Antidepressants for people with epilepsy and depression
CONCLUSIONS: Existing evidence on the effectiveness of antidepressants in treating depressive symptoms associated with epilepsy is still very limited. Rates of response to antidepressants were highly variable. There is low certainty evidence from one small RCT (64 participants) that venlafaxine may improve depressive symptoms more than no treatment; this evidence is limited to treatment between 8 and 16 weeks, and does not inform longer-term effects. Moderate to low evidence suggests neither an increase nor exacerbation of seizures with SSRIs. There are no available comparative data to inform the choice of antidepressant d...
Source: Cochrane Database of Systematic Reviews - April 16, 2021 Category: General Medicine Authors: Melissa J Maguire Anthony G Marson Sarah J Nevitt Source Type: research

Abdominal ultrasound and alpha-foetoprotein for the diagnosis of hepatocellular carcinoma  in adults with chronic liver disease
CONCLUSIONS: In the clinical pathway for the diagnosis of HCC in adults, AFP and US, singularly or in combination, have the role of triage-tests. We found that using AFP, with 20 ng/mL as a cut-off, about 40% of HCC occurrences would be missed, and with US alone, more than a quarter. The combination of the two tests showed the highest sensitivity and less than 5% of HCC occurrences would be missed with about 15% of false-positive results. The uncertainty resulting from the poor study quality and the heterogeneity of included studies limit our ability to confidently draw conclusions based on our results.PMID:33855699 | DOI:...
Source: Cochrane Database of Systematic Reviews - April 15, 2021 Category: General Medicine Authors: Agostino Colli Tin Nadarevic Damir Miletic Vanja Giljaca Mirella Fraquelli Davor Štimac Giovanni Casazza Source Type: research

Thrombolytic therapy for pulmonary embolism
CONCLUSIONS: Low-certainty evidence suggests that thrombolytics may reduce death following acute pulmonary embolism compared with heparin (the effectiveness was mainly driven by one trial with massive PE). Thrombolytic therapy may be helpful in reducing the recurrence of pulmonary emboli but may cause more major and minor haemorrhagic events, including haemorrhagic stroke. More studies of high methodological quality are needed to assess safety and cost effectiveness of thrombolytic therapy for people with pulmonary embolism.PMID:33857326 | DOI:10.1002/14651858.CD004437.pub6 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 15, 2021 Category: General Medicine Authors: Zhiliang Zuo Jirong Yue Bi Rong Dong Taixiang Wu Guan J Liu Qiukui Hao Source Type: research

Dopamine agonists for preventing ovarian hyperstimulation syndrome
CONCLUSIONS: Dopamine agonists probably reduce the incidence of moderate or severe OHSS compared to placebo/no intervention, while we are uncertain of the effect on adverse events and pregnancy outcomes (live birth, clinical pregnancy, miscarriage). Dopamine agonists plus co-intervention may decrease moderate or severe OHSS rates compared to co-intervention only, but we are uncertain whether dopamine agonists affect pregnancy outcomes. When compared to other active interventions, we are uncertain of the effects of dopamine agonists on moderate or severe OHSS and pregnancy outcomes.PMID:33851429 | DOI:10.1002/14651858.CD008...
Source: Cochrane Database of Systematic Reviews - April 14, 2021 Category: General Medicine Authors: Huilin Tang Selma M Mourad Aihua Wang Suo-Di Zhai Roger J Hart Source Type: research

Regular treatment with formoterol and an inhaled corticosteroid versus regular treatment with salmeterol and an inhaled corticosteroid for chronic asthma: serious adverse events
CONCLUSIONS: Overall, for both adults and children, evidence is insufficient to show whether regular formoterol in combination with budesonide, beclomethasone, fluticasone, or mometasone has a different safety profile from salmeterol in combination with fluticasone or budesonide. Five deaths of any cause were reported across all studies and no deaths from asthma; this information is insufficient to permit any firm conclusions about the relative risks of mortality on combination formoterol in comparison to combination salmeterol inhalers. Evidence on all-cause non-fatal serious adverse events indicates that there is probabl...
Source: Cochrane Database of Systematic Reviews - April 14, 2021 Category: General Medicine Authors: Orlagh O'Shea Elizabeth Stovold Christopher J Cates Source Type: research

