Centre For Evidence-Based Medicine Research Articles

Effectiveness and Feasibility of Blood Flow Restriction Training for People with Multiple Sclerosis: A Systematic Review.

Multiple sclerosis (MS) is an immune-mediated inflammatory disease that primarily targets the myelin of axons. Extremities are frequently affected, resulting in a negative impact on both activities of daily living (ADL) and quality of life. In recent years, there has been increasing interest in the potential benefits of exercise and blood flow restriction training (BFRT) programs as a therapeutic tool in people with neurological disorders. The aim of the present systematic review was to know the clinical effects of BFRT programs in people with MS. A systematically comprehensive literature search was conducted and registered in PROSPERO prior to its execution under the reference number CRD42024588963. The following data sources were used: Pubmed, Scopus, Web of Science (WOS) and the Cochrane Library. The following data were extracted from the papers: study design, sample, interventions, dosage, outcome measures and results. To assess the methodological quality of the papers included, the Quality Index of Downs and Black was used. Additionally, the articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. Also, the Cochrane Handbook for Systematic Reviews of Interventions was used by two independent reviewers to assess risk of bias, assessing the six different domains. Seven articles with a total of 71 participants were included in the review. Of the seven articles, five papers studied the effectiveness of BFRT combined with strengthening exercises and two papers studied the effect of BFRT combined with aerobic exercise. Of the five articles that analyzed BFRT combined with strengthening exercises, only two presented a control group. Both performed a low-load resistance training in combination with BFRT with four series, 30/15/15/15 repetitions and a rest of 1 min between the series and 3 min between the exercises. The control groups to which they were compared performed a high intensity strengthening exercise protocol which had the same exercises, sets, rests and duration of the protocol as the experimental groups. For those two papers which investigated the effects of BFRT combined with aerobic training, exercise was performed in two sessions per week for a period of 8 and 6 weeks, respectively. In both studies, the experimental protocol began with a warm-up phase and ended with a cool-down phase, and there were differences in cuff management. All these investigations found positive effects in the interventions that combined exercise with BFRT. The characteristics, outcome measures, effects of the interventions and the assessment of the methodological quality of the included studies and risk of bias are shown in the tables. BFRT in people with MS appears to be effective and safe for people with MS. BFRT might show positive clinical effects on strength, hypertrophy and balance outcomes. Nevertheless, future research should be conducted with better methodological quality to ensure the potential benefits of BFRT in people with MS since the studies analyzed present a high risk of bias and methodological limitations.

Spotlight on Amniotic Membrane Extract Eye Drops: A Review of the Literature.

To review the literature focusing on the effectiveness of amniotic membrane extract eye drops (AMEDs) in the treatment of ocular surface diseases. PubMed/MEDLINE, Scopus, and CENTRAL databases were searched until March 4, 2024. Overall, we identified 1,121 studies, 26 of which were selected for a full-text review. Twelve studies met the inclusion criteria and were analyzed for clinical improvements, time to resolution of corneal staining, adverse events, and preparation methods. Strength of clinical data was graded according to the Oxford Center for Evidence-Based Medicine. Overall, AMED compounds were used in 296 eyes of 205 patients. Fifty-nine percent of eyes were treated for dry eye disease, 23% for an epithelial defect, and the rest (18%) for other corneal wound healing disorders. Three main types of eye drops preparation were described, that is, lyophilized, homogenized, and fresh AMED. Although the methods of outcome reporting were heterogeneous, all included studies showed various grades of improvement in both signs and symptoms. The overall incidence of ocular side effects was 2.3%. Despite the suboptimal quality of evidence, overall, the available literature suggests that AMED is a valuable tool in the treatment of ocular surface disorders.

As-Needed Pilocarpine for Radiation-Induced Xerostomia in Head and Neck Cancers.

