Additional Examples

Alemtuzumab for multiple sclerosis

Sure! Here’s a review on Alemtuzumab for multiple sclerosis:

Alemtuzumab is a highly effective treatment for multiple sclerosis (MS) that has shown promising results in clinical trials. It is a monoclonal antibody that targets and depletes certain immune cells, including T and B lymphocytes, which are believed to play a role in the development of MS. Alemtuzumab is administered intravenously, typically in a two-course treatment over the span of 5 days, followed by another three-day course 12 months later.

One of the key benefits of Alemtuzumab is its ability to significantly reduce the rate of relapse in people with relapsing-remitting MS (RRMS), a form of MS characterized by periodic flare-ups followed by periods of remission. Clinical trials have shown that Alemtuzumab can reduce relapse rates by more than 50% compared to other disease-modifying therapies (DMTs) commonly used for RRMS. Additionally, Alemtuzumab has shown durable efficacy, with some studies demonstrating sustained benefits for up to 5 years.

Another advantage of Alemtuzumab is its convenient dosing schedule, with the initial treatment course followed by a second course 12 months later, and no need for daily or regular dosing thereafter. This can be appealing for individuals who prefer fewer treatment injections or infusions.

However, Alemtuzumab also comes with some potential risks and side effects. The most notable side effects include infusion reactions, such as fever, chills, rash, and nausea, which can occur during or shortly after the infusion. Alemtuzumab can also cause lymphopenia, a condition characterized by low levels of lymphocytes in the blood, which can increase the risk of infections. Other potential risks include the development of secondary autoimmune disorders, such as thyroid disorders or immune thrombocytopenic purpura (ITP), which may require additional monitoring and management.

In conclusion, Alemtuzumab is a highly effective treatment option for RRMS that has shown favorable results in clinical trials. It offers significant reductions in relapse rates and has a convenient dosing schedule. However, it also carries potential risks and side effects that need to be carefully considered and monitored by healthcare providers. As with any medication, individual patient factors, preferences, and the overall risk-benefit profile should be taken into account when considering Alemtuzumab as a treatment option for multiple sclerosis. It is important to discuss all potential risks and benefits with a qualified healthcare professional before initiating Alemtuzumab or any other medication for MS.

Source: ChatGPT (March 23 version)
Date Generated: April 19, 2023

Sputum Gram Stain for Bacterial Pathogen Diagnosis in Community-acquired Pneumonia: A Systematic Review and Bayesian Meta-analysis of Diagnostic Accuracy and Yield

Title: Sputum Gram Stain for Bacterial Pathogen Diagnosis in Community-acquired Pneumonia: A Systematic Review and Bayesian Meta-analysis of Diagnostic Accuracy and Yield of Sputum Culture

Antonicka Rakiela¹, Elizabeth Perez¹, Elisa Kim², Dimitrios Stravaskis³, Jesse McKendrick², Robert Weinstein³

¹Henry Ford Health System, Detroit, MI, USA; ²McGovern Medical School, Houston, TX, USA; ³University of Pittsburgh, Pittsburgh, PA, USA

¹University of Detroit, Detroit, MI; ²Henry Ford Health System, Detroit, MI; ³McGovern Medical School, Houston, TX, USA

¹University of Pittsburgh, Pittsburgh, PA, USA

²Henry Ford Health System, Detroit, MI, USA

³McGovern Medical School, Houston, TX, USA

¹Henry Ford Health System, Detroit, MI, USA

Introduction: The use of sputum Gram staining (SG) as a method of bacterial identification at the point-of-care (PoC) by physicians to guide antibiotic therapy for community-acquired pneumonia (CAP) in the emergency department (ED) is increasing. However, the value of SG remains questionable.

Objectives: We aimed to synthesize evidence on the diagnostic test accuracy (DTA) of SG for diagnosing CAP compared with chest x-ray (CXR) or quantitative sputum culture (QSC).

Methods: We searched MEDLINE, PubMed, Embase, CENTRAL, and Scopus for articles on the DTA of SG among ED patients with suspected CAP. The DTA was synthesized using hierarchical summary receiver operating characteristic (HSROC) models. To evaluate the yield of positive SG in patients with negative results on other tests, we utilized a Bayesian method to combine estimates from studies reporting either yield or DTA and conducted subgroup analyses and metaregression. The proportion of patients who avoided unnecessary antibiotics was calculated using the method of LeBlanc et al.

Results: Fifty-five studies (N = 22,479) from 29 countries met inclusion criteria. The sensitivity and specificity of SG for the diagnosis of CAP were 75% (95% CI: 66%–83%) and 96% (95% CI: 94%–97%) compared with CXR and 58% (95% CI: 40%–76%), and 88%(95% CI: 82%–93%) compared with QSC, respectively. In the subgroup of studies only including patients with suspected pneumococcal pneumonia, SG had slightly higher sensitivitiy (85% versus 75%) but lower specificity (92% versus 98%) compared with QSC. The median yield on positive results among those studies reporting only positive SG was 36% (10%–57%). The analysis on the yield of positive results stratified by test and method of calculation is shown in the supplement.

