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Diagnostics (Basel, Switzerland) Jan 2024. This paper aims to estimate asymptomatic hip osteonecrosis prevalence in SLE patients using MRI examination and to determine the prevalence among higher risk... (Review)
Review
. This paper aims to estimate asymptomatic hip osteonecrosis prevalence in SLE patients using MRI examination and to determine the prevalence among higher risk subpopulations. . PubMed, Embase, Cochrane, and SCOPUS were searched from inception to May 9th, 2023. Studies on patients who were clinically diagnosed with systemic lupus erythematosus without reported symptoms attributable to hip osteonecrosis were included. Two independent reviewers extracted data and assessed the risk of bias. Data collected from each study include the study year, the number of hips screened, the number of hips with osteonecrosis, demographics, laboratory data, medications, follow-up time, radiological protocols, and MRI-based osteonecrosis detection and grading criteria. . Eleven eligible studies including 503 participants (15-35 years old; 74-100% female) with SLE were identified. Significant risk of bias was determined in one study. The overall prevalence of osteonecrosis of the hip was found to be 14% (184/1006 hip joints, 95% confidence interval: 7-22%, number needed to scan: 7.1). SLE patients who received corticosteroid treatment had a higher prevalence of asymptomatic hip osteonecrosis (18%) compared to non-corticosteroid users (0%, -value < 0.01). Additionally, meta-regression results revealed that daily corticosteroid dose was associated with increased prevalence of asymptomatic osteonecrosis (0.5%/milligram, -value < 0.01). . The high prevalence of asymptomatic hip osteonecrosis in SLE patients raises concerns about the timeliness of interventions. The limitations of this study include a relatively low number of identified studies; and one study lacked full-text availability.
PubMed: 38337795
DOI: 10.3390/diagnostics14030279 -
Annals of Internal Medicine Nov 2020Opioids are frequently prescribed for acute musculoskeletal injuries and may result in long-term use and consequent harms. (Meta-Analysis)
Meta-Analysis
Predictors of Prolonged Opioid Use After Initial Prescription for Acute Musculoskeletal Injuries in Adults : A Systematic Review and Meta-analysis of Observational Studies.
BACKGROUND
Opioids are frequently prescribed for acute musculoskeletal injuries and may result in long-term use and consequent harms.
PURPOSE
To explore factors associated with persistent opioid use after its prescription for acute musculoskeletal injury.
DATA SOURCES
Searches of multiple electronic databases, without language restrictions, from inception to 6 January 2020, and reference lists of selected articles.
STUDY SELECTION
Observational studies of adults with opioid prescriptions for outpatient acute musculoskeletal injuries, in an adjusted model, that explored risk factors for prolonged use.
DATA EXTRACTION
6 reviewers, working in pairs, independently extracted data, rated the quality of studies, and evaluated the certainty of evidence.
DATA SYNTHESIS
14 cohorts with 13 263 393 participants were included. The overall prevalence of prolonged opioid use after musculoskeletal injury for high-risk populations (that is, patients receiving workers' compensation benefits, Veterans Affairs claimants, or patients with high rates of concurrent substance use disorder) was 27% (95% CI, 18% to 37%). The prevalence among low-risk populations was 6% (CI, 4% to 8%; for interaction < 0.001). Moderate-certainty evidence showed increased odds of persistent opioid use with older age (absolute risk increase [ARI] for every 10-year increase, 1.1% [CI, 0.7% to 1.5%]) and physical comorbidity (ARI, 0.9% [CI, 0.1% to 1.7%]). Low-certainty evidence suggested increased risk for persistent opioid use with past or current substance use disorder (ARI, 10.5% [CI, 4.2% to 19.8%]), prescriptions lasting more than 7 days (median ARI, 4.5%), and higher morphine milligram equivalents per day.
LIMITATION
Sparse, heterogeneous data with suboptimal adjustment for potential confounders.
CONCLUSION
Avoiding prescribing opioids for acute musculoskeletal injuries to patients with past or current substance use disorder, and restricting duration to 7 days or less and using lower doses when they are prescribed, are potentially important targets to reduce rates of persistent opioid use.
PRIMARY FUNDING SOURCE
National Safety Council. (PROSPERO: CRD42018104968).
