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Minerva Ginecologica Dec 2017Endometriosis is a chronic inflammatory disease that affects young women in reproductive age. It has mainly three different clinical presentations: superficial... (Review)
Review
INTRODUCTION
Endometriosis is a chronic inflammatory disease that affects young women in reproductive age. It has mainly three different clinical presentations: superficial (peritoneal), ovarian (endometriomas) and deep endometriosis (DE). The last one is the most advanced form of the disease, frequently impairing fertility and harming women's quality of life (QoL).
EVIDENCE ACQUISITION
We conducted a systematic review on the surgical treatment of DE in the last ten years focusing on its benefits to improve QoL and for pain relief as well as related surgical complications.
EVIDENCE SYNTHESIS
Twenty-three studies were included for qualitative analysis. Overall, included studies showed a relevant improvement in QoL as well as in pain scores using specific questionnaires and the ten-point Visual Analogue Scale (VAS) for pain.
CONCLUSIONS
Until further comparative studies regarding medical versus surgical treatment for DE are concluded, currently, surgery is the best option for patients with DE and severe pain (VAS>7).
Topics: Endometriosis; Female; Humans; Infertility, Female; Pain Measurement; Pelvic Pain; Postoperative Complications; Quality of Life; Severity of Illness Index; Surveys and Questionnaires
PubMed: 28545293
DOI: 10.23736/S0026-4784.17.04082-5 -
BMJ (Clinical Research Ed.) Apr 2006To evaluate factors predisposing women to chronic and recurrent pelvic pain. DESIGN, DATA SOURCES, AND METHODS: Systematic review of relevant studies without language... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate factors predisposing women to chronic and recurrent pelvic pain. DESIGN, DATA SOURCES, AND METHODS: Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors.
RESULTS
There were 122 studies (in 111 articles) of which 63 (in 64,286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18,601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12,040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain.
CONCLUSION
Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.
Topics: Chronic Disease; Dysmenorrhea; Dyspareunia; Female; Humans; Pelvic Pain; Regression Analysis; Risk Factors
PubMed: 16484239
DOI: 10.1136/bmj.38748.697465.55 -
Alimentary Pharmacology & Therapeutics Apr 2022Ustekinumab is effective in treating Crohn's disease (CD) and ulcerative colitis (UC). However, the loss of response (LOR) to ustekinumab and the efficacy of dose... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ustekinumab is effective in treating Crohn's disease (CD) and ulcerative colitis (UC). However, the loss of response (LOR) to ustekinumab and the efficacy of dose escalation have not been systematically explored.
METHODS
Databases were searched for eligible studies from inception through July 2021. Summary estimates were pooled, and subgroup analyses were performed to explore heterogeneity.
RESULTS
We included 14 studies (CD: 13; UC: 1). In CD patients, the annual risk of LOR to ustekinumab and dose escalation among primary responders was 21% (95% confidence interval [CI] 12-31%, 1530 person-years, n = 9) per person-year and 25% (95% CI 12-32%, 657 person-years, n = 5) per person-year respectively. Clinical response was regained in 58% (95% CI 49-67%, 279 patients, n = 8) of secondary non-responders after dose escalation (interval reduction or intravenous reinduction). In UC patients, no studies provided data on LOR, but only one study showed that 35% (100/284) of patients underwent dose escalation (or sham dose adjustment), leading to an annual risk of dose escalation of 18% per person-year. After dose escalation, 58% (14/24) of the patients regained symptomatic remission.
CONCLUSIONS
Primary responders with CD experienced LOR to ustekinumab at a risk of 21% per person-year and required dose escalation at a risk of 25% per person-year. Fifty-eight per cent of secondary non-responders with CD may benefit from dose escalation. LOR has not been well characterized in patients with UC.
Topics: Colitis, Ulcerative; Crohn Disease; Humans; Inflammatory Bowel Diseases; Ustekinumab
PubMed: 35141914
DOI: 10.1111/apt.16802 -
Journal of Gynecology Obstetrics and... Apr 2022Our study aims to compare the effects of using hyaluronan gel, an intrauterine device, and their combination to prevent intrauterine adhesions. (Meta-Analysis)
Meta-Analysis Review
Comparison of effectiveness of hyaluronan gel, intrauterine device and their combination for prevention adhesions in patients after intrauterine surgery: Systematic review and meta-analysis.