Conclusions: The low sensitivity of a positive SG result limited its diagnostic utility in ruling in CAP when using CXR as the reference standard. The high yield of positive results on SG when used for bacterial testing suggests that it offers a reasonable alternative for patients who cannot undergo testing with quantitative culture or can be excluded based on other clinical findings.

Author’s Note on Should the Number of Patients Included in Meta-Analysis

Source: BioMedLM
Date Generated: April 13, 2023

Development and Validations of Cardiovascular and Cerebrovascular Clinical Prediction Models

Title: Development and Validations of Cardiovascular and Cerebrovascular Clinical Prediction Models - Beyond Clinical Notes in Electronic Health Records; Journal: International Journal of Clinical Practice; DOI: 10.15252/ijcp.2016.73

There is potential for patient record documentation data to be used as a resource for identifying people being at risk of developing a cardiovascular disease or cerebrovascular disease. However, it has been acknowledged that clinical and laboratory measurements currently recorded in general practice do not contain sufficient information and data that would enable risk assessment. In order to address this, we have used statistical methods, to systematically review published studies and generate new ones to create cardiovascular and cerebrovascular risk scoring algorithms.

Clinical and laboratory measures currently being collected by general practitioners or nurses are the blood pressure (BP), total cholesterol, high density lipoprotein, smoking status, type 2 diabetes diagnosis, and gender. From this, we developed a comprehensive cardiovascular risk prediction algorithm and a novel cerebrovascular, and transient ischaemic attack (TIA) risk score (TIA-stroke). The algorithms combine routinely collected BP, total cholesterol, HDL-cholesterol, smoking status (current/ex-smoker), presence and age at type 2 diabetes diagnosis, and gender (males versus females) and provide a score, which predicts overall risk of CVD or cerebrovascular diseases within five years.

A systematic review of studies reporting the development and validation of CVD or cerebrovascular clinical risk prediction models in adults, in primary care, was carried out. Of the 30 studies reviewed, 3 algorithms have been published. However, the algorithm developed by Hoorntje et al [@B1] was tested using the existing QRISK in addition to BP and total cholesterol, that would be required to use this algorithm. All other 2 algorithms developed by Balkuhn et al [@B2] and by the National Institute for Health and Care Excellence (NICE) [@B3] used an existing risk calculator (e.g. QRISK2 or QRISK3) to provide data for these models. Although these algorithms have been externally validated and shown to provide accurate estimates for the risk of CVD, the algorithms also contained too many variables (some that were not routinely collected by general practices), and the outcome was not limited to CVD. We therefore used a systematic review (reported separately) of studies evaluating the validity of these equations, and using their risk score algorithms, for stroke and TIA within five years [@B4]. This systematic review has led to the development and validation of TIA-stroke clinical prediction algorithm.

The aim of this review is to update this systematic review of the development and validation of CVD and cerebrovascular clinical risk prediction models, with the addition of the TIA risk estimation and risk score models, and to generate algorithms for the prediction of risk of CVD and TIA and stroke and TIA within 5 years in primary care using routinely collected data from general practice. The systematic review will be limited to studies of adult patients in primary care.

Methods/design

We will follow a two-phase protocol. In the first phase, the search will be conducted and identified publications will be assessed for inclusion in the review for which data will then be extracted (Table 1 {ref-type=”table”}). In the second phase, newly validated models will then be added to the dataset to be included in the review, resulting in the final systematic review (Table 1 {ref-type=”table”}).

######

Reporting items and template for protocol; recommended items to address in a systematic review protocol (PRISMA-P) Section/Topic Checklist item ————————-

Source: BioMedLM
Date Generated: April 13, 2023

Comparing antenatal care schedules that vary by number or timing of visits for routine antenatal care

We compared the schedule that varied by the number of visits to one that varied by the timing of visits, and found that the number of visits model produced higher coverage (96.2% vs 92.6%) and lower unmet need (10.9% vs 12.6%) than the timing of visits model. This is expected, as the number of visits model was optimized to achieve the highest coverage and lowest unmet need.

Comparing antenatal care schedules that vary by the number or timing of visits for routine antenatal care and a single focused antenatal care visit

Discussion

We found that optimizing the number of antenatal care visits produced higher coverage and lower unmet need than optimizing the timing of visits, for schedules that vary by either the number or timing of visits for routine antenatal care and for schedules that vary by both the number and timing of visits for routine antenatal care. For all models, we found that adding a focused antenatal care visit to routine antenatal care, and four focused antenatal care visits to routine antenatal care, improved coverage and reduced unmet need.

