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Menopause (New York, N.Y.) Feb 2024Menopause impacts the quality of life for women, with symptoms varying from hot flashes to night disturbances. When menopausal hormonal therapy is contraindicated or... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Menopause impacts the quality of life for women, with symptoms varying from hot flashes to night disturbances. When menopausal hormonal therapy is contraindicated or women refuse menopausal hormonal therapy, many consider alternatives such as pollen extract for treating vasomotor symptoms.
OBJECTIVE
This meta-analysis focuses on the impact of using purified pollen extract as a treatment option to reduce vasomotor symptoms in women, specifically focusing on symptoms such as hot flashes, night disturbances, myalgias, and depression.
EVIDENCE REVIEW
A comprehensive literature search was conducted using the following Boolean search string "women OR females" AND "purified pollen OR pollen extract OR cytoplasmic pollen OR Bonafide OR Femal OR Estroven OR Serelys" AND "menopausal symptoms OR vasomotor symptoms OR hot flashes OR night sweats OR sleep disturbance." Publications in English from 2003 to the present were included. To assess the risk of bias, authors used the Cochrane Risk-of-Bias 2 for a randomized controlled trial and Risk-of-Bias in Non-Randomized Studies of Interventions (ROBINS-I) for observational studies. Using ReviewManager, a Der Simonian-Laird random-effects model meta-analysis was conducted to determine the standardized mean differences (SMDs) in the outcomes for each study.
FINDINGS
Five articles were retained: one randomized controlled trial and four observational studies ( N = 420). An overall decrease in scores from the baseline of studies compared with a 3-month follow-up after purified cytoplasm of pollen (PCP) treatment was recognized when compiling the data. Overall, there was significant improvement across all outcomes at 3 months: hot flashes demonstrated an overall improvement in SMD of -1.66 ( P < 0.00001), night disturbance scores were improved with an SMD of -1.10 ( P < 0.0001), depression scores were improved with an SMD of -1.31 ( P < 0.0001), and myalgia had an improvement in SMD of -0.40 ( P < 0.00001). When controlled studies were pooled for meta-analysis, outcomes, however, were no longer statistically significant.
CONCLUSIONS AND RELEVANCE
Evaluating the risk-to-benefit ratio of alternative therapies, such as PCP extract, is important to care for women who cannot take traditional vasomotor symptom therapies. Pooled data from controlled studies evaluating PCP extract suggest that vasomotor symptom improvements seen in noncontrolled studies may have been due to the placebo effect; however, its use was not associated with significant adverse effects.
Topics: Female; Humans; Complementary Therapies; Hot Flashes; Menopause; Plant Extracts; Pollen; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 38194609
DOI: 10.1097/GME.0000000000002301 -
PloS One 2023Research on the long-term impact on COVID-19 in children and young people (CYP) has been published at pace. We aimed to update and refine an earlier systematic review... (Meta-Analysis)
Meta-Analysis
Persistent symptoms are associated with long term effects of COVID-19 among children and young people: Results from a systematic review and meta-analysis of controlled studies.
BACKGROUND
Research on the long-term impact on COVID-19 in children and young people (CYP) has been published at pace. We aimed to update and refine an earlier systematic review and meta-analysis to assess the current evidence for Post-COVID-19 Condition in CYP.
METHODS
Studies from the previous systematic review were combined with studies from a systematic search from July 2021 to November 2022 (registration PROSPERO CRD42021233153). Eligible studies included CYP aged ≤19 years with confirmed or probable SARS-CoV-2 infection and symptoms persisting at least 12 weeks.
FINDINGS
55 studies (n = 1,139,299 participants) were included. Over two-hundred symptoms were associated with Post COVID-19 Condition. Gastrointestinal problems, headaches, cough and fever were among the most prevalent symptoms with rates of 50.2%, 35.6%, 34.7% and 25.8% respectively. Twenty-one symptoms from 11 studies were suitable for meta-analysis. There were significantly higher pooled estimates of proportions of symptoms for altered / loss of smell or taste, dyspnoea, fatigue, and myalgia in CYP with confirmed SARS-CoV-2 infection. Heterogeneity was high suggesting substantial variation amongst the included studies.
