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Reproductive Health Feb 2021Pelvic organ prolapse remains the public health challenge globally. Existing evidences report the effect of woman's weight on the pelvic organ prolapse inconsistently... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pelvic organ prolapse remains the public health challenge globally. Existing evidences report the effect of woman's weight on the pelvic organ prolapse inconsistently and this urges the need of pooled body weight effect on the pelvic organ prolapse. Although there was a previous work on this regard, it included papers reported before June 18/2015. Thus, updated and comprehensive evidence in this aspect is essential to devise strategies for interventions.
OBJECTIVE
This review aimed at synthesizing evidence regarding the pooled effect of body weight on the pelvic organ prolapsed.
METHODS
For this review, we searched all available articles through databases including PubMed, Web of Sciences, CINAHL, JBI library, Cochran library, PsycInfo and EMBASE as well as grey literature including Mednar, worldwide science, PschEXTRA and Google scholar. We included cohort, case-control, cross-sectional and experimental studies which had been reported between March 30, 2005 to March 30, 2020. In the effect analysis, we utilized random model. The heterogeneity of the studies was determined by I2 statistic and the publication bias was checked by Egger's regression test. Searching was limited to studies reported in the English language.
RESULTS
A total of 14 articles with 53,797 study participants were included in this systematic review (SR) and meta analysis (MA). The pooled result of this Meta analyses depict that body mass index (BMI) doesn't have statistical significant association with pelvic organ prolapse.
CONCLUSION
This review point out that women's body mass index has no significant effect on the development of pelvic organ prolapse. However, the readers should interpret the result with cautions due to the presence of considerable limitations in this work. Trial registration The protocol of this systematic review (SR) and meta analysis (MA) has been registered in PROSPERO databases with the Registration number of CRD42020186951.
Topics: Adolescent; Adult; Aged; Body Mass Index; Child; Female; Humans; Middle Aged; Obesity; Pelvic Organ Prolapse; Risk Factors
PubMed: 33608022
DOI: 10.1186/s12978-021-01104-z -
Journal of Orthopaedic Trauma 2009Pelvic and acetabular fractures have been identified as risk factors for deep venous thrombosis (DVT) and thromboembolic complications. A systematic review was performed... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Pelvic and acetabular fractures have been identified as risk factors for deep venous thrombosis (DVT) and thromboembolic complications. A systematic review was performed to evaluate the effectiveness of thromboprophylactic strategies to prevent DVT or pulmonary embolism (PE) after pelvic or acetabular fractures.
DATA SOURCES
Relevant articles were identified by searching MEDLINE, MEDLINE In Process & Other Non-indexed Citations, EMBASE, CENTRAL, and the Cochrane Database of Systematic Reviews. All languages and years indexed were searched.
STUDY SELECTION
Manuscripts were included if (1) the study included an intervention or strategy aimed at preventing thromboembolic disease, (2) the subjects in the study had suffered a pelvic or acetabular fracture, and (3) the primary outcome of the study was DVT or PE.
DATA EXTRACTION
The intervention, sample size, DVT, and/or PE incidence, and method of diagnosis were recorded for each study.
DATA SYNTHESIS
Eleven studies with 1760 subjects were included. Included studies were grouped into 5 types of interventions: mechanical compression devices, inferior vena cava filters, low-molecular weight heparins, ultrasound screening, and magnetic resonance venography screening. Most studies were observational designs with minimal control data for comparison. Quantitative pooling was not possible based on significant study heterogeneity.
CONCLUSIONS
Although several strategies have been used to prevent thromboembolism in pelvic and acetabular fracture patients, our results suggest that clinicians have limited data to guide their prophylactic decisions. Well-designed clinical trials to prevent and detect venous thromboembolism in pelvic and acetabular trauma are still needed.
Topics: Acetabulum; Comorbidity; Fibrinolytic Agents; Fractures, Bone; Humans; Incidence; Pelvic Bones; Risk Assessment; Risk Factors; Thrombosis; Treatment Outcome
PubMed: 19390367
DOI: 10.1097/BOT.0b013e3181a5369c -
JAMA Mar 2017Recent changes in the periodicity of cervical cancer screening have led to questions about the role of screening pelvic examinations among asymptomatic women. (Review)
Review
IMPORTANCE
Recent changes in the periodicity of cervical cancer screening have led to questions about the role of screening pelvic examinations among asymptomatic women.