Topics: Adult; Age Distribution; Analgesics, Opioid; Comorbidity; Drug Administration Schedule; Humans; Musculoskeletal System; Observational Studies as Topic; Opioid-Related Disorders; Prevalence; Risk Factors; Substance-Related Disorders
PubMed: 32805130
DOI: 10.7326/M19-3600 -
The Cochrane Database of Systematic... 2000The administration of clomiphene citrate is followed by an enhanced release of pituitary gonadotropins resulting in follicular recruitment. After the drug is stopped,... (Review)
Review
BACKGROUND
The administration of clomiphene citrate is followed by an enhanced release of pituitary gonadotropins resulting in follicular recruitment. After the drug is stopped, there is continuing secretion of estradiol, selection of the dominant follicle and, in successful cases, ovulation. Clomiphene is indicated as the initial treatment in the majority of women with amenorrhoea and oligomennorhoea. In women with irregular ovulation it seems to re-establish typical frequency of ovulation. Its effectiveness in oligo-amenorrhoeic women was tested in a number of randomized controlled trials at that time. These trials form the basis for the following review.
OBJECTIVES
Clomiphene citrate enhances the release of pituitary hormones, often resulting in ovulation. The objective of this review was to assess the effects of clomiphene citrate on ovulation and pregnancy in women with oligo-ovulatory subfertility.
SEARCH STRATEGY
The Cochrane Subfertility Review Group specialised register of controlled trials was searched.
SELECTION CRITERIA
Randomised trials of clomiphene compared with placebo or no treatment in women with oligo-ovulatory subfertility of at least 12 months duration.
DATA COLLECTION AND ANALYSIS
Trial quality was assessed and data were extracted independently by two reviewers.
MAIN RESULTS
Four studies were included. They were all of crossover design. Since it was not possible to separate data from the first and second phases of these trials, the effect of clomiphene may be overestimated. Compared with placebo, clomiphene citrate was associated with increased ovulation. The odds ratio for high doses (50-250 milligrams per day) was 6.82 (95% confidence interval 3.92 to 11.85). This dropped to a non-significant odds ratio of 1.29 (95% confidence interval 0.48 to 3.49) with low doses (10 milligrams per day). Clomiphene citrate (all doses) was associated with an increased pregnancy rate per treatment cycle (odds ratio 3.41, 95% confidence interval 4.23 to 9.48).
REVIEWER'S CONCLUSIONS
Clomiphene citrate (at doses between 50 to 250 milligrams per day) appears to be an effective method of inducing ovulation and improving fertility in oligo-ovulatory women. However adverse effects include possible ovarian cancer risk and risk of multiple pregnancy.
Topics: Amenorrhea; Clomiphene; Female; Fertility Agents, Female; Humans; Infertility, Female; Oligomenorrhea; Ovulation Induction; Pregnancy
PubMed: 10796477
DOI: 10.1002/14651858.CD000056 -
Orthopaedic Journal of Sports Medicine Jul 2022Postoperative treatment plans after orthopaedic procedures frequently include opioids for pain relief. (Review)
Review
BACKGROUND
Postoperative treatment plans after orthopaedic procedures frequently include opioids for pain relief.
PURPOSE
To evaluate opioid use in the early postoperative phase after arthroscopic rotator cuff repair (ARCR) to develop a procedure-specific understanding of the current role of opioids in pain management for this procedure.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A PubMed search was used to identify eligible studies. Data on patient demographics, visual analog scale pain scores, and opioid use patterns (in morphine milligram equivalents [MMEs]) were collected and assessed. Cumulative MMEs were reported on postoperative day (POD) zero, and mean MMEs were reported on subsequent PODs (days 1, 2, 3, 5, 7, and 14). Metaregression, indices, and Cochran tests were used to evaluate study variation, heterogeneity, and variance.
RESULTS
A total of 1487 patients in 22 studies were included in the analysis. An estimated 51% (95% CI, 31%-70%) of patients with nerve blocks (NBs) were opioid-free through POD-0 versus 40% (95% CI, 1.2%-97%) of patients without NBs, which increased to 65% (95% CI, 55%-74%) versus 25% (95% CI, 1.7%-86%) by POD-1. Opioid requirements were highest in the first 72 hours after ARCR. NB use reduced opioid requirement on POD-0 compared with no NB use (15.8 vs 45.0 MMEs, respectively; < .001) but did not reduce requirements after that. In addition, NB use led to a statistically significant increase in opioid requirements on POD-7 (28.6 vs 9.5 MMEs, respectively; < .001). Using a model that assumes stable opioid requirements between our time points, weighted mean cumulative opioid consumption was 163 MMEs in the first week and 273 MMEs in the first 2 weeks (150 and 287 MMEs in patients with NB; 180 and 261 MMEs in patients without NB, respectively).