This study aimed to evaluate the efficacy of as-needed pilocarpine for the management of radiation-induced xerostomia. Additionally, the study sought to assess the side effects associated with an as-needed regimen. A randomized, double-blinded, placebo-controlled crossover study was conducted on patients who had undergone radiation therapy for head and neck cancers and developed xerostomia. Participants took pilocarpine or placebo as needed for symptom relief at 2 weeks per treatment, which included a one-week washout period. The primary outcome measure was the severity of dry mouth symptoms, quantified using the Xerostomia Inventory (XI). The primary outcome was the change in the XI score. Among the 20 participants who completed the crossover study, there was a significant reduction in XI scores during the treatment phase with pilocarpine compared to the scores during the placebo phase. The mean difference in XI scores was -18.05 (95% CI: -17.17, -6.13, p < 0.001), with a-49.77 ± 3.22% change (p < 0.001). Only one participant withdrew due to pilocarpine side effects. As-needed pilocarpine administration is effective in relieving symptoms of radiation-induced xerostomia, with fewer side effects and reduced treatment costs compared to fixed-dose regimens. This study guides the potential shift toward flexible dosing strategies in clinical practice, promoting enhanced patient-centered, tailored care and adherence. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines Laryngoscope, 134:4542-4548, 2024.

Interventions to Improve the Occupational Performance of Youth With Persistent Postconcussion Symptoms: A Systematic Review.

Persistent postconcussion symptoms (PPCS) may negatively affect youth's occupational performance in activities of daily living, education, play and leisure, social participation, and rest and sleep. This review provides occupational therapists with evidence related to interventions for youth with PPCS. Searches were performed in Embase, PubMed, SportDiscus, CINAHL, and Web of Science. Inclusion criteria were as follows: studies published in English from January 1, 2013, to February 7, 2023; youth ages 3 to 18 yr old; PPCS for at least 2 wk after injury; interventions within the scope of occupational therapy; and outcomes related to areas of occupation. All levels of evidence (1-5) were included and graded for quality using the Oxford Centre for Evidence-Based Medicine (2009) levels of evidence. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Twenty articles met inclusion criteria (7 randomized controlled trials, 1 nonrandomized controlled group design, 3 single-group designs, 5 case series, and 4 single-subject designs). Interventions reviewed were active rehabilitation, vision-related interventions, psychoeducation, cognitive-behavioral therapy (CBT) techniques, the Cognitive Orientation to daily Occupational Performance (CO-OP), and music therapy. Strong evidence supports CBT, with significant clinical outcomes in sleep and education. Moderate strength of evidence supports psychoeducation and active rehabilitation for improving functional outcomes. More evidence is needed to make clinical recommendations regarding vision-related interventions, the CO-OP, and music therapy. Occupational therapists should consider CBT, psychoeducation, and active rehabilitation to improve occupational performance among youth with PPCS. Plain-Language Summary: Some youth will have persistent symptoms that do not resolve within 2 weeks after a concussion. Because of these persistent symptoms, they may have difficulty completing everyday activities. This review evaluated evidence addressing the ability of youth with persistent postconcussion symptoms (PPCS) to complete everyday activities. The authors found that cognitive-behavioral therapy, psychoeducation (aimed at helping youth understand and cope with their concussion symptoms), and active rehabilitation (aerobic and coordination exercises, such as jumping jacks and ball skills) should be considered when working with youth (ages 3-18 years) with PPCS. Using these interventions in occupational therapy sessions may improve the ability of youth to complete their everyday activities after a concussion.

Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review.