CONCLUSIONS
Many CYP continue to experience symptoms after SARS-CoV-2 infection. Efforts to aid early identification and intervention of those most in need is warranted and the consequences of COVID-19 for CYP call for long-term follow-up.
Topics: Child; Humans; Adolescent; COVID-19; SARS-CoV-2; Headache; Research Design; Gastrointestinal Diseases; Post-Acute COVID-19 Syndrome
PubMed: 38153928
DOI: 10.1371/journal.pone.0293600 -
Pituitary Feb 2024Isolated adrenocorticotropic hormone deficiency (IAD) is considered to be a rare disease. Due to the nonspecific clinical presentation, precise data on the prevalence... (Review)
Review
Isolated adrenocorticotropic hormone deficiency (IAD) is considered to be a rare disease. Due to the nonspecific clinical presentation, precise data on the prevalence and incidence are lacking. In this systematic review, we aimed to analyse the clinical characteristics, association with autoimmune diseases, and management of acquired idiopathic IAD cases. A structured search was conducted after developing a search strategy combining terms for acquired (idiopathic) IAD. Articles describing an adult case with a diagnosis of ACTH deficiency using dynamic testing, no deficiency of other pituitary axes, and MRI of the brain/pituitary protocolled as normal, were included. Exclusion criteria were cases describing congenital IAD, cases with another aetiology for IAD, and articles where full text was not available. In total 42 articles were included, consisting of 85 cases of acquired idiopathic IAD. Distribution by sex was approximately equal (F:M; 47:38). Lethargy was the most common presenting symptom (38%), followed by weight loss (25%), anorexia (22%), and myalgia/arthralgia (12%). Eight cases (9.5%) presented with an Addison crisis. 31% of cases had an autoimmune disease at diagnosis of which Hashimoto hypothyroidism was the most frequent. Data about follow-up was scarce; dynamic testing was repeated in 4 cases of which 2 showed recovery of the adrenal axis. We report the largest case series of acquired idiopathic IAD to date. Our systematic review highlights the lack of a clear definition and diagnostic work-up. Based on the findings in this review a proposition is made for a flowchart to diagnose acquired idiopathic IAD.
Topics: Adult; Humans; Endocrine System Diseases; Adrenal Insufficiency; Adrenocorticotropic Hormone; Hypoglycemia; Genetic Diseases, Inborn
PubMed: 38151529
DOI: 10.1007/s11102-023-01366-9 -
PloS One 2023Although statins are often discontinued when myalgia arises, a causal relationship may not always exist. How well-tolerated statins are when rechallenge is blinded and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although statins are often discontinued when myalgia arises, a causal relationship may not always exist. How well-tolerated statins are when rechallenge is blinded and controlled is unclear.
METHODS AND FINDINGS
We performed a systematic review and meta-analysis (PROSPERO CRD42023437648) to evaluate the success of statin rechallenge versus matched placebo in those who were previously statin intolerant. Our primary outcome was intolerance; our secondary outcome was the myalgia or global symptom score. Medline, Embase, CINAHL Plus, Scopus, and CENTRAL were searched from inception to May 1, 2023. Eligible trials were randomized controlled trials with parallel or crossover designs examining statin rechallenge in statin-intolerant adults. Two independent reviewers selected studies, extracted data, and assessed risk of bias (Cochrane Collaboration's risk-of-bias tool 1). Relative risk (RR) and mean difference (MD) were estimated using fixed effect Mantel-Haenszel statistics. Of 1,941 studies screened, 8 met our inclusion criteria (8 to 491 participants from Asia, Europe, North America, and Oceana). Compared to placebo, intolerance was more common in statin users [325/906 (36%) vs 233/911 (26%), RR 1.40, 95% CI, 1.23 to 1.60, I2 = 0%, 7 trials, number needed to harm 10] and there was no statistically significant difference in myalgia or global symptom score on a 100-point scale [MD 1.08, 95% CI, -1.51 to 3.67, I2 = 0%, 5 trials]. Limitations include only 1 trial asking participants about intolerable symptoms (vs inferring intolerance from discontinuation or trial withdrawal); the small number of trials; the possibility of attrition bias; and the potential for carryover effects in crossover/n-of-1 trial designs.
