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Maturitas May 2023Endometriosis is a benign, estrogen-dependent, chronic inflammatory disease and is the commonest cause of chronic pelvic pain in younger women. Cardiovascular disease is... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Endometriosis is a benign, estrogen-dependent, chronic inflammatory disease and is the commonest cause of chronic pelvic pain in younger women. Cardiovascular disease is the main cause of death worldwide. Because the relationship between endometriosis and CV disease is not well established, we performed a systematic review of longitudinal studies that assessed the occurrence of cardiovascular events in women with endometriosis compared to those without endometriosis.
STUDY DESIGN
Systematic review with meta-analysis of longitudinal cohort/nested case-control studies with endometriosis patients and controls. A search was conducted of the MEDLINE, CENTRAL, and Embase databases from inception to November 2022. Random-effects meta-analysis was performed to estimate pooled hazard ratios (HR) and 95 % confidence intervals (95%CI).
MAIN OUTCOME MEASURE
Cardiovascular outcomes such as ischemic heart disease and cerebrovascular disease.
RESULTS
Six cohort studies were included, with a total of 254,929 participants. Meta-analysis showed that endometriosis was associated with a significantly increased risk of ischemic heart disease (HR 1.50, 95%CI 1.37-1.65; I = 0 %) and cerebrovascular disease (HR 1.17, 95%CI 1.07-1.29; I = 0 %). The one study that examined the relationship between cardiovascular mortality and endometriosis found a decreased risk in women with endometriosis relative to women without endometriosis (HR 0.55 (95%CI 0.47-0.65)).
CONCLUSIONS
Endometriosis is associated with a significantly increased risk of cardiovascular disease, namely ischemic heart disease and cerebrovascular disease. Further studies are required to determine if endometriosis and/or its treatments are risk factors (particularly for cardiovascular mortality), and whether preventive measures could reduce the burden of cardiovascular disease in women with endometriosis. Study protocol registered at PROSPERO: CRD42022298830.
Topics: Humans; Female; Cardiovascular Diseases; Endometriosis; Cerebrovascular Disorders; Myocardial Ischemia; Cohort Studies
PubMed: 37075537
DOI: 10.1016/j.maturitas.2023.04.001 -
Journal of Obstetrics and Gynaecology :... Dec 2023This study assessed the efficacy and safety between broad spectrum penicillin (P2) with or without beta-lactamase inhibitors (P2+) versus first and second generation... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of broad spectrum penicillin with or without beta-lactamase inhibitors vs first and second generation cephalosporins as prophylactic antibiotics during cesarean section: a systematic review and meta-analysis.
This study assessed the efficacy and safety between broad spectrum penicillin (P2) with or without beta-lactamase inhibitors (P2+) versus first and second generation cephalosporins (C1&C2) in the prevention of post-cesarean infections. Relevant randomized controlled trials (RCTs) were searched in English and Chinese databases: nine RCTs were involved. Six trials compared P2+ vs C1&C2, no differences were found between interventions for endometritis, wound infection, urinary tract infection, febrile morbidity and maternal rashes. Four trials compared P2 vs C1&C2, no differences were found between interventions for endometritis, febrile morbidity, wound infection and urinary tract infection. Postoperative hospitalization was longer for women in P2 than C1&C2. Based on these results, P2/P2+ and C1&C2 may have similar efficacy on postoperative infections after cesarean section, there is no data on infant outcomes. CRD42022345721.
Topics: Female; Pregnancy; Humans; beta-Lactamase Inhibitors; Antibiotic Prophylaxis; Surgical Wound Infection; Endometritis; Penicillins; Urinary Tract Infections; Cesarean Section; Cephalosporins; Anti-Bacterial Agents
PubMed: 37071668
DOI: 10.1080/01443615.2023.2195946 -
The Ocular Surface Jul 2023In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular...
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
Topics: Humans; Eye; Eye Diseases; Cosmetics; Randomized Controlled Trials as Topic
PubMed: 37061220
DOI: 10.1016/j.jtos.2023.04.005 -
Journal of Assisted Reproduction and... May 2023
Meta-Analysis
Comment on: Does antibiotic therapy for chronic endometritis improve clinical outcomes of patients with recurrent implantation failure in subsequent IVF cycles? a systematic review and meta-analysis.