Depression and anxiety disorders are common, and treatment often includes psychological interventions. Digital health interventions, delivered through technologies such as web-based programs and mobile apps, are increasingly used in mental health treatment. Acceptability, the extent to which an intervention is viewed positively, has been identified as contributing to patient adherence and engagement with digital health interventions. Acceptability, therefore, impacts the benefit derived from using digital health interventions in treatment. Understanding the acceptability of digital mental health interventions among patients with depression or anxiety disorders is essential to maximize the effectiveness of their treatment. This review investigated the acceptability of technology-based interventions among patients with depression or anxiety disorders. A systematic review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines. We searched PubMed, Web of Science, and Ovid in May 2022. Studies were included if they evaluated digital interventions for the treatment of depression or anxiety disorders and investigated their acceptability among adult patients. Studies were excluded if they targeted only specific populations (eg, those with specific physical health conditions), investigated acceptability in healthy individuals or patients under the age of 18 years, involved no direct interaction between patients and technologies, used technology only as a platform for traditional care (eg, videoconferencing), had patients using technologies only in clinical or laboratory settings, or involved virtual reality technologies. Acceptability outcome data were narratively synthesized by the direction of acceptability using vote counting. Included studies were evaluated using levels of evidence from the Oxford Centre for Evidence-Based Medicine. The risk of bias was assessed using a tool designed for this review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). A total of 143 articles met the inclusion criteria, comprising 67 (47%) articles on interventions for depression, 65 (45%) articles on interventions for anxiety disorders, and 11 (8%) articles on interventions for both. Overall, 90 (63%) were randomized controlled trials, 50 (35%) were other quantitative studies, and 3 (2%) were qualitative studies. Interventions used web-based programs, mobile apps, and computer programs. Cognitive behavioral therapy was the basis of 71% (102/143) of the interventions. Digital mental health interventions were generally acceptable among patients with depression or anxiety disorders, with 88% (126/143) indicating positive acceptability, 8% (11/143) mixed results, and 4% (6/143) insufficient information to categorize the direction of acceptability. The available research evidence was of moderate quality. Digital mental health interventions seem to be acceptable to patients with depression or anxiety disorders. Consistent use of validated measures for acceptability would enhance the quality of evidence. Careful design of acceptability as an evaluation outcome can further improve the quality of evidence and reduce the risk of bias. Open Science Framework Y7MJ4; https://doi.org/10.17605/OSF.IO/SPR8M.

Immunogenicity of Botulinum Toxin Type A in Different Clinical and Cosmetic Treatment, a Literature Review.

Botulinum toxin type A is widely utilized for both therapeutic and aesthetic purposes, yet concerns regarding its immunogenicity have raised issues related to treatment failure and adverse reactions. This review aims to evaluate the immunogenicity of commercially available botulinum toxin type A products across various clinical indications and identify the risk factors associated with antibody formation. A comprehensive search of electronic databases was conducted to find studies that investigated the immunogenicity of botulinum toxin type A in patients treated for different conditions. The studies were classified based on the Oxford Center for Evidence-Based Medicine's evidence hierarchy. The overall incidence of neutralizing antibody formation with botulinum toxin type A treatment is relatively low. However, it varies depending on the indication and is influenced by factors such as the frequency of injections and the cumulative dose. The total cumulative dose and the number of treatment cycles are critical factors in determining the risk of developing antibodies against botulinum toxin type A. This literature review highlights that the immunogenicity of botulinum toxin type A products differs across indications, with repeated injections posing a significant risk for the formation of neutralizing antibodies. The findings underscore the need for further research to better understand antibody formation mechanisms and to develop strategies that minimize their impact on treatment efficacy.

Who Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings

Low back pain is a very common condition that affects most people at some point in their lives. It represents a burden on those affected, reducing their ability to participate in activities of normal life; at the same time, dealing with it increases the economic costs of healthcare. The aim of this guideline was to contribute to WHO activities for reducing the impact of low back pain in adults and to support the WHO approach to integrated care for older people in primary care. In December 2023, the World Health Organization (WHO) published the "WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings". It was developed following the process according to the WHO handbook for guideline development. The team at the WHO Collaborating Centre for Evidence-Based Medicine at the University for Continuing Education Krems (Austria) translated the summary of this guideline for its application in German-speaking countries. The guideline addresses 37 interventions for the treatment of chronic primary low back pain in primary care and provides 24 recommendations and one good practice statement. No recommendations were made regarding twelve interventions due to equivocation or lack of sufficient evidence. The recommended interventions are intended to provide a range of options to support and personalize care for adults with chronic primary low back pain.

Pharmacokinetics and Pharmacodynamics of Systemic Corticosteroids in Autoimmune and Inflammatory Diseases: A Review of Current Evidence.