Botulinum toxin type A versus anticholinergics for cervical dystonia
CONCLUSIONS: We found very low-certainty evidence that BtA is more effective, better tolerated, and safer than trihexyphenidyl. We found no information on a dose-response relationship with BtA, differences between BtA formulations or different anticholinergics, the utility of electromyography-guided injections, or the duration of treatment effect.PMID:33852744 | DOI:10.1002/14651858.CD004312.pub3 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 14, 2021 Category: General Medicine Authors: Filipe B Rodrigues Gon çalo S Duarte Mafalda Castel ão Raquel E Marques Joaquim Ferreira Cristina Sampaio Austen P Moore Jo ão Costa Source Type: research

Dopamine agonists for preventing ovarian hyperstimulation syndrome
CONCLUSIONS: Dopamine agonists probably reduce the incidence of moderate or severe OHSS compared to placebo/no intervention, while we are uncertain of the effect on adverse events and pregnancy outcomes (live birth, clinical pregnancy, miscarriage). Dopamine agonists plus co-intervention may decrease moderate or severe OHSS rates compared to co-intervention only, but we are uncertain whether dopamine agonists affect pregnancy outcomes. When compared to other active interventions, we are uncertain of the effects of dopamine agonists on moderate or severe OHSS and pregnancy outcomes.PMID:33851429 | DOI:10.1002/14651858.CD008...
Source: Cochrane Database of Systematic Reviews - April 14, 2021 Category: General Medicine Authors: Huilin Tang Selma M Mourad Aihua Wang Suo-Di Zhai Roger J Hart Source Type: research

Regular treatment with formoterol and an inhaled corticosteroid versus regular treatment with salmeterol and an inhaled corticosteroid for chronic asthma: serious adverse events
CONCLUSIONS: Overall, for both adults and children, evidence is insufficient to show whether regular formoterol in combination with budesonide, beclomethasone, fluticasone, or mometasone has a different safety profile from salmeterol in combination with fluticasone or budesonide. Five deaths of any cause were reported across all studies and no deaths from asthma; this information is insufficient to permit any firm conclusions about the relative risks of mortality on combination formoterol in comparison to combination salmeterol inhalers. Evidence on all-cause non-fatal serious adverse events indicates that there is probabl...
Source: Cochrane Database of Systematic Reviews - April 14, 2021 Category: General Medicine Authors: Orlagh O'Shea Elizabeth Stovold Christopher J Cates Source Type: research

Botulinum toxin type A versus anticholinergics for cervical dystonia
CONCLUSIONS: We found very low-certainty evidence that BtA is more effective, better tolerated, and safer than trihexyphenidyl. We found no information on a dose-response relationship with BtA, differences between BtA formulations or different anticholinergics, the utility of electromyography-guided injections, or the duration of treatment effect.PMID:33852744 | DOI:10.1002/14651858.CD004312.pub3 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 14, 2021 Category: General Medicine Authors: Filipe B Rodrigues Gon çalo S Duarte Mafalda Castel ão Raquel E Marques Joaquim Ferreira Cristina Sampaio Austen P Moore Jo ão Costa Source Type: research

Non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger
CONCLUSIONS: For adults with trigger finger, by 24 weeks' follow-up, results from two trials show that compared to glucocorticoid injection, NSAID injection offered little to no benefit in the treatment of trigger finger. Specifically, there was no difference in resolution, symptoms, recurrence, total active motion, residual pain, participant-reported treatment success, or adverse events.PMID:33849080 | DOI:10.1002/14651858.CD012789.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 13, 2021 Category: General Medicine Authors: Mabel Qi He Leow Qishi Zheng Luming Shi Shian Chao Tay Edwin Sy Chan Source Type: research

Monitoring of stimulated cycles in assisted reproduction (IVF and ICSI)
CONCLUSIONS: This review update found no new randomised trials. Evidence from the six studies previously identified did not suggest that combined monitoring by TVUS and serum estradiol is more efficacious than monitoring by TVUS alone with regard to clinical pregnancy rates and the incidence of OHSS. The number of oocytes retrieved appeared similar for both monitoring protocols. The data suggest that both these monitoring methods are safe and reliable. However, these results should be interpreted with caution because the overall quality of the evidence was low. Results were compromised by imprecision and poor reporting of ...
Source: Cochrane Database of Systematic Reviews - April 12, 2021 Category: General Medicine Authors: Irene Kwan Siladitya Bhattacharya Andrea Woolner Source Type: research