OBJECTIVE
To systematically review literature on health benefits, accuracy, and harms of the screening pelvic examination for gynecologic conditions for the US Preventive Services Task Force (USPSTF).
DATA SOURCES
MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through January 13, 2016, with surveillance through August 3, 2016.
STUDY SELECTION
Two reviewers independently screened abstracts and studies. The search yielded 8678 unique citations; 316 full-text articles were reviewed, and 9 studies including 27 630 patients met inclusion criteria.
DATA EXTRACTION AND SYNTHESIS
Two reviewers rated study quality using USPSTF criteria.
MAIN OUTCOMES AND MEASURES
Morbidity; mortality; diagnostic accuracy for any gynecologic cancer or condition except cervical cancer, gonorrhea, and chlamydia, which are covered by other USPSTF screening recommendations; harms (false-positive rates, false-negative rates, surgery rates).
RESULTS
No trials examined the effectiveness of the pelvic examination in reducing all-cause mortality, reducing cancer- and disease-specific morbidity and mortality, or improving quality of life. Eight studies reported accuracy for the screening pelvic examination: ovarian cancer (4 studies; n = 26 432), bacterial vaginosis (2 studies; n = 930), trichomoniasis (1 study; n = 779), and genital herpes (1 study; n = 779). In the 4 ovarian cancer screening studies, low prevalence of ovarian cancer consistently resulted in low positive predictive values (PPVs) and false-positive rates, with a lack of precision in accuracy estimates (sensitivity range, 0%-100%; specificity range, 91%-99%; PPV range, 0%-3.6%; negative predictive value [NPV] range, ≥99%). Each diagnostic accuracy study for bacterial vaginosis, trichomoniasis, and genital herpes was performed in a high-prevalence population with substantial proportions of symptomatic patients and reported accuracy characteristics for individual physical examination findings (bacterial vaginosis, homogeneous discharge: sensitivity range, 69%-79%; specificity range, 54%-97%; PPV range, 52%-95%; NPV range, 79%-80%; herpes simplex virus, vulvar ulcerations: sensitivity, 20%; specificity, 98%; PPV, 88%; NPV, 57%; trichomoniasis, colpitis macularis: sensitivity, 2%; specificity, 100%; PPV, 100%; NPV, 85%). Surgery rates resulting from an abnormal screening pelvic examination for ovarian cancer ranged from 5% to 36% at 1 year, with the largest study reporting an 11% surgery rate and 1% complication rate within 1 year of a screening pelvic examination with abnormal findings.
CONCLUSIONS AND RELEVANCE
No direct evidence was identified for overall benefits and harms of the pelvic examination as a 1-time or periodic screening test. Limited evidence was identified regarding the diagnostic accuracy and harms of routine screening pelvic examinations in asymptomatic primary care populations.
Topics: Adult; Clinical Trials as Topic; Female; Genital Diseases, Female; Gynecological Examination; Humans; Mass Screening
PubMed: 28267861
DOI: 10.1001/jama.2016.12819 -
BMC Women's Health Aug 2020Pelvic organ prolapse can significantly affect a woman's quality of life by compromising physical, social, psychological and sexual function. Pelvic organ disorders and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pelvic organ prolapse can significantly affect a woman's quality of life by compromising physical, social, psychological and sexual function. Pelvic organ disorders and its consequences have higher economic burden to the patient as well to the country. Therefore, this systematic review and met- analysis aimed to estimate the burden of POP in Ethiopia.
METHODS
International databases (MEDLINE/Pub Med, Hinari, Scopus, Google scholar, African journals and literatures were searched and seven eligible cross sectional and two case control studies were included in this systematic review and meta-analysis. Eggers test and funnel plot were computed to check publication bias across the studies. Publication bias was computed using a funnel plot and eggers test. Heterogeneity of the studies was checked using Cochrane Q-test and I statistic. Subgroup analysis was computed for the evidence of heterogeneity.
