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European Journal of Medical Research Mar 2024Granulomatous mastitis (GM) is a rare, benign, inflammatory breast disease with an unknown etiology that predominantly affects women of reproductive age. The definitive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Granulomatous mastitis (GM) is a rare, benign, inflammatory breast disease with an unknown etiology that predominantly affects women of reproductive age. The definitive treatment of GM is currently controversial; an appropriate therapeutic strategy has yet to be identified, and the disease's high recurrence rate remains. This study aims to determine the recurrence rate for each GM treatment strategy to identify the most appropriate treatment modality.
METHODS
The search for relevant articles was undertaken using three international databases, including Medline, Scopus, and Web of Science. Articles published in English until the end of 2021 evaluating the recurrence rate of GM were included. Using Stata 13.0, the pooled incidence and 95% confidence interval (CI) for the recurrence rate were determined.
RESULTS
Sixty-five eligible studies were included in our study. The recurrence rates of systemic steroid use, topical steroid use, antibiotic use, methotrexate use, observation, drainage, excision, antibiotic use and surgery, steroid use and surgery, antibiotic and steroid use, methotrexate and steroid use were 24% (95% CI: 21-27%), 11% (95% CI: 6-21%), 18% (95% CI: 14-22%), 13% (95% CI: 7-22%), 11% (95% CI: 7-17%), 65% (95% CI: 50-78%), 13% (95% CI: 10-16%), 23% (95% CI: 14-36%), 7% (95% CI: 5-11%), 11% (95% CI: 6-18%), and 4% (95% CI: 2-8%), respectively. Drainage had the highest recurrence rate, while combined methotrexate and steroid treatment had the lowest rate.
CONCLUSION
The optimal treatment strategy for GM depends on the disease's severity, consequences, and the patient's features. The study results indicate that combination therapy is preferable for minimizing the risk of relapse and reducing treatment complications.
Topics: Female; Humans; Granulomatous Mastitis; Methotrexate; Steroids; Combined Modality Therapy; Anti-Bacterial Agents; Recurrence
PubMed: 38475841
DOI: 10.1186/s40001-024-01761-3 -
Frontiers in Veterinary Science 2022Understanding distribution of bovine mastitis pathogen spp. can contribute to the treatment decision and the control within programs of bovine mastitis, we conducted a...
Understanding distribution of bovine mastitis pathogen spp. can contribute to the treatment decision and the control within programs of bovine mastitis, we conducted a meta-analysis to investigate the epidemiology and antimicrobial resistance rates of spp. associated with bovine mastitis in China. Three databases, namely, PubMed, Google scholar, and China National Knowledge Infrastructure database, were utilized to obtain relevant publications. According to PRISMA reporting standards, a total of 38 publications were included in the research, among them, 7 papers included an AMR test. The pooled prevalence of spp. was 5.41% (95% CI: 3.87-7.50%). Subgroup analysis revealed that the prevalence was higher in South China (8.55%, 95% CI: 3.57-19.09%) than in North China (4.22%, 95% CI: 2.46-7.14%), in 2010-2020 (7.45%, 95% CI: 5.29-110.40%) than in 2000-2010 (3.14%, 95% CI: 1.90-15.14%), and in the clinical bovine mastitis cases (7.49%, 95% CI: 3.71-14.54%) than in the subclinical cases (4.03%, 95% CI: 1.55-10.08%). The pooled AMR rate revealed that spp. were most resistant to sulfonamides (45.07%, 95% CI: 27.72-63.71%), followed by tetracyclines (36.18%, 95% CI: 23.36-51.34%), aminoglycosides (27.47%, 95% CI: 17.16-40.92%), β-lactams (27.35%, 95% CI: 16.90-41.05%), amphenicol (26.82%, 95% CI: 14.17-44.87%), lincosamides (21.24%, 95% CI: 7.65-46.75%), macrolides (20.98%, 95% CI: 7.20-47.58%), polypeptides (15.51%, 95% CI: 6.46-32.78%), and quinolones (7.8%, 95% CI: 3.25-17.56%). The climate difference between South and North China and the natural pathogenicity of spp. may be the primary reasons for its distribution, and the prevalence of spp. indicated that the genus is an increasing hazard to the dairy industry. The prevalence of AMR in China is commonly higher than in the European countries and Canada, this is a very important concern for strategy programs to control bovine mastitis caused by spp. in China.