Monitoring of stimulated cycles in assisted reproduction (IVF and ICSI)
CONCLUSIONS: This review update found no new randomised trials. Evidence from the six studies previously identified did not suggest that combined monitoring by TVUS and serum estradiol is more efficacious than monitoring by TVUS alone with regard to clinical pregnancy rates and the incidence of OHSS. The number of oocytes retrieved appeared similar for both monitoring protocols. The data suggest that both these monitoring methods are safe and reliable. However, these results should be interpreted with caution because the overall quality of the evidence was low. Results were compromised by imprecision and poor reporting of ...
Source: Cochrane Database of Systematic Reviews - April 12, 2021 Category: General Medicine Authors: Irene Kwan Siladitya Bhattacharya Andrea Woolner Source Type: research

Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis
CONCLUSIONS: Based on moderate-certainty evidence, somatostatin analogues alone and vasopressin analogues alone (with supportive therapy) probably result in increased mortality, compared to endoscopic sclerotherapy. Based on moderate-certainty evidence, vasopressin analogues alone and band ligation alone probably result in fewer adverse events compared to endoscopic sclerotherapy. Based on low-certainty evidence, balloon tamponade plus sclerotherapy may result in large increases in serious adverse events compared to sclerotherapy. Based on low-certainty evidence, sclerotherapy plus somatostatin analogues may result in larg...
Source: Cochrane Database of Systematic Reviews - April 10, 2021 Category: General Medicine Authors: Danielle Roberts Lawrence Mj Best Suzanne C Freeman Alex J Sutton Nicola J Cooper Sivapatham Arunan Tanjia Begum Norman R Williams Dana Walshaw Elisabeth Jane Milne Maxine Tapp Mario Csenar Chavdar S Pavlov Brian R Davidson Emmanuel Tsochatzis Kurinchi Se Source Type: research

Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis
CONCLUSIONS: Based on moderate-certainty evidence, somatostatin analogues alone and vasopressin analogues alone (with supportive therapy) probably result in increased mortality, compared to endoscopic sclerotherapy. Based on moderate-certainty evidence, vasopressin analogues alone and band ligation alone probably result in fewer adverse events compared to endoscopic sclerotherapy. Based on low-certainty evidence, balloon tamponade plus sclerotherapy may result in large increases in serious adverse events compared to sclerotherapy. Based on low-certainty evidence, sclerotherapy plus somatostatin analogues may result in larg...
Source: Cochrane Database of Systematic Reviews - April 10, 2021 Category: General Medicine Authors: Danielle Roberts Lawrence Mj Best Suzanne C Freeman Alex J Sutton Nicola J Cooper Sivapatham Arunan Tanjia Begum Norman R Williams Dana Walshaw Elisabeth Jane Milne Maxine Tapp Mario Csenar Chavdar S Pavlov Brian R Davidson Emmanuel Tsochatzis Kurinchi Se Source Type: research

Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis
CONCLUSIONS: Based on moderate-certainty evidence, somatostatin analogues alone and vasopressin analogues alone (with supportive therapy) probably result in increased mortality, compared to endoscopic sclerotherapy. Based on moderate-certainty evidence, vasopressin analogues alone and band ligation alone probably result in fewer adverse events compared to endoscopic sclerotherapy. Based on low-certainty evidence, balloon tamponade plus sclerotherapy may result in large increases in serious adverse events compared to sclerotherapy. Based on low-certainty evidence, sclerotherapy plus somatostatin analogues may result in larg...
Source: Cochrane Database of Systematic Reviews - April 10, 2021 Category: General Medicine Authors: Danielle Roberts Lawrence Mj Best Suzanne C Freeman Alex J Sutton Nicola J Cooper Sivapatham Arunan Tanjia Begum Norman R Williams Dana Walshaw Elisabeth Jane Milne Maxine Tapp Mario Csenar Chavdar S Pavlov Brian R Davidson Emmanuel Tsochatzis Kurinchi Se Source Type: research

