Objective: The objective of this systematic review and meta-analysis is to examine the association between sudden sensorineural hearing loss (SSNHL) and risk of metabolic syndrome (MetS), and the association between MetS and prognosis of SSNHL. Databases Reviewed: We systematically searched MED-LINE, Embase, and Cochrane Central Register electronic databases from their dates of conception to February 4, 2020. Methods: We included observational studies analyzing 1) the prevalence of MetS among SSNHL patients, or 2) the prognosis of SSNHL patients in MetS patients. A standardized form was completed in duplicate extracting data on study characteristics, participant demographics, and SSNHL outcome or recovery measures. Random-effects meta-analyses were performed pooling odds ratios using the generic inverse method. Risk of bias was assessed using the Newcastle Ottawa Scale.Results: Three studies examining the prevalence of MetS among patients with SSNHL (11,890 total participants; 3,034 SSNHL participants) yielded a significantly increased risk of MetS among SSNHL, with a pooled odds ratio of 1.88 (95% CI, 1.01-3.50). Three studies examining the association of SSNHL prognosis in patients with MetS (608 SSNHL participants, 234 concomitant SSNHL, and MetS participants) demonstrated that SSNHL patients with MetS were significantly more likely to have poorer recovery compared to SSNHL patients without MetS (pooled odds ratio 2.77; 95% CI, 2.33-3.28). Conclusion: Our findings suggest an association between prevalence of MetS and SSNHL, as well as poorer prognosis of SSNHL in patients with concomitant MetS.
Study Design:A systematic review (SR) and meta-analysis (MA) of randomised controlled trials (RCTs).Objective: To evaluate the totality of evidence in relation to the effectiveness of acupuncture for non-specific chronic low back pain (NSCLBP). Summary of BackgroundData: Acupuncture has become a popular alternative for treating clinical symptoms of NSCLBP. A number of RCTs have examined the effectiveness of acupuncture in the treatment of NSCLBP. Methods: A systematic literature search was completed without date or language restrictions up to May 2012. Studies included in the review were RCTs that examined all forms of acupuncture that adhered to the Traditional Acupuncture Theory for treating NSCLBP.Outcome measures included impairment, activity limitation and participation restriction. The methodological quality of the studies was examined using the Cochrane risk of bias tool. Results:Thirty-two studies were included in the SR, of which twenty-five studies presented relevant data for the MA. Acupuncture had a clinically meaningful reduction in levels of self-reported pain [MD=-16.76 (95% CI -33.33, -0.19), p=0.05, I 2 =90%] when compared to sham, and improved function [SMD=-0.94 (95% CI -1.41, -0.47), p<0.00, I 2 =78%] when compared to no treatment immediately post-intervention. Levels of function also clinically improved when acupuncture in-addition to usual-care, or electro-acupuncture was compared to usual-care alone. When acupuncture was compared to medications (NSAIDS, muscle relaxants and analgesics) and usual-care, there were statistically significant differences between the control and the intervention groups but these differences were too small to be of any clinical significance. There was no evidence in support of acupuncture over transcutaneous electrical nerve stimulation. Conclusion: This SR demonstrates that acupuncture may have a favourable effect on selfreported pain and functional limitations on NSCLBP. However, the results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies. Key words: Chronic non-specific low back pain, acupuncture, systematic review, metaanalysis Level of Evidence: 1 This systematic review and meta-analysis examines the effectiveness of acupuncture on nonspecific chronic low-back-pain (NSCLBP). Thirty-two studies were included in the review, of which twenty-five studies presented relevant data for meta-analysis. Results suggest acupuncture may reduce levels of self-reported pain and functional limitations for patients with NSCLBP. A total of thirty-two randomised controlled trials that examined acupuncture that adhered to the Traditional Acupuncture Theory for treating patients with non-specific chronic low back pain (NSCLBP) were included in the systematic review, of which twenty-five studies presented relevant data for the meta-analysis. The methodological quality of the studies was examined using the Cochrane crite...
BackgroundLatent tuberculosis infection (LTBI) treatment is essential in preventing the reactivation of tuberculosis. We compared the clinical and demographic characteristics of patients that have completed traditional therapy with 9 months of isoniazid (9H) with those that have completed 3 months of rifapentine plus isoniazid using directly observed therapy (3HP), focusing on adverse effects, a barrier to completion that may contribute to discontinuation of therapy.MethodsWe conducted a retrospective chart review (July 2013-March 2017) to compare the 9H group and 3HP group. Demographic and clinical variables were described by therapy type and groups were compared using Fisher’s exact test or t-test, as appropriate.ResultsPatients in the study sample (n = 124) had a mean age of 49.8 (SD=14.8) years old. Approximately half received 3HP (n = 64, 51.6%). Demographics in the 3HP and 9H groups were similar. Significantly more patients in the 3HP group completed treatment (81.3% vs. 61.7%, P < 0.0001). No patients were lost to follow-up in the 3HP group, 14 (23.33%) were lost in the 9H group. Gastrointestinal (GI) upset (n = 16), elevated liver function tests (LFTs) (n = 11), and headaches (n = 9) were the most frequent side effects. Except for neuropathy and pancreatitis, all other adverse side effects had higher incidence in the 3HP group. Specifically, the incidence of GI symptoms (23.4% vs. 1.7%, P = 0.0003), weakness (9.4% vs. 0%, P = 0.028), and headache (14.1% vs. 0%, P = 0.003) were significantly higher in the 3HP group. Of the observed patients with adverse reactions that received 3HP, 88.24% (n = 30) had them resolved within the first two weeks.ConclusionThe 3HP group had a higher completion rate and no loss to follow-up compared with 23% loss to follow-up in the 9H group, however, adverse reactions were significantly higher in the 3HP group. Closer weekly monitoring of the 3HP group could lend itself to capturing more adverse reactions, however, 88% of those adverse reactions resolved within the first two weeks of therapy. Liver function tests were not significantly different (P = 0.2079) between the two groups, and were mildly elevated. We conclude that three months of rifapentine plus isoniazid for the treatment of LTBI may be a favorable option over the traditional 9 months of isoniazid in certain populations.Disclosures All authors: No reported disclosures.
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