Systemic corticosteroids have a long history of use in the treatment of autoimmune and inflammatory diseases. Both efficacy and safety show large interindividual variability (IIV), suggesting that corticosteroids may have the potential for individualised dosing strategies to optimise therapy. This systematic review aims to provide an overview of current evidence on the pharmacokinetic (PK) and pharmacodynamic (PD) relationships of systemic corticosteroids in patients with autoimmune and inflammatory diseases. A systematic literature search was conducted in PubMed and Embase for PK/PD studies of systemic corticosteroids in autoimmune and inflammatory diseases in humans published until December 2023. Studies were scored from 1 to 5 according to criteria for the levels of evidence, as inspired by the Oxford Centre for Evidence-Based Medicine. Twelve studies (1981-2016) were included. The majority of these studies had a small sample size. The corticosteroids involved were prednisone, prednisolone, methylprednisolone and budesonide. Substantial IIV of corticosteroid PK was described in all studies. Evidence for a relationship between the PK of corticosteroids and efficacy was inconclusive and limited. However, there was some evidence for a relationship between the PK of prednisolone and the severity of Cushingoid features. There is insufficient evidence to draw firm conclusions on the potential associations between PK and clinical outcome of systemic corticosteroid treatment in autoimmune and inflammatory diseases. This is remarkable given the many decades that steroid drugs have been used in clinical care. Prospective research is recommended with robust and well-defined cohorts to fully quantify the PK/PD associations of corticosteroids.

Assessing the Reporting Quality of Machine Learning Algorithms in Head and Neck Oncology.

This study aimed to assess reporting quality of machine learning (ML) algorithms in the head and neck oncology literature using the TRIPOD-AI criteria. A comprehensive search was conducted using PubMed, Scopus, Embase, and Cochrane Database of Systematic Reviews, incorporating search terms related to "artificial intelligence," "machine learning," "deep learning," "neural network," and various head and neck neoplasms. Two independent reviewers analyzed each published study for adherence to the 65-point TRIPOD-AI criteria. Items were classified as "Yes," "No," or "NA" for each publication. The proportion of studies satisfying each TRIPOD-AI criterion was calculated. Additionally, the evidence level for each study was evaluated independently by two reviewers using the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Discrepancies were reconciled through discussion until consensus was reached. The study highlights the need for improvements in ML algorithm reporting in head and neck oncology. This includes more comprehensive descriptions of datasets, standardization of model performance reporting, and increased sharing of ML models, data, and code with the research community. Adoption of TRIPOD-AI is necessary for achieving standardized ML research reporting in head and neck oncology. Current reporting of ML algorithms hinders clinical application, reproducibility, and understanding of the data used for model training. To overcome these limitations and improve patient and clinician trust, ML developers should provide open access to models, code, and source data, fostering iterative progress through community critique, thus enhancing model accuracy and mitigating biases. NA Laryngoscope, 2024.

Blood Flow Restriction Training Improves Muscular Outcomes in Patients With Chronic Ankle Instability: A Critically Appraised Topic

Clinical Scenario: The high recurrence of lateral ankle sprains progresses to chronic ankle instability (CAI) and can affect many athletes in all sports. CAI is often associated with a decrease in muscle strength, an increase in pain, a decrease in the range of motion, and a decrease in balance or neuromuscular control. The use of blood flow restriction (BFR) with CAI can increase muscular outcomes and be used as a rehabilitation tool. Clinical Question: Is there evidence to suggest that BFR improves strength, muscle activation, and/or cross-sectional area of the lower leg musculature in those with CAI? Clinical Bottom Line: There is moderate evidence to support therapeutic exercise with low-intensity BFR in patients with CAI. The evidence concluded a significant improvement in BFR to increase muscle activation of the fibularis longus, anterior tibialis, vastus lateralis, and soleus. There is moderate evidence suggesting BFR can induce strength gains in the muscles of the lower extremity in patients with CAI. Strength of Recommendation: The comprehensive evidence is a Strength of Recommendation Taxonomy (SORT) Grade B, with a level of evidence of 2, according to the Centre for Evidence-Based Medicine (CEBM) for the studies included.

Expert consensus on the clinical application of aromatase inhibitors to improve adolescent height

Aromatase inhibitors have been widely used to improve height in the world and China. However, due to their off-label use and relatively short application time, there is a lack of consistent understanding and expert consensus on the indications, efficacy, and side effects of the drugs at home and abroad. Therefore, the Growth and Development and Gonadal Diseases Committee of Chinese Aging Well Association and the Adolescent Medicine and Health Professional Committee of the Chinese Medical Doctor Association organized 28 domestic experts in growth and development, based on the clinical evidence level classification and recommendation level of the Oxford University Evidence-Based Medicine Center to establish some preliminary recommendations on the efficacy, adverse reactions, precautions, dosage, and course of use of aromatase inhibitors in treating children with short stature and improving their year-end height. Combined with the Delphi method evaluation, 14 recommendations were finally formulated to standardized the clinical application of aromatase inhibitors in improving adolescent height.

