• 2018-07
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  • Limitations of meta analyses are


    Limitations of meta-analyses are often based on the strength of the data available. Only 26% of the eligible studies were judged to be at low risk of overall bias in this analysis. Other studies may have been at low risk for bias but failed to report information necessary for this determination. All RCTs have a methodology for randomisation and concealment of allocation and reporting such information will allow for better comparison across studies in the future. It is also imperative that future reports include information on adherence, preferably in a standardised manner. Future meta-analyses would also benefit from findings where data have been stratified by baseline iron status. Iron is an essential trace Thiola required for growth, development, and normal cellular functioning. However, there is also considerable danger of toxicity with iron if excessive amounts accumulate in the body. Although a finely tuned feedback control system helps to limit the possibility of excessive accumulation, it is possible that various pathologies may alter this feedback, placing the individual at risk. Therefore, knowing the baseline iron status of an individual will aid in properly interpreting the research findings. As stated by Pasrich and colleagues, more RCTs of non-haematological outcomes are needed to make definitive conclusions as to the benefits and harm of daily iron supplementation in this age group. Detailed reporting of findings that include stratification of results by baseline iron status will provide us with data needed to properly inform policy.
    Noma is a disease surrounded by riddles. It manifests itself only in the poorest populations in developing countries, enclosed by ignorance and extreme poverty. The worldwide prevalence of noma is unknown—estimates range from 30 000 to 140 000 cases. Most cases of noma worldwide occur in the so-called noma belt, which is situated directly south of the Sahara and runs across Africa from Senegal to Ethiopia. Another puzzle is that child mortality and malnutrition are prevalent on the Indian subcontinent, but noma is not reported there. The prevention and treatment of noma is not a priority in the countries where the disease is prevalent. Moreover, deaths from noma are not included in the mortality statistics of these countries. The cause of noma—the biological mechanism that ignites the gangrene—remains a mystery. Although the disease is clearly an opportunistic infection, we still do not know whether some of the commensal microorganisms in the oral microbiota play a particular part in the expanding gangrene. Also puzzling is how an unknown percentage (a common estimate suggests 10%) of noma patients survive the often extensive gangrene without any medical treatment. Antibiotic treatment of noma has not been subject to medical research, except for in some old observational studies. Furthermore, after one and a half centuries of surgical experiments, a good surgical treatment for a frequent sequela of noma, complete trismus of the mouth, has still not been found.
    The diagnosis of pulmonary tuberculosis in young children is challenging because clinical and radiological features are often non-specific. Achieving a definite diagnosis through microbiological confirmation is especially problematic in this population owing to the typically low bacillary burden and the difficulty in obtaining a quality respiratory specimen. For adults, WHO has endorsed a single Xpert MTB/RIF assay for initial diagnosis, especially in people with HIV and in those with suspected drug-resistant tuberculosis. A consensus has not yet been reached on the value of the Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in young children. Xpert MTB/RIF has been shown to give a rapid diagnosis on induced sputum, nasopharyngeal aspirate, and gastric aspirate samples in about 70% of children in hospital with culture-confirmed tuberculosis. Most children with suspected tuberculosis, however, present to primary care clinics with less severe disease.