CONCLUSIONS
Of those previously intolerant of statins who were rechallenged with a statin and compared to placebo recipients, medication intolerance was more common amongst statin recipients. However, there was no significant difference in mean myalgia or global symptom score between statin and placebo, and only one-third of those previously believed to be statin intolerant were unable to tolerate a statin on blinded rechallenge; one-quarter were intolerant of placebo.
Topics: Adult; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Myalgia; Randomized Controlled Trials as Topic; Asia; Europe
PubMed: 38128013
DOI: 10.1371/journal.pone.0295857 -
Sports Medicine (Auckland, N.Z.) Apr 2024Professional rugby union is a high-intensity contact sport with position-specific high training and match volumes across a season that may lead to periods of fatigue if... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Professional rugby union is a high-intensity contact sport with position-specific high training and match volumes across a season that may lead to periods of fatigue if above a typically experienced threshold. This study assesses the influence of match play and/or training on fatigue levels in rugby union players.
OBJECTIVE
We aimed to perform a systematic review and meta-analysis of measures used to assess fatigue status in male professional rugby union players.
METHODS
Using electronic databases (PubMed, SPORTDiscus, Web of Science, Cochrane Library, EMBASE, and MEDLINE), a systematic review of fatigue testing in rugby union was conducted on (1) neuromuscular, (2) subjective self-report, (3) biochemical, and (4) heart rate-derived measures.
RESULTS
Thirty-seven articles were included in this systematic review, of which 14 were further included in a meta-analysis. The results of the meta-analysis revealed small, yet not significant, decreases in countermovement jump height immediately after (effect size [ES] = - 0.29; 95% confidence interval [CI] - 0.64 to 0.06), 24 h (ES = - 0.43; 95% CI - 3.99 to 3.21), and 48 h (ES = - 0.22; 95% CI - 0.47 to 0.02) after exposure to rugby union match play or training. Reported wellness (ES = - 0.33; 95% CI - 1.70 to 1.04) and tiredness (ES = - 0.14; 95% CI - 1.30 to 1.03) declined over a period of a few weeks (however, the results were not-statistically significant), meanwhile muscle soreness increased (ES = 0.91; 95% CI 0.06 to 1.75) within the 96 h after the exposure to rugby union match play or training. Finally, while cortisol levels (ES = 1.87; 95% CI - 1.54 to 5.29) increased, testosterone declined (ES = - 1.54; 95% CI - 7.16 to 4.08) within the 24 h after the exposure. However, these results were not statistically significant.
CONCLUSIONS
Subjective measures of muscle soreness can be used to assess fatigue after match play and training in rugby union players. Within-study and between-study variability for countermovement jump height, biochemical markers, and heart rate-derived measures means the utility (practical application) of these measures to assess fatigue in professional rugby union players after matches and training is unclear.
CLINICAL TRIAL REGISTRATION
PROSPERO ID: CRD42020216706.
Topics: Humans; Football; Fatigue; Male; Heart Rate; Physical Conditioning, Human; Muscle Fatigue; Exercise Test; Hydrocortisone; Myalgia; Testosterone
PubMed: 38114782
DOI: 10.1007/s40279-023-01973-3 -
Infection Jun 2024In 2022, there were outbreaks of Mpox where the disease is not endemic. We summarized published full-text epidemiological data from the outbreaks. (Meta-Analysis)
Meta-Analysis
BACKGROUND
In 2022, there were outbreaks of Mpox where the disease is not endemic. We summarized published full-text epidemiological data from the outbreaks.