Aortic root enlargement versus stentless valve implantation for avoidance of patient-prosthesis mismatch in patients with small aortic root: protocol for a systematic review

IntroductionAvoiding patient-prosthesis mismatch (PPM) in patients with small aortic annulus (SAA) during aortic valve replacement (AVR) is still a challenging surgical problem. Among surgical options available, aortic root enlargement (ARE)...

Perioperative infection prevention during inflatable penile prosthesis surgery: a narrative review.

Penile prostheses are an option for the management of erectile dysfunction (ED). Over the years penile prosthesis surgery has become increasingly safe owing to improvements such as antibiotic usage, coated devices, and surgical techniques. However, infection remains a dreaded complication during prosthesis surgery. Efforts to minimize risk of infection in the perioperative period have been extensively studied. Herein, we performed a narrative review on preoperative, intraoperative, and postoperative strategies for infection prevention during placement of a penile prosthesis with a comparison of infection prevention strategies to other surgical fields. A literature review was performed using PubMed and Google Scholar. Studies evaluating perioperative management of penile prosthesis infection were included. The following search terms were used to for our literature search: penile prosthesis, inflatable penile prosthesis, infection, prevention, perioperative management. Articles were graded based on the 2011 Oxford Centre for Evidence Based Medicine (OCEBM) guidelines and a table was generated with each intervention discussed and its level of evidence based on current literature. Optimization of patient's comorbid conditions can help reduce risk during prosthesis operations. Monitoring and optimizing a patient's glycemic control has been investigated, but the current literature does not necessarily support a strict hemoglobin A1c (HbA1c) or pre-operative blood glucose level. Surgical field preparation using chlorhexidine-based solutions has been shown to be superior to iodine-based solutions. Appropriately selected peri-operative antibiotics have also been shown to reduce infection risk. Intraoperatively, the use of coated devices in addition to a 'no touch' technique have been shown to significantly reduce the risk of inflatable penile prosthesis (IPP) infection. Post operatively, available evidence of antibiotic use has not been demonstrated to be effective in reducing infection rates. Surgical infection following placement of an IPP is a devastating and morbid complication with infection rate up as high as 1-3% in virgin cases and 7-18% in revision cases. While perioperative techniques exist and have reduced risk of infection, more prospective data is needed to evaluate the clinical significance of these different approaches. More research in these areas, along with future options such as nanoparticles, antibiotic coated suture, and next generation sequencing (NGS) for bacterial pathogens, may shed light on further ways to optimize infection reduction strategies for prosthesis surgery.

The Effect of Token Economy on Managing Aggression in Adults and Adolescents with Mental Disorders: A Recent Review

Context: Individuals with mental illness may exhibit aggression due to psychological instability. The Token Economy is a behavioral approach that aims to achieve desired changes by using tokens as reinforcements. Objectives: This study investigates the effectiveness of token reinforcement in reducing aggressive behavior in mentally ill patients and identifies the factors that enhance the effectiveness of the Token Economy program. Evidence Acquisition: A search for studies was conducted in the databases of PubMed, Google Scholar, ProQuest, Scopus, and Web of Science using several keywords, including "Contingency Management," "Token Reinforcement," "Token Economy," "behavioral disorder," "mental disorder," "aggression," "violence," "disruptive behavior," and "challenging behavior." The search focused on articles published from 2003 to 2023 that included the implementation of token reinforcement in various settings for managing aggression. Results: A total of 12 studies met the inclusion criteria. After reviewing these studies, several factors were identified as responsible for the program's effectiveness. The Quality Assessment Tool for Quantitative Studies and the Oxford Centre for Evidence-Based Medicine (2011) were used to evaluate the studies. Of the 12 studies, two were rated as strong quality, one as moderate, and nine as weak quality. Additionally, three studies were classified as level 2, one as level 3, and eight as level 4, indicating significant methodological limitations. Conclusions: Generally, 9 studies supported the effectiveness of the Token Economy in managing aggression in adults and adolescents with mental illness. This approach can be useful in the modern rehabilitation and education of individuals with aggressive behavior. We recommend further studies with higher methodological quality to examine the generalizability and transferability of the results.

