Evidence-based Review Research Articles

An evidence-based review of the pre-requisite interventions for women's inclusion in the blue economy in the global south: A case study of India

The blue economy (BE) is a new frontier that could promote ocean sustainability and equity in the access and utilization of ocean resources. This is more relevant amongst ocean-dependent communities in the global south, such as in India. However, despite increasing evidence of the potential of the BE in promoting women’s inclusion, systemic barriers are still prevalent. Current interventions to bridge gaps concerning gender equity and women's inclusion in the BE are largely fragmented and less comprehensive. This undermines avenues geared towards reactivating gender inclusion and women’s empowerment (WE). Further negative ramifications might emerge, including a limited understanding of evidence-based and context-specific solutions for WE in the BE, ocean sustainability challenges, and the effectiveness of current solutions for coastal women's inclusion. Here, we draw together diverse perspectives systematically extracted from the literature on WE in the BE and develop a ‘strategic sustainable transformational pathway.’ The proposed pathway is grounded on transformative WE perspectives, experiences, and knowledge from India and the global south. The pathway highlights that addressing gender inequality and the core needs of women in the BE requires phased assessments. This can help inform transformative actions for WE. Phased assessments should be based on inclusive stakeholder participation in co-designing, co-monitoring, and continuous evaluation of the efficacy of specific BE interventions. Such actions can contribute to marine social science research that is largely less explored. Future studies can explore the applicability of the pathway by using myriad transdisciplinary approaches centered on participatory co-design and co-inclusion. In India, this can begin with the re-defining of BE in the context of WE. This can help generate micro-level narratives of coastal women on how to promote equity, and WE in the BE, across geographies.

American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis.

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection. False positives due to blood culture contamination (BCC) vary from 1% to as high as >10% of all BC results. False-positive BC results may result in patients undergoing unnecessary antimicrobial treatments, increased healthcare costs, and delay in detecting the true cause of infection or other non-infectious illness. Previous guidelines from the Clinical and Laboratory Standards Institute, College of American Pathologists, and others, based on expert opinion and surveys, promoted a limit of ≤3% as acceptable for BCC rates. However, the data supporting such recommendations are controversial. A previous systematic review of BCC examined three practices for reducing BCC rates (venipuncture, phlebotomy teams, and pre-packaged kits). Subsequently, numerous studies on different practices including using diversion devices, disinfectants, and education/training to lower BCC have been published. The goal of the current guideline is to identify beneficial intervention strategies to reduce BCC rates, including devices, practices, and education/training by providers in collaboration with the laboratory. We performed a systematic review of the literature between 2017 and 2022 using numerous databases. Of the 11,319 unique records identified, 311 articles were sought for full-text review, of which 177 were reviewed; 126 of the full-text articles were excluded based on pre-defined inclusion and exclusion criteria. Data were extracted from a total of 49 articles included in the final analysis. An evidenced-based committee's expert panel reviewed all the references as mentioned in Data Collection and determined if the articles met the inclusion criteria. Data from extractions were captured within an extraction template in the US Agency for Healthcare Research and Quality's Systematic Review Data Repository (https://srdr.ahrq.gov/). BCC rates were captured as the number of events (contaminated samples) per arm (standard practice versus improvement practice). Modified versions of the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for risk of bias assessment (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). We used Grading of Recommendations, Assessment, Development and Evaluations to assess strength of evidence. There are several interventions that resulted in significant reduction in BCC rates: chlorhexidine as a disinfectant for skin preparation, using a diversion device prior to drawing BCs, using sterile technique practices, using a phlebotomy team to obtain BCs, and education/training programs. While there were no substantial differences between methods of decreasing BCC, our results indicate that the method of implementation can determine the success or failure of the intervention. Our evidence-based systematic review and meta-analysis support several interventions to effectively reduce BCC by approximately 40%-60%. However, devices alone without an education/training component and buy-in from key stakeholders to implement various interventions would not be as effective in reducing BCC rates.

IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management.

