Background: The incidence of Aluminum Phosphide (AlP) poisoning constituted one of the most common causes of poisoning death in low- and middle-income countries (LMICs). Aims: to evaluate the data available on the safety and efficacy of oil-based gastric lavage (GL) compared with standard therapy for the treatment of AlP poisoning. Design: were previously established (PROSPERO ID: CRD42022296780); an exhaustive search was carried out in different databases, identifying randomized controlled trials (RCTs). Settings: health centers of any level. Participants: Any person presented within 6 hours post-exposure to AlP. Interventions: Lavage solution with oils, including liquid paraffin or coconut oil. Findings: We identified 7 RCTs. The evidence from 4 RCTs indicates that GL with paraffin oil is an effective treatment for acute AlP poisoning, decreasing the mortality rate (RR = 0.62; 95%CI = 0.48 to 0.81; participants = 226; I2=10%; low-quality evidence). We estimate an NNT of 4. Likewise, this intervention reduces the need for intubation and mechanical ventilation (RR = 0.62; 95%CI = 0.40 to 0.79; participants= 226; I2 = 0%; low-quality evidence). Regarding GL with coconut oil, the evidence from 4 RCTs, indicates a slight reduction in mortality in patients with acute AlP poisoning (RR= 0.82; 95%CI = 0.69 to 0.98; participants= 112; I 2= 0%; very low-quality evidence). Conclusions: Limited evidence suggests that GL with paraffin oil is effective in reducing the mortality rate in acute AlP poisoning. Likewise, limited evidence showed in favor of paraffin oil concerning the need for intubation and mechanical ventilation. This efficacy was not confirmed in terms of length of hospital stay or the total amount of vasoactive agents used. Very limited evidence suggests that GL with coconut oil may have benefits in terms of mortality in patients with acute AlP poisoning. Very limited evidence suggests that both interventions would have a benign safety profile. Conclusions: Limited evidence suggests that GL with paraffin oil is effective in reducing the mortality rate in acute AlP poisoning. Likewise, limited evidence showed in favor of paraffin oil concerning the need for intubation and mechanical ventilation. This efficacy was not confirmed in terms of length of hospital stay or the total amount of vasoactive agents used. Very limited evidence suggests that GL with coconut oil may have benefits in terms of mortality in patients with acute AlP poisoning. Very limited evidence suggests that both interventions would have a benign safety profile.

Abstract contenBackground: Smoking is a chronic disease and one of the main causes of years of life lost or years lived with disability and is considered worldwide the main cause of preventable death. Aims: To review the efficacy and safety of cytisine for smoking cessation. Design: were previously established (PROSPERO ID: CRD42022296780); an exhaustive search was carried out in different databases, identifying randomized controlled trials (RCTs). Settings: health centers of any level. Participants: persons of any age or gender, smokers. Interventions: cytisine at standard dosage versus placebo, varenicline, and nicotine replacement therapy (NRT). Findings: We identified 12 RCTs. Eight RCTs compared cytisine to placebo at the standard dose (RR= 2.25, 95% CI 1.40 to 3.62; I2= 90%). Following sensitivity analysis, we pooled the findings of five RCTs evidencing that cytisine is an effective treatment for smoking cessation,  increasing the chances of quitting We pooled the findings of five RCTs which contributed to the primary analysis covering 2134 patients, 1099 of whom took cytisine, and indicates that cytisine at the standard dosage is an effective smoking cessation treatment that increases the chances of quitting compared to placebo (smoking cessation rate at longest follow-up: RR= 3.46, 95% CI 2.45 to 4.89; participants = 2134; I²= 18%; smoking cessation rate at least six months: RR of 3.40 (95% CI 2.17 to 5.32); participants = 1938; I²= 35%; low-quality evidence). We estimate an NNT of 6. Two trials compared the efficacy of cytisine versus NRT and the combination of both studies yields modest results in favor of cytisine. Three trials compared cytisine versus varenicline, without a clear benefit for cytisine. Meta-analyses of all non-serious AEs in the cytisine group versus placebo groups yielded a RR of 1.24 (95% CI 1.11 to 1.39; participants = 5895; studies = 8; I² = 0%; high-quality evidence). Conclusions: cytisine increased the chances of successful smoking cessation by more than three-fold compared with placebo. Cytisine had a benign safety profile, with no evidence of serious safety concerns. Limited evidence suggests that cytisine may be more effective than NRT, with modest cessation rates. [O1]