Bed sharing versus no bed sharing for healthy term neonates
CONCLUSIONS: We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).PMID:33831222 | DOI:10....
Source: Cochrane Database of Systematic Reviews - April 8, 2021 Category: General Medicine Authors: Rashmi R Das Mari Jeeva Sankar Ramesh Agarwal Source Type: research

Bed sharing versus no bed sharing for healthy term neonates
CONCLUSIONS: We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).PMID:33831222 | DOI:10....
Source: Cochrane Database of Systematic Reviews - April 8, 2021 Category: General Medicine Authors: Rashmi R Das Mari Jeeva Sankar Ramesh Agarwal Source Type: research

Anti-seizure medications for Lennox-Gastaut syndrome
CONCLUSIONS: RCTs of monotherapy and head-to-head comparison of add-on ASMs are currently lacking. However, we found high-certainty evidence for overall seizure reduction with add-on lamotrigine and rufinamide, with low-certainty evidence for AE leading to study discontinuation compared with add-on placebo or another add-on ASM. The evidence for other add-on ASMs for overall seizure cessation or reduction was low to very low with high- to low-certainty evidence for AE leading to study discontinuation. Future research should consider outcome reporting of overall seizure reduction (applying automated seizure detection device...
Source: Cochrane Database of Systematic Reviews - April 7, 2021 Category: General Medicine Authors: Francesco Brigo Katherine Jones Christin Eltze Sara Matricardi Source Type: research

Anti-seizure medications for Lennox-Gastaut syndrome
CONCLUSIONS: RCTs of monotherapy and head-to-head comparison of add-on ASMs are currently lacking. However, we found high-certainty evidence for overall seizure reduction with add-on lamotrigine and rufinamide, with low-certainty evidence for AE leading to study discontinuation compared with add-on placebo or another add-on ASM. The evidence for other add-on ASMs for overall seizure cessation or reduction was low to very low with high- to low-certainty evidence for AE leading to study discontinuation. Future research should consider outcome reporting of overall seizure reduction (applying automated seizure detection device...
Source: Cochrane Database of Systematic Reviews - April 7, 2021 Category: General Medicine Authors: Francesco Brigo Katherine Jones Christin Eltze Sara Matricardi Source Type: research

Primary prevention of variceal bleeding in people with oesophageal varices due to liver cirrhosis: a network meta-analysis
CONCLUSIONS: Based on low-certainty evidence, beta-blockers, variceal band ligation, sclerotherapy, and beta-blockers plus nitrates may decrease mortality compared to no intervention in people with high-risk oesophageal varices in people with cirrhosis and no previous history of bleeding. Based on low-certainty evidence, variceal band ligation may result in a higher number of serious adverse events than beta-blockers. The evidence indicates considerable uncertainty about the effect of beta-blockers versus variceal band ligation on variceal bleeding. The evidence also indicates considerable uncertainty about the effect of t...
Source: Cochrane Database of Systematic Reviews - April 6, 2021 Category: General Medicine Authors: Davide Roccarina Lawrence Mj Best Suzanne C Freeman Danielle Roberts Nicola J Cooper Alex J Sutton Amine Benmassaoud Maria Corina Plaz Torres Laura Iogna Prat Mario Csenar Sivapatham Arunan Tanjia Begum Elisabeth Jane Milne Maxine Tapp Chavdar S Pavlov Br Source Type: research

Exercise training for bronchiectasis
CONCLUSIONS: This review provides low-certainty evidence suggesting improvement in functional exercise capacity and quality of life immediately following exercise training in people with stable bronchiectasis; however the effects of exercise training on cough-related quality of life and psychological symptoms appear to be minimal. Due to inadequate reporting of methods, small study numbers, and variation between study findings, evidence is of very low to moderate certainty. Limited evidence is available to show longer-term effects of exercise training on these outcomes.PMID:33822364 | DOI:10.1002/14651858.CD013110.pub2 (So...
Source: Cochrane Database of Systematic Reviews - April 6, 2021 Category: General Medicine Authors: Annemarie L Lee Carla S Gordon Christian R Osadnik Source Type: research

Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions
CONCLUSIONS: We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and...
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Ameer Hohlfeld Sumayyah Ebrahim Muhammed Zaki Shaik Tamara Kredo Source Type: research