Obesity is a significant global health issue. Metabolic and bariatric surgery (MBS) is the gold standard in the treatment of obesity due to its proven effectiveness and safety in the short and long term. However, MBS is not suitable for all patients. Some individuals are at high surgical risk or refuse surgical treatment, while others do not meet the criteria for MBS despite having obesity-related comorbidities. This gap has driven the development of endoscopic solutions like endoscopic sleeve gastroplasty (ESG), which offers a less invasive alternative that preserves organ function and reduces risks. A recent IFSO International Delphi consensus study highlighted that multidisciplinary experts agree on the utility of ESG for managing obesity in patients with class I and II obesity and for those with class III obesity who do not wish to pursue or qualify for MBS. This IFSO Bariatric Endoscopy Committee position statement aims to augment these consensus statements by providing a comprehensive systematic review of the evidence and delivering an evidence-based position on the value of ESG within the spectrum of obesity management. A comprehensive systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Cochrane guidelines. Systematic Review: The systematic review included 44 articles encompassing 15,714 patients receiving ESG. The studies varied from large case series to cohort studies and a randomized controlled trial (RCT). The mean baseline BMI was 37.56kg/m2. The review focused on weight loss outcomes and safety data. Time point Mean %EWL Mean %TBWL 6months 48.04 15.66 12months 53.09 17.56 18months 57.98 16.25 24months 46.57 15.2 36months 53.18 14.07 60months 45.3 15.9 These results demonstrate significant weight loss following ESG. The pooled serious adverse event (SAE) rate was 1.25%. This low rate of SAEs indicates that ESG is a relatively safe procedure. The quality of evidence from the included observational studies was assessed as very low, primarily due to the inherent limitations associated with observational study designs, such as potential biases and lack of randomization. In contrast, the quality of evidence from the single randomized controlled trial was rated as MODERATE, reflecting a more robust study design that provides a higher level of evidence despite some limitations. The IFSO Bariatric Endoscopy Committee, after conducting a comprehensive systematic review and meta-analysis, endorses endoscopic sleeve gastroplasty (ESG) as an effective and valuable treatment for obesity. ESG is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for metabolic bariatric surgery. ESG provides significant weight loss outcomes and demonstrates a favorable safety profile with a low rate of serious adverse events. Despite the limitations of the included observational studies, the randomized controlled trial included in the analysis reinforces the efficacy and safety of ESG and provides an evidence-based foundation for the position statement. Thus, the IFSO position statement supports and provides an evidence base for the role of ESG within the broader spectrum of obesity management.

Evidence-Based Review on Symptomatic Management of Huntington's Disease.

Huntington's disease (HD) is a neurodegenerative disorder characterized by motor, behavioral, and cognitive impairments and significant impacts on patient quality of life. This evidence-based review, conducted by the Korean Huntington Disease Society task force, systematically examines current pharmacological and nonpharmacological interventions for symptomatic management of HD. Following PRISMA guidelines, databases were searched for studies up to August 2022 that focused on 23 symptoms across four domains: motor, neuropsychological, cognition, and others. This review provides a comprehensive and systematic approach to the management of HD, highlighting the need for more high-quality clinical trials to develop robust evidence-based guidelines.