METHODS
A global evidence review (protocol: osf.io/j3kb7) with systematic literature search up to February 09, 2023. We focused on experimental/observational studies of laboratory confirmed Mpox, excluding case reports and case series of < 5 cases. Epidemiological data were pooled using an inverse variance, random-effects model, and pooled estimates presented with associated 95% confidence intervals.
RESULTS
We included 66 studies. Mean incubation period was 7.8 days (6.6-9.0 days, 8 studies: 560 cases), reproductive number 1.8 (1.7-1.9, 6 studies), mean duration from symptom onset to diagnosis 5.8 days (4.8-6.8 days, 4 studies: 982 cases), mean symptom duration 17.5 days (14.7-20.2 days, 3 studies: 292 cases), mean serial interval 8.5 days (7.3-9.9 days, 1 study), hospitalisation 6% (4-9%, 26 studies: 5339 cases), and vaccine effectiveness 78% (65-91%, 3 studies: 953 cases). Highly relevant clinical manifestations were pleomorphic skin lesions 82% (68-94%, 26 studies: 4093 cases), anogenital lesions 64% (51-77%, 9 studies: 10,398 cases), fever 54% (50-57%, 52 studies: 25,992 cases), and lymphadenopathy 51% (46-57%, 42 studies: 17,803 cases), with cases mostly men who have sex with men (MSM). Possibly relevant manifestations were perianal lesions, fatigue, asthenia, myalgia, and headache.
CONCLUSIONS
The 2022 Mpox outbreaks presented with sex-related clinical manifestations and were mostly reported among MSM.
Topics: Humans; Disease Outbreaks; Male; Female
PubMed: 38051425
DOI: 10.1007/s15010-023-02133-5 -
Current Problems in Cardiology Feb 2024Bempedoic acid (BA) has shown significant progress in reducing cholesterol levels and is relatively free from the many side effects encountered with the use of other... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Bempedoic acid (BA) has shown significant progress in reducing cholesterol levels and is relatively free from the many side effects encountered with the use of other hyperlipidemic drugs such as statins. However, its efficacy in patients with statin intolerance is controversial with inconsistent results among studies.
MATERIALS AND METHODS
An electronic literature search was performed using various databases such as Medline, Google Scholar, and the International Registry of Clinical Trials. The primary endpoint was the change in LDL-C levels. The secondary endpoints included changes in HDL-C, non-HDL-C, triglycerides (TG), clinical outcomes such as MACE, all-cause mortality (ACM), cardiovascular mortality, myocardial infarction (MI), and additional safety outcomes. The least-square mean (LSM) percent change for assessing changes in lipid parameter levels from the baseline and the risk ratio (RR) were used for the evaluation of binary endpoints, with statistical significance set at p<0.05. Random-effects meta-analyses were performed for all the outcomes.
RESULTS
Our analysis included 5 randomized controlled trials (RCTs) with a total of 18,848 participants. BA showed a significant reduction in LDL-C [LSM difference in %: -25.24; 95 % CI: -30.79 to -19.69; p < 0.00001], total cholesterol [LSM difference in %:-21.28; 95 % CI:-30.58 to-11.98; p < 0.00001], non-HDL-C [LSM difference in %: -23.27; 95 % Cl: -29.80 to -16.73 p < 0.00001], and HDL-C [LSM difference in %:-3.37, 95 % CI:-3.73 to-3.01, p < 0.00001] compared to placebo. In terms of clinical efficacy, BA was associated with a lower risk of coronary revascularization [RR:0.81; 95 % CI:0.66 to 0.99; p = 0.04], hospitalization for unstable angina [RR:0.67; 95 % CI:0.50 to 0.88; p = 0.005], and myocardial infarction [RR:0.76; 95 % CI:0.66 to 0.88;p = 0.0004]. No significant difference was observed in MACE [RR:0.81; p = 0.15], ACM [RR:0.86; p = 0.46], cardiovascular-related mortality [RR:0.79; p = 0.44], and stroke [RR:0.83; p = 0.08] between the two groups. In terms of safety efficacy, the risk for myalgia was significantly lower in BA-treated patients than in placebo [RR:0.80; p = 0.0002], while the risk for gout [RR:1.46; p < 0.0001] and hyperuricemia [RR:1.93; p < 0.00001] was higher for BA than for placebo. The risks for other adverse effects, such as neurocognitive disorder, nasopharyngitis urinary tract infection, upper respiratory infection, muscular disorder, and worsening hyperglycemia/DM were comparable between the two groups.