Disease-modifying treatments for primary autoimmune haemolytic anaemia
CONCLUSIONS: Available literature on the effectiveness of immunomodulatory therapy for primary AIHA is restricted to comparison between rituximab plus glucocorticoid and glucocorticoid alone, in patients with newly diagnosed warm AIHA, calling for need for additional studies. The current result suggests that combinatory therapy with rituximab and glucocorticoid may increase the rate of complete haematological response over glucocorticoid monotherapy.PMID:33786812 | DOI:10.1002/14651858.CD012493.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Anthony Pak-Yin Liu Daniel Kl Cheuk Source Type: research

Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions
CONCLUSIONS: We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and...
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Ameer Hohlfeld Sumayyah Ebrahim Muhammed Zaki Shaik Tamara Kredo Source Type: research

Disease-modifying treatments for primary autoimmune haemolytic anaemia
CONCLUSIONS: Available literature on the effectiveness of immunomodulatory therapy for primary AIHA is restricted to comparison between rituximab plus glucocorticoid and glucocorticoid alone, in patients with newly diagnosed warm AIHA, calling for need for additional studies. The current result suggests that combinatory therapy with rituximab and glucocorticoid may increase the rate of complete haematological response over glucocorticoid monotherapy.PMID:33786812 | DOI:10.1002/14651858.CD012493.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Anthony Pak-Yin Liu Daniel Kl Cheuk Source Type: research

Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions
CONCLUSIONS: We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and...
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Ameer Hohlfeld Sumayyah Ebrahim Muhammed Zaki Shaik Tamara Kredo Source Type: research

Disease-modifying treatments for primary autoimmune haemolytic anaemia
CONCLUSIONS: Available literature on the effectiveness of immunomodulatory therapy for primary AIHA is restricted to comparison between rituximab plus glucocorticoid and glucocorticoid alone, in patients with newly diagnosed warm AIHA, calling for need for additional studies. The current result suggests that combinatory therapy with rituximab and glucocorticoid may increase the rate of complete haematological response over glucocorticoid monotherapy.PMID:33786812 | DOI:10.1002/14651858.CD012493.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Anthony Pak-Yin Liu Daniel Kl Cheuk Source Type: research

Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions
CONCLUSIONS: We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and...
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Ameer Hohlfeld Sumayyah Ebrahim Muhammed Zaki Shaik Tamara Kredo Source Type: research

Disease-modifying treatments for primary autoimmune haemolytic anaemia
CONCLUSIONS: Available literature on the effectiveness of immunomodulatory therapy for primary AIHA is restricted to comparison between rituximab plus glucocorticoid and glucocorticoid alone, in patients with newly diagnosed warm AIHA, calling for need for additional studies. The current result suggests that combinatory therapy with rituximab and glucocorticoid may increase the rate of complete haematological response over glucocorticoid monotherapy.PMID:33786812 | DOI:10.1002/14651858.CD012493.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Anthony Pak-Yin Liu Daniel Kl Cheuk Source Type: research

Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions
CONCLUSIONS: We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and...
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Ameer Hohlfeld Sumayyah Ebrahim Muhammed Zaki Shaik Tamara Kredo Source Type: research

Disease-modifying treatments for primary autoimmune haemolytic anaemia
CONCLUSIONS: Available literature on the effectiveness of immunomodulatory therapy for primary AIHA is restricted to comparison between rituximab plus glucocorticoid and glucocorticoid alone, in patients with newly diagnosed warm AIHA, calling for need for additional studies. The current result suggests that combinatory therapy with rituximab and glucocorticoid may increase the rate of complete haematological response over glucocorticoid monotherapy.PMID:33786812 | DOI:10.1002/14651858.CD012493.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Anthony Pak-Yin Liu Daniel Kl Cheuk Source Type: research

Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions
CONCLUSIONS: We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and...
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Ameer Hohlfeld Sumayyah Ebrahim Muhammed Zaki Shaik Tamara Kredo Source Type: research

Disease-modifying treatments for primary autoimmune haemolytic anaemia
CONCLUSIONS: Available literature on the effectiveness of immunomodulatory therapy for primary AIHA is restricted to comparison between rituximab plus glucocorticoid and glucocorticoid alone, in patients with newly diagnosed warm AIHA, calling for need for additional studies. The current result suggests that combinatory therapy with rituximab and glucocorticoid may increase the rate of complete haematological response over glucocorticoid monotherapy.PMID:33786812 | DOI:10.1002/14651858.CD012493.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 31, 2021 Category: General Medicine Authors: Anthony Pak-Yin Liu Daniel Kl Cheuk Source Type: research

