P–394 Intralipid infusion at time of embryo transfer in women with history of recurrent implantation failure: a systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M P Rimmer ◽  
N Black ◽  
S Keay ◽  
S Quenby ◽  
B. H.A Wattar
Keyword(s):  
Systematic Review ◽  
Embryo Transfer ◽  
Meta Analysis ◽  
Small Sample ◽  
Risk Of Bias ◽  
Population Characteristics ◽  
Implantation Failure ◽  
Randomised Trials ◽  
Recurrent Implantation Failure ◽  
History Of

Abstract Study question What is the effectiveness of IV Intralipid (IVI) in improving pregnancy rates in women undergoing IVF with history of Recurrent implantation failure (RIF) to improve reproductive outcomes. Summary answer The evidence to support the use of IVI at the time of embryo transfer in women with RIF is limited. More RCTs are needed. What is known already: Optimising the implantation process following embryo transfer remains a clinical challenge with 10% of couples undergoing IVF affected by (RIF). Immunotherapy could help to optimise endometrial receptivity and increase the chances for successful conception in women with history of RIF. Intra-venous Intralipid (IVI), a fat-based emulsion of soybean oil, glycerine, phospholipids, egg, and polyunsaturated fatty acids, has been evaluated in several trials as a potential intervention to downregulate the uNK cells and macrophages as well as inhibit the pro-inflammatory mediators including T1 helper cells. Evidence synthesis is needed to evaluate the effectiveness of this intervention. Study design, size, duration We performed this systematic review using a prospectively registered protocol (CRD42019148517) and reported in accordance with the PRISMA guidelines. Participants/materials, setting, methods: We searched MEDLINE, EMBASE and CENTRAL for any randomised trials evaluating the use of IVI at the time of embryo transfer in women undergoing assisted conception until September 2020. We extracted data in duplicate and assessed risk of bias using the Cochrane Risk of Bias tools. We meta-analysed data using a random effect model and reported on dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI). Main results and the role of chance We included five randomised trials reporting on 843 women with an overall moderate risk of bias. All trials used 20% IVI solution at the time of embryo transfer compared to normal saline infusion or no intervention (routine care). The IVI group had a higher chance of clinical pregnancy (172 vs 119, RR 1.55, 95%CI 1.16–2.07, I2 44.2%) and live birth (132 vs 73, RR 1.83, 95%CI 1.42–2.35, I2 0%) post treatment compared to no intervention. Limitations, reasons for caution Our findings are limited by the small sample size and the variations in treatment protocols and population characteristics. Wider implications of the findings: Our meta-analysis offers an overview on the value of IVI to help women affected by RIF. Given the limitations and the quality of included trials, adopting the use of IVI a-la-carte to couples undergoing IVF remains immature. IVI should not be offered until larger RCTs demonstrate a persistent benefit. Trial registration number CRD42019148517

scholarly journals Natural history of non-bullous impetigo: A systematic review of time to resolution or improvement without antibiotic treatment

2020 ◽  
pp. bjgp20X714149
Author(s):  
Tammy Hoffmann ◽  
Ruwani Peiris ◽  
Paul Glasziou ◽  
Gina Cleo ◽  
Christopher Del Mar
Keyword(s):  
Systematic Review ◽  
Placebo Group ◽  
Natural History ◽  
Antibiotic Use ◽  
Careful Consideration ◽  
Risk Of Bias ◽  
Symptom Improvement ◽  
Randomised Trials ◽  
Duration Of Symptoms ◽  
History Of