Universal Health Care Coverage for Aging Population

The term Universal Health Coverage (UHC) refers to a situation where “all people (both males and females, boys and girls) have access, without financial hardship, to the full range of type of quality health services when and where they need them, now and at times”. The UHC envisages coverage of the full range of essential health care services: from health promotion to (1) ‘Prevention’, (2) ‘Treatment’, (3) ‘Rehabilitation’, and (4) ‘Palliative care’ [aimed at improving quality of life of people (adults and children) and their families confronted with life-threatening illness]. It is pertinent to note that the UHC aligns with the SDG (Sustainable Development Goal) Target 3.8: achieve universal health coverage. The UHC is, thus, global commitment. However, in to deliver this promise, national governments need and inter-governmental organizations need to have health systems that are rooted in the locations communities they serve. Also, such health systems need to be • Need-based, • Efficient, and • Equitable. The author of this review paper argues that Primary Health Care (PHC) is the most effective and cost-efficient way to reach out to people with the UHC, with consideration of “need-based approach”. Further, it is due to this consideration of need-based theory that every country, with its own socio-economic and demographic profile, adopts a different strategy for the purpose of achieving the UHC. Furthermore, national governments decide what to cover, depending on the needs of their populations, including availability of health infrastructure (resources). Investment in the scientifically designed UHC programs has the potential to ensures that health needs of people are (a) ‘Identified’, (b) ‘Prioritized’, and (c) ‘Addressed’. The conceptual framework of the UHC is of increased relevance for aging population (individuals above the age of 65). The author of this work is of the considered research view that objective of achieving the SDG-3.8 target cannot be fully and adequately realized without transforming health care system that has significant impact on functional ability in older age people (or aging population). Objective of this evidence-based review paper is to investigate into significance and implications of the UHC for aging population. Also, it briefly outlines renewed strategies needed for the UHC for aging population. Secondary data (largely ‘qualitative’ in nature) have been used. The method of data analysis is ‘descriptive’, involving non-statistical (mathematical) techniques. The paper briefly concludes that scientifically-designed mechanism for offering the UHC for older people, without financial burden, is crucial. It is important that health financing systems of the national governments are designed to cater to health needs of older people, while protecting them from to access services when they are needed, but also to protect them from financial catastrophe (by abolishing “out of pocket spending”).

Unveiling the utility of artificial intelligence for prediction, diagnosis, and progression of diabetic kidney disease: an evidence-based systematic review and meta-analysis

Objective The purpose of this study was to conduct a systematic investigation of the potential of artificial intelligence (AI) models in the prediction, detection of diagnostic biomarkers, and progression of diabetic kidney disease (DKD). In addition, we compared the performance of non-logistic regression (LR) machine learning (ML) models to conventional LR prediction models. Methods Until January 30, 2024, a comprehensive literature review was conducted by investigating databases such as Medline (via PubMed) and Cochrane. Research that is inclusive of AI or ML models for the prediction, diagnosis, and progression of DKD was incorporated. The area under the Receiver Operating Characteristic Curve (AUROC) served as the principal outcome metric for assessing model performance. A meta-analysis was performed utilizing MedCalc statistical software to calculate pooled AUROC and assess the performance differences between LR and non-LR models. Results A total of 57 studies were included in the meta-analysis. The pooled AUROC of AI or ML model was 0.84 (95% CI = 0.81-0.86, p < 0.0001) for analyzing prediction of DKD, 0.88 (95%CI = 0.84-0.92, p < 0.0001) for detecting diagnostic biomarkers, and 0.80 (95% CI = 0.77-0.82, p < 0.0001) for analyzing progression of DKD. The pooled AUROC of LR and non-LR ML models exhibited no significant differences across all categories (p > 0.05), except for the random forest (RF) model, which displayed a statistically significant increase in predictive accuracy compared to LR for DKD occurrence (p < 0.04). Conclusion ML models showed solid DKD prediction effectiveness, with pooled AUROC values over 0.8, suggesting good performance. These data demonstrated that non-LR and LR models perform similarly in overall CKD management, but the RF model outperforms the LR model, particularly in predicting the occurrence of DKD. These findings highlight the promise of AI technologies for better DKD management. To improve model reliability, future study should include extended follow-up periods as well as external validation.

An Evidence-Based Comprehensive Review of Laughter Therapy in Depression Management