RESULTS
This systematic review and meta-analysis revealed that the overall national prevalence of pelvic organ prolapse in Ethiopia was 23.52% (95% CI: 61.04, 80.24). Being rural resident (AOR = 3.29; 95% CI: 1.38-7.85), I = 47.5%, P = 0.167), having < 18.5 BMI (AOR = 2.59; 95% CI: 1.53-4.4), I = 59.9%, P = 0.64), and age > 40(AOR = 7.43; 95% CI: 2.27-24.29), I = 75.9%, P = 0.016) were the associated risk factors for pelvic organ prolapse.
CONCLUSIONS
The pooled prevalence of pelvic organ prolapse was high. Residence, body mass index and age of the women were the predictors of pelvic organ prolpase. Creating awareness and identifying the modifiable and non modifiable risk factors for pelvic organ prolpase is a crucial strategy to prevent further complications and risk of operation.
Topics: Adult; Age Factors; Aged; Body Mass Index; Ethiopia; Female; Humans; Middle Aged; Pelvic Organ Prolapse; Quality of Life; Residence Characteristics; Risk Factors; Rural Population; Urban Population
PubMed: 32762749
DOI: 10.1186/s12905-020-01039-w -
Taiwanese Journal of Obstetrics &... Jan 2022Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize... (Review)
Review
Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize published literature on the diagnosis and treatment of this condition. Thus, a systematic literature search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library. An effort was made to numerically analyze all parameters included in case reports and retrospective analyses, as well. The typical and atypical features of this condition, investigations used, type of treatment and histopathology were recorded. More specifications about the surgical treatment, such as operations previously performed, type of surgery and treatment after surgery have been acknowledged. Other sites of endometriosis, the presence of pelvic endometriosis and the follow-up and recurrence have been also documented. Overall, the search yielded 61 eligible studies including 133 cases of inguinal endometriosis. The typical clinical presentation includes a unilateral inguinal mass, with or without catamenial pain. Transabdominal or transvaginal ultrasound was typically used as the first line method of diagnosis. Groin incision and exploratory surgery was the treatment indicated by the majority of the authors, while excision of part of the round ligament was reported in about half of the cases. Chemotherapy and radiotherapy were initiated in cases of coexisting endometriosis-related neoplasia. Inguinal recurrence or malignant transformation was rarely reported. The treatment of inguinal endometriosis is surgical and a long-term follow-up is needed. More research is needed on the effectiveness of suppressive hormonal therapy, recurrence rate and its relationship with endometriosis-associated malignancies.
Topics: Endometriosis; Female; Groin; Humans; Inguinal Canal; Round Ligament of Uterus; Treatment Outcome; Ultrasonography
PubMed: 35181041
DOI: 10.1016/j.tjog.2021.11.007 -
Injury Apr 2022It is unclear which pharmacological agents, and at what dosage and timing, are most effective for venous thromboembolism (VTE) prophylaxis in patients with...
BACKGROUND
It is unclear which pharmacological agents, and at what dosage and timing, are most effective for venous thromboembolism (VTE) prophylaxis in patients with pelvic/acetabular fractures.
METHODS
We searched the Cochrane Database of Systematic Reviews, Embase, Web of Science, EBSCO, and PubMed on October 3, 2020, for English-language studies of VTE prophylaxis in patients with pelvic/acetabular fractures. We applied no date limits. We included studies that compared efficacy of pharmacological agents for VTE prophylaxis, timing of administration of such agents, and/or dosage of such agents. We recorded interventions, sample sizes, and VTE incidence, including deep vein thrombosis (DVT) and pulmonary embolism.
RESULTS
Two studies (3604 patients) compared pharmacological agents, reporting that patients who received direct oral anticoagulants (DOACs) were less likely to develop DVT than those who received low molecular weight heparin (LMWH) (p < 0.01). Compared with unfractionated heparin (UH), LMWH was associated with lower odds of VTE (odds ratio [OR] = 0.37, 95% confidence interval [CI]: 0.22-0.63) and death (OR = 0.27, 95% CI: 0.10-0.72). Three studies (3107 patients) compared timing of VTE prophylaxis, reporting that late prophylaxis was associated with higher odds of VTE (OR = 1.9, 95% CI: 1.2-3.2) and death (OR = 4.0, 95% CI: 1.5-11) and higher rates of symptomatic DVT (9.2% vs. 2.5%, p = 0.03; and 22% vs. 3.1%, p = 0.01). One study (31 patients) investigated dosage of VTE prophylaxis, reporting that a higher proportion of patients with acetabular fractures were underdosed (23% of patients below range of anti-Factor Xa [aFXa] had acetabular fractures vs. 4.8% of patients within adequate range of aFXa, p<0.01).