OBJECTIVE
Our study aims to compare the effects of using hyaluronan gel, an intrauterine device, and their combination to prevent intrauterine adhesions.
METHODS
The systematic review was conducted according to the PRISMA 2020 checklist and has been registered in the PROSPERO.
INCLUSION AND EXCLUSION CRITERIA
randomized controlled trials (RCTs) in English, patients after intrauterine surgery were included. Patients with hypersensitivity and pelvic inflammatory disease were excluded.
DATA SOURCES
PubMed, The Cochrane Library, ClinicalTrials.gov, Embase, and MEDLINE. The search was performed on studies published before February 1, 2021 to identify articles evaluating the effectiveness of hyaluronan gel, an intrauterine device, and their combination in the prevention of intrauterine adhesions.
RESULTS
8 RCTs were included for qualitative analysis reporting on 1226 participants. Five randomized trials compared recurrence rates between two groups: hyaluronan gel and control (RR = 0.53, 95% CI: 0.40 to 0.69, P < .00001). Hyaluronan gel had a significant role on reducing adhesion formation after surgical intervention. Meta-analysis of pregnancy rates compared hyaluronan gel usage and group with IUD or lack of treatment (RR = 1.58, 95% CI: 1.10 to 2.27, P = .01). Hyaluronan gel group had significantly higher pregnancy rates compared with another group in this meta-analysis.
CONCLUSION
Based on our study, it has become more evident that hyaluronic acid is an effective and safe method after adhesiolysis to prevent recurrence and lead to pregnancy in comparison with other techniques. Nevertheless, further research is needed to achieve more answers regarding adhesions prevention.
Topics: Female; Gels; Humans; Hyaluronic Acid; Hysteroscopy; Intrauterine Devices; Pregnancy; Tissue Adhesions
PubMed: 35134573
DOI: 10.1016/j.jogoh.2022.102334 -
The International Journal of Eating... Jun 2021Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of... (Review)
Review
The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?-A systematic review.
OBJECTIVE
Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers-Danlos syndrome contribute toward disordered eating.
METHODS
Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to structure and complete the review.
RESULTS
A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series.
DISCUSSION
Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers-Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues.
Topics: Anorexia Nervosa; Avoidant Restrictive Food Intake Disorder; Eating; Feeding and Eating Disorders; Gastrointestinal Diseases; Humans; Malnutrition
PubMed: 34042203
DOI: 10.1002/eat.23553 -
Reproductive Health Sep 2017Intra-uterine contraception (IUC) involves the use of an intra-uterine device (IUD), a highly effective, long-acting, reversible contraceptive method. Historically, the... (Review)
Review
BACKGROUND
Intra-uterine contraception (IUC) involves the use of an intra-uterine device (IUD), a highly effective, long-acting, reversible contraceptive method. Historically, the popularity of IUC has waxed and waned across different world regions, due to policy choices and shifts in public opinion. However, despite its advantages and cost-effectiveness for programmes, IUC's contribution to contraceptive prevalence is currently negligible in many countries. This paper presents the results of a systematic review of the global literature on provider and lay perspectives on IUC. It aims to shed light on the reasons for low use of IUC and reflect on potential opportunities for the method's promotion.
METHODS
A systematic search of the literature was conducted in four peer-reviewed journals and four electronic databases (MEDLINE, EMBASE, POPLINE, and Global Health). Screening resulted in the inclusion of 68 relevant publications.
RESULTS
Most included studies were conducted in areas where IUD use is moderate or low. Findings are similar across these areas. Many providers have low or uneven levels of knowledge on IUC and limited training. Many wrongly believe that IUC entails serious side effects such as pelvic inflammatory disease (PID), and are reluctant to provide it to entire eligible categories, such as HIV-positive women. There is particular resistance to providing IUC to teenagers and nulliparae. Provider opinions may be more favourable towards the hormonal IUD. Some health-care providers choose IUC for themselves. Many members of the public have low knowledge and unfounded misconceptions about IUC, such as the fear of infertility. Some are concerned about the insertion and removal processes, and about its effect on menses. However, users of IUC are generally satisfied and report a number of benefits. Peers and providers exert a strong influence on women's attitudes.