Interventions for weight loss in people with chronic kidney disease who are overweight or obese
CONCLUSIONS: All types of weight loss interventions had uncertain effects on death and cardiovascular events among overweight and obese adults with CKD as no studies reported these outcome measures. Non-surgical weight loss interventions (predominately lifestyle) appear to be an effective treatment to reduce body weight, and LDL cholesterol. Surgical interventions probably reduce body weight, waist circumference, and fat mass. The current evidence is limited by the small number of included studies, as well as the significant heterogeneity and a high risk of bias in most studies.PMID:33782940 | DOI:10.1002/14651858.CD013119...
Source: Cochrane Database of Systematic Reviews - March 30, 2021 Category: General Medicine Authors: Marguerite M Conley Catherine M McFarlane David W Johnson Jaimon T Kelly Katrina L Campbell Helen L MacLaughlin Source Type: research

Interventions for atypical haemolytic uraemic syndrome
Cochrane Database Syst Rev. 2021 Mar 23;3:CD012862. doi: 10.1002/14651858.CD012862.pub2.ABSTRACTBACKGROUND: Atypical haemolytic uraemic syndrome (aHUS) is a rare disorder characterised by thrombocytopenia, microangiopathic haemolytic anaemia, and acute kidney injury. The condition is primarily caused by inherited or acquired dysregulation of complement regulatory proteins with ~40% of those affected aged
Source: Cochrane Database of Systematic Reviews - March 30, 2021 Category: General Medicine Authors: Dan Pugh Eoin D O'Sullivan Fiona Ai Duthie Philip Masson David Kavanagh Source Type: research

High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome
CONCLUSIONS: Moderate-certainty evidence shows that high levels compared to low levels of PEEP do not reduce mortality before hospital discharge. Low-certainty evidence suggests that high levels of PEEP result in little to no difference in the risk of barotrauma. Low-certainty evidence also suggests that high levels of PEEP improve oxygenation up to the first and third days of mechanical ventilation, and moderate-certainty evidence indicates that high levels of PEEP improve oxygenation up to the seventh day of mechanical ventilation. As in our previous review, we found clinical heterogeneity - mainly within participant cha...
Source: Cochrane Database of Systematic Reviews - March 30, 2021 Category: General Medicine Authors: Roberto Santa Cruz Fernando Villarejo Celica Irrazabal Agust ín Ciapponi Source Type: research

Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis
CONCLUSIONS: The evidence indicates considerable uncertainty about the effect of the interventions on mortality. Variceal band ligation might result in fewer serious adverse events than sclerotherapy. TIPS might result in a large decrease in symptomatic rebleed than variceal band ligation. Sclerotherapy probably results in fewer 'any' variceal rebleeding than no active intervention. Beta-blockers plus sclerotherapy and TIPS probably result in fewer 'any' variceal rebleeding than sclerotherapy. Beta-blockers alone and TIPS might result in more other compensation events than sclerotherapy. The evidence indicates considerable...
Source: Cochrane Database of Systematic Reviews - March 30, 2021 Category: General Medicine Authors: Maria Corina Plaz Torres Lawrence Mj Best Suzanne C Freeman Danielle Roberts Nicola J Cooper Alex J Sutton Davide Roccarina Amine Benmassaoud Laura Iogna Prat Norman R Williams Mario Csenar Dominic Fritche Tanjia Begum Sivapatham Arunan Maxine Tapp Elisab Source Type: research

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period
CONCLUSIONS: The evidence is very uncertain about benefits and harms of VTE thromboprophylaxis in women during pregnancy and the early postnatal period at increased risk of VTE. Further high-quality very large-scale randomised trials are needed to determine effects of currently used treatments in women with different VTE risk factors. As sufficiently large definitive trials are unlikely to be funded, secondary data analyses based on high-quality registry data are important.PMID:33779986 | DOI:10.1002/14651858.CD001689.pub4 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 29, 2021 Category: General Medicine Authors: Philippa Middleton Emily Shepherd Judith C Gomersall Source Type: research