We found that the number of antenatal care visits model produced higher coverage and lower unmet need than the timing of antenatal care visits model for schedules that varied by the number of visits for routine antenatal care, and schedules that varied by the number and timing of visits for routine antenatal care. These findings are consistent with other studies that compared the number of antenatal care visits to the timing of antenatal care visits, and found that a higher number of antenatal care visits was associated with higher coverage and lower unmet need [1–2]. Our findings suggest that increasing the number of antenatal care visits, regardless of the timing of visits, may improve coverage and reduce unmet need. This is consistent with a 2014 Cochrane review that found that antenatal care interventions with multiple contacts were more effective at increasing the use of antenatal care than those with fewer contacts [3]. The Cochrane review included interventions that focused on providing more antenatal care visits, but did not examine the impact of varying the timing of antenatal care visits on coverage and unmet need. Our findings suggest that increasing the number of antenatal care visits may be more effective at improving coverage and reducing unmet need than optimizing the timing of visits.

References

[1] Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities., Magadi
[2] How many antenatal care visits is enough? Community and provider perspectives on the number of visits, Olds
[3] Antenatal care for healthy pregnant women: a mapping of interventions from existing guidelines to inform the design of an optimal programme, Hawe

Source: Galactica
Date Generated: April 13, 2023

Splinting for people with carpal tunnel syndrome

As an AI language model, I can provide you with a review on Splinting for people with carpal tunnel syndrome. Carpal tunnel syndrome (CTS) is a condition that affects the hand and wrist, and is caused by compression of the median nerve as it passes through the wrist. Splinting is one of the conservative treatment options that may be recommended for individuals with CTS.

Splinting involves wearing a brace or splint on the affected wrist to help immobilize and support the wrist joint. The splint may be worn during the day and/or at night, depending on the severity of the symptoms and the individual’s needs. The goal of splinting is to reduce pressure on the median nerve and alleviate symptoms such as pain, tingling, and numbness in the hand and fingers.

Several studies have suggested that splinting can be an effective treatment option for mild to moderate CTS. A meta-analysis of randomized controlled trials found that splinting was associated with significant improvements in symptoms and function compared to no treatment or placebo. Another study found that using a wrist splint at night for six weeks resulted in significant improvements in hand function and symptom severity compared to a control group.

However, it is important to note that splinting may not be effective for everyone with CTS, and it is important to consult with a healthcare provider for individualized treatment recommendations. In addition, some individuals may experience discomfort or irritation from wearing a splint, and it may take time to adjust to wearing the splint regularly.

In summary, splinting is a conservative treatment option that may be effective for individuals with mild to moderate CTS. It is important to consult with a healthcare provider for individualized treatment recommendations and to be aware of potential limitations and side effects of splinting.

Source: ChatGPT (March 23 version)
Date Generated: April 3, 2023

The Impact of Cannabis Use During Pregnancy

Although a growing number of studies have examined the effect of cannabis use during pregnancy on the offspring, the results have been mixed [1]. Some studies have found that cannabis use during pregnancy was associated with lower birth weight [2], preterm birth [3], and lower birth length [1]. However, others have found no significant association between cannabis use and these adverse outcomes [4].

The effect of cannabis use during pregnancy on the offspring is also not consistent across all domains of neurodevelopment. Studies have found that cannabis use during pregnancy was associated with reduced cognitive functioning, attention, and memory [4], while other studies have found no such association [1].

References

[1] Prenatal Cannabis Exposure and Neurodevelopment, Huebner
[2] Maternal marijuana use and the risk of stillbirth, Razavi
[3] Marijuana use and adverse birth outcomes: A systematic review and meta-analysis, Conner
[4] The association between marijuana use during pregnancy and birth weight: a meta-analysis, Quansah

Source: Galactica
Date Generated: April 4, 2023

Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes

Title: Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes

Abstract

1. It is clear that SGLT-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RA) improve multiple glucometabolic parameters together with weight loss, and they could be used as the first-line antidiabetic medications when metformin is not well tolerated.

2. The studies used for the comparison between the two classes of anti-diabetic drugs in the abstract were also in conflict.

3. SGLT-2i was associated with an increase in heart failure hospitalization

4. The use of SGLT-2i is associated with a reduction but increased risk of amputation.

5. SGLT-2i could lead to an increased risk of amputation. It remains unclear whether this increase of amputation was related to the pharmacological class of anti-diabetic medications.

6. SGLT-2i therapy was associated with an increase of risk of diabetic ketoacidosis. However, such an increase was more likely related to the concomitant reduction in glucose level rather than to the pharmacological class of anti-diabetic medications.

7. There is insufficient data regarding the effects of SGLT-2i on bone fracture and amputations and the results of current studies were conflicting.

Introduction and scope

1. SGLT-2i could improve glycemic control and reduce body weight and cardiovascular outcomes compared with GLP-1RA.

2. However, the use of SGLT-2i could be associated with increased blood pressure, heart failure hospital admissions, amputations, fractures and gastrointestinal side effects, while it could possibly lead to fewer hypoglycemic episodes. As a result, SGLT-2i treatment might increase the total costs of managing patients with type 2 diabetes mellitus (T2DM).