Abstract: Depression is a widespread mental health challenge, necessitating diverse therapeutic approaches. Emerging research suggests that laughter may offer a valuable adjunctive intervention for individuals grappling with depressive symptoms. This review systematically investigates the multifaceted relationship between laughter and depression, elucidating the underlying mechanisms and potential therapeutic benefits. A comprehensive literature search was conducted across multiple electronic databases, including PubMed, PsycINFO, Scopus, and Google Scholar. Keywords used in the search included “laughter therapy,” “humor,” “depression,” “mental health,” and “psychological well-being.” The search was limited to articles published in English and included both peer-reviewed journal articles and relevant gray literature. Relevant data were extracted from each study, including the study design, sample size, participant characteristics, type of laughter intervention, duration and frequency of the intervention, outcome measures, and key findings. The extracted data were organized into tables to facilitate comparison across studies. By synthesizing findings from clinical studies, neuroscience research, and anecdotal evidence, this review examines the physiological, psychological, and social dimensions of laughter's impact on depression. Special attention is given to neurochemical pathways, stress modulation, cognitive restructuring, and social dynamics. The physiological effects of laughter on depression encompass neurochemical regulation (endorphins, serotonin, dopamine), stress reduction, and immune system modulation. Psychologically, laughter contributes to cognitive reframing, enhanced coping mechanisms, and mood regulation. Socially, it strengthens social bonds, mitigates social isolation, and fosters a positive social environment. In conclusion, this review synthesizes current knowledge on the healing potential of laughter in mitigating depression, providing a holistic understanding of its multifaceted impact. The findings underscore the importance of integrating laughter-based interventions into mental health care practices and highlight avenues for future research and clinical applications in the realm of depression treatment.

Clinical Indications and Outcomes of Sinus Floor Augmentation With Bone Substitutes: An Evidence-Based Review.

Clinical Indications and Outcomes of Sinus Floor Augmentation With Bone Substitutes: An Evidence-Based Review.

Evaluation and treatment of rhinosinusitis with primary antibody deficiency in children: Evidence-based review with recommendations.

There is clear evidence that prevalence of primary antibody deficiency (PAD) is higher in children with chronic rhinosinusitis (CRS) than in the general population. The purpose of this multi-institutional and multidisciplinary evidence-based review with recommendations (EBRR) is to thoroughly review the literature on rhinosinusitis with PAD, summarize the existing evidence, and provide recommendations on the evaluation and management of rhinosinusitis in children with PAD. The PubMed, Embase, and Cochrane databases were systematically reviewed from inception through December 2023. Studies on the evaluation and management of rhinosinusitis in PAD patients were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on the evaluation and management principles for PAD were generated. A total of 50 studies were included in this evidence-based review. These studies were evaluated on the incidence of PAD in rhinosinusitis patients, the incidence of rhinosinusitis in PAD patients, and on the different treatment modalities used and their outcome. The aggregate quality of evidence varied across the reviewed domains. Based on the currently available evidence, the incidence of PAD in children with recalcitrant CRS can be significantly elevated. Despite the presence of multiple studies addressing rhinosinusitis and PAD, the level of evidence supporting different treatment options continues to be lacking. Optimal management requires a multidisciplinary approach through collaboration with clinical immunology. There is need for higher level studies that compare different treatments in children with PAD and rhinosinusitis.

Surgical anatomy of the cystic artery: A systematic review with meta-analysis

BackgroundThe current evidence-based systematic review with meta-analysis presents a detailed overview of the cystic artery (CA) surgical anatomy, including its origin, number, topography, and morphometry. Moreover, the surgical implications of these variants are further discussed. MethodsAccording to the Evidence-Based Anatomy Workgroup and PRISMA 2020 guidelines, the systematic review was performed using four online databases. The Anatomical Quality Assurance Tool was used to evaluate the risk of bias. Meta-analysis was performed with the R programming software. The pooled prevalence and pooled mean of different CA parameters were calculated. ResultsThe CA most commonly originated from the right hepatic artery (a pooled prevalence of 85.75 %). Other described origins (in order of frequency) were the aberrant right hepatic artery, the common hepatic, the left hepatic, the gastroduodenal, the superior mesenteric, and the middle hepatic arteries. The CA was single in 88.59 %, while it can be identified as double, triple, or absent. Most commonly, it was located inside the cystohepatic triangle in 83.83 %. Most commonly, it was superomedially to the cystic duct (77.80 %) and posteriorly to the common hepatic duct (35.08 %). The CA pooled mean length was 21.34 mm, and its diameter was more commonly over 1 mm. ConclusionThe CA surgical anatomy is paramount when operating on the gallbladder. The CA's altered anatomy and adjacent area could lead to confusion, iatrogenic injury, and prolonged surgical time. The CA depicts high morphological variability; therefore, surgeons should consider the typical anatomy and possible (usual and unusual) variants.