Abstract Background: Non-bullous impetigo is typically treated with antibiotics. However, the duration of symptoms without their use is not established which hampers informed decision-making about antibiotic use. Aim: To determine the natural history of non-bullous impetigo. Design and Setting: Systematic review. Method: We searched PubMed up to January 2020 and reference lists of articles identified in the search. Eligible studies involved participants with impetigo in either the placebo group of randomised trials or in single-group prognostic studies not using antibiotics and measured time to resolution or improvement. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were percentage of participants who, at any timepoint, had: i) symptom resolution, ii) symptom improvement, or iii) failed to improve. Adverse event data were also extracted. Results: Seven randomised trials (557 placebo group participants) were identified. At about 7 days, the percentage of participants classified as resolved ranged from 13% to 74% across the studies, whereas the percentage classified as ‘failure to improve’ ranged from 16% to 41%. The rate of adverse effects was low. Incomplete reporting of some details limited assessment of risk of bias. Conclusions: While some uncertainty around the natural history of non-bullous impetigo remains, symptoms resolve in some patients by about 7 days without using antibiotics, with about one-quarter of patients not improving. Immediate antibiotic use may not be mandatory and discussions with patients should include the expected course of untreated impetigo and careful consideration of the benefits and harms of antibiotic use.

scholarly journals Natural history of uncomplicated urinary tract infection without antibiotics: a systematic review

2020 ◽  
Vol 70 (699) ◽  
pp. e714-e722
Author(s):  
Tammy Hoffmann ◽  
Ruwani Peiris ◽  
Chris Del Mar ◽  
Gina Cleo ◽  
Paul Glasziou
Keyword(s):  
Systematic Review ◽  
Urinary Tract Infection ◽  
Placebo Group ◽  
Urinary Tract ◽  
Natural History ◽  
Tract Infection ◽  
Risk Of Bias ◽  
Uncomplicated Urinary Tract Infection ◽  
Randomised Trials ◽  
History Of

BackgroundAlthough uncomplicated urinary tract infection (UTI) is commonly treated with antibiotics, the duration of symptoms without their use is not established; this hampers informed decision making about antibiotic use.AimTo determine the natural history of uncomplicated UTI in adults.Design and settingSystematic review.MethodPubMed was searched for articles published until November 2019, along with reference lists of articles identified in the search. Eligible studies were those involving adults with UTIs in either the placebo group of randomised trials or in single-group prognostic studies that did not use antibiotics and measured symptom duration. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were the percentage of patients who, at any time point, were symptom free, had symptom improvement, or had worsening symptoms (failed to improve). Adverse event data were also extracted.ResultsThree randomised trials (346 placebo group participants) were identified, all of which specified women only in their inclusion criteria. The risk of bias was generally low, but incomplete reporting of some details limited assessment. Over the first 9 days, the percentage of participants who were symptom free or reported improved symptoms was reported as rising to 42%. At 6 weeks, the percentage of such participants was 36%; up to 39% of participants failed to improve by 6 weeks. The rate of adverse effects was low and, in two trials, progression to pyelonephritis was reported in one placebo participant.ConclusionAlthough some uncertainty around the natural history of uncomplicated UTIs remains, some women appear to improve or become symptom free spontaneously, and most improvement occurs in the first 9 days. Other women either failed to improve or became worse over a variable timespan, although the rate of serious complications was low.

scholarly journals Transmission of COVID-19 through breastfeeding

2020 ◽  
Author(s):  
Cynthia Carrasco ◽  
Ana Beatriz Pizarro ◽  
Gabriela Urrea ◽  
Nicolás Meza ◽  
Catalina Verdejo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Breast Milk ◽  
Vertical Transmission ◽  
Direct Evidence ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Data Sources ◽  
Randomised Trials ◽  
Web Based

ObjectiveThis living systematic review aims to evaluate the vertical transmission of SARS-CoV-2 through breast milk and breastfeeding in patients with COVID-19 providing a timely, rigorous and continuously updated summary of the evidence available on .Data sources We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal.Eligibility criteria for selecting studies and methodsWe adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include primary studies evaluating the role of breast milk and breastfeeding transmission. Randomised trials evaluating breast milk and breastfeeding in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19 will be searched in case we find no direct evidence from randomised trials, or if the direct evidence provides low- or very low-certainty for critical outcomes.Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates.

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