Observational Studies In MEDLINE Research Articles

Rehabilitation of Chronic Pain in Post-Critical Care Patients. A Narrative Review

Chronic pain in post-critical care patients is a multifaceted issue with profound implications for patient well-being and quality of life. This review aims to address the rehabilitation of patients who suffer from chronic pain following discharge from the intensive care unit (ICU). Despite growing awareness of the prevalence and impact of this condition, significant gaps in knowledge persist regarding the optimal rehabilitation strategies for these patients. To conduct this study, an extensive literature search was undertaken, encompassing peer-reviewed articles, clinical trials, and observational studies in Medline, Scopus, and Cinahl databases, using specific keywords. Studies were identified based on their titles, abstracts, and those that met the inclusion criteria. Sixteen studies were eligible for inclusion in this review, varying in methodology, assessment tool, assessment time, or follow-up. The findings of this review illuminate the existing gaps in knowledge by synthesizing evidence on the various rehabilitation approaches employed, their effectiveness, and the factors influencing patient outcomes. So far, healthcare professionals have targeted either pain treatment, finding an analgesic medication or the proper position/exercise, or pain management, helping the patient manage life despite the unrelieved pain. Conventional pain treatment or control has been replaced by pain rehabilitation, in which a biopsychosocial approach enables healthcare professionals to provide patients with the knowledge and skills to manage their pain and disability through personal multidimensional choices. Early rehabilitation programs, quick mobilization, and greater family participation should be encouraged. The strengths of this study lie in its thorough analysis of the available literature and the provision of valuable insights into the heterogeneous nature of chronic pain in post-critical care patients. However, limitations include the limited availability of high-quality randomized controlled trials in this domain. Overall, this review contributes to an improved understanding of rehabilitation strategies for chronic pain in post-critical care patients and underscores the need for further research to enhance patient care and outcomes.

Abstract P345: Physical Activity and Cardiorespiratory Fitness Among Adolescents With Type 1 and Type 2 Diabetes: A Systemic Review and Meta-Analysis

Background: Physical activity (PA) is a cornerstone in the management of pediatric diabetes, due in part to a dose-response effect on cardiorespiratory fitness (CRF). The extent to which PA and CRF is impaired in children and adolescents with diabetes remains unclear. Hypothesis: We hypothesized that PA and CRF would be lower in children and adolescents with type 1 (T1D) and (T2D) compared to controls. Design and Methods: To test this hypothesis we conducted a systematic review of observational studies in MEDLINE, Embase, the Cochrane Library, and CINAHL from 2000 to April 2022. Cross sectional studies that reported PA and/or CRF for children and adolescents (0-21 years) with T1D, T2D and controls without diabetes were included in the analysis. We excluded studies in adults and those that did not differentiate diabetes type. The main outcomes of interest were objective or subjective measures of PA and direct or indirect measures of CRF. Co-variates extracted from each manuscript included body mass index, sex, measures of socio-economic status, age and ethnicity. A modified risk of bias tool was used to assess the methodological quality of each study. (Prospero registration: CRD42022329303). We used an inverse variance weighted meta-analysis to estimate effect size and precision effects. A random effects model was used. Results: Of 7857 citations retrieved, we included 42 studies with T1D (n=4027 with T1D, n=9699 controls) and 14 studies with T2D (n=581 with T2D, n=1008 controls). 26 and 2 studies included direct and indirect measures of cardiorespiratory fitness respectively. 14 and 26 studies include objective and subjective measures of PA respectively. The standardized mean difference (SMD) was PA [-0.28; 95% CI: -0.46, -0.10; I 2 = 89%] and CRF [-0.30; 95% CI: -0.66, 0.06; I 2 = 92%] were lower children and adolescents with for T1D compared to controls. The SMD for PA [-0.61; 95% CI: -0.98, -0.24; I 2 = 89%] and CRF [-1.20; 95% CI: -1.73, -0.67; I 2 = 91%] were also lower for children and adolescents with T2D compared to controls. The majority of studies were considered a high risk of bias. Conclusions: Children and adolescents with T1D display modestly lower daily PA and CRF compared to controls. Deficits in PA and CRF are more profound among children and adolescents with T2D.