Biologic Use During Pregnancy and Breastfeeding in Dermatology: An Evidence-Based Review.

Biologic medications have revolutionized the treatment of many dermatologic conditions. However, their use during pregnancy and breastfeeding is a subject of ongoing concern due to limited data on their safety in these populations. As the course of many inflammatory skin conditions is unpredictable during pregnancy and may worsen, biologics are important therapeutic tools for disease stabilization in this patient population. In this review, we provide a comprehensive summary of the gestational safety profile of biologics commonly used in dermatology and provide recommendations during pre-conception, pregnancy, and post-partum periods. We also examine fertility data, placental transfer of biologics, and postpartum immunosuppression/immunomodulation data. J Drugs Dermatol. 2024;23(11):1010-1015. doi:10.36849/JDD.7816R1.

Natural Flavonoids as an Intervention for Hepatic Encephalopathy: Preclinical Evidence-based Review

Abstract: Hepatic encephalopathy (HE) is a serious neuropsychiatric disorder caused in patients with both; acute and chronic liver diseases, which consists of various complications ranging from cognitive impairment, disorientation, confusion, and coma. The available therapies mainly focus on decreasing ammonia levels either through increasing its elimination or decreasing its production, some medications may subside the duration and limit the consequences of HE, but there is no complete available treatment for HE-like manifestation. Thus, there is a need to explore new pharmacotherapy for the treatment and management of HE. Flavonoids are polyphenolic compounds easily found in vegetables, fruits, flowers, beverages, and plants based foods. In modern research, flavonoids have gained attention due to their broad pharmacological properties, like anti-oxidant, antiviral, anti-inflammatory, cardioprotective, cytoprotective, and neuroprotective activity. Several preclinical studies suggest that various flavonoids have a potential therapeutic role in a variety of metabolic- related neurological disorders, including HE. This review focuses on all pre-clinical reports that highlight the neuroprotective potential of natural flavonoids for the management of HE. Based on numerous pre-clinical studies and taking into account the therapeutic effects of natural flavonoids, the present study illustrates the cellular and molecular mechanisms responsible for the potential role of natural flavonoids as pharmacotherapy for the management and treatment of HE.

Optimal Sequence for Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer: An Evidence-Based Review.

Historically, multimodal therapeutic strategies involving preoperative chemoradiotherapy (CRT), surgery, and adjuvant chemotherapy (CT) have been employed to treat locally advanced rectal cancer (LARC). Total Neoadjuvant Therapy (TNT) is showing promise in improving outcomes. Despite its benefits, the optimal sequencing within TNT-whether induction chemotherapy should precede or follow chemoradiotherapy-remains a critical question. This study endeavors to explore the effects of different TNT sequencing strategies on patient outcomes, including tumor downstaging, pathological response, organ preservation, and the balance between efficacy and tolerability. Our methodology entailed a comprehensive literature review conducted on Medline, focusing on recent research, including retrospective studies, systematic reviews, and clinical trials. The review emphasized the comparison of induction chemotherapy versus consolidation chemotherapy within TNT regimens, assessing outcomes such as pathological response, organ preservation rates, and adverse effects. To ensure the selection of appropriate and high-quality studies, specific inclusion and exclusion criteria were applied. The analysis revealed that induction chemotherapy might lead to decreased adherence to subsequent chemoradiotherapy while offering an early intervention against micrometastasis and potentially improving overall chemotherapy compliance. Conversely, consolidation chemotherapy has been associated with higher pathological complete response (pCR) rates and improved tolerability, indicating its potential for patients requiring local symptom relief or those eligible for a nonoperative management approach. Comparative studies like CAO/ARO/AIO-12 and the OPRA trials have significantly contributed to our understanding, suggesting that while both strategies have distinct advantages, the choice between induction and consolidation chemotherapy should be tailored based on individual patient profiles and tumor characteristics. This narrative review underscores the importance of a nuanced approach to TNT sequencing in locally advanced rectal cancer, highlighting the need for further research to refine treatment strategies.