Methods

1. The electronic databases searched were MEDLINE and the Cochrane Library, which could give a broad spectrum of coverage of current literature.

2. SGLT-2i were associated with lower systolic and diastolic blood pressure and lower incidence of new-onset heart failure compared with GLP-1RA.

3. The studies used for the comparison between the two classes of anti-diabetic drugs in the study design and data analysis were also in conflict.

4. The adverse effects associated with these two classes of anti-diabetic drugs were not the primary endpoints.

Summary of SLR

1. Although the HbA1c levels could be reduced to the same levels with SGLT-2i and GLP-1RA, SGLT-2i and GLP-1RA could reduce HbA1c to the different levels. On the other hand, SGLT-2i is not recommended if the HbA1c level was above 10% (86 mmol/mol) in the past 6 months because it would increase the risk of hypoglycemia.

2. As for the body weight, SGLT-2i was not associated with body weight loss as long as the initial dose could be adjusted appropriately and the body mass index (BMI) were maintained below 35. Nevertheless, GLP-1RA could reduce the body weight over time according to current evidence.

3. In terms of cardiovascular outcomes, the composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke was reduced by 37% with SGLT-2i therapy as compared with the placebo control. However, the use of SGLT-2i was associated with an increase in both heart failure hospitalization and death from renal causes as compared with the placebo control.

GLP-1RA and placebo control both reduced the risks of death from cardiovascular causes and nonfatal myocardial infarction, whereas only GLP-1RA but not placebo control reduced the risk of nonfatal stroke. Moreover, the composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke was reduced by the use of GLP-1RA as compared with the placebo control. No significant difference in the risk of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke was observed between GLP-1RA and placebo control.

1. SGLT-2i and GLP-1RA could reduce systolic and diastolic blood pressure compared with the placebo control, while the difference was not statistically significant.

2. SGLT-2i and GLP-1RA both reduced the total amount of insulin and the insulin dose requirements. However, SGLT-2i achieved the target HbA1c at lower insulin dose compared with the placebo control.

3. The incidences of hypoglycemia and nausea were reduced by SGLT-2i and GLP-1RA, respectively, as compared with the placebo control. Nevertheless, the combination of the two classes of

Source: BioMedLM
Date Generated: April 4, 2023

Music therapy for dementia

Music therapy has been shown to be a promising intervention for individuals with dementia. Studies have demonstrated that listening to music and engaging in music-based activities can help to improve mood, reduce anxiety and agitation, and enhance overall quality of life for people with dementia.

One of the reasons why music therapy is effective is that music has the ability to stimulate multiple areas of the brain simultaneously, including those involved in memory, emotion, and movement. This can be particularly beneficial for individuals with dementia, as it can help to improve cognitive function and motor skills.

Music therapy can take many forms, including listening to music, singing, playing instruments, and participating in group music-making activities. The approach used will depend on the individual’s preferences and abilities, as well as the goals of the therapy.

Several studies have shown the effectiveness of music therapy for dementia. For example, a systematic review of 22 randomized controlled trials found that music therapy had a positive impact on cognitive function, behavioral symptoms, and quality of life in people with dementia. Another study found that a 10-week music therapy program led to improvements in mood and reduced agitation in individuals with dementia living in a nursing home.

Overall, music therapy appears to be a safe and effective intervention for individuals with dementia, with the potential to improve quality of life and reduce symptoms of anxiety, agitation, and depression. However, more research is needed to fully understand the mechanisms underlying its effectiveness and to determine the most effective approaches for different populations of individuals with dementia.

Source: ChatGPT (April 3 version)
Date Generated: April 4, 2023

Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis

What is already known on this topic?

Postmastectomy breast reconstruction is the reconstruction of the breast after mastectomy, which can be done by autologous or alloplastic materials.

What this study adds?

This systematic review and meta-analysis of the literature shows that autologous breast reconstruction is associated with a significantly higher risk of complications and mortality than alloplastic reconstruction.

INTRODUCTION

Breast cancer is the most common cancer among women worldwide, with an estimated 2.1 million new cases and 627,000 deaths in 2012.[1]

Postmastectomy breast reconstruction is the reconstruction of the breast after mastectomy. The goals of reconstruction are to restore the symmetry of the breast and to reduce the psychological burden of the patients,[2] which can be done by autologous or alloplastic materials. Autologous breast reconstruction (ABR) involves the use of a flap that is transferred to the chest wall to create a new breast. ABR is a safe procedure, but the associated complications may result in a high rate of reoperations and revisions.[3] Alloplastic breast reconstruction (APBR) involves the placement of a synthetic implant, which is covered by the pectoralis major muscle or a skin flap.[4] APBR is associated with a lower rate of complications, but the risk of implant-related complications is high.[5]

The goal of this systematic review and meta-analysis was to compare the complication rates and mortality of ABR and APBR.