PubMed: 35812847
DOI: 10.3389/fvets.2022.757504 -
The Cochrane Database of Systematic... Dec 2014Leading health authorities all recommend exclusive breastfeeding to six months' postpartum. While most women initiate breastfeeding, many discontinue due to difficulties... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Leading health authorities all recommend exclusive breastfeeding to six months' postpartum. While most women initiate breastfeeding, many discontinue due to difficulties encountered rather than maternal choice. One common breastfeeding difficulty is painful nipples. Research has identified poor infant positioning or latch as a common cause of painful nipples. While many different interventions designed to reduce nipple pain in breastfeeding women have been evaluated, it is unclear which intervention is the most effective treatment. An understanding of nipple pain and treatment options are needed to improve breastfeeding duration and exclusivity rates and to address systematically one of the most frequent difficulties encountered by breastfeeding women.
OBJECTIVES
To assess the effects of all interventions in the resolution or reduction of nipple pain and the impact of the interventions on other outcomes such as nipple trauma, nipple infections, breast mastitis, breastfeeding duration, breastfeeding exclusivity, and maternal satisfaction.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and scanned secondary references.
SELECTION CRITERIA
All randomised or quasi-randomised controlled trials designed to evaluate any intervention for treating nipple pain among breastfeeding women. Trials using a cluster-randomised design were eligible for inclusion. Cross-over trials were not eligible for inclusion. The following interventions were eligible for inclusion compared with each other or usual care (i.e. education only): pharmacological (e.g. antifungal creams); non-pharmacological topical treatments (e.g. lanolin); dressings (e.g. hydrogel dressings); nipple protection devices (e.g. breast shells), phototherapy, and expressed breast milk. Nipple pain in women who are feeding with expressed breast milk (i.e. women of infants in neonatal units) is associated with other methods of removing milk from the mother's breast such as manual expression and various types of breast pumps. Nipple pain and subsequent treatment is different in this unique maternal population and thus we excluded women solely feeding with expressed breast milk from this review.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion, extracted data, evaluated methodological quality, and checked data for accuracy. We sought additional information from several trial researchers.
MAIN RESULTS
We included four trials of good methodological quality involving 656 women in the review. The four included trials evaluated five different interventions including glycerine pads, lanolin with breast shells, lanolin alone, expressed breast milk, and an all-purpose nipple ointment. All studies included education to position the infant at the breast correctly as part of routine postpartum care to both treatment and control groups.Pooled data existed only for the comparison of lanolin versus usual care. We did not pool data for other outcomes due to either heterogeneity in outcome measures or differing interventions.There was no evidence that glycerine gel dressings or breast shells with lanolin significantly improved nipple pain. One trial found no clear differences in nipple pain (at one to three days, four to five days, or six to seven days' post-treatment) between women who applied lanolin or nothing to their nipples. In contrast, the same trial found that women who applied expressed breast milk had significantly lower perceptions of nipple pain following four to five days of treatment than women who applied lanolin. However, this beneficial effect was not maintained after six to seven days of treatment. There were no group differences in nipple pain perceptions at any assessment between women who applied expressed breast milk and women who applied nothing. Women who applied an "all-purpose nipple ointment", in comparison to women who applied lanolin, had no improvement in nipple pain after seven days of treatment. There was insufficient evidence that glycerine gel dressings, lanolin with breast shells, lanolin alone, expressed breast milk, or all-purpose nipple ointment improved maternal perceptions of nipple pain.Overall, there was insufficient evidence to recommend any intervention for the treatment of nipple pain. However, one important finding was that regardless of the treatment used, for most women nipple pain reduced to mild levels after approximately seven to 10 days' postpartum. The provision of anticipatory guidance regarding usual time to pain reduction may be a useful strategy in assisting women to continue to breastfeed and to do so exclusively. The overall quality of the evidence for the primary outcome of nipple pain as assessed using GRADE was of low quality, mainly because single studies with few participants contributed data for analysis.