Screening for prostate cancer: protocol for updating multiple systematic reviews to inform a Canadian Task Force on Preventive Health Care guideline update

PurposeTo inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening for prostate cancer in adults aged 18 years and older in primary care. This protocol outlines the planned scope and methods for a series of systematic reviews.MethodsUpdates of two systematic reviews and a de novo review will be conducted to synthesize the evidence on the benefits and harms of screening for prostate cancer with a prostate-specific antigen (PSA) and/or digital rectal examination (DRE) (with or without additional information) and patient values and preferences. Outcomes for the benefits of screening include reduced prostate cancer mortality, all-cause mortality, and incidence of metastatic prostate cancer. Outcomes for the harms of screening include false-positive screening tests, overdiagnosis, complications due to biopsy, and complications of treatment including incontinence (urinary or bowel), and erectile dysfunction. The quality of life or functioning (overall and disease-specific) and psychological effects outcomes are considered as a possible benefit or harm. Outcomes for the values and preferences review include quantitative or qualitative information regarding the choice to screen or intention to undergo screening. For the reviews on benefits or harms, we will search for randomized controlled trials, quasi-randomized, and controlled studies in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. For the review on values and preferences, we will search for experimental or observational studies in MEDLINE, Embase, and PsycInfo. For all reviews, we will also search websites of relevant organizations, gray literature, and reference lists of included studies. Title and abstract screening, full-text review, data extraction, and risk of bias assessments will be completed independently by pairs of reviewers with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of the evidence for each outcome.DiscussionThe series of systematic reviews will be used by the Canadian Task Force on Preventive Health Care to update their 2014 guideline on screening for prostate cancer in adults aged 18 years and older.Systematic review registrationThis review has been registered with PROSPERO (CRD42022314407) and is available on the Open Science Framework (osf.io/dm32k).

A systematic review article Exposure to cement dust and respiratory health for communities residing near cement factories: A systematic review of the literature.

Objective: To examine the strength of evidence through systematic review of published literature on the association between effects of exposure to cement dust on respiratory health of communities residing near cement plants. Design and data sources: A systematic search and review of observational studies in Medline, Embase, and Cumulative Index to Nursing and allied Health Literature (CINAHL), and other sources was conducted. Eligibility criteria: Peer reviewed articles, published from 1996 to 2022 that investigated effects of exposure to cement dust on human respiratory health (pulmonary functions and symptoms) were included. The studies must have been conducted in communities residing near a cement factory; were original research and written in English. The search key words were: cement, cement dust, cement dust exposure, respiratory health, cement respiratory health effect, cement dust exposure respiratory effect, cement pulmonary function, and cement dust pulmonary health. Results: 443 studies were retrieved and screened. Only 12 of these met the inclusion criteria. The majority of studies were assessed as being of moderate quality; seven of these studies were cross sectional study design and only five studies performed actual measurement of ambient concentration of particulate matter (PM) while the rest assumed high exposure levels based on other studies’ findings. Furthermore, all the five studies that measured exposure used environmental monitoring rather than more precise methods of measuring personal exposure. Most studies reported higher levels of PM2.5 and PM10 in the exposed compared to the controls and demonstrated a statistically significant difference in the prevalence of respiratory symptoms and reduced pulmonary functions or some degree of association. Conclusion: This review shows that despite showing some degree of association between exposure to cement dust and respiratory ill health, the existing evidence is insufficient to draw firm conclusion mainly because the studies were of low quality. To improve the quality of evidence, future studies should include panel studies, personal monitoring of the exposure, source apportionment and chemical characterisation coupled with using standardized measurement tools for exposure and outcome at predetermined intervals

EVIDENCE OF THE ASSOCIATION BETWEEN SLEEP DURATION AND BLOOD PRESSURE IN ADOLESCENTS: A SYSTEMATIC REVIEW.