Lung recruitment manoeuvres for reducing mortality and respiratory morbidity in mechanically ventilated neonates
CONCLUSIONS: There is insufficient evidence to guide the use of LRMs in mechanically ventilated neonates. Well-designed randomised trials with larger sample sizes are needed to further evaluate the potential benefits and risks of LRM application in this population.PMID:33781001 | DOI:10.1002/14651858.CD009969.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 29, 2021 Category: General Medicine Authors: Elizabeth V Blazek Christine E East Jacqueline Jauncey-Cooke Fiona Bogossian Caroline A Grant Judith Hough Source Type: research

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period
CONCLUSIONS: The evidence is very uncertain about benefits and harms of VTE thromboprophylaxis in women during pregnancy and the early postnatal period at increased risk of VTE. Further high-quality very large-scale randomised trials are needed to determine effects of currently used treatments in women with different VTE risk factors. As sufficiently large definitive trials are unlikely to be funded, secondary data analyses based on high-quality registry data are important.PMID:33779986 | DOI:10.1002/14651858.CD001689.pub4 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 29, 2021 Category: General Medicine Authors: Philippa Middleton Emily Shepherd Judith C Gomersall Source Type: research

Lung recruitment manoeuvres for reducing mortality and respiratory morbidity in mechanically ventilated neonates
CONCLUSIONS: There is insufficient evidence to guide the use of LRMs in mechanically ventilated neonates. Well-designed randomised trials with larger sample sizes are needed to further evaluate the potential benefits and risks of LRM application in this population.PMID:33781001 | DOI:10.1002/14651858.CD009969.pub2 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 29, 2021 Category: General Medicine Authors: Elizabeth V Blazek Christine E East Jacqueline Jauncey-Cooke Fiona Bogossian Caroline A Grant Judith Hough Source Type: research

Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults
CONCLUSIONS: There is low-certainty evidence on the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD. Trials of BP self-monitoring with mobile-phone telemedicine support reported modest benefits. One trial at low risk of bias reported modest reductions in LDL cholesterol but no benefits for BP. There is moderate-certainty evidence that these interventions do not result in harm. Further trials of these interventions are warranted.PMID:33769555 | DOI:10.1002/14651858.CD012675.pub3 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 26, 2021 Category: General Medicine Authors: Melissa J Palmer Kazuyo Machiyama Susannah Woodd Anasztazia Gubijev Sharmani Barnard Sophie Russell Pablo Perel Caroline Free Source Type: research

Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults
CONCLUSIONS: There is low-certainty evidence on the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD. Trials of BP self-monitoring with mobile-phone telemedicine support reported modest benefits. One trial at low risk of bias reported modest reductions in LDL cholesterol but no benefits for BP. There is moderate-certainty evidence that these interventions do not result in harm. Further trials of these interventions are warranted.PMID:33769555 | DOI:10.1002/14651858.CD012675.pub3 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 26, 2021 Category: General Medicine Authors: Melissa J Palmer Kazuyo Machiyama Susannah Woodd Anasztazia Gubijev Sharmani Barnard Sophie Russell Pablo Perel Caroline Free Source Type: research

Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults
CONCLUSIONS: There is low-certainty evidence on the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD. Trials of BP self-monitoring with mobile-phone telemedicine support reported modest benefits. One trial at low risk of bias reported modest reductions in LDL cholesterol but no benefits for BP. There is moderate-certainty evidence that these interventions do not result in harm. Further trials of these interventions are warranted.PMID:33769555 | DOI:10.1002/14651858.CD012675.pub3 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 26, 2021 Category: General Medicine Authors: Melissa J Palmer Kazuyo Machiyama Susannah Woodd Anasztazia Gubijev Sharmani Barnard Sophie Russell Pablo Perel Caroline Free Source Type: research