A critical appraisal of the WHO 2024 systematic review of the effects of RF-EMF exposure on tinnitus, migraine/headache, and non-specific symptoms

Abstract The World Health Organization (WHO) in 2012 initiated an expert consultation about research on the health effects of radio-frequency electromagnetic fields (RF-EMF) for a WHO monograph that was last updated in 1993. The project was abandoned over concerns about the quality of the commissioned review papers. The WHO restarted the project in 2019 by commissioning 10 systematic reviews (SRs) of the research on RF-EMF exposure and adverse biological and health outcomes in laboratory animals, cell cultures, and human populations. The second of these SRs, published in 2024, addresses human observational studies of RF-EMF exposure and non-specific symptoms, including tinnitus, migraine/headache, and sleep disturbance. The present commentary is a critical appraisal of the scientific quality of this SR (SR7) employing criteria developed by the Oxford Centre for Evidence-Based Medicine. Based upon our review, we call for a retraction of SR7 and an impartial investigation by unconflicted experts of the currently available evidence and future research priorities.

Does dry needling aid in post-training recovery? A critically appraised topic

Clinical scenarioFollowing intense physical training, it is common for athletes to develop muscle soreness, muscle tightness and a sense of fatigue. Minimizing the time spent in this state is advantageous to limit time off from sport, potential injury and lack of mental focus. Clinical questionDoes dry needling aid in post-training recovery in athletes? Summary of key findingsA search was performed for articles exploring the effect of dry needling on exercise/training recovery in athletes. Six articles were included in this critically appraised topic. Three articles were randomized controlled trials, one was a cross-over design, one was a case series, and one was a survey. Five of the six studies demonstrated that dry needling had some sort of positive effect on post-training recovery. One article found DN did not improve muscle soreness after a long distance race. Clinical bottom lineBased on six studies, DN provides mixed results on a variety of physiological and subjective measures. No adverse effects were reported with the use of DN on athletes following post-training. Strength of recommendationIn agreement with the Center of Evidence-Based Medicine, the consistent results from three Level II and two Level III intervention studies designate that there is grade D evidence that DN may aid in some post-training recovery variables.

Pain Mechanosensitivity in Individuals With and Without a History of Lateral Ankle Sprain: A Critically Appraised Topic

Clinical Scenario: Pain is a common symptom experienced by individuals who sustain an acute lateral ankle sprain and can continue to persist among those who develop chronic ankle instability. Most rehabilitation protocols for individuals with acute ankle sprains or chronic ankle instability focus on restoring physical impairments and have largely omitted any pain-relieving therapies. This impairment-based focus has led pain to be an understudied symptom among individuals with an ankle sprain history. Overlooking the role of pain has also left clinicians with little insight into whether pain experienced after an ankle sprain is local (i.e., peripheral sensitization) or widespread (i.e., central sensitization). Understanding the pain profiles for those with an ankle sprain history may represent an unexploited area for clinicians and future research to improve health outcomes for this patient population. Clinical Question: Is there evidence to suggest that pain mechanosensitivity levels are different between those with and without a history of lateral ankle sprain? Summary of Key Findings: The literature was systematically searched for Level 4 evidence or higher. The search yielded two cross-sectional case-control studies and one cross-sectional study that met the inclusion and exclusion criteria. Based on the available evidence, pain mechanosensitivity levels are lower across ligamentous stabilizers immediately after an acute ankle sprain and over lower extremity neuromuscular structures among individuals with chronic ankle instability. Clinical Bottom Line: There is weak evidence to support an ankle sprain history can affect local pain mechanosensitivity levels of structures surrounding the ankle but not at distant locations. Strength of Recommendation: Level 4 evidence is available according to the Center for Evidence-Based Medicine.