ABSTRACTObjective: To review the epidemiological evidence of the association between sleep duration and blood pressure in adolescents.Data sources: We performed a systematic review of observational studies in Medline, Scopus, Lilacs, Web of Science, Science Direct databases and Virtual Libraries in English, Spanish and Portuguese published until September 2018. Studies were selected first by title and abstract, then by complete reading, according to the eligibility criteria. The reference list of selected articles was evaluated in order to retrieve relevant studies.Data synthesis: Initially, 1,455 articles were retrieved. After exclusion due to duplicity or not meeting the eligibility criteria, 13 articles were included in the review. Studies varied greatly in sample size (143 to 6,940 patients), methods of measuring blood pressure and sleep duration, cutoff points, categorization and adjustment of variables. The main evidence from the studies is that short sleep duration is associated with high blood pressure in adolescence, although the presence of association between high blood pressure and long sleep duration is possible, but not clear in the literature.Conclusions: Sleep duration, especially short duration, is associated with high blood pressure in adolescents. Such evidence draws attention to implications on cardiovascular health in this age group.

Association between hidradenitis suppurativa, depression, anxiety, and suicidality: A systematic review and meta-analysis

Previousstudies found conflicting results about whether hidradenitis suppurativa (HS) is associated with depression or anxiety. To determine the relationship of HS with depression and anxiety. A systematic review was performed of published observational studies in MEDLINE, PubMed, Embase, Global Resource for Eczema Trials (GREAT), Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane, Scopus, and PsychInfo that analyzed depression or anxiety in HS. Two reviewers performed title/abstract review and data extraction. Meta-analysis was performed with random-effects weighting. Thirty-eight studies met inclusion criteria; 27 had sufficient data for meta-analysis. The prevalences of depression (26.5% vs 6.6%) and anxiety (18.1% vs 7.1%) were higher in persons with versus without HS. Patients with HS had higher odds of depression in 12 of 13 studies and pooled analysis (odds ratio, 2.54; 95% confidenceinterval, 2.15-3.01), and anxiety in 6 of 6 studies and pooled analysis (odds ratio, 2.00; 95% confidence interval, 1.66-2.42). Similar results were found in sensitivity analyses for different methods of HS diagnosis (physician diagnosed and chart review) and control groups (healthy and dermatologic control individuals). HS was associated with higher antidepressant and anxiolytic use and with suicidality, but not mean depression and anxiety scale scores. Individual-level data were unavailable. Patients with HS have higher odds of depression, anxiety, and suicidality.

Cochrane review: Search strategies to identify observational studies in MEDLINE and EMBASE

Cochrane review: Search strategies to identify observational studies in MEDLINE and EMBASE

183 Association of atopic dermatitis, ultraviolet radiation and climate factors: a systematic review and ecological meta-analysis

Previous studies found conflicting results about the relationship of ultraviolet radiation (UVR) and climate with atopic dermatitis (AD) prevalence. We examined the relationship of UVR and climate with lifetime and point AD prevalences globally. A systematic review was performed of all published observational studies in MEDLINE, EMBASE, LILACS, Scopus, Cochrane library and GREAT that analyzed AD prevalence. Mean UVR dose exposure was determined from the Tropospheric Emission Monitoring Internet Service. Mean daily temperature and total precipitation were obtained from the Intergovernmental Panel on Climate Change Data Distribution center. Linear and nonlinear associations (penalized spline term) of AD prevalence with mean and maximum UV dose exposures, temperature and precipitation were assessed using generalized linear mixed-effects regression models. Overall, 284 studies met inclusion criteria. The pooled global lifetime and point prevalences (95% confidence interval [CI]) of AD were 13.8% (12.6, 14.9%) and 9.4% (7.6, 11.3%), respectively. Lifetime prevalence of AD was inversely and non-linearly associated with mean UVR dose exposure (P=0.003) and temperature (P=0.01). Point prevalence of AD was inversely and non-linearly associated with mean UVR dose exposure (P=0.04) and linearly associated with mean temperature (beta [95% CI]: -0.19 [-0.34, -0.05], P=0.01). Lifetime and point prevalence of AD were not associated with precipitation levels. Snowy climate was associated with higher lifetime (beta [95% CI]: 4.79 [1.34, 8.25]) and point (6.13 [1.43, 10.83]) prevalences of AD compared to equatorial climate. Similar results were seen in studies of children and/or adults. The results of this ecological study support a role for UVR, temperature and climate type in global AD prevalence.