CONCLUSION
Opioid use is relatively common in the early postoperative period after ARCR. Pain scores and opioid requirements may spike on POD-1; however, patients should be educated and reassured that they will gradually decrease usage over the initial 2-week postoperative period.
PubMed: 35898204
DOI: 10.1177/23259671221112086 -
Archives of Internal Medicine Jan 2007Several studies suggest that weight loss reduces C-reactive protein (CRP) level; however, the consistency and magnitude of this effect has not been well characterized.... (Review)
Review
BACKGROUND
Several studies suggest that weight loss reduces C-reactive protein (CRP) level; however, the consistency and magnitude of this effect has not been well characterized. Our objective was to test the hypothesis that weight loss is directly related to a decline in CRP level.
DATA SOURCES
We searched the Cochrane Controlled Trials Register and MEDLINE databases and conducted hand searches and reviews of bibliographies to identify relevant weight loss intervention studies.
STUDY SELECTION
We included all weight loss intervention studies that had at least 1 arm that was a surgical, lifestyle, dietary, and/or exercise intervention. Abstracts were independently selected by 2 reviewers.
DATA EXTRACTION
Two reviewers independently abstracted data on the characteristics of each study population, weight loss intervention, and change in weight and CRP level from each arm of all included studies.
DATA SYNTHESIS
We analyzed the mean change in CRP level (milligrams per liter) and the mean weight change (kilograms), comparing the preintervention and postintervention values from each arm of 33 included studies using graphical displays of these data and weighted regression analyses to quantify the association.
RESULTS
Weight loss was associated with a decline in CRP level. Across all studies (lifestyle and surgical interventions), we found that for each 1 kg of weight loss, the mean change in CRP level was -0.13 mg/L (weighted Pearson correlation, r = 0.85). The weighted correlation for weight and change in CRP level in the lifestyle interventions alone was 0.30 (slope, 0.06). The association appeared roughly linear.
CONCLUSION
Our results suggest that weight loss may be an effective nonpharmacologic strategy for lowering CRP level.
Topics: Biomarkers; C-Reactive Protein; Humans; Life Style; Weight Loss
PubMed: 17210875
DOI: 10.1001/archinte.167.1.31 -
The Cochrane Database of Systematic... Apr 1996The administration of clomiphene citrate is followed by an enhanced release of pituitary gonadotropins resulting in follicular recruitment. After the drug is stopped,... (Review)
Review
BACKGROUND
The administration of clomiphene citrate is followed by an enhanced release of pituitary gonadotropins resulting in follicular recruitment. After the drug is stopped, there is continuing secretion of estradiol, selection of the dominant follicle and, in successful cases, ovulation. Clomiphene is indicated as the initial treatment in the majority of women with amenorrhoea and oligomennorhoea. In women with irregular ovulation it seems to re-establish typical frequency of ovulation. Its effectiveness in oligo-amenorrhoeic women was tested in a number of randomised controlled trials at that time. These trials form the basis for the following review.
OBJECTIVES
Clomiphene citrate enhances the release of pituitary hormones, often resulting in ovulation. The objective of this review was to assess the effects of clomiphene citrate on ovulation and pregnancy in women with oligo-ovulatory subfertility.
SEARCH STRATEGY
The Cochrane Subfertility Review Group specialised register of controlled trials was searched.
SELECTION CRITERIA
Randomised trials of clomiphene compared with placebo or no treatment in women with oligo-ovulatory subfertility of at least 12 months duration.
DATA COLLECTION AND ANALYSIS
Trial quality was assessed and data were extracted independently by two reviewers.