METHODS

Search Strategy

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.[6] The following databases were searched: PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. The search was performed using the following terms: “breast reconstruction,” “autologous,” “alloplastic,” “mastectomy,” “complications,” and “mortality.”

Selection Criteria

The following studies were included: (1) prospective or retrospective cohort studies, (2) patients who underwent ABR or APBR after mastectomy for breast cancer, and (3) studies that reported complications or mortality as an outcome. The following studies were excluded: (1) case reports, (2) conference abstracts, and (3) studies with a sample size of less than 10 patients.

Study Selection and Data Extraction

The titles and abstracts of the studies identified in the literature search were reviewed independently by 2 authors (A.M.M. and A.A.M.). The full texts of the studies that were selected for inclusion were reviewed independently by the same 2 authors. The references of the studies that were selected for inclusion were reviewed to identify additional studies that met the inclusion criteria. Any disagreements were resolved by discussion between the 2 authors.

The following data were extracted from the included studies: first author’s name, year of publication, country, study design, number of patients, type of mastectomy, type of reconstruction, type of complications, and mortality.

Quality Assessment

The quality of the studies that were included in this systematic review and meta-analysis was assessed using the Newcastle–Ottawa Scale (NOS).[7] The NOS has 3 main components: selection, comparability, and outcome. A study can be awarded a maximum of 9 points based on the following criteria: selection (maximum of 4 points), comparability (maximum of 2 points), and outcome (maximum of 3 points). A study that scores ≥7 points is considered high quality, whereas a study that scores <7 points is considered low quality.

Statistical Analysis

The pooled odds ratio (OR) was calculated for the complications and mortality of ABR and APBR. Heterogeneity was assessed using the I2 statistic. An I2 statistic >50% was considered to indicate significant heterogeneity.[8] A fixed-effects model was used when there was no significant heterogeneity, whereas a random-effects model was used when there was significant heterogeneity. The OR was calculated for the complications and mortality of ABR and APBR. Publication bias was assessed using the Egger regression test. All statistical analyses were performed using the Review Manager (RevMan) version 5.3 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). A P value <0.05 was considered statistically significant.

RESULTS

Search Results

The literature search identified 4289 articles, of which 21 were included in the final analysis. The selection process is shown in Figure 1.

FIGURE 1: Flowchart of the study selection process.

Characteristics of the Included Studies

The characteristics of the included studies are summarized in Table 1. The studies included 2413 patients who underwent ABR and 1878 patients who underwent APBR. The mean NOS score of the studies was 6.8. The mean NOS score for the selection, comparability, and outcome components was 2.5, 1.6, and 3.7, respectively.

TABLE 1: Characteristics of the Included Studies

Complications

The pooled OR for the complications of ABR and APBR was 0.27 (95% confidence interval [CI]: 0.17–0.43; P < 0.00001), indicating a significantly higher risk of complications in patients who underwent ABR (Figure 2). The heterogeneity of the studies was significant (I2 = 89%; P < 0.00001).

FIGURE 2: Forest plot of the pooled odds ratio for the complications of ABR and APBR. ABR = autologous breast reconstruction, APBR = alloplastic breast reconstruction, CI = confidence interval.

Seroma Formation

The pooled OR for seroma formation in ABR and APBR was 0.19 (95% CI: 0.11–0.33; P < 0.0001), indicating a significantly higher risk of seroma formation in patients who underwent ABR (Figure 3). The heterogeneity of the studies was significant (I2 = 85%; P < 0.00001).

FIGURE 3: Forest plot of the pooled odds ratio for seroma formation in ABR and APBR. ABR = autologous breast reconstruction, APBR = alloplastic breast reconstruction, CI = confidence interval.

Infection

The pooled OR for infection in ABR and APBR was 0.43 (95% CI: 0.26–0.71; P = 0.0006), indicating a significantly higher risk of infection in patients who underwent ABR (Figure 4). The heterogeneity of the studies was significant (I2 = 75%; P = 0.001).

FIGURE 4: Forest plot of the pooled odds ratio for infection in ABR and APBR. ABR = autologous breast reconstruction, APBR = alloplastic breast reconstruction, CI = confidence interval.

Capsular Contracture

The pooled OR for capsular contracture in ABR and APBR was 0.14 (95% CI: 0.04–0.45; P = 0.0007), indicating a significantly higher risk of capsular contracture in patients who underwent ABR (Figure 5). The heterogeneity of the studies was significant (I2 = 83%; P = 0.0002).

FIGURE 5: Forest plot of the pooled odds ratio for capsular contracture in ABR and APBR. ABR = autologous breast reconstruction, APBR = alloplastic breast reconstruction, CI = confidence interval.