219 A systematic review and meta-analysis of the association between hidradenitis suppurativa, depression, suicidal ideation, and anxiety

Hidradenitis suppurativa (HS) is associated with pain, disfigurement and psychological distress. However, previous studies found conflicting results about whether HS is associated with increased prevalence of depression or anxiety. We sought to determine the complex relationship between HS, depression, and anxiety. A systematic review was performed of all published observational studies in MEDLINE, Pubmed, EMBASE, GREAT, LILACS, Cochrane Library, Scopus and PsychInfo that analyzed depression or anxiety in HS. Two reviewers performed study title/abstract review and data abstraction. Pooled meta-analysis was performed using random-effects weighting. Overall, 39 studies met inclusion criteria; 27 had sufficient data for meta-analysis. The prevalence of depression was higher in persons with vs. without HS (26.6% vs. 6.6%; logistic regression, odds ratio [95% confidence interval]: 2.54 [2.15-3.01]). In particular, HS was associated with higher odds of questionnaire based (2.61 [1.36-6.00]) and physician diagnosed (2.58 [2.15-3.08]) depression. Severe HS was associated with even higher odds of depression (n=3 studies). Similar results were found for anxiety (18.1% vs. 7.1%, 2.00 [1.66-2.42]). HS was associated with higher mean scores for multiple depression (n=11 studies) and anxiety scales (n=3 studies), and higher odds of anti-depressant (n=2 studies) and anxiolytic use (n=1 studies), and suicidality (n=2 studies). In conclusion, HS patients have higher odds of depression, anxiety, and suicidality.

Search strategies to identify observational studies in MEDLINE and Embase.

Systematic reviews are essential for decision-making. Systematic reviews on observational studies help answer research questions on aetiology, risk, prognosis, and frequency of rare outcomes or complications. However, identifying observational studies as part of systematic reviews efficiently is challenging due to poor and inconsistent indexing in literature databases. Search strategies that include a methodological filter focusing on study design of observational studies might be useful for improving the precision of the search performance. To assess the sensitivity and precision of a search strategy with a methodological filter to identify observational studies in MEDLINE and Embase. We searched MEDLINE (1946 to April 2018), Embase (1974 to April 2018), CINAHL (1937 to April 2018), the Cochrane Library (1992 to April 2018), Google Scholar and Open Grey in April 2018, and scanned reference lists of articles. Studies using a relative recall approach, i.e. comparing sensitivity or precision of a search strategy containing a methodological filter to identify observational studies in MEDLINE and Embase against a reference standard, or studies that compared two or more methodological filters. Two review authors independently screened articles, extracted relevant information and assessed the quality of the search strategies using the InterTASC Information Specialists' Sub-Group (ISSG) Search Filter Appraisal Checklist. We identified two eligible studies reporting 18 methodological filters. All methodological filters in these two studies were developed using terms from the reference standard records.The first study evaluated six filters for retrieving observational studies of surgical interventions. The study reported on six filters: one Precision Terms Filter (comprising terms with higher precision while maximum sensitivity was maintained) and one Specificity Terms Filter (comprising terms with higher specificity while maximum sensitivity was maintained), both of which were adapted for MEDLINE, for Embase, and for combined MEDLINE/Embase searches. The study reported one reference standard consisting of 217 articles from one systematic review of which 83.9% of the included studies were case seriesThe second study reported on 12 filters for retrieving comparative non-randomised studies (cNRSs) including cohort, case-control, and cross-sectional studies. This study reported on 12 filters using four different approaches: Fixed method A (comprising of a fixed set of controlled vocabulary (CV) words), Fixed method B (comprising a fixed set of CV words and text words (TW)), Progressive method (CV) (a random choice of study design-related CV terms), and Progressive method (CV or TW) (a random choice of study design-related CV terms, and title and abstracts-based TWs). The study reported four reference standards consisting of 89 cNRSs from four systematic reviews.The six methodological filters developed from the first study reported sensitivity of 99.5% to 100% and precision of 16.7% to 21.1%. The Specificity Terms Filter for combined MEDLINE/Embase was preferred because it had higher precision and equal sensitivity to the Precision Terms Filter. The 12 filters from the second study reported lower sensitivity (48% to 100%) and much lower precision (0.09% to 4.47%). The Progressive method (CV or TW) had the highest sensitivity.There were methodological limitations in both included studies. The first study used one surgical intervention-focused systematic review thus limiting the generalizability of findings. The second study used four systematic reviews but with less than 100 studies. The external validation was performed only on Specificity Terms Filter from the first study Both studies were published 10 years ago and labelling and indexing of observational studies has changed since then. We found 18 methodological filters across two eligible studies. Search strategies from the first study had higher sensitivity and precision, underwent external validation and targeted observational studies. Search strategies from the second study had lower sensitivity and precision, focused on cNRSs, and were not validated externally. Given this limited and heterogeneous evidence, and its methodological limitations, further research and better indexation are needed.

