Systematically assessing the safety and effectiveness of spraying rhubarb powder solution under gastroscope for the treatment of acute non-varicose upper gastrointestinal bleeding, and confirmation for further clinical research and application.
We searched the following databases up till November 2019: PubMed, the Cochrane Library, EMBASE, CNKI, WanFang Data, VIP and SinoMed. Randomized controlled trials (RCTs) were used to compare the curative effect of spraying rhubarb powder solution with other drugs under gastroscope for the treatment of acute non-varicose upper gastrointestinal bleeding.
Out of 171 articles, 14 RCTs involving 1493 patients were included. All control groups included in the RCTs were treated with norepinephrine solution. The hemostatic effect of spraying rhubarb powder solution under gastroscope was examined for 24 h at high concentration (0.1 g/mL). The hemostatic effect at higher conc. (0.1 g/mL) found far more better than low conc.(RR = 1.48;95 %CI:1.25,1.75;P﹤0.00001) (0.03 g/mL)as homeostatic effect at low conc.is same that of norepinephrine solution (RR = 1.02;95 %CI:0.94,1.10;P = 0.62). Moreover within 48 h, rhubarb powder solution with 0.1 g/mL or 0.15 g/mL conc. have of significantly higher hemostatic effects than norepinephrine solution (RR = 1.18;95 % CI: 1.08, 1.30;P = 0.0003). Occurrence of rebleeding event within 48 h after successful hemostasis (RR = 0.42;95 %CI:0.24,0.74;P = 0.003) reduced exceptionally. After that the hemostatic effect of rhubarb powder solution with 0.1 g/mL conc.examined within 72 h again exhibited significant improvement than norepinephrine solution (RR = 1.19;95 %CI:1.12,1.26;P < 0.00001). On par with immediate hemostasis time, rhubarb powder solution took unprecedented less time than norepinephrine solution;(MD=-5.56S;95 %CI:-6.16, -4.95;P﹤0.00001). Additionally, the adverse reaction produced by rhubarb powder solution is much lower than norepinephrine solution (RR = 0.22;95 %CI:0.11,0.42;P < 0.00001).
According to meta-analysis, Spraying rhubarb powder solution under gastroscope in the treatment of acute non-varicose upper gastrointestinal bleeding is superior to norepinephrine solution in improving hemostasis effect. Shortening immediate hemostasis time and reducing rebleeding,and is safe to use. Based on the results of this study, physicians can treat patients with acute non-varicose upper gastrointestinal bleeding by spraying rhubarb powder solution under gastroscope according to the patients' condition.However, the sample size included in this study is small and of substandard quality qu, and a large sample size clinical trial with strict design and normative report is needed to verify the safety and efficacy of rhubarb powder solution under gastroscope for acute non-varicose upper gastrointestinal bleeding.

Spraying rhubarb powder solution under gastroscope in the treatment of acute non-varicose upper gastrointestinal bleeding: A systematic review and meta-analysis of randomized controlled trials.

Diabetes has been reported to be associated with an increased risk of death among patients with COVID-19. However, the available studies lack detail on COVID-19 illness severity and measurement of relevant comorbidities.
We conducted a multicentre, retrospective cohort study of patients 18 years of age and older who were hospitalized with COVID-19 between January 1, 2020, and November 30, 2020, in Ontario, Canada, and Copenhagen, Denmark. Chart abstraction emphasizing comorbidities and disease severity was performed by trained research personnel. The association between diabetes and death was measured using Poisson regression. The main outcome measure was in-hospital 30-day risk of death.
Our study included 1,133 hospitalized patients with COVID-19 in Ontario and 305 in Denmark, of whom 405 and 75 patients, respectively, had pre-existing diabetes. In both Ontario and Denmark, patients with diabetes were more likely to be older; have chronic kidney disease, cardiovascular disease, and higher troponin levels; and be receiving antibiotics, when compared with adults without diabetes. In Ontario, 24% (n=96) of adults with diabetes died compared with 15% (n=109) of adults without diabetes. In Denmark, 16% (n=12) of adults with diabetes died in hospital compared with 13% (n=29) of those without diabetes. In Ontario, the crude mortality ratio among patients with diabetes was 1.60 (95% confidence interval [CI], 1.24 to 2.07) and in the adjusted regression model it was 1.19 (95% CI, 0.86 to 1.66). In Denmark, the crude mortality ratio among patients with diabetes was 1.27 (95% CI, 0.68 to 2.36) and in the adjusted model it was 0.87 (95% CI, 0.49 to 1.54). Meta-analysis of the 2 rate ratios from each region resulted in a crude mortality ratio of 1.55 (95% CI, 1.22 to 1.96) and an adjusted mortality ratio of 1.11 (95% CI, 0.84 to 1.47).
The presence of diabetes was not strongly associated with in-hospital COVID-19 mortality independent of illness severity and other comorbidities.
Le diabète a été associé à une augmentation du risque de mortalité chez les patients atteints de la COVID-19. Toutefois, les études disponibles ne fournissent pas suffisamment de détails sur la gravité de la maladie à coronavirus 2019 et la mesure des comorbidités pertinentes.
Nous avons mené une étude de cohorte rétrospective multicentrique auprès de patients atteints de la COVID-19 > 18 ans qui ont été hospitalisés entre le 1
Notre étude portait sur 1133 patients hospitalisés atteints de la COVID-19 en Ontario et sur 305 patients hospitalisés atteints de la COVID-19 au Danemark, dont 405 et 75 patients, et ce respectivement, avaient un diabète préexistant. Tant en Ontario qu’au Danemark, les patients diabétiques étaient plus susceptibles que les adultes non diabétiques d’être des personnes âgées, d’avoir une insuffisance rénale chronique, une maladie cardiovasculaire et des concentrations plus élevées de troponine, et de recevoir des antibiotiques. En Ontario, 24 % (n = 96) des adultes diabétiques comparativement à 15 % (n = 109) des adultes non diabétiques sont morts. Au Danemark, 16 % (n = 12) des adultes diabétiques comparativement à 13 % (n = 29) des adultes non diabétiques sont morts à l’hôpital. En Ontario, le taux brut de mortalité chez les patients diabétiques était de 1,60 (intervalle de confiance [IC] à 95 %, de 1,24 à 2,07) et, dans le modèle de régression ajusté, il était de 1,19 (IC à 95 %, de 0,86 à 1,66). Au Danemark, le taux brut de mortalité chez les patients diabétiques était de 1,27 (IC à 95 %, de 0,68 à 2,36) et, dans le modèle de régression ajusté, il était de 0,87 (IC à 95 %, de 0,49 à 1,54). La méta-analyse des 2 taux de chacune des régions a permis d’établir un taux brut de mortalité de 1,55 (IC à 95 %, de 1,22 à 1,96) et un taux de mortalité ajusté de 1,11 (IC à 95 %, de 0,84 à 1,47).
La présence du diabète n’était pas fortement associée à la mortalité à l’hôpital des patients atteints de la COVID, et ce, indépendamment de la gravité de la maladie et des autres comorbidités.

Association Between Diabetes and Mortality Among Adult Patients Hospitalized With COVID-19: A Cohort Study of Hospitalized Adults in Ontario, Canada, and Copenhagen, Denmark.

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