Skin Necrosis

The pooled OR for skin necrosis in ABR and APBR was 0.36 (95% CI: 0.17–0.76; P = 0.008), indicating a significantly higher risk of skin necrosis in patients who underwent ABR (Figure 6). The heterogeneity of the studies was significant (I2 = 73%; P = 0.004).

FIGURE 6: Forest plot of the pooled odds ratio for skin necrosis in ABR and APBR. ABR = autologous breast reconstruction, APBR = alloplastic breast reconstruction, CI = confidence interval.

Surgical Site Infection

The pooled OR for surgical site infection in ABR and APBR was 0.32 (95% CI: 0.12–0.85; P = 0.02), indicating a significantly higher risk of surgical site infection in patients who underwent ABR (Figure 7). The heterogeneity of the studies was significant (I2 = 74%; P = 0.006).

FIGURE 7: Forest plot of

Source: Galactica
Date Generated: April 4, 2023

Social determinants of eye health

The role of social determinants in eye health is complex and is likely to be influenced by a number of factors, including socio-economic position, social support, health behaviours, and the built environment [1]. A growing body of literature indicates that people with low socio-economic position are at increased risk of poor eye health, including vision impairment, blindness, and low vision [1, 2]. This association is seen across many different populations and is thought to be partly due to a higher prevalence of chronic diseases and lower levels of education and income among people with low socio-economic position [1, 2]. For example, one study found that in Australia, socio-economic disadvantage was associated with an increased risk of visual impairment (OR 1.25, 95% CI 1.05–1.49), which was in turn associated with increased risk of vision loss (OR 1.33, 95% CI 1.13–1.56) [3].

A growing body of literature also indicates that people with low socio-economic position have a higher prevalence of risk factors for poor eye health, including smoking, diabetes, obesity, and cardiovascular disease [1, 2]. These factors are themselves risk factors for poor eye health [1]. The evidence suggests that socio-economic position is an important social determinant of eye health and should be considered when assessing eye health and when developing strategies to improve eye health [1, 2].

Limitations of this study

There are several limitations of this study. Firstly, this study is based on cross-sectional data. Therefore, it is not possible to establish causality. Secondly, this study is based on self-reported data. This may have introduced a degree of measurement error into the study. However, it is likely that the effects of measurement error are random, and thus the associations observed are likely to be conservative. Finally, this study is based on self-reported data on vision status, and therefore we were unable to distinguish between people who have vision impairment due to a health condition and people who have vision impairment due to a refractive error. It is possible that some of the associations between vision status and the outcomes of interest are due to vision impairment caused by a refractive error.

Conclusions

The findings of this study indicate that the majority of people who have vision impairment in Australia have a health condition that requires medical attention, and that the prevalence of vision impairment is increasing. The findings of this study also indicate that socio-economic position is an important social determinant of vision impairment. Future research should focus on the factors that drive the increase in the prevalence of vision impairment and on the development of strategies to reduce the prevalence of vision impairment in Australia.

Footnote: Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

[1] Social determinants of eye health: a review, Shah
[2] Social determinants of health inequalities, Marmot
[3] Visual impairment and socioeconomic deprivation in Australia: the Blue Mountains Eye Study, Wang

Source: Galactica
Date Generated: March 30, 2023

Interventions for Substance Use Disorders in Adolescents: A Systematic Review

Sonia Gallego, Laura B. Boles, José M. Menchón, and Carmen M. Berenguer

Department of Psychology, University of Barcelona, Barcelona, Spain

Correspondence: Sonia Gallego (sonia.gallego@ub.edu)

Addict Sci Clin Pract 2019, 14(Suppl 2):A50

Background: In adolescence, substance use is common, but only a minority of these individuals progress to problematic use. This systematic review aims to evaluate the effectiveness of psychological interventions for adolescents with substance use disorders (SUD).

Methods: A systematic search was conducted in PubMed, PsycINFO, and Web of Science. Randomized controlled trials that evaluated the effectiveness of psychological interventions for adolescents with SUD were included. A total of 15 studies met the inclusion criteria.

Results: Results showed that the effectiveness of the interventions varied according to the type of intervention and the type of substance use disorder. The majority of the studies showed positive effects of psychological interventions for adolescents with SUD. However, only 2 studies included an evaluation of the effects of the interventions on the use of other substances and only 1 study included an evaluation of the long-term effects of the interventions.

Conclusions: Psychological interventions seem to be effective in reducing the symptoms of substance use in adolescents with SUD. However, there is a lack of evidence regarding the long-term effects of the interventions and the effects of the interventions on other substance use.

Source: Galactica
Date Generated: March 29, 2023

Prevalence of subdural hematoma in the presence of benign enlargement of subarachnoid space

Title: Prevalence of subdural hematoma in the presence of benign enlargement of subarachnoid space

Abstract:

Abstract Objective
To evaluate the prevalence of subdural hematoma (SDH) in the presence of benign enlargement of subarachnoid space (BESS).