The relationship between pemphigus and systemic lupus erythematosus: a cross-sectional study, systematic review, and meta-analysis.

The coexistence of pemphigus and systemic lupus erythematosus (SLE) had been reported anecdotally. Anti-desmoglein (Dsg)1 and anti-Dsg3 antibodies were detected concomitantly with antinuclear autoantibodies among blood donors. The aim of the current study was to study the association between pemphigus and SLE in Israeli patients and to synthesize existing data on this association in the current literature. The current study included two sections. Initially, a cross-sectional study was performed to compare pemphigus patients with age-, sex-, and ethnicity-matched control subjects regarding the prevalence of SLE using a real-life large-scale computerized database. Next, a systematic review and meta-analysis of similar observational studies in Medline, Embase, and Web of Science (1823-2017) was conducted. As for the cross-sectional study, a total of 1985 patients with pemphigus and 9874 controls were included in the study. The prevalence of SLE was slightly higher among patients with pemphigus as compared to controls (OR, 1.85; 95% CI, 0.89-3.82). In a sensitivity analysis that included patients who received pemphigus-related treatments, the association between pemphigus and SLE had been substantiated and was statistically significant (OR, 2.10; 95% CI, 1.00-4.48). In the meta-analysis section, three eligible studies, comprising 10,389 pemphigus patients met the eligibility criteria. The overall pooled multivariate OR was 2.50 (95% CI 1.54-4.07, I2 = 44.19%, P = 0.167) across all studies. In conclusion, the meta-analysis provides epidemiologic evidence that these B cell-driven diseases are significantly associated. Further research is required to elucidate the molecular mechanism underlying this association.

STROBE Maddelerine Uyum ve Tasarım Etkisinin Raporlanmasına Yönelik Bir MEDLINE Taraması

Objective: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement is a checklist and has been developed to improve the reporting of observational studies. The design effect for observational studies is an important factor in sample size determinations however is not considered under STROBE. In this study, it is aimed to evaluate compliance with STROBE in the articles reviewed in MEDLINE and highlight the necessity of thinking out design effect. Material and Methods: A database search has been performed on the observational studies n=342, that are free full text, written in English and published in MEDLINE. The frequency of compliance with STROBE was examined and an auxiliary review with respect to the design effect was done by one reviewer. Results: 342 articles evaluated, 224 (65.5%) were cross-sectional and 118 (34.5%) cohort studies. The best compliance (above 90%) was for items 1(b), 2 and 14(a) while the worst fit (under 20%) was for items 12(d), 13(c) and 16(c). In n=6 (1.8%) cross-sectional studies design effect was reported. Conclusion: In terms of the quality of the reporting of observational trials, current observational studies in MEDLINE could still benefit from increased reporting of methodologic details including the reporting design effect, sample size determinations, methods taking account of sampling strategy for cross-sectional studies, power analyses and consideration of potential bias. For items under methods section (items 4-12) compliance is lower than other items. Discarding design effect has a potential of source of bias. Authors should report the design effect and can also be consider within the items 4 or 9 or 10.