CONCLUSION
Both providers and lay people have inaccurate knowledge and misconceptions about IUC, which contribute to explaining its low use. However, many reported concerns and fears could be alleviated through correct information. Concerted efforts to train providers, combined with demand creation initiatives, could therefore boost the method's popularity. Further research is needed on provider and lay perspectives on IUDs in low- and middle-income countries.
Topics: Adult; Contraception; Female; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Intrauterine Devices
PubMed: 28950913
DOI: 10.1186/s12978-017-0380-8 -
Diseases of the Colon and Rectum Dec 2012The learning curve for laparoscopic colorectal surgery has not been conclusively analyzed. No reliable framework for case selection during training is available. (Review)
Review
BACKGROUND
The learning curve for laparoscopic colorectal surgery has not been conclusively analyzed. No reliable framework for case selection during training is available.
OBJECTIVE
The aim of this study was to analyze the length of the learning curve of laparoscopic colorectal surgeons and to recommend a case selection framework at the early stage of independent practice.
DATA SOURCES
Medline (1988-2010, October week 4) and Embase (1988-2010) were used for the literature review, databases were retrieved from the authors, and expert opinion was surveyed.
STUDY SELECTION
Studies describing the learning curve of laparoscopic or laparoscopically assisted colorectal surgery were selected.
INTERVENTION
No interventions were performed.
MAIN OUTCOME MEASURES
Learning curves were analyzed by using risk-adjusted, bootstrapped cumulative sum curves. Conversions and complications were independent variables in a multilevel random-effects regression model. Recommendations are based on analysis of ORs and a structured expert opinion gauging process.
RESULTS
Twenty-three studies were identified, showing great disparity on the length of the learning curve. Seven studies, representing 4852 cases (19 surgeons), were analyzed. Risk-adjusted cumulative sum charts demonstrated the length of the learning curves to be 152 cases for conversions, 143 for complications, 96 for operating time, 87 for blood loss, and 103 for length of stay. Body mass index and pelvic dissection (rectum), especially in male patients, independently increased the risk of complication and conversion. The expert survey revealed that increasing T stage and complicated inflammatory disease are likely to increase the complexity of the case. Based on this evidence, a framework for case selection in training was proposed.
LIMITATIONS
The generalizability of the study results maybe reduced because of inconsistent data quality and individual variations in the length of the learning curve
CONCLUSIONS
This multicenter database suggests a length of the learning curve of 88 to 152 cases. The use of the suggested framework may prevent high conversion and complication rates during the learning curve.
Topics: Clinical Competence; Colorectal Surgery; Humans; Laparoscopy; Learning Curve; Postoperative Complications; Regression Analysis
PubMed: 23135590
DOI: 10.1097/DCR.0b013e31826ab4dd -
Human Fertility (Cambridge, England) Dec 2023The purpose of this systematic review is to identify common hysteroscopic findings suggestive of endometritis, chronic or subclinical, based on current scientific... (Review)
Review
The purpose of this systematic review is to identify common hysteroscopic findings suggestive of endometritis, chronic or subclinical, based on current scientific evidence. Data sources were MEDLINE, Embase, PubMed and other sources of grey literature. Four (4) authors independently selected studies addressing hysteroscopic detection of CE based on specific and clearly stated hysteroscopic criteria. The diagnosis was confirmed by histologic assessment, as stated in the materials and methods of these studies included. The initial search identified 599 studies, of which 21 met the inclusion criteria. Significant heterogeneity among published studies on Chronic endometritis (CE) remains the main limitation in performing a metanalysis and further analysis of diagnostic accuracy on the subject. Hysteroscopy is an important diagnostic tool in cases of chronic endometritis when accompanied by endometrial biopsies. Clinicians relate hyperaemia and endometrial oedema with chronic endometritis while more than half include micropolyposis as a pathognomonic feature of this subclinical condition. Micropolyps, stromal oedema, haemorrhagic spots, strawberry aspect, and hyperaemia are proposed as adequate indicators of hysteroscopic evidence of CE according to the literature. The impact of CE in long-term reproductive outcomes remain unclear, thus clinicians ought to communicate this to the patients and provide treatment where clinically appropriate. In addition, we present hysteroscopic images of histologically confirmed CE cases that could play the role of a hysteroscopic atlas.