Topics: Female; Humans; Pregnancy; Endometritis; Anti-Bacterial Agents; Embryo Implantation; Chronic Disease; Fertilization in Vitro; Pregnancy Rate
PubMed: 37012449
DOI: 10.1007/s10815-023-02770-7 -
Biology Mar 2023Endometriosis is an inflammatory chronic systemic disease resulting in pelvic pain and infertility. However, despite a high prevalence of endometriosis, disease... (Review)
Review
Endometriosis is an inflammatory chronic systemic disease resulting in pelvic pain and infertility. However, despite a high prevalence of endometriosis, disease identification is still insufficient, and a high percentage of misdiagnosing was observed. Hence, a comprehensive study needs to be done to improve our understanding of the pathogenesis of endometriosis. Aberrant hypermethylation of HOXA10 has been reported to play a role in endometriosis. Thus, a comprehensive literature search was conducted to identify the DNA methylation level of HOXA10 among endometriosis patients across populations. The literature search was done using PubMed, Scopus, EBSCOhost, and Science Direct applying (HOXA10 OR "homeobox A10" OR "HOXA-10" OR HOX1) AND ("DNA methylation" OR methylation) AND (endometriosis OR endometrioma) as keywords. From 491 retrieved studies, five original articles investigating the DNA methylation level of HOXA10 from endometrium tissues among endometriosis women were included. All five included studies were classified as high-quality studies. High HOXA10 DNA methylation level was observed in the endometrium tissue of women with endometriosis in all the included studies. The secretory phase was identified as the best sampling time for HOXA10 DNA methylation study in endometriosis, and the most studied DNA methylation site is the promoter region of the HOXA10. However, more studies are needed to expose the HOXA10 mechanism in the pathogenesis of endometriosis.
PubMed: 36979165
DOI: 10.3390/biology12030474 -
Diagnostics (Basel, Switzerland) Mar 2023Hydrosalpinx is a condition with a crucial prognostic role in reproduction, and its diagnosis by a non-invasive technique such as ultrasound is key in achieving an... (Review)
Review
Hydrosalpinx is a condition with a crucial prognostic role in reproduction, and its diagnosis by a non-invasive technique such as ultrasound is key in achieving an adequate reproductive assessment while avoiding unnecessary laparoscopies. The aim of the present systematic review and meta-analysis is to synthetize and report the current evidence on transvaginal sonography (TVS) accuracy to diagnose hydrosalpinx. Articles on the topic published between January 1990 and December 2022 were searched in five electronic databases. Data from the six selected studies, comprising 4144 adnexal masses in 3974 women, 118 of which were hydrosalpinxes, were analyzed as follows: overall, TVS had a pooled estimated sensitivity for hydrosalpinx of 84% (95% confidence interval (CI) = 76-89%), specificity of 99% (95% CI = 98-100%), positive likelihood ratio of 80.7 (95% CI = 33.7-193.0), and negative likelihood ratio of 0.16 (95% CI = 0.11-0.25) and DOR of 496 (95% CI = 178-1381). The mean prevalence of hydrosalpinx was 4%. The quality of the studies and their risk of bias were assessed using QUADAS-2, evidencing an overall acceptable quality of the selected articles. We concluded that TVS has a good specificity and sensitivity for diagnosing hydrosalpinx.
PubMed: 36900092
DOI: 10.3390/diagnostics13050948 -
Medicine Feb 2023The most common tubal disease leading to infertility occurs in the distal region, manifesting as hydrosalpinx. Tubal surgery is an effective alternative treatment.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The most common tubal disease leading to infertility occurs in the distal region, manifesting as hydrosalpinx. Tubal surgery is an effective alternative treatment. However, subpopulations that benefit the most from tubal repair surgery remain unclear. The objective of this study was to investigate the natural pregnancy outcomes of patients with hydrosalpinx after reproductive surgery and those with different grades of hydrosalpinx.
METHODS
We searched the major online databases (PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials) to collect observational studies on patients with hydrosalpinx who underwent surgeries to preserve natural fertility from January 2000 to August 2022. The outcome indicators were natural intrauterine pregnancy (IUP) and ectopic pregnancy (EP) rates. Studies on patients with hydrosalpinx who underwent laparoscopic surgeries and those who intended to be conceived naturally were included. Studies on patients with non-hydrosalpinx diseases, those who underwent open surgery, and those who intended to undergo assisted conception were excluded. The Newcastle-Ottawa scale for observational studies was used for quality evaluation. Meta-analysis of a single rate was performed using RevMan5.3 software.
