To determine the effect of Trendelenburg position on the diameter or cross-section area of the internal jugular vein (IJV) a systematic review and metanalysis was performed. Studies that evaluated the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) with ultrasonography in supine and any degree of head-down tilt (Trendelenburg position) were analyzed. A total of 22 articles (613 study subjects) were included. A >5° Trendelenburg position statistically increases RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended for CVC placement, when patient conditions allow it, and US-guided cannulation is not available.

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This study aims to estimate the effect of synthetic and biologic disease-modifying antirheumatic drugs (DMARDs) on radiographic progression and quality of life in adult patients with psoriatic arthritis. A comprehensive search was performed using MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CCRCT). Clinical trials comparing DMARDs with placebo for ≥ 12 weeks were included. The meta-analysis was conducted with a random-effects model using mean differences (MD). A total of 16 trials with overall moderate quality of evidence were included. Exposure to a biologic agent reduced radiographic progression at 24 weeks of treatment (MD: − 0.66; [95% CI − 0.97 to − 0.34]; P < .00001; I 2 = 100%). The reduction of the baseline score was more than two times higher for TNF blockers compared with IL-17 and IL-12/IL-23 inhibitors (MD: − 0.94 vs − 0.41). Improvement in health-related quality of life scores was observed in biologic-treated populations (MD: − 0.21; [95% CI − 0.25 to − 0.18]; P < .00001; I 2 = 97%). No sufficient data were available regarding conventional synthetic agents. Our data analyses suggest a better control of radiological damage with bDMARDs, as compared to placebo, after 24 weeks of treatment. However, the accuracy of these results in real life are jeopardized by the exceedingly high level of heterogeneity exhibited within and across included studies, and the true intervention effect cannot be determined with confidence. Further research is required to assess long-term outcomes and to control heterogeneity in the evaluation of treatments for psoriatic arthritis. PROSPERO registration number: CRD42019122223.

Objective To determine the most frequently body frame size (BFS) measurement and to compare the cut‐off values used for classifying body size in children and adolescents. Methods This systematic review focused on primary studies and scientific reports published in Medline Ovid, EMBASE, Web of Science, or Scopus between January 1, 2007 and March 31, 2021. Eligible studies must have included at least one BFS parameter measured in healthy children or adolescents. A descriptive analysis and graphic comparison were performed when values of the body frame were available. Results A total of 26 studies involving 317 202 children and adolescents from all over the world were included. The report of Frame index predominated (46%). It was followed by the biacromial diameter single or combined with the bitrochanteric and biiliocristal diameter (27%), the wrist circumference (19%), and the grant index (12%). Fourteen studies reported percentile values of the BFS measurement, but only four presented cut‐off values. Conclusions There was no unified BFS measurement in children and adolescents neither reference cut‐off values for categorization. The Frame index was the most frequently used. It is difficult to compare BFS statistics due to the diversity of measurements. It is necessary to standardize the use of the methods for measuring BFS.

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Introduction The anatomy of the internal jugular vein (IJV) may be influenced by the position of the patient. A head‐down‐tilt or Trendelenburg position could potentially increase the size and diameter of the IJV, however, its use in clinical scenarios, such as cathetherization (a frequent procedure), is debatable. Small venous cross‐section could make cannulation difficult, even while guided by ultrasound, increasing the risk of complications. The objective of this study was to systematically review all studies that analyze parameters of IJV size variations due to Trendelenburg position evaluated by ultrasound. Methods Adhering to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, all cross‐sectional studies comparing the effect of Trendelenburg position were included. Any degree of head‐down tilt with a supine position on the cross‐sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) in healthy adults were eligible. Measurements and outcomes had to be with ultrasonography. An experienced librarian designed and conducted the search strategy in Ovid MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane. Four independent reviewers, working in duplicate, assessed for eligibility of studies. Cross‐sectional area (CSA) and anteroposterior (AP) diameter of the RIJV were collected and pooled using fixed‐effects meta‐analyses. Effect sizes are presented as mean difference (MD) and 95% confidence interval (CI). Heterogeneity between studies was assessed using the X2 test and I2 statistic. Data syntheses were conducted using Review Manager Version 5.3. Results A total of 22 articles (613 study subjects) were included. The overall risk of bias was moderate. In healthy adults, exposure to any degree of the Trendelenburg position significantly increased the CSA (MD:0.38cm²; [95% CI:0.35‐0.41]; P<0.00001; I²=0%) and AP diameter (MD:1.87 mm; [95% CI:1.51‐2.23]; P<0.00001; I²=0%) of the RIJV. No significant changes were exhibited when comparing the results of studies performed with the head rotated (MD:0.35cm²; [95% CI:0.29‐0.42]; P<0.00001; I²=0%) with those using a neutral position of the head (MD:0.38 cm²; [95% CI:0.35‐0.41]; P<0.00001; I²=0%) No significant increase of the AP diameter of the RIJV was identified from the 10° Trendelenburg position to both 15° and 20° inclinations. Conclusions The available published evidence favors Trendelenburg position, with a >5° statistically increasing RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended by international guidelines for CVC placement, when patient conditions allow it, as most guidelines fail to mention patient positioning.

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We assessed the available evidence regarding adverse effects on surrogate and patient-important health outcomes of third- and fourth-generation combined oral contraceptives among premenopausal women. We performed a systematic review and meta-analysis including randomized controlled trials and observational studies comparing third- and fourth-generation combined oral contraceptives with other generation contraceptives or placebo. Studies that enrolled women aged 15 to 50 years, with at least three cycles of intervention and 6 months of follow-up were included. A total of 33 studies comprising 629,783 women were included. Low-density lipoprotein cholesterol levels were significantly lower in fourth-generation oral contraceptives (mean differences (MD): −0.24 mmol/L; [95% CI −0.39 to −0.08]), while total cholesterol was significantly increased in levonorgestrel users when compared to third-generation oral contraceptives (MD: 0.27 mmol/L; [95% CI 0.04 to 0.50]). A decreased arterial thrombosis incidence was shown in fourth-generation oral contraceptive users, as compared to levonorgestrel (incidence rate ratio (IRR): 0.41; [95% CI 0.19 to 0.86]). No difference was found in the occurrence of deep venous thrombosis between fourth-generation oral contraceptives and levonorgestrel users (IRR: 0.91; [95% CI 0.66 to 1.27]; p = 0.60; I2 = 0%). Regarding the remaining outcomes, data were heterogeneous and showed no clear difference. In premenopausal women, the use of third- and fourth-generation oral contraceptives is associated with an improved lipid profile and lower risk of arterial thrombosis. Data were inconclusive regarding the rest of outcomes assessed. This review was registered in PROSPERO with CRD42020211133.