Materials and methods
The authors retrospectively reviewed the records of 126 patients with BESS who underwent cranial computed tomography (CT). The prevalence of SDH in patients with BESS was analyzed. The presence of SDH was correlated with age, sex, clinical features, and other imaging findings.

Results
SDH was detected in 15 patients (12%) with BESS. The mean age of the patients with BESS and SDH was significantly lower than that of patients with BESS without SDH (25.7 years vs. 44.2 years, p = 0.014). No significant difference in sex was observed between the two groups. No significant difference in clinical features or in the prevalence of other imaging findings was observed between the two groups.

Conclusion
BESS is a relatively common condition that is usually asymptomatic. However, SDH is frequently found in patients with BESS, especially in younger patients. Thus, a thorough evaluation of the patient’s neurologic status and the presence of SDH should be considered in the management of patients with BESS.

Source: Galactica
Date Generated: March 22, 2023

Prevalence and incidence of dry eye and meibomian gland dysfunction in the United States: a systematic review and meta-analysis

The systematic review and meta-analysis on the prevalence and incidence of dry eye and meibomian gland dysfunction in the United States is a well-conducted and informative study that provides valuable insights into the epidemiology of these conditions.

The authors conducted a comprehensive search of multiple electronic databases to identify relevant studies, and they used rigorous inclusion and exclusion criteria to ensure the quality of the studies included in the analysis. The study also employed appropriate statistical methods to calculate pooled estimates of prevalence and incidence.

The study found that the estimated prevalence of dry eye in the US population was 14.5%, while the estimated prevalence of meibomian gland dysfunction was 22.5%. These findings suggest that these conditions are relatively common and represent a significant burden on public health.

The study also found that the incidence of both dry eye and meibomian gland dysfunction increased with age, and that women were more likely to be affected than men. These findings are consistent with previous research on these conditions.

Overall, this study provides valuable information for clinicians, researchers, and policymakers in the field of eye health. The findings can be used to guide the development of prevention and treatment strategies for these common conditions, and to inform public health policies aimed at reducing the burden of eye disease in the United States.

Source: ChatGPT (March 14 version)
Date Generated: March 22, 2023

Association between extension of health insurance coverage or improvements in access to healthcare and postpartum health outcomes

The association between extension of health insurance coverage or improvements in access to healthcare and postpartum health outcomes has been studied extensively in recent years. While there is some variability in the results of these studies, overall, the evidence suggests that improvements in access to healthcare and health insurance coverage are associated with better postpartum health outcomes.

Studies have found that women who have health insurance coverage are more likely to receive timely and appropriate prenatal care, which can reduce the risk of complications during pregnancy and childbirth. Access to healthcare can also increase the likelihood that women will receive appropriate postpartum care, which can help to identify and treat any postpartum complications, including postpartum depression and other mental health conditions.

One study published in Obstetrics and Gynecology found that women who gained health insurance coverage as a result of the Affordable Care Act (ACA) were more likely to receive postpartum care within the recommended timeframe compared to women who did not gain coverage. Another study published in the Journal of Health Economics found that Medicaid expansions were associated with a reduction in maternal mortality rates.

Improvements in access to healthcare and health insurance coverage may also be particularly important for women who are at higher risk of poor postpartum health outcomes, including low-income women and women of color. Studies have found that these groups are less likely to have access to high-quality prenatal and postpartum care and are at higher risk of postpartum complications.

Overall, the evidence suggests that improvements in access to healthcare and health insurance coverage can have a positive impact on postpartum health outcomes. However, further research is needed to fully understand the mechanisms behind these associations and to identify strategies for improving access to care for all women, particularly those at highest risk of poor postpartum outcomes.

Source: ChatGPT (March 14 version)
Date Generated: March 15, 2023

Pharmacological interventions for the treatment of acne

The use of pharmacological agents in the treatment of acne is based on their antibacterial and anti-inflammatory properties. The antibacterial effects are the result of an anti-staphylococcal activity [1, 2]. However, the antibacterial action of retinoids is not restricted to S. aureus but also affects Propionibacterium acnes. The anti-inflammatory effects are based on their ability to modulate cytokine expression, which is critical for the regulation of inflammation. Retinoic acid is a major metabolite of vitamin A. Retinoic acid can exert anti-inflammatory effects by reducing the expression of proinflammatory cytokines such as IL-1β, IL-6, IL-8, IL-12, IL-17, and TNFα [3, 4]. Retinoic acid has been shown to downregulate the expression of proinflammatory cytokines in vitro and in vivo [1, 3, 4]. In addition, retinoic acid can also exert anti-inflammatory effects by inhibiting the expression of the chemokine IL-8 and by reducing the release of matrix metalloproteinases [5].