RESULTS
A total of 10 articles were included in this study, including 1317 patients with hydrosalpinx. Seven studies were retrospective and 3 were prospective. It was found that after surgery for preserving natural fertility function, the IUP and EP rates of patients with hydrosalpinx were 27% (95% confidence interval [CI]: 22-32%) and 4.8% (95% CI: 2.91-8.26%), respectively. In addition, the IUP and EP rates in patients with mild (n = 254), moderate (n = 252), and severe (n = 473) hydrosalpinx were 50.5% (95% CI: 38.65-61.97%), 32.9% (95% CI: 21.88-46.24%), 10.7% (95% CI: 4.76-21.88%), and 7.4% (95% CI: 2.91-19.35%), 9.09% (95% CI: 6.54-13.79%), 8.3%, 8.26% (95% CI: 3.85-18.03%), respectively.
CONCLUSION
Patients with mild to moderate hydrosalpinx will benefit more from reproductive surgery to improve natural pregnancy outcomes. However, the small sample size in our study needs to be further expanded, and the grouping needs to be more refined, such as grouping based on age. This may provide more guidance in clinical practice.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Retrospective Studies; Prospective Studies; Fertilization in Vitro; Salpingitis; Pregnancy Rate; Infertility, Female
PubMed: 36827021
DOI: 10.1097/MD.0000000000032806 -
Minerva Obstetrics and Gynecology Feb 2023To perform a systematic review and meta-analysis of the diagnostic performance of the so-called Gynecologic Imaging and Report Data System (GI-RADS) for classifying... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
To perform a systematic review and meta-analysis of the diagnostic performance of the so-called Gynecologic Imaging and Report Data System (GI-RADS) for classifying adnexal masses.
EVIDENCE ACQUISITION
A search for studies reporting about the use of GI-RADS system for classifying adnexal masses from January 2009 to December 2021 was performed in Medline (Pubmed), Google Scholar, Scopus, Cochrane, and Web of Science databases. Pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odd ratio (DOR) were calculated. Studies' quality was evaluated using QUADAS-2.
EVIDENCE SYNTHESIS
We identified 510 citations. Ultimately, 26 studies comprising 7350 masses were included. Mean prevalence of ovarian malignancy was 26%. The risk of bias was high in eight studies for domain "patient selection" and low for "index test," "reference test" domains for all studies. Overall, pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio and DOR of GI-RADS system for classifying adnexal masses were 94% (95% confidence interval [CI]=91-96%), 90% (95% CI=87-92%), 9.1 (95% CI=7.0-11.9), and 0.07 (95% CI=0.05-0.11), and 132 (95% CI=78-221), respectively. Heterogeneity was high for both sensitivity and specificity. Meta-regression showed that multiple observers and study's design explained this heterogeneity among studies.
CONCLUSIONS
GI-RADS system has a good diagnostic performance for classifying adnexal masses.
Topics: Female; Humans; Adnexal Diseases; Ovarian Neoplasms; Sensitivity and Specificity; Diagnostic Imaging
PubMed: 36790399
DOI: 10.23736/S2724-606X.22.05122-3 -
Journal of Crohn's & Colitis Jun 2023Restorative proctocolectomy [RPC] without a defunctioning loop ileostomy [DLI] in patients with ulcerative colitis [UC] remains controversial. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Restorative proctocolectomy [RPC] without a defunctioning loop ileostomy [DLI] in patients with ulcerative colitis [UC] remains controversial.
AIM
To compare safety and efficacy of RPC with and without DLI in patients exclusively with UC.
METHODS
A systematic review was performed according to PRISMA/MOOSE guidelines. Dichotomous variables were pooled as odds ratios [OR]. Continuous variables were pooled as weighted mean differences [WMD]. Quality assessment was performed using the Newcastle-Ottawa score [NOS].