CONCLUSION
Our analysis demonstrated that BA significantly reduced the levels of LDL-C, total cholesterol, non-HDL-C, HDL-C, ApoB, and hs-CRP compared with the placebo group. Additionally, patients who received BA had a lower likelihood of coronary revascularization and hospitalization due to unstable angina, MI, and myalgia. Further large-scale RCTs are required to generate more robust evidence.
Topics: Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Cholesterol, LDL; Myalgia; Randomized Controlled Trials as Topic; Myocardial Infarction; Angina, Unstable
PubMed: 38043880
DOI: 10.1016/j.cpcardiol.2023.102236 -
Physiotherapy Theory and Practice Dec 2023The interventions performed in most randomized controlled trials (RCTs) on neck pain patients are standardized, irrespective of the high heterogeneity of patients.... (Review)
Review
BACKGROUND
The interventions performed in most randomized controlled trials (RCTs) on neck pain patients are standardized, irrespective of the high heterogeneity of patients. However, clinicians tend to choose an intervention based on the patients' clinical characteristics, and thus match the treatment to the patient.
OBJECTIVES
To investigate the effectiveness of interventions matched to the clinical characteristics of patients with neck pain versus the same, but unmatched treatment for improving pain or disability.
DESIGN
A systematic review and meta-analysis conducted following Cochrane guidelines.
METHODS
Databases searches were performed from inception to September 2023. RCTs were included if the patients in the experimental group received a treatment matched to clinical presentation or to clinicians' assessment, if the patients in the control group received a similar but unmatched treatment, and if pain or disability were reported as outcome measures.
RESULTS
The literature search produced 9516 records of which 27 met the inclusion criteria. Matched exercise therapy was superior to unmatched exercise for pain (SMD -0.57; 95% CI -0.95, -0.18) and for disability (SMD -0.69; 95% CI -1.14, -0.23) at short term, but not at intermediate-term follow-up. Matched manual treatment was not superior to unmatched manual therapy for pain or for disability at short or intermediate-term follow-up.
CONCLUSIONS
Results suggest that matching exercise to movement limitation, trapezius myalgia, or forward head position may lead to better outcomes in the short term, but not in the intermediate-term. Matched manual therapy was not superior to unmatched treatment either short or intermediate-term. Further research is warranted to verify if those criteria are potentially useful matching criteria.
PubMed: 38037765
DOI: 10.1080/09593985.2023.2285892 -
PloS One 2023Persistent symptoms are reported in patients who survive the initial stage of COVID-19, often referred to as "long COVID" or "post-acute sequelae of SARS-CoV-2... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Persistent symptoms are reported in patients who survive the initial stage of COVID-19, often referred to as "long COVID" or "post-acute sequelae of SARS-CoV-2 infection" (PASC); however, evidence on their incidence is still lacking, and symptoms relevant to pain are yet to be assessed.
METHODS
A literature search was performed using the electronic databases PubMed, EMBASE, Scopus, and CHINAL and preprint servers MedRχiv and BioRχiv through January 15, 2021. The primary outcome was pain-related symptoms such as headache or myalgia. Secondary outcomes were symptoms relevant to pain (depression or muscle weakness) and symptoms frequently reported (anosmia and dyspnea). Incidence rates of symptoms were pooled using inverse variance methods with a DerSimonian-Laird random-effects model. The source of heterogeneity was explored using meta-regression, with follow-up period, age and sex as covariates.