CONCLUSIONS
Early VTE chemoprophylaxis (within 24 or 48 h after injury) was better than late administration in terms of VTE and death. Many patients with acetabular fractures are underdosed with LMWH, with inadequate aFXa levels. Compared with UH, LMWH was associated with lower odds of VTE and death. DOACs were associated with lower risk of DVT compared with LMWH.
LEVEL OF EVIDENCE
III, systematic review of retrospective cohort studies.
Topics: Anticoagulants; Chemoprevention; Heparin; Heparin, Low-Molecular-Weight; Humans; Pulmonary Embolism; Retrospective Studies; Venous Thromboembolism
PubMed: 35148902
DOI: 10.1016/j.injury.2022.01.045 -
Sports Medicine (Auckland, N.Z.) Apr 2020Treadmills are often used in research, clinical practice, and training. Biomechanical investigations comparing treadmill and overground running report inconsistent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Treadmills are often used in research, clinical practice, and training. Biomechanical investigations comparing treadmill and overground running report inconsistent findings.
OBJECTIVE
This study aimed at comparing biomechanical outcomes between motorized treadmill and overground running.
METHODS
Four databases were searched until June 2019. Crossover design studies comparing lower limb biomechanics during non-inclined, non-cushioned, quasi-constant-velocity motorized treadmill running with overground running in healthy humans (18-65 years) and written in English were included. Meta-analyses and meta-regressions were performed where possible.
RESULTS
33 studies (n = 494 participants) were included. Most outcomes did not differ between running conditions. However, during treadmill running, sagittal foot-ground angle at footstrike (mean difference (MD) - 9.8° [95% confidence interval: - 13.1 to - 6.6]; low GRADE evidence), knee flexion range of motion from footstrike to peak during stance (MD 6.3° [4.5 to 8.2]; low), vertical displacement center of mass/pelvis (MD - 1.5 cm [- 2.7 to - 0.8]; low), and peak propulsive force (MD - 0.04 body weights [- 0.06 to - 0.02]; very low) were lower, while contact time (MD 5.0 ms [0.5 to 9.5]; low), knee flexion at footstrike (MD - 2.3° [- 3.6 to - 1.1]; low), and ankle sagittal plane internal joint moment (MD - 0.4 Nm/kg [- 0.7 to - 0.2]; low) were longer/higher, when pooled across overground surfaces. Conflicting findings were reported for amplitude of muscle activity.
CONCLUSIONS
Spatiotemporal, kinematic, kinetic, muscle activity, and muscle-tendon outcome measures are largely comparable between motorized treadmill and overground running. Considerations should, however, particularly be given to sagittal plane kinematic differences at footstrike when extrapolating treadmill running biomechanics to overground running. Protocol registration CRD42018083906 (PROSPERO International Prospective Register of Systematic Reviews).
Topics: Adolescent; Ankle Joint; Biomechanical Phenomena; Cross-Over Studies; Exercise Test; Female; Humans; Male; Range of Motion, Articular; Running
PubMed: 31802395
DOI: 10.1007/s40279-019-01237-z -
European Journal of Trauma and... Apr 2023Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is... (Review)
Review
INTRODUCTION
Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is lacking. The current review provides a comprehensive summary of the complications after pelvic ring and acetabular fracture surgery in relation to the surgical approach.
MATERIAL AND METHODS
Pubmed and Embase databases were systematically searched using the key words: pelvic fracture, acetabular fracture, fixation, surgical approaches, complications, and their synonyms. Extracted data included patient and fracture characteristics, surgical approaches, and post-operative complications; surgical site infections (SSI), implant-related complications, malunion and non-union. Study data were summarized using descriptive statistics.
RESULTS
Twenty-two studies (twenty-one retrospective cohort studies, of which three comparative, and one randomized controlled trial) were included in this review. The overall complication rates reported for the included surgical approaches were: 17% for the (Modified) Stoppa approach, 11% for percutaneous fixation, 5% for the Kocher-Langenbeck approach, 7% for the ilioinguinal approach and 31% for external fixation. The most frequent complications were SSI (22%) and neurological (31%) complications, which were most often reported in patients treated with an external fixator. Re-operation rates were comparable for the surgical approaches (4-8%). Two studies reported on risk factors and identified concomitant traumatic injuries, prolonged ICU stay and high body mass index as risk factors for SSI.