A SYSTEMATIC REVIEW AND META-ANALYSIS OF DEPRESSION AND SUICIDE IN ATOPIC DERMATITIS

Introduction Atopic dermatitis (AD) is associated with psychological distress. However, previous studies found conflicting results about whether AD is associated with increased depression or suicidality. The objective of this study was to determine the complex relationship between AD and depression. Methods A systematic review was performed of all published observational studies in MEDLINE, Pubmed, EMBASE, GREAT, LILACS, Cochrane Library, Scopus and PsychInfo that analyzed depression in AD. Two reviewers performed study title/abstract review and data abstraction. Pooled meta-analysis was performed using random-effects weighting. Results Overall, 106 studies met inclusion criteria; 36 had sufficient data for meta-analysis. The prevalence of any depression was higher in persons with vs. without AD (20.1% vs. 14.8%). Similar results were found in sensitivity analyses of studies assessing clinical depression, depressive symptoms, and adults, with healthy controls, low and high study quality. AD was associated with significantly higher depression scales, parental depression, anti-depressant use, and suicidality. No publication bias was detected. Conclusions AD patients have higher odds of depression and suicidality.

The coexistence of pemphigus and psoriasis: a systematic review and meta-analysis.

There is little consensus regarding the association between pemphigus and psoriasis. The aim of the current study is to synthesize existing data on the prevalence of psoriasis in patients with pemphigus and on the association between the two conditions. We performed a systematic review and meta-analysis of observational studies in Medline, Embase, and Web of Science (1900-2018). Reference lists of included studies were also searched for eligible studies. Quality of evidence was assessed using Newcastle-Ottawa scale (NOS). A meta-analysis was performed using random-effects models to estimate pooled prevalence rates and odds ratios (ORs) with 95% confidence intervals (CI). Subgroup and sensitivity analyses were also conducted. Twelve eligible studies comprising 12,238 patients with pemphigus were included in the quantitative synthesis. The overall random-effects pooled prevalence of psoriasis among patients with pemphigus was 2.4% (95% CI, 1.0-4.4) across all studies. The overall pooled multivariate OR for psoriasis in patients with pemphigus was significantly increased and estimated at 3.5 (95% CI, 1.6-7.6). In conclusion, a significant association was found between pemphigus and psoriasis. Physicians managing patients with pemphigus may be aware of this comorbidity. Further studies are warranted to establish the precise mechanisms underlying this relationship.

A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis

Previous studies found conflicting results about whether atopic dermatitis (AD) begins in adulthood. To determine rates, predictors, and phenotypic differences of adult-onset AD. A systematic review was performed with all published observational studies in Medline, Embase, GREAT (Global Resource of EczemA Trials), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library, and Scopus that analyzed the age of AD onset beyond 10years of age. At least two reviewers performed study title, abstract review, and data extraction. Pooled meta-analysis of the proportion of adult-onset AD was performed by using random-effects weighting (I2=99.3%). Overall, 25 studies met inclusion criteria. Seventeen studies reported age of AD onset as after 16years of age and had sufficient data for meta-analysis. The pooled proportion (95% confidence interval) of adult-onset AD was 26.1% (16.5%-37.2%). Similar results were found in sensitivity analyses by AD diagnostic method, study region, and sex. Phenotypic differences were observed across studies for adult-onset and child-onset AD, including higher rates of foot dermatitis and personal history of atopy but lower rates of flexural lesions and other signs and symptoms. Characteristics of adult-onset versus child-onset AD were not commonly reported. AD is not only a disease of childhood; 1 in 4 adults with AD report adult-onset disease, which has distinct clinical characteristics as compared to child-onset AD.

Underlying Systemic Diseases in Pyoderma Gangrenosum: A Systematic Review and Meta-Analysis.