Topics: Female; Humans; Chronic Disease; Edema; Endometritis; Endometrium; Hyperemia; Hysteroscopy
PubMed: 37811835
DOI: 10.1080/14647273.2023.2265155 -
Infectious Diseases and Therapy Dec 2021Neisseria gonorrhoeae (Ng) is the second most common sexually transmitted bacterial infection (STI), leading to serious health problems in men, women and newborns. While... (Review)
Review
OBJECTIVE
Neisseria gonorrhoeae (Ng) is the second most common sexually transmitted bacterial infection (STI), leading to serious health problems in men, women and newborns. While early antibiotic treatment is effective, infections are increasingly antibiotic-resistant. No systematic reviews present health problems associated with Ng infections or their likelihood of occurrence. The objective, therefore, was to conduct a systematic literature review to address these gaps.
METHODS
A systematic literature review was conducted of all studies with an English abstract published since 1950 (Pubmed)/1966 (Embase). The search included patients with a history of/current sexually transmitted Ng infection. Expected outcomes were defined from published reviews of gonorrhoea health problems. Observational studies with a control group were included. A decision tree determined the best quality studies for each outcome, prioritising generalisable populations, laboratory-confirmed diagnosis, clearly defined outcomes, no STI co-infections, adjusted analyses and risk estimates. Where feasible, a meta-analysis was performed; otherwise, the best quality study estimates were identified.
FINDINGS
In total, 46 studies were included, and 22 health problems were identified. Of these problems, Ng infection was statistically significantly associated with preterm premature ruptures of membranes, preterm birth, low birth weight, stillbirth, infant death, neonatal ophthalmia, schizophrenia in offspring, pelvic inflammatory disease and subsequent tubal infertility, human immunodeficiency virus and prostate cancer/problems. High-quality evidence was generally lacking, with high heterogeneity across studies, and limited or inconclusive data on other health problems.
CONCLUSION
Ng infection is associated with severe health problems in women, men and newborns. More high-quality comparative studies are needed to address the limitations in current knowledge.
PubMed: 34279817
DOI: 10.1007/s40121-021-00481-z -
Journal of Traditional Chinese Medicine... Feb 2024To systematically evaluate the efficacy and safety of acupuncture (AM) in the treatment of pregnancy-related symptoms such as acute vomiting during pregnancy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically evaluate the efficacy and safety of acupuncture (AM) in the treatment of pregnancy-related symptoms such as acute vomiting during pregnancy.
METHODS
We comprehensively searched the available literature up to November 2021, including PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure Database, for randomized controlled trials (RCTs) on AM for the treatment of severe vomiting, insomnia, pharyngeal and pelvic pain, mood abnormalities, and dyspepsia during pregnancy.
RESULTS
Sixteen RCTs with a cumulative sample size of 1178 cases were included. Of these, 964 patients were included in the Meta-analysis. The Meta-analysis results showed that AM was more efficient than Western medicine in treating discomfort during pregnancy [odds ratio () = 1.19, 95% confidence interval () (1.11, 1.28), 0.01]. AM was better than the control group in improving the visual analog scale scores [standard mean difference () = 0.62, 95% (0.53, 0.71), 0.01]. AM was superior to the control group in improving Numerical Rating Scale (NRS) symptom scores [ = 7.31, 95% (3.36, 15.94), 0.01]. There was no significant difference in adverse effects between the AM and sham-AM groups and the analgesic drug group [ = 0.70, 95% (0.39, 1.28), = 0.25], but the treatment and control groups had mild adverse effects with a low incidence.
CONCLUSIONS
AM is more effective than other treatments or pharmacotherapy alone in the treatment of pregnancy-related symptoms, and is relatively safe. However, the quality of the included trials was rather poor, and high-quality studies are required to confirm our findings.
Topics: Female; Humans; Pregnancy; Acupuncture Therapy; China; Pelvic Pain; Sleep Initiation and Maintenance Disorders; Vomiting
PubMed: 38213235
DOI: 10.19852/j.cnki.jtcm.20231204.006