CONCLUSION
External fixation of pelvic fractures is associated with highest complications rates including SSI's and neurological complications. Although post-operative complications are frequently reported after pelvic fracture surgery, more studies are needed that identify potential risk factors. These will assist the surgeon in (pre)operative decision making and development of preventive strategies.
Topics: Humans; Fracture Fixation, Internal; Acetabulum; Retrospective Studies; Fractures, Bone; Pelvic Bones; Hip Fractures; Spinal Fractures; Surgical Wound Infection; Randomized Controlled Trials as Topic
PubMed: 36434301
DOI: 10.1007/s00068-022-02118-3 -
International Journal of Oral and... Jan 2022Maxillomandibular deformity (MMD) and body posture appear to be correlated. However, no systematic literature review of the available evidence to support this... (Review)
Review
Maxillomandibular deformity (MMD) and body posture appear to be correlated. However, no systematic literature review of the available evidence to support this correlation has been performed to date. The aim of this study was to conduct a systematic literature review on posture and MMD. This systematic literature review was registered in the PROSPERO database. Systematic searches of the MEDLINE, Scopus, Cochrane Library, and Web of Science databases were performed. In total, 13 clinical studies were included. Nine found a significant association between MMD and body posture or body balance: two studies showed a correlation between increased cervical lordosis and skeletal class III MMD, two studies showed an interaction between mandibular deviation and scoliosis, four studies demonstrated a significant association between lumbar column and pelvis anatomy and MMD, and one study found a correlation between displacement of the centre of mass and MMD. However, the level of evidence is low; the methods used to evaluate body posture and MMD were inconsistent. Orthognathic surgery could modify body posture. Although there seems to be an interaction between body posture and facial deformity, the number of studies is too small and the level of evidence too low to strongly support this association.
Topics: Humans; Orthognathic Surgery; Orthognathic Surgical Procedures; Posture
PubMed: 34120792
DOI: 10.1016/j.ijom.2021.05.003 -
Annals of Surgical Oncology May 2016Abdominopelvic cancer surgery increases the risk of postoperative venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) thromboprophylaxis is recommended,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Abdominopelvic cancer surgery increases the risk of postoperative venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) thromboprophylaxis is recommended, and the role of extended thromboprophylaxis (ETP) is controversial. We performed a systematic review to determine the effect of ETP on deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and all-cause mortality after abdominal or pelvic cancer surgery.
METHODS
A search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was undertaken, and studies were included if they compared extended duration (2-6 weeks) with conventional duration of thromboprophylaxis (2 weeks or less) after cancer surgery. Pooled relative risk (RR) was estimated using a random effects model.
RESULTS
Seven randomized and prospective studies were included, comprising 4807 adult patients. ETP was associated with a significantly reduced incidence of all VTEs [2.6 vs. 5.6 %; RR 0.44, 95 % confidence interval (CI) 0.28-0.70, number needed to treat (NNT) = 39] and proximal DVT (1.4 vs. 2.8 %; RR 0.46, 95 % CI 0.23-0.91, NNT = 71). There was no statistically significant difference in the incidence of symptomatic PE (0.8 vs. 1.3 %; RR 0.56, 95 % CI 0.23-1.40), major bleeding (1.8 vs. 1.0 %; RR 1.19, 95 % CI 0.47-2.97), and all-cause mortality (4.2 vs. 3.6 %; RR 0.79, 95 % CI 0.47-1.33). None of the outcomes differed if randomized trials were analyzed independently.
CONCLUSIONS
ETP after abdominal or pelvic surgery for cancer significantly decreased the incidence of all VTEs and proximal DVTs, but had no impact on symptomatic PE, major bleeding, or 3-month mortality. ETP should be routinely considered in the setting of abdominal and pelvic surgery for cancer patients.
Topics: Abdominal Neoplasms; Adult; Anticoagulants; Chemoprevention; Heparin, Low-Molecular-Weight; Humans; Pelvic Neoplasms; Postoperative Complications; Venous Thromboembolism
PubMed: 26887853
DOI: 10.1245/s10434-016-5127-1