AUTHORS' CONCLUSIONS
There was insufficient evidence that glycerine gel dressings, breast shells with lanolin, lanolin alone, or the all-purpose nipple ointment significantly improved maternal perceptions of nipple pain. The results from these four trials of good methodological quality suggested that applying nothing or just expressed breast milk may be equally or more beneficial in the short-term experience of nipple pain than the application of an ointment such as lanolin.The quality of the evidence for this review did not lead to robust conclusions regarding the objectives assessed. We included only four trials, incorporating 656 women, in the review and all four trials compared varying interventions, participants, study outcome measures, and standards of usual care. The methodological quality of the included studies was good but the overall quality of the evidence for the primary outcome of nipple pain was of low quality, mainly because single studies with few participants contributed data for analysis.
Topics: Bandages; Breast Diseases; Breast Feeding; Female; Gels; Glycerol; Humans; Lanolin; Milk, Human; Nipples; Ointments; Pain Management; Protective Devices; Randomized Controlled Trials as Topic
PubMed: 25506813
DOI: 10.1002/14651858.CD007366.pub2 -
Journal of Dairy Science Sep 2021Many dairy cattle worldwide are housed in tiestalls, meaning that they are tethered by the neck to individual stalls. On some farms, tied cattle are permitted seasonal... (Review)
Review
Many dairy cattle worldwide are housed in tiestalls, meaning that they are tethered by the neck to individual stalls. On some farms, tied cattle are permitted seasonal access to pasture, but otherwise their movements are restricted compared with cows housed in freestall barns or other loose housing systems. The aim of this systematic review is to summarize the scientific literature pertaining the welfare of tied dairy cattle through comparison with less-restrictive housing systems. Articles identified by PubMed and Web of Science underwent a 5-phase screening process, resulting in the inclusion of 102 papers. These papers addressed measures of welfare related to affective state, natural behavior, and health (with the lattermost category subdivided into hoof and leg disorders, lameness, mastitis, transition disease, and other diseases or conditions). Health was the most researched topic (discussed in 86% of articles); only 19% and 14% of studies addressed natural behavior and affective state, respectively. Our review highlights different health benefits for tethered and loose cattle. For example, tied cattle experience reduced prevalence of white line disease and digital dermatitis, whereas loose cattle experience fewer leg lesions and injuries. The prevalence of mastitis, transition diseases, and other conditions did not differ consistently across housing types. We found that the expression of certain natural behaviors, particularly those associated with lying down (e.g., time spent kneeling, unfulfilled intentions to lie down), were impaired in tiestalls. Articles addressing affective state found benefits to loose housing, but these studies focused almost exclusively on (1) physiological measurements and (2) cow comfort, a concept that lacks a consistent operational definition across studies. We call for future research into the affective state of tied cattle that extends beyond these explorations and employs more sophisticated methodologies.
Topics: Animals; Cattle; Cattle Diseases; Dairying; Farms; Female; Hoof and Claw; Housing, Animal; Lameness, Animal
PubMed: 34253364
DOI: 10.3168/jds.2020-19609 -
Journal of Gynecology Obstetrics and... Jun 2024This systematic review aims to evaluate the efficacy and safety of Pyridoxine compared to Dopaminergic agonists (cabergoline and bromocriptine) in post-partum lactation... (Comparative Study)
Comparative Study Review
This systematic review aims to evaluate the efficacy and safety of Pyridoxine compared to Dopaminergic agonists (cabergoline and bromocriptine) in post-partum lactation inhibition. Cochrane Central, PubMed/MEDLINE, Cochrane Central, ScienceDirect, ClinicalTrials.gov, Web of Science, CINAHL and Google Scholar, covering the period from inception to November 2023. Additionally, the bibliographies of included articles and previous meta-analyses were screened for any relevant articles. The systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. The outcomes of interest encompassed inhibition of lactation, breast pain/tenderness, breast engorgement, milk secretion, fever, mastitis, prolactin level and adverse events related to pyridoxine, cabergoline and bromocriptine. Methodological quality assessment was conducted using the Cochrane risk of bias assessment tool for rigorous evaluation. Three clinical trials assessed the effectiveness of pyridoxine and dopaminergic agents (cabergoline and bromocriptine) for lactation inhibition. It was assessed by using different assessment methods such as a scale for milk secretion, serum prolactin levels, and questionnaires for assessing breast engorgement, breast pain, and milk leakage. On the global assessment of the therapeutic efficacy of dopaminergic agents, it was found that there was significant inhibition of lactation as compared to pyridoxine (p < 0.001). In conclusion, this systematic review contributes significant insights into lactation inhibition interventions. Dopaminergic agonists, specifically cabergoline and bromocriptine, stand out as more effective and tolerable choices compared to Pyridoxine. These findings provide a foundation for informed clinical decisions and underscore the need for careful consideration of lactation inhibition strategies in diverse clinical contexts.
