of acute GE in the paediatric population. Method: Major electronic databases were searched from April 2014 to January 2015. Additional literature was obtained through hand-searching and reviewing of reference lists of articles and other systematic reviews. Randomised controlled trials (RCTs) in a hospital setting, involving participants < 16 years were used as the data source. Two reviewers independently screened studies for eligibility, assessed study quality and performed data extraction. Review Manager 5 was used to analyse data and a randomeffects model of meta-analysis was applied owing to heterogeneity. Results: Ten of 190 articles were selected for final inclusion. A meta-analysis of five of the included studies showed that Saccharomyces boulardii compared with the control significantly shortened the duration of diarrhoea (in days) (MD -0.57, 95% CI -0.83 to -0.30, p < 0.0001), but there was no difference between groups regarding time to achieving formed stools. No adverse effects were reported. The GRADE tool assessed overall methodological quality as moderate. Conclusion: Saccharomyces boulardii showed a potential benefit in treating acute GE in the paediatric patient. A dose of 250 mg 1-2 times per day for up to 5 days showed some benefit and appears safe. Larger, rigorous RCTs are needed to investigate the efficacy and safety of Saccharomyces boulardii in order to offer specific treatment guidelines. Trial registration: CRD42014009913.
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