There is little consensus regarding the prevalence and distribution of underlying systemic diseases among patients with pyoderma gangrenosum. The objective of this study was to synthesize existing data on the prevalence of associated systemic diseases in patients with pyoderma gangrenosum. We performed a systematic review and meta-analysis of observational studies in MEDLINE, EMBASE, and Scopus (1823-2017). The quality of evidence was assessed using a modified Newcastle-Ottawa Scale. A meta-analysis was performed using random-effects models to estimate pooled prevalence rates with 95% confidence intervals. Twenty-one eligible studies comprising 2611 patients with pyoderma gangrenosum were included in the quantitative synthesis. The overall random-effects pooled prevalence of associated systemic diseases was 56.8% (95% confidence interval 45.5-67.4). The leading underlying disease was inflammatory bowel disease (17.6%; 95% confidence interval 13.0-22.7), followed by arthritis (12.8%; 95% confidence interval 9.2-16.9), hematological malignancies (8.9%; 95% confidence interval 6.5-11.6), and solid malignancies (7.4%; 95% confidence interval 5.8-9.1). In 16.3% (95% confidence interval 7.7-27.1) of cases, the onset of pyoderma gangrenosum was attributed to the pathergy phenomenon. More than half of patients with pyoderma gangrenosum present with a relevant underlying disease. Inflammatory bowel disease and arthritis are the most frequently associated diseases. Relative to the reported literature, the pooled prevalence of arthritis and hematological malignancies is lower, while the pooled prevalence of solid malignancies is higher. Owing to the high level of heterogeneity among most of the comparisons, results should be interpreted with caution.

Risk factors for malnutrition in stroke patients: A meta-analysis

Stroke is a common cause of death and disability worldwide. Among stroke patients, malnutrition is a significant problem that contributes to poor outcome. Clinical evidence is required to identify risk factors for malnutrition and to adopt appropriate management strategies during early stroke intervention. Thus, we performed a meta-analysis of potential risk factors related to malnutrition in stroke patients. We systemically searched relevant observational studies in MEDLINE, EMBASE, Chinese Biomedical Literature Database (CBLD), China National Knowledge Infrastructure (CNKI), and VIP Database of Chinese periodicals from January 1990 to September 2017 in any language. Patients included in this study were adults who suffered from stroke. Stata 12.0 and Review Manager 5.1 software were used to pool useful data and calculate odds ratios (ORs) and their 95% confidence intervals (CIs). We also performed heterogeneity and sensitivity analyses, and evaluated publication bias. Twenty-nine observational studies involving 8838 participants who met our inclusion criteria were incorporated into the meta-analysis, and thirteen risk factors related to malnutrition were studied. The following variables probably correlated with an increased risk of malnutrition in stroke patients: malnutrition on admission (OR=8.34, 95% CI=4.60-15.10, P<0.00001), dysphagia (OR=2.60, 95% CI=2.24-3.03, P<0.00001), previous stroke (OR=3.04, 95% CI=2.35-3.95, P<0.00001), diabetes mellitus (OR=1.79, 95% CI=1.35-2.38, P<0.0001), tube feeding (OR=5.43, 95% CI=3.99-7.37, P<0.00001) and reduced level of consciousness (OR=2.82, 95% CI=2.12-3.75, P<0.00001). The factors alcohol consumption, hypertension, male sex, depressed mood, pneumonia and infection need to be re-evaluated. Conversely, smoking was most likely not associated with post-stroke malnutrition. Our meta-analysis has revealed a variety of risk factors for malnutrition during hospital stay among stroke patients. Early identification of these factors is warranted for improving patient outcomes.

Segunda y tercera generación de anticonceptivos orales e infarto de miocardio: revisión sistemática y metaanálisis

IntroductionContraceptives are drugs taken to prevent pregnancy and maintain control of the female hormonal cycle. Second-generation contraceptives include levonorgestrel, while third-generation contraceptives are made with desogestrel or gestodene. The objective of this systematic review and meta-analysis is to determine the risk of myocardial infarction when using second- or third-generation oral contraceptives. Materials and methodsA systematic review of observational studies in Medline and Cochrane from 1 January 1996 to 1 June 2015. The meta-analysis was performed using a random effects model. The outcomes are the risk of myocardial infarction due to the use of second- or third-generation oral contraceptives. ResultsThe four observational studies met certain inclusion and quality control criteria. The results of the meta-analysis using the random effects model were 1.0995 for second-generation and 0.8298 for third-generation contraceptives, but these results were not significant. The result of the comparison between third- and second-generation products was also not significant, with a value of 0.7361. ConclusionsWe were unable to draw conclusions from the meta-analysis because the results were not significant. We are therefore unable to indicate the whether the risk of myocardial infarction increases with the use of second- or third-generation oral contraceptives.