Topics: Humans; Bromocriptine; Female; Pyridoxine; Cabergoline; Dopamine Agonists; Lactation; Lactation Disorders; Clinical Trials as Topic
PubMed: 38554942
DOI: 10.1016/j.jogoh.2024.102783 -
International Journal of Surgery Case... Aug 2021
PubMed: 34362684
DOI: 10.1016/j.ijscr.2021.106250 -
Frontiers in Veterinary Science 2020The literature contains an extensive panel of studies focusing on the costs of animal diseases. The losses of an agriculture holding can be influenced by many factors...
The literature contains an extensive panel of studies focusing on the costs of animal diseases. The losses of an agriculture holding can be influenced by many factors since farming is a complex system and diseases are closely interrelated. Meta-analysis can be used to detect effects (i.e., change in clinical mastitis losses here) across studies and to identify factors that may influence those effects. This includes the external validity of the published study results with regard to the input parameters and the internal validity of the study, particularly how other diseases related to the target disease were accounted for. Mixed-effect meta-regressions were performed to estimate the mean clinical mastitis losses per case across the literature and to elucidate to what extent clinical mastitis losses are influenced by (i) general factors, such as etiology; (ii) the types of losses that contribute to the total mastitis losses; and (iii) prices. In total, 82 observations from nine studies were included in the meta-analysis to assess mean clinical mastitis losses per case. The multivariate meta-regression showed that etiology significantly influenced the clinical mastitis loss per case. The mean loss was determined to be €224 per case for all published etiologies. In detail, mean losses equalled €457 and €101 per case of clinical mastitis due to gram-negative and gram-positive bacteria, respectively, and €428 and €74 per case of clinical mastitis due to and , respectively. Additionally, the mean loss obtained depended on whether diagnostic costs and reduced feed intake in cases of mastitis were included in the clinical mastitis loss calculation. The monetary values of labor cost, drug cost and culling cost, as well as treatment price (all included), significantly influenced the clinical mastitis losses per case. All other tested moderators were not associated with mastitis losses, highlighting the need for more standardized economic studies, for both methods and ways results are presented, and suggesting that the mastitis losses assessed in the literature cannot be extrapolated (limited external validity). Although meta-analyses are useful to overview the burden of diseases across studies, their ability to summarize extensive literature with various economic assessments is limited. These limitations in loss assessments also suggest the need to focus on management strategies rather than on pure monetary estimations of disease costs, at least for production diseases at the farm level.
PubMed: 32258070
DOI: 10.3389/fvets.2020.00149 -
Frontiers in Veterinary Science 2022In this study, to optimize the control program, a meta-analysis was conducted to investigate the epidemiology and antimicrobial resistance (AMR) profile of -associated...
In this study, to optimize the control program, a meta-analysis was conducted to investigate the epidemiology and antimicrobial resistance (AMR) profile of -associated bovine mastitis in China from 2000 to 2020. A total of 33 publications from PubMed, Google Scholar, and China National Knowledge Infrastructure (CNKI) database were included in our research, among which nine publications included the AMR test. The pooled prevalence of was 36.23%, and subgroup analysis revealed that the prevalence dropped from 2000-2010 to 2011-2020, which shows that China is on the right track. The pooled AMR rate indicate isolates were most resistant to β-lactams (50.68%), followed by quinolones (36.23%), macrolides (34.08%), sulfonamides (32.25%), tetracyclines (27.83%), aminoglycosides (26.44%), lincosamides (23.39%), and amphenicol (10.33%). Both the pooled prevalence and AMR of in China are higher than those in Western countries, such as Germany, Belgium, Ireland, and the United States-countries with a long animal husbandry history and good management. Thus, there is still room to improve the treatment of -associated bovine mastitis in China.