MAIN RESULTS
Four studies were included. They were all of crossover design. Since it was not possible to separate data from the first and second phases of these trials, the effect of clomiphene may be overestimated. Compared with placebo, clomiphene citrate was associated with increased ovulation. The odds ratio for high doses (50-250 milligrams per day) was 6.82 (95% confidence interval 3.92 to 11.85). This dropped to a non-significant odds ratio of 1.29 (95% confidence interval 0.48 to 3.49) with low doses (10 milligrams per day). Clomiphene citrate (all doses) was associated with an increased pregnancy rate per treatment cycle (odds ratio 3.41, 95% confidence interval 4.23 to 9.48).
AUTHORS' CONCLUSIONS
Clomiphene citrate (at doses between 50 to 250 milligrams per day) appears to be an effective method of inducing ovulation and improving fertility in oligo-ovulatory women. However adverse effects include possible ovarian cancer risk and risk of multiple pregnancy.
Topics: Amenorrhea; Clomiphene; Female; Fertility Agents, Female; Humans; Infertility, Female; Oligomenorrhea; Ovulation Induction; Pregnancy
PubMed: 17636579
DOI: 10.1002/14651858.CD000056.pub2 -
JAMA Pediatrics Nov 2015Metformin hydrochloride use is increasing in children and adolescents. Previous meta-analyses have identified a large variability in the effects of metformin use on body... (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Metformin hydrochloride use is increasing in children and adolescents. Previous meta-analyses have identified a large variability in the effects of metformin use on body mass index changes but have not considered height changes as a confounder, to our knowledge.
OBJECTIVE
To conduct a systematic review and meta-analysis of the effects of metformin use on height in children and adolescents.
DATA SOURCES
Computerized databases, including MEDLINE and EMBASE, were searched up to September 9, 2014, for terms related to metformin and childhood or adolescence.
STUDY SELECTION
Randomized clinical trials examining the effects of metformin use on height of participants younger than 19 years were considered eligible. Trials with cointerventions other than lifestyle changes were excluded.
DATA EXTRACTION AND SYNTHESIS
Height, weight, body mass index, age, sex, metformin dosage, and study duration were independently extracted by 2 reviewers. The weighted mean differences for changes in height, weight, and body mass index were compared between the metformin and control groups using random-effects models.
MAIN OUTCOME AND MEASURE
Height changes.
RESULTS
Ten studies were included, with a total of 562 participants, 330 (58.7%) of whom were female. The mean age within the studies ranged from 7.9 to 16.1 years, with a high variability in most studies. The duration of metformin interventions lasted from 3 to 48 months. Overall, height changes were not significantly different between the metformin and control groups. However, stratified analyses according to the cumulative metformin dose (in milligrams per day times the number of days of treatment) showed a greater increase in height with metformin use in the 5 studies providing the largest cumulative metformin doses (weighted mean difference, 1.0; 95% CI, 0.0 to 2.0 cm) but not in the 5 studies providing the lowest doses (weighted mean difference, -0.1; 95% CI, -0.7 to 1.0 cm) compared with the control group.
CONCLUSIONS AND RELEVANCE
Preliminary evidence suggests a dose-response relationship between metformin use and increases in height in children and adolescents compared with a control group. While an approximate 1-cm increase in height may appear small, it is likely underestimated given that many studies were of short duration and included older adolescents, potentially after epiphyseal growth plate closure.
Topics: Adolescent; Body Height; Body Mass Index; Body Weight; Child; Female; Humans; Hypoglycemic Agents; Male; Metformin; Randomized Controlled Trials as Topic
PubMed: 26414449
DOI: 10.1001/jamapediatrics.2015.2186 -
Disability and Rehabilitation Jul 2018To synthesise and critically appraise randomised controlled trials examining the effect of symptom-controlling medication on gait outcomes in people with multiple... (Review)
Review
PURPOSE
To synthesise and critically appraise randomised controlled trials examining the effect of symptom-controlling medication on gait outcomes in people with multiple sclerosis (MS).
METHOD
The literature search examined five databases (Medline, Embase, AMED, Cochrane (CENTRAL), and CINAHL until the end of November 2016. Eligible studies included medication to address symptoms associated with MS and an objective gait outcome measure. Two reviewers independently extracted data and assessed study quality using structured data extraction forms and the PEDro scale.
RESULTS
From 249 papers identified, 13 papers met inclusion criteria, examining three medications. Fampridine was found to significantly increase gait speed, but only in those people who responded to medication, which was less than half (pooled mean: 39%). Ten milligrams of fampridine twice daily significantly improves gait endurance. No definitive conclusions can be made about the efficacy of cannabinoid medication due to conflicting results across three studies. A single study of baclofen did not provide evidence to support the use of this medication to improve gait.