Outcome Of Benign Breast Tumor Excision Using Ultrasound-Guided Vacuum Assisted Breast Biopsy: A Literature Review

Introduction. Benign breast tumors have a significant incidence among breast diseases that cause anxiety for patients. Surgical management is one of the managements. Vacuum-assisted breast biopsy (VABB) could be applied to tumors with a size of less than 3 cm or multiple lesions. One of its techniques is guided by ultrasonography (USG). In Indonesia, the ultrasound-guided (USG-guided) VABB has already been applied in several healthcare instances. Nevertheless, there are still opinions about tumor recurrence after the procedure. This study’s purpose is to observe the tumor recurrence and patients' satisfaction with benign breast tumor excision with USG-guided VABB. Method. Literature was reviewed through the Cochrane Database of Systematic Reviews, PubMed, Scopus, and ProQuest from December 2021 to March 2022. All papers identified were screened and identified. The study's level of evidence and quality were assessed using the Centre for Evidence-Based Medicine, University of Oxford criteria 2011. Results. In total, 1677 studies were found, and after evaluation, 29 studies were relevant—the recurrence rates of benign breast tumors after USG-guided VABB were varied. The lowest being 0% and the highest being 32.6%. Higher recurrence occurs in larger lesion sizes. Moreover, several factors that could be related were lesion size, multiple size, and hematoma in the procedure. Patients' satisfaction was high, including the postoperative scar that is not visible or minimal (5-6 mm). Conclusion. Benign breast tumor management with USG-guided VABB is a good alternative, with a recurrence rate similar to open excision and high patient satisfaction.

Urinary Tract Obstruction Secondary to Fungal Balls: A Systematic Review

Objectives: To understand the clinical characteristics, risk factors, diagnosis, treatment, and outcomes of urinary tract obstruction caused by fungal balls. Materials and Methods: A comprehensive search was conducted across PubMed, Embase, and Medline following the PRISMA guidelines, including case reports and case series. Study quality and risk of bias were assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) document. The systematic review process was aimed at gathering and synthesising all available research evidence on the topic. Results: We included 54 articles reporting on 57 patients, primarily males (61.4%) with a median age of 56 years. The most common presenting symptoms were flank pain (71.9%) and fevers (59.6%). All diagnoses were made on the presence of yeast in urine or intra-operative tissue cultures and the presence of obstruction on imaging. The most common pathogen isolated were those of the Candida species (61.5%) followed by Aspergillus (33.3%). Multimodal management was the mainstay approach with the use of systemic and local antifungal therapy in combination with surgical drainage of the obstruction. The mortality rate was around 12.3%. Conclusions: Management of renal or ureteral obstruction caused by fungal balls requires a multimodal and multidisciplinary approach, comprising systemic antifungal therapy, drainage procedures, and in some instances, surgical intervention. The growing prevalence of antifungal resistance and the high mortality potential of fungal uropathy necessitates ongoing research into the optimal diagnostic and treatment modalities for this condition.

Lipids and Statin Medication With Sensorineural Hearing Loss: A Mendelian Randomization Study.

Recent insights suggest that lipids and statin medication play a role in the development of sensorineural hearing loss (SNHL), yet the exact role remains controversial. This research applied Mendelian randomization (MR) to assess whether lipids and statin medication are associated with an increased risk of SNHL. A two-sample MR was used in this study. Genetic instruments were constructed from variants associated with risk factors. Data for lipids and statin medication were obtained from the IEU OpenGWAS project, and for SNHL from the Finngen research project, which comprises 32,487 individuals with SNHL and 331,736 control individuals. Genetically predicted higher levels of triglycerides were associated with an increased risk of SNHL. The use of genetically predicted atorvastatin was associated with a lower risk of SNHL. Rosuvastatin has demonstrated potential in treating SNHL, yet further investigations are warranted to elucidate its relationship with SNHL. Insufficient evidence was available to suggest that the genetically predicted level of high-density lipoprotein cholesterol or low-density lipoprotein cholesterol or the use of simvastatin were associated with SNHL. The study provides genetic evidence suggesting that increased levels of triglycerides in the blood could be a risk factor for SNHL and that the use of certain statin medications, including atorvastatin and rosuvastatin, could reduce the risk of SNHL. These results align with findings from previous observational studies that have linked hyperlipidemia with the risk of SNHL. According to the Oxford Centre for Evidence-Based Medicine 2011 levels of Evidence, the study has a third level of Evidence Laryngoscope, 134:4366-4373, 2024.