Current Science and Practice of Surgical and Nonsurgical Opportunities for Ovarian Cancer Prevention.

Due to improved understanding of ovarian cancer pathogenesis, we have an unprecedented chance to decrease the burden of disease by maximizing opportunities for prevention. Innovations in surgical options for prevention stem from the discovery that many cases directly or indirectly arise from the fallopian tube. Surgical prevention with salpingectomy alone decreases risk by ≥50%. Effective hormonal and nonhormonal chemopreventive agents are also available. Risk stratification is key to ensuring that options for prevention are appropriately matched to individual risk profile. This evidence-based review provides a critical appraisal of the translational health research endeavors supporting ovarian cancer prevention in clinical practice.

The lingual and facial arteries' common origin: a systematic review with meta-analysis and a computed tomography angiography study.

The present evidence-based systematic review with meta-analysis aimed to investigate the fusion morphology of the lingual artery and facial artery (in the form of the linguofacial trunk-LFT) pooled prevalence and morphometry. After carefully investigating the data literature, a retrospective computed tomography angiography (CTA) study was performed to investigate a few parameters that were not well-studied. An evidence-based systematic review retrieved 41 studies that met our inclusion criteria to identify the LFT pooled prevalence. The literature search was performed using PubMed, Google Scholar, Scopus, and Web of Sciences databases. Then, a meta-analysis of the literature was performed using the open-source R programming language and the RStudio software. Moreover, two hundred CTAs were randomly selected and retrospectively studied to identify LFT topography, morphology, and morphometry. The LFT pooled prevalence was calculated at 16.41%. The subgroup analyses for nationality, type of study, laterality, and gender retrieved no statistically significant association. The unilateral appearance was estimated at 15.92%, compared to the bilateral at 3.28% (p < 0.001). Concerning the findings of our original study, 50 LFTs were identified (12.5%) unilaterally in 34 patients and bilaterally in 8 patients. A significant correlation was observed between the distance LFT origin from the carotid bifurcation (CCB) (p < 0.001) and the distances LA and FA origin from the CCB (p = 0.004). A systematic review with meta-analysis of the LFT were presented, along with an original imaging retrospective study investigating detailed parameters of LFT topography, morphology and morphometry. Knowledge of LFT presence is essential for interventionists in the head and neck region.

Toddler’s fracture: an updated guide on evaluation and management

Toddler’s fractures are commonly encountered in pediatric healthcare. These injuries are associated with little to no risk of fracture displacement or failure to heal, regardless of treatment modality. The standard treatment for these injuries has historically been several weeks of weightbearing restriction and immobilization in a circumferential cast or posterior splint. Over the last decade, numerous reports comparing clinical outcomes and iatrogenic complication rates between treatment modalities have emerged, revealing a concerning trend of higher rates of skin breakdown in patients treated with traditional management compared to those treated with removable walking boot immobilization or no immobilization. Current management practices for toddler’s fractures vary widely with respect to both initial and follow-up care, reflecting a need for additional guidance on this topic. This review provides an updated, evidence-based review of evaluation and management strategies for the toddler’s fracture.