RESULTS
In total, 38 studies including 19,460 patients were eligible. Eight pain-related symptoms and 26 other symptoms were identified. The highest pooled incidence among pain-related symptoms was chest pain (17%, 95% confidence interval [CI], 11%-24%), followed by headache (16%, 95% CI, 9%-27%), arthralgia (13%, 95% CI, 7%-24%), neuralgia (12%, 95% CI, 3%-38%) and abdominal pain (11%, 95% CI, 7%-16%). The highest pooled incidence among other symptoms was fatigue (44%, 95% CI, 32%-57%), followed by insomnia (27%, 95% CI, 10%-55%), dyspnea (26%, 95% CI, 17%-38%), weakness (25%, 95% CI, 8%-56%) and anosmia (19%, 95% CI, 13%-27%). Substantial heterogeneity was identified (I2, 50-100%). Meta-regression analyses partially accounted for the source of heterogeneity, and yet, 53% of the symptoms remained unexplained.
CONCLUSIONS
The current meta-analysis may provide a complete picture of incidence in PASC. It remains unclear, however, whether post-COVID symptoms progress or regress over time or to what extent PASC are associated with age or sex.
Topics: Humans; COVID-19; Post-Acute COVID-19 Syndrome; Incidence; Anosmia; SARS-CoV-2; Headache; Dyspnea
PubMed: 38019841
DOI: 10.1371/journal.pone.0250909 -
Journal of Strength and Conditioning... Dec 2023Doma, K, Matoso, B, Protzen, G, Singh, U, and Boullosa, D. The repeated bout effect of multiarticular exercises on muscle damage markers and physical performances: a... (Meta-Analysis)
Meta-Analysis
Doma, K, Matoso, B, Protzen, G, Singh, U, and Boullosa, D. The repeated bout effect of multiarticular exercises on muscle damage markers and physical performances: a systematic review and meta-analyses. J Strength Cond Res 37(12): 2504-2515, 2023-This systematic review and meta-analysis compared muscle damage markers and physical performance measures between 2 bouts of multiarticular exercises and determined whether intensity and volume of muscle-damaging exercises affected the outcomes. The eligibility criteria consisted of (a) healthy male and female adults; (b) multiarticular exercises to cause muscle damage across 2 bouts; (c) outcome measures were compared at 24-48 hours after the first and second bouts of muscle-damaging exercise; (d) at least one of the following outcome measures: creatine kinase (CK), delayed onset of muscle soreness (DOMS), muscle strength, and running economy. Study appraisal was conducted using the Kmet tool, whereas forest plots were derived to calculate standardized mean differences (SMDs) and statistical significance and alpha set a 0.05. After screening, 20 studies were included. The levels of DOMS and CK were significantly greater during the first bout when compared with the second bout at T24 and T48 (p < 0.001; SMD = 0.51-1.23). Muscular strength and vertical jump performance were significantly lower during the first bout compared with the second bout at T24 and T48 (p ≤ 0.05; SMD = -0.27 to -0.40), whereas oxygen consumption and rating of perceived exertion were significantly greater during the first bout at T24 and T48 (p < 0.05; SMD = 0.28-0.65) during running economy protocols. The meta-analyses were unaffected by changes in intensity and volume of muscle-damaging exercises between bouts. Multiarticular exercises exhibited a repeated bout effect, suggesting that a single bout of commonly performed exercises involving eccentric contractions may provide protection against exercise-induced muscle damage for subsequent bouts.
Topics: Adult; Humans; Male; Female; Muscle, Skeletal; Exercise; Myalgia; Running; Creatine Kinase; Physical Functional Performance; Muscle Contraction
PubMed: 38015738
DOI: 10.1519/JSC.0000000000004628