Neonatal Blue Light Phototherapy and Melanocytic Nevus Count in Children: A Systematic Review and Meta-Analysis of Observational Studies.

Neonatal blue light phototherapy (NBLP) is an established method of managing neonatal hyperbilirubinemia. Approximately 5% of newborns are exposed to NBLP. Evidence of whether NBLP predisposes to the development of melanocytic nevi later in life has been conflicting. The goal of the current study was to conduct a systematic review and meta-analysis to quantitatively assess the effect of NBLP on melanocytic nevus count. We searched for observational studies in Medline, EMBASE, and the Cochrane Central Register from their inception to April 15, 2015. Meta-analysis of Observational Studies in Epidemiology guidelines were followed. DerSimonian and Laird random-effects models were used to calculate the weighted mean difference (WMD). Publication bias was assessed using a funnel plot and the Egger's test. Five studies with a total of 2,921 subjects were included, of whom 642 underwent NBLP. With random-effects modeling, those who had previous NBLP did not have a significantly higher mean number of melanocytic nevi (WMD = 0.32 [95% confidence interval -0.67, 1.31], p = 0.53). Visual inspection of the funnel plot suggested potential publication bias, although the Egger's test (p = 0.09) indicated no small-study effect. There was no evidence that prior NBLP exposure significantly increased the number of melanocytic nevi. Available evidence has not revealed any cause for major concern for NBLP. Other risk factors such as exposure to sunlight, childhood history of sunburn, and fair skin complexion might play a greater role in the development of melanocytic nevi in childhood.

What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis.

BackgroundA previous systematic review on prognostic factors for knee osteoarthritis (OA) progression showed associations for generalized OA and hyaluronic acid levels. Knee pain, radiographic severity, sex, quadriceps strength, knee injury, and regular sport activities were not associated. It has been a decade since the literature search of that review and many studies have been performed since then investigating prognostic factors for radiographic knee OA progression.Questions/purposesThe purpose of this study is to provide an updated systematic review of available evidence regarding prognostic factors for radiographic knee OA progression.MethodsWe searched for observational studies in MEDLINE and EMBASE. Key words were: knee, osteoarthritis (or arthritis, or arthrosis, or degenerative joint disease), progression (or prognosis, or precipitate, or predictive), and case-control (or cohort, or longitudinal, or follow-up). Studies fulfilling the inclusion criteria were assessed for methodologic quality according to established criteria for reviews on prognostic factors in musculoskeletal disorders. Data were extracted and results were pooled if possible or summarized according to a best-evidence synthesis. A total of 1912 additional articles were identified; 43 met our inclusion criteria. The previous review contained 36 articles, thus providing a new total of 79 articles. Seventy-two of the included articles were scored high quality, the remaining seven were low quality.ResultsThe pooled odds ratio (OR) of two determinants showed associations with knee OA progression: baseline knee pain (OR, 2.38 [95% CI, 1.74–3.27) and Heberden nodes (OR, 2.66 [95% CI, 1.46–8.84]). Our best-evidence synthesis showed strong evidence that varus alignment, serum hyaluronic acid, and tumor necrosis factor-α are associated with knee OA progression. There is strong evidence that sex, former knee injury, quadriceps strength, smoking, running, and regular performance of sports are not associated with knee OA progression. Evidence for the majority of determined associations, however, was limited, conflicting, or inconclusive.ConclusionsBaseline knee pain, presence of Heberden nodes, varus alignment, and high levels of serum markers hyaluronic acid and tumor necrosis factor-α predict knee OA progression. Sex, knee injury, and quadriceps strength, among others, did not predict knee OA progression. Large variation remains in definitions of knee OA and knee OA progression. Clinical studies should use more consistent definitions of these factors to facilitate data pooling by future meta-analyses.Electronic supplementary materialThe online version of this article (doi:10.1007/s11999-015-4349-z) contains supplementary material, which is available to authorized users.