PubMed: 36439336
DOI: 10.3389/fvets.2022.1006676 -
Preventive Veterinary Medicine Apr 2021Managing the health needs of livestock contributes to reducing poverty and improving the livelihoods of smallholder and pastoralist livestock keepers globally. Animal...
Prioritizing smallholder animal health needs in East Africa, West Africa, and South Asia using three approaches: Literature review, expert workshops, and practitioner surveys.
Managing the health needs of livestock contributes to reducing poverty and improving the livelihoods of smallholder and pastoralist livestock keepers globally. Animal health practitioners, producers, policymakers, and researchers all must prioritize how to mobilize limited resources. This study employed three approaches to prioritize animal health needs in East and West Africa and South Asia to identify diseases and syndromes that impact livestock keepers. The approaches were a) systematic literature review, b) a series of expert workshops, and c) a practitioner survey of veterinarians and para-veterinary professionals. The top constraints that emerged from all three approaches include endo/ ectoparasites, foot and mouth disease, brucellosis, peste des petits ruminants, Newcastle disease, and avian influenza. Expert workshops additionally identified contagious caprine pleuropneumonia, contagious bovine pleuropneumonia, mastitis, and reproductive disorders as constraints not emphasized in the literature review. Practitioner survey results additionally identified nutrition as a constraint for smallholder dairy and pastoralist small ruminant production. Experts attending the workshops agreed most constraints can be managed using existing veterinary technologies and best husbandry practices, which supports a shift away from focusing on individual diseases and new technologies towards addressing systemic challenges that limit access to veterinary services and inputs. Few research studies focused on incidence/ prevalence of disease and impact, suggesting better incorporation of socio-economic impact measures in future research would better represent the interests of livestock keepers.
Topics: Africa, Eastern; Africa, Western; Animal Husbandry; Animals; Asia; Cattle; Cattle Diseases; Chickens; Goat Diseases; Goats; Poultry Diseases
PubMed: 33581421
DOI: 10.1016/j.prevetmed.2021.105279 -
Journal of Dairy Science Aug 2009The objectives of this paper are to provide an introduction to meta-analysis and systematic review and to discuss the rationale for this type of research and other... (Review)
Review
The objectives of this paper are to provide an introduction to meta-analysis and systematic review and to discuss the rationale for this type of research and other general considerations. We highlight methods used to produce a rigorous meta-analysis and discuss some aspects of interpretation of meta-analysis drawing on examples from the animal and veterinary science literature. Meta-analysis is a rapidly expanding area of research that has been relatively underutilized in animal and veterinary science. It is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis. The examination of variability or heterogeneity in study results is also a critical outcome. The benefits of meta-analysis include a consolidated and quantitative review of a large, and often complex, sometimes apparently conflicting, body of literature. Meta-analytic methods place less emphasis on dichotomous outcomes from null hypothesis significance testing and greater emphasis on determining the magnitude and the precision of an effect of interest. A substantial benefit of meta-analysis is the potential to investigate new hypotheses using existing data, both through the development of a priori hypotheses and by examination of the heterogeneity in study responses. The specification of the outcome and hypotheses that are tested is critical to the conduct of meta-analyses, as is a sensitive literature search. A failure to identify the majority of existing studies can lead to erroneous conclusions; however, there are methods of examining data to identify the potential for studies to be missing; for example, by the use of funnel plots. Many of the statistical methods to conduct meta-analysis are widely used. Bayesian methods are well suited to meta-analysis. The post-hoc methods used to evaluate heterogeneity and publication bias, which include the I (2) statistic, L'Abbé plots, Galbraith plots, Rosenthal's N, and influential study analysis are exclusively used in meta-analysis. Examples where meta-analyses have been repeated in animal science or veterinary medicine show good consistency in estimates of effect. Findings of studies to date have provided new understandings of rumen modifiers, milk fever, parasite control, mastitis, somatotropin, and reproductive manipulations. Rigorously conducted meta-analyses are useful tools to improve animal well-being and productivity. The need to integrate findings from many studies ensures that meta-analytic research is desirable and the large body of research now generated makes the conduct of this research feasible.
Topics: Animals; Meta-Analysis as Topic; Publication Bias; Reproduction; Review Literature as Topic; Statistics as Topic; Veterinary Medicine
PubMed: 19620636
DOI: 10.3168/jds.2009-2140