RESULTS
A total of 20 studies [five paediatric and 15 adult] with 4550 UC patients [without DLI, n = 2370, 52.09%; with DLI, n = 2180, 47.91%] were eligible for inclusion. The median NOS was 8 [range 6-9]. There was no increased risk of anastomotic leak [AL] (OR 1.13, 95% confidence interval [CI]: 0.92, 1.39; p = 0.25), pouch excision [OR 1.01, 95% CI: 0.68, 1.50; p = 0.97], or overall major morbidity [OR 1.44, 95% CI, 0.91, 2.29; p = 0.12] for RPC without DLI, and this technique was associated with fewer anastomotic strictures [OR 0.45, 95% CI: 0.29, 0.68; p = 0.0002] and less bowel obstruction [OR 0.73, 95% CI: 0.57, 0.93; p = 0.01]. However, RPC without DLI increased the likelihood of pelvic sepsis [OR 1.68, 95% CI: 1.03, 2.75; p = 0.04] and emergency reoperation [OR 1.74, 95% CI: 1.22, 2.50; p = 0.002].
CONCLUSION
RPC without DLI is not associated with increased clinically overt AL or pouch excision rates. However, it is associated with increased risk of pelvic sepsis and emergency reoperation. RPC without DLI is feasible, but should only be performed judiciously in select UC patient cohorts in high-volume, specialist, tertiary centres.
Topics: Humans; Proctocolectomy, Restorative; Ileostomy; Colitis, Ulcerative; Anastomotic Leak; Sepsis; Postoperative Complications
PubMed: 36776034
DOI: 10.1093/ecco-jcc/jjad021 -
AJR. American Journal of Roentgenology Jul 2023O-RADS ultrasound (US) and O-RADS MRI have been developed to standardize risk stratification of ovarian and adnexal lesions. The purpose of this study was to perform a... (Meta-Analysis)
Meta-Analysis Review
O-RADS ultrasound (US) and O-RADS MRI have been developed to standardize risk stratification of ovarian and adnexal lesions. The purpose of this study was to perform a meta-analysis evaluating the diagnostic performance of O-RADS US and O-RADS MRI for risk stratification of ovarian and adnexal lesions. We searched the Web of Science, PubMed, Cochrane Library, Embase, and Google Scholar databases from January 1, 2020, until October 31, 2022, for studies reporting on the performance of O-RADS US or O-RADS MRI in the diagnosis of malignancy of ovarian or adnexal lesions. Study quality was assessed with QUADAS-2. A hierarchic summary ROC model was used to estimate pooled sensitivity and specificity. Heterogeneity was assessed with the statistic. Metaregression analysis was performed to explore potential sources of heterogeneity. O-RADS US was compared with the International Ovarian Tumor Analysis (IOTA) simple rules and Assessment of Different Neoplasias in the Adnexa (ADNEX) model in studies providing head-to-head comparisons. Twenty-six studies comprising 9520 patients were included. O-RADS US was evaluated in 15 and O-RADS MRI in 12 studies; both systems were evaluated in one of the studies. Quality assessment revealed that risk of bias or concern about applicability most commonly related to patient selection. Pooled sensitivity and specificity of O-RADS US were 95% (95% CI, 91-97%) and 82% (95% CI, 76-87%) and of O-RADS MRI were 95% (95% CI, 92-97%) and 90% (95% CI, 84-94%). Analysis with the statistic revealed significant heterogeneity among studies of O-RADS US in both sensitivity and specificity (both < .001) and among studies of O-RADS MRI in specificity ( < .001) but not sensitivity ( = .07). In metaregression, no factor was significantly associated with sensitivity or specificity of either system (all > .05). O-RADS US showed no significant difference in sensitivity or specificity versus IOTA simple rules in four studies (sensitivity, 96% vs 93%; specificity, 76% vs 82%) or versus the ADNEX model in three studies (sensitivity, 96% vs 96%; specificity, 79% vs 78%). O-RADS US and O-RADS MRI both have high sensitivity for ovarian or adnexal malignancy. O-RADS MRI, but not O-RADS US, also has high specificity. Awareness of the diagnostic performance results regarding O-RADS US and O-RADS MRI will be helpful as these systems are increasingly implemented into clinical practice.
Topics: Female; Humans; Ovarian Neoplasms; Sensitivity and Specificity; Magnetic Resonance Imaging; Ultrasonography; Risk Assessment; Adnexal Diseases
PubMed: 36722758
DOI: 10.2214/AJR.22.28396