International travel-related control measures to contain the COVID-19 pandemic: a rapid review
CONCLUSIONS: With much of the evidence derived from modelling studies, notably for travel restrictions reducing or stopping cross-border travel and quarantine of travellers, there is a lack of 'real-world' evidence. The certainty of the evidence for most travel-related control measures and outcomes is very low and the true effects are likely to be substantially different from those reported here. Broadly, travel restrictions may limit the spread of disease across national borders. Symptom/exposure-based screening measures at borders on their own are likely not effective; PCR testing at borders as a screening measure likely...
Source: Cochrane Database of Systematic Reviews - March 25, 2021 Category: General Medicine Authors: Jacob Burns Ani Movsisyan Jan M Stratil Renke Lars Biallas Michaela Coenen Karl Mf Emmert-Fees Karin Geffert Sabine Hoffmann Olaf Horstick Michael Laxy Carmen Klinger Suzie Kratzer Tim Litwin Susan Norris Lisa M Pfadenhauer Peter von Philipsborn Kerstin S Source Type: research

Contested effects and chaotic policies: the 2020 story of (hydroxy) chloroquine for treating COVID-19
Cochrane Database Syst Rev. 2021 Mar 25;3:ED000151. doi: 10.1002/14651858.ED000151.NO ABSTRACTPMID:33765340 | DOI:10.1002/14651858.ED000151 (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 25, 2021 Category: General Medicine Authors: Susan Gould Susan L Norris Source Type: research

Pharmacological and non-pharmacological strategies for obese women with subfertility
CONCLUSIONS: Evidence is insufficient to support the use of pharmacological and non-pharmacological strategies for obese women with subfertility. No data are available for the comparison of pharmacological versus non-pharmacological strategies. We are uncertain whether pharmacological or non-pharmacological strategies effect live birth, ongoing pregnancy, adverse events, clinical pregnancy, quality of life, or mental heath outcomes. However, for obese women with subfertility, a lifestyle intervention may reduce BMI. Future studies should compare a combination of pharmacological and lifestyle interventions for obese women w...
Source: Cochrane Database of Systematic Reviews - March 25, 2021 Category: General Medicine Authors: Seyed Abdolvahab Taghavi Madelon van Wely Shayesteh Jahanfar Fatemeh Bazarganipour Source Type: research

Transepithelial versus epithelium-off corneal crosslinking for progressive keratoconus
CONCLUSIONS: Because of lack of precision, frequent indeterminate risk of bias due to inadequate reporting, and inconsistency in outcomes measured and reported among studies in this systematic review, it remains unknown whether transepithelial CXL, or any other approach, may confer an advantage over epithelium-off CXL for patients with progressive keratoconus with respect to further progression of keratoconus, visual acuity outcomes, and patient-reported outcomes (PROs). Arrest of the progression of keratoconus should be the primary outcome of interest in future trials of CXL, particularly when comparing the effectiveness ...
Source: Cochrane Database of Systematic Reviews - March 25, 2021 Category: General Medicine Authors: Sueko M Ng Mark Ren Kristina B Lindsley Barbara S Hawkins Irene C Kuo Source Type: research

Endothelin receptor antagonists for pulmonary arterial hypertension
CONCLUSIONS: For people with pulmonary arterial hypertension with WHO functional class II and III, endothelin receptor antagonists probably increase exercise capacity, improve WHO functional class, prevent WHO functional class deterioration, result in favourable changes in cardiopulmonary haemodynamic variables compared with placebo. However, they are less effective in reducing dyspnoea and mortality. The efficacy data were strongest in those with idiopathic pulmonary hypertension. The irreversible liver failure caused by sitaxsentan and its withdrawal from global markets emphasise the importance of hepatic monitoring in p...
Source: Cochrane Database of Systematic Reviews - March 25, 2021 Category: General Medicine Authors: Chao Liu Junmin Chen Yanqiu Gao Bao Deng Kunshen Liu Source Type: research

Lens extraction for chronic angle-closure glaucoma
CONCLUSIONS: Moderate certainty evidence showed that lens extraction has an advantage over LPI in treating chronic PACG with clear crystalline lenses over three years of follow-up; ultimately, the decision for intervention should be part of a shared decision-making process between the clinician and the patient. For people with chronic PACG and visually significant cataracts, low certainty evidence suggested that combining phacoemulsification with either viscogonioplasty or goniosynechialysis does not confer any additional benefit over phacoemulsification alone. There was insufficient evidence to draw any meaningful conclus...
Source: Cochrane Database of Systematic Reviews - March 24, 2021 Category: General Medicine Authors: Ariel Yuhan Ong Sueko M Ng S Swaroop Vedula David S Friedman Source Type: research