A Cross-Sectional Evidence-Based Review of Drug Promotional Literature (DPL) in a Government Medical College

A Cross-Sectional Evidence-Based Review of Drug Promotional Literature (DPL) in a Government Medical College

Erratum] Non-invasive brain stimulation in craving disorders: evidence-based umbrella review

INTRODUCTION: The use of brain stimulation in the control of craving disorders is controversial, mainly in relation to the best target, technique, duration, frequency and parameters. Several meta-analyses have been published, and their data should be summarized to support the best evidence-based clinical practice. OBJECTIVE: To provide the best level of evidence for the use of non-invasive brain stimulation (NIBS) in the control of craving disorders. METHODS: Umbrella review registraded on Prospero (CRD42021239577), and conducted according to PRISMA recommendations. The methodological quality and evidence level were assessed through AMSTAR, AMSTAR rank and GRADE. RESULTS: A total of 81 meta-analyses were screened and the final analysis was made on 10 studies including 224 randomized clinical trials (RCTs) enrolling 5,555 patients. The main targets of stimulation were the right, left and bi-hemispheric dorsolateral prefrontal cortices. The studies used anodal tDCS, and high-frequency rTMS. The protocols with the larger effect sizes were anodal tDCS with 2mA, for 30 minutes over the right DLPFC (g=0.45; 95%CI 0.328-0.583; p&lt;0.001), and high-frequency rTMS (10Hz), with 100% of the resting motor threshold, over the left DLPFC (g=1.116; 95%CI 0.597-1.634; p&lt;0.001). The quality of evidence ranged from very low to moderate because of inconsistencies mainly due to sample heterogeneity. CONCLUSION: The results of 10 meta-analyses assessing the efficacy of NIBS in the control of craving disorders are robust regarding the effect sizes and provide evidence that bi-hemispheric tDCS and high-frequency rTMS over the DLPFC are effective in the control of craving disorders. However, the evidence level is from low to moderate.

Supplementation with Folic Acid or 5-Methyltetrahydrofolate and Prevention of Neural Tube Defects: An Evidence-Based Narrative Review.

Background: Folic acid (FA), which in its chemical form is pteroylglutamic acid, is the fully oxidised, water-soluble, monoglutamic form of vitamin B9. This compound is part of the folate group but with higher bioavailability, and it is found in vitamin supplements and fortified foods and drugs. Folate metabolism is complex and associated with various metabolic pathways, all of which confer protection on the cell and allow its survival. Methods: We conducted a non-systematic search of articles published in English and Spanish including controlled trials, cohort studies, systematic re-views, and meta-analyses were included, as well as key studies in animal models related to pharmacokinetic studies. Search terms encompassed: "folic acid", "folates", "5-metyltetrahydrofolate", "5-MTHF", "neural tube defects", "supplementation", "fortification", AND "homocysteine" Results: A crucial role demonstrated for FA is to help prevent neural tube defects (NTDs). However, more studies are definitely still needed to establish 5-MTHF as a safe and effective therapeutic approach comparable with FA. Moreover, there is a lack of clinical studies that evaluate the efficacy of 5-MTHF supplementation in the prevention of NTDs. The present evidence-based narrative review discusses differences between FA and 5-MTHF in terms of structure, metabolism, bioavailability, clinical efficacy, and safety. Conclusions: Despite the potential value of 5-MTHF as an alternative to FA, clinical studies would be urgently needed to support the efficacy, dosage, timing, and/or safety of its use as a supplement.

The Cervical Intervertebral Foramen: Microanatomy, Pathology, and Clinical Implications.

This is an evidence-based narrative review article. We hope to provide a primer on cervical intervertebral foramen (cIVF) anatomy for spine surgeons, interventionalists, and physiatrists who regularly treat cervical spine pathology, and encourage further exploration of this topic. This corridor for exiting cervical nerve roots is characterized by its intricate microanatomy involving ligamentous, nervous, and vascular structures. Degenerative changes such as facet hypertrophy and disc herniations alter these relationships, potentially leading to nerve root compression and cervical radiculopathy. This review synthesizes existing knowledge on the cIVF. Key imaging, cadaveric, and clinical studies serve as a foundation for this anatomic review. We explore topics such as dynamic changes that affect foraminal size and their implications for nerve root compression, the relationship of the dorsal root ganglion to the cervical foramen, and the function and clinical significance of foraminal ligaments, arteries, and veins. Changes in the cIVF are frequently the basis of cervical degenerative pathologies. A comprehensive understanding of its microanatomical structure will allow the practitioner to better treat the underlying disease process causing their symptoms and signs.