CONCLUSIONS
Limited evidence is available to guide gait symptom control for people with MS. Further research that includes three-dimensional gait analysis, patient perceived measures of gait dysfunction and explores combined efficacy of other modalities on gait is needed. Implications for Rehabilitation Gait disturbance is a common and disabling symptom of multiple sclerosis. Fampridine and cannabis medication may increase gait speed, baclofen does not. Fampridine can be used to improve gait endurance. Future research should include both quantitative and qualitative outcome measures of gait and investigate the combined efficacy of pharmacological and non-pharmacological interventions to assist clinicians to maximise gait improvements.
Topics: 4-Aminopyridine; Baclofen; Cannabinoids; Gait Disorders, Neurologic; Humans; Multiple Sclerosis; Muscle Relaxants, Central; Potassium Channel Blockers
PubMed: 28376639
DOI: 10.1080/09638288.2017.1309581 -
The Cochrane Database of Systematic... Jul 2007Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased... (Review)
Review
BACKGROUND
Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity.
OBJECTIVES
The objective of this review was to assess the effects of iron supplementation on haematological and biochemical parameters, and on pregnancy outcome.
SEARCH STRATEGY
The Cochrane Pregnancy and Childbirth Group trials register was searched. Study authors were also contacted.
SELECTION CRITERIA
Acceptably controlled trials of iron supplementation for pregnant women.
DATA COLLECTION AND ANALYSIS
Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information.
MAIN RESULTS
Twenty trials were included. Iron supplementation raised or maintained the serum ferritin above 10 milligrams per litre. It resulted in a substantial reduction of women with a haemoglobin level below 10 or 10.5 grams in late pregnancy. Iron supplementation, however, had no detectable effect on any substantive measures of either maternal or fetal outcome. One trial, with the largest number of participants of selective versus routine supplementation, showed an increased likelihood of caesarean section and post-partum blood transfusion, but a lower perinatal mortality rate (up to 7 days after birth).
AUTHORS' CONCLUSIONS
Iron supplementation appears to prevent low haemoglobin at birth or at six weeks post-partum. There is very little information on pregnancy outcomes for either mother or baby. There are few data derived from communities where iron deficiency is common and anaemia is a serious health problem.
Topics: Anemia, Iron-Deficiency; Dietary Supplements; Female; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic
PubMed: 17636593
DOI: 10.1002/14651858.CD000117.pub2 -
Environmental Health Perspectives Oct 2014In contrast to current methods of expert-based narrative review, the Navigation Guide is a systematic and transparent method for synthesizing environmental health... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In contrast to current methods of expert-based narrative review, the Navigation Guide is a systematic and transparent method for synthesizing environmental health research from multiple evidence streams. The Navigation Guide was developed to effectively and efficiently translate the available scientific evidence into timely prevention-oriented action.
OBJECTIVES
We applied the Navigation Guide systematic review method to answer the question "Does fetal developmental exposure to perfluorooctanoic acid (PFOA) or its salts affect fetal growth in animals ?" and to rate the strength of the experimental animal evidence.
METHODS
We conducted a comprehensive search of the literature, applied prespecified criteria to the search results to identify relevant studies, extracted data from studies, obtained additional information from study authors, conducted meta-analyses, and rated the overall quality and strength of the evidence.
RESULTS
Twenty-one studies met the inclusion criteria. From the meta-analysis of eight mouse gavage data sets, we estimated that exposure of pregnant mice to increasing concentrations of PFOA was associated with a change in mean pup birth weight of -0.023 g (95% CI: -0.029, -0.016) per 1-unit increase in dose (milligrams per kilogram body weight per day). The evidence, consisting of 15 mammalian and 6 nonmammalian studies, was rated as "moderate" and "low" quality, respectively.
CONCLUSION
Based on this first application of the Navigation Guide methodology, we found sufficient evidence that fetal developmental exposure to PFOA reduces fetal growth in animals.
Topics: Animals; Birth Weight; Caprylates; Environmental Health; Environmental Pollutants; Evidence-Based Medicine; Female; Fetal Development; Fluorocarbons; Mice; Pregnancy
PubMed: 24968374
DOI: 10.1289/ehp.1307177