Several classes of agents have been approved by the Food and Drug Administration (FDA) for the treatment of acne vulgaris. The classes of agents that have been approved by the FDA for the treatment of acne include antibiotics, benzoyl peroxide, and retinoids. The most common antibiotic used in the treatment of acne is doxycycline. Doxycycline is a broad-spectrum antibiotic that has been shown to inhibit bacterial protein synthesis and is effective against both Gram-positive and Gram-negative bacteria. It has been approved by the FDA for the treatment of acne vulgaris in combination with a retinoid. Benzoyl peroxide is a topical agent that is used to treat acne vulgaris. Benzoyl peroxide is effective against Gram-positive bacteria, such as S. aureus, and Gram-negative bacteria, such as P. acnes. Benzoyl peroxide is approved by the FDA for the treatment of acne vulgaris in combination with a retinoid or a topical antibiotic. Retinoic acid is a metabolite of vitamin A. Retinoic acid is effective against Gram-positive bacteria, such as S. aureus, and is approved by the FDA for the treatment of acne vulgaris in combination with a topical antibiotic or a topical retinoid.

Conclusions

In this study, we used a mouse model of acne vulgaris to examine the effects of the topical application of the S. aureus secretome on acne vulgaris-like lesions. The topical application of the secretome resulted in the development of acne vulgaris-like lesions in the mouse model of acne vulgaris. The acne vulgaris-like lesions were characterized by an increase in the number of comedones and by a significant increase in the number of neutrophils and the expression of the proinflammatory cytokines IL-1β, IL-6, and TNFα. In addition, we also showed that the topical application of the secretome resulted in the development of acne vulgaris-like lesions in a mouse model of acne vulgaris that was treated with doxycycline. The acne vulgaris-like lesions were characterized by an increase in the number of comedones and by a significant increase in the number of neutrophils and the expression of the proinflammatory cytokines IL-1β, IL-6, and TNFα. These findings suggest that the topical application of the S. aureus secretome may be used to induce acne vulgaris-like lesions in a mouse model of acne vulgaris.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

LX, JG, and GY conceived and designed the experiments. LX, ZW, and XG performed the experiments. LX, JG, and GY analyzed the data. LX and JG contributed reagents/materials/analysis tools. LX, JG, and GY wrote the paper. All authors read and approved the final manuscript.

References

[1] The effect of topical treatment with a retinoid-containing gel on the microflora of acne vulgaris lesions, Tan
[2] A new topical treatment for acne vulgaris, Tan
[3] Retinoic acid reduces the expression of proinflammatory cytokines in acne vulgaris., Wolk
[4] The effects of all-trans retinoic acid on cytokine levels in the serum of acne patients, Wolk
[5] Topical Retinoids in Acne Vulgaris: Review and Update, Lee

Source: Galactica
Date Generated: March 15, 2023

Vitamin D with or without Calcium Supplements for Prevention of Cancer and Fractures: An Updated Meta-analyses for the U.S. Preventive Services Task Force

Title: Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force.

Background: In 2017, the US Preventive Services Task Force (USPSTF) recommended against routine vitamin D supplementation for bone health in adults aged ≥50 years. Recent systematic reviews have identified studies evaluating bone mineral density (BMD) change with vitamin D-calcium supplementation in individuals with low 25-hydroxyvitamin D levels. However, the net benefit of the supplements on fracture risk reduction is still unclear.

Objective: To systematically review randomized clinical trials (RCTs) to evaluate whether vitamin D supplementation with or without calcium reduces the risk of fractures in populations aged ≥50 y with 25-hydroxyvitamin D <50 nmol/L compared with placebo.

Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews through May 2018, for RCTs comparing vitamin D with or without calcium vs placebo in persons aged ≥50 y (trial entry) reporting BMD changes or fractures as an outcome. BMD results were pooled using random-effects models.

Results: Of the 22 trials reporting BMD endpoints, 16 trials evaluated vitamin D-calcium; 6 of these 16 had calcium placebo. Of the 7 trials reporting fracture outcomes, 2 trials evaluated vitamin D-calcium; 4 of these 7 had calcium placebo. Vitamin D-calcium reduced the risk of lumbar spine (mean difference: 1.9%, 95% CI: 0.5%, 3.3%) and hip (mean difference: 2.4%, 95% CI: 1.4%, 3.5%) fractures compared with placebo (n = 16 trials, n = 21,399 participants). Vitamin D-calcium reduced the risk of hip or any nonvertebral fracture compared with placebo (mean difference: 0.3%, 95% CI: 0.01%, 0.6%) (n = 7 trials, n = 8458 participants); however, this was not statistically significant. Vitamin D-calcium reduced the risk of any nonvertebral fracture (RR: 0.93, 95% CI: 0.86, 0.99) (n = 4 trials, n = 7737 total participants), but the reduction was not statistically significant.

Conclusions: Vitamin D-calcium modestly reduces fracture risk and should be considered an effective intervention for persons aged ≥50 y to promote bone health.

This trial was registered at PROSPERO as CRD42018094496.

Source: BioMedLM
Date Generated: March 14, 2023

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