Current medical research and opinion
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Review Meta Analysis
Intravenous Ringer's lactate versus usual care during labor in nulliparous women: a systematic review and meta-analysis of randomized controlled trials.
Due to limited research on the effectiveness and safety of intravenous (IV) fluids administered during labor, there are no guidelines available. Thus, this meta-analysis aims to evaluate efficacy of IV Ringer's lactate during labor as compared to usual care. ⋯ IV Ringer's lactate reduced the duration of active labor, the need for oxytocin augmentation and the prolonged labor incidence. However, it did not differ in effect on immediate neonatal health but was found to have more potential for reducing maternal vomiting as compared to usual care with unrestricted oral intake. Further research is needed to explore its effects in the larger and more diverse populations and with different IV fluids for evidence-based guidelines.
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Heart failure (HF) is associated with disabling symptoms, poor quality of life, and a poor prognosis with substantial excess mortality in the years following diagnosis. Overactivation of the sympathetic nervous system is a key feature of the pathophysiology of HF and is an important driver of the process of adverse remodelling of the left ventricular wall that contributes to cardiac failure. Drugs which suppress the activity of the renin-angiotensin-aldosterone system, including β-blockers, are foundation therapies for the management of heart failure with reduced ejection fraction (HFrEF) and despite a lack of specific outcomes trials, are also widely used by cardiologist in patients with HF with preserved ejection fraction (HFpEF). ⋯ Moreover, β-blockers also reduce mortality in the setting of HF occurring alongside common comorbid conditions, such as diabetes, CKD (of any severity), and COPD. Higher doses of β-blockers are associated with better clinical outcomes in populations with HF, so that ensuring adequate titration of therapy to their maximal (or maximally tolerated) doses is important for ensuring optimal outcomes for people with HF. In principle, a patient with HF could have combined treatment with a β-blocker, renin-angiotensin-aldosterone system inhibitor/neprilysin inhibitor, mineralocorticoid receptor antagonist, and a SGLT2 inhibitor, according to tolerability.