Lithium can cause hyperthyroidism as well as hypothyroidism: A systematic review of an under-recognised association

2019 ◽  
Vol 53 (5) ◽  
pp. 384-402 ◽  
Author(s):  
Fiona Fairbrother ◽  
Nicola Petzl ◽  
James G Scott ◽  
Steve Kisely
Keyword(s):  
Cohort Studies ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Lithium Treatment ◽  
Affective State ◽  
Case Series ◽  
Case Control ◽  
Lithium Therapy ◽  
Clinical Implications ◽  
Cross Sectional

Objective: Hypothyroidism is a well-documented consequence of lithium treatment. Less well known is a possible association between lithium therapy and hyperthyroidism. This may have clinical implications as rapid changes in thyroid hormones may worsen a person’s affective state, while symptoms of hyperthyroidism can mimic those of mania. We therefore systematically reviewed the published literature for evidence of lithium-induced hyperthyroidism. Methods: We searched PubMed, Embase and CINAHL for articles where individuals developed biochemically confirmed hyperthyroidism (with or without clinical symptoms), while on lithium therapy for an affective illness. We included case reports, case series, cross-sectional, case control and cohort studies. Results: We included 52 studies, 39 of which were individual case reports and 3 were case series. There were 10 cross-sectional or case control or cohort studies. All the research designs suggested an association between the prescription of lithium and hyperthyroidism. However, these findings were limited by the quality of the included studies, small number of participants and the general lack of either a clear temporal relationship or dose response. Conclusion: Hyperthyroidism is an uncommon side-effect of lithium compared to hypothyroidism but may have clinical implications. However, large prospective studies are required to clarify this association and to further inform the management of patients treated with lithium where hyperthyroidism occurs.

scholarly journals Is the Simplicity of the Evidence Pyramid Actually Detrimental for Understanding Evidence?

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Annette O'Connor
Keyword(s):  
Cohort Studies ◽  
Real World ◽  
Disease Risk ◽  
Case Reports ◽  
Meta Analysis ◽  
Information Source ◽  
Case Series ◽  
Case Control ◽  
Current Evidence ◽  
Case Control Studies

The evidence pyramid for assessing the efficacy of interventions under real world conditions has been used in various forms for many years, and to a lesser extent the pyramid has been used for assessing evidence for disease risk factors. While acknowledging minor differences, many pyramids list the following information sources for interventions in decreasing order of “validity”: systematic review and meta-analysis of randomised control trials, randomised controlled trials, cohort studies, case control studies, case series and case reports. The evidence pyramid is often used as a teaching aid to help clinicians and students visualise the concept that all studies might not have equal evidentiary value when evaluating real world efficacy.The rationale for the hierarchy of the pyramid is partially based on the potential for bias in some designs and partially based on the external validity of the information source. Designs with greater potential for bias “on average” are placed lower on the pyramid. The greater risk of bias means a greater risk that effect size estimates from studies lower on the pyramid may be systematically incorrect (overestimated or underestimated). As such, the evidence pyramid makes very broad statements about the design “on average”. Of course, for any particular study or topic, the pyramid may not be correct. Regardless, the generalisations described in the evidence pyramid have over the years been considered useful and use of the tool continues likely because of its simplicity. However, the validity of most pyramids that we have seen (and used ourselves, and published ourselves) is predicated on two potentially false concepts. The first potentially false concept conveyed by most evidence pyramids, is that there is only one case-control design and it is of lesser evidentiary value than cohort studies. The second potentially false concept conveyed by evidence pyramids is that the terms cohort, case control, and case series can be used to “filter” out studies of lower evidentiary value.In this presentation Annette discusses the validity of the evidence pyramid on the interpretation of evidence from primary research. She proposes a new way to think about evidence from primary studies using the framework for classifying epidemiologic studies proposed by Pearce (2012) based on incident and prevalent cases. This would also result in a rethinking of the current evidence pyramid.

Types of trials

2017 ◽  
Author(s):  
Mark Harrison
Keyword(s):  
Emergency Medicine ◽  
Cohort Studies ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Case Control ◽  
Controlled Trials ◽  
Case Control Studies ◽  
Advantages And Disadvantages ◽  
Randomized Controlled

This chapter describes types of trials as applied to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details and advantages and disadvantages of case reports, case series, cohort studies, case–control studies, randomized controlled trials, crossover trials, systematic reviews, and meta-analysis. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.

scholarly journals Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives

2021 ◽  
pp. jnnp-2021-326405
Author(s):  
Jonathan P Rogers ◽  
Cameron J Watson ◽  
James Badenoch ◽  
Benjamin Cross ◽  
Matthew Butler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Neuropsychiatric Symptoms ◽  
Case Series ◽  
Case Control ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Early Literature ◽  
Cross Sectional Studies

There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations. We searched MEDLINE, Embase, PsycINFO and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence. 13 292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% (95% CI 35.2% to 51.3%), n=15 975, 63 studies), weakness (40.0% (95% CI 27.9% to 53.5%), n=221, 3 studies), fatigue (37.8% (95% CI 31.6% to 44.4%), n=21 101, 67 studies), dysgeusia (37.2% (95% CI 29.8% to 45.3%), n=13 686, 52 studies), myalgia (25.1% (95% CI 19.8% to 31.3%), n=66 268, 76 studies), depression (23.0% (95% CI 11.8% to 40.2%), n=43 128, 10 studies), headache (20.7% (95% CI 16.1% to 26.1%), n=64 613, 84 studies), anxiety (15.9% (5.6% to 37.7%), n=42 566, 9 studies) and altered mental status (8.2% (95% CI 4.4% to 14.8%), n=49 326, 19 studies). Heterogeneity for most clinical manifestations was high. Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic’s early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.

Post-Thrombotic Syndrome (PTS) in Children: A Systematic Review of Prevalence, Validity of Outcome Measures, and Prognostic Factors.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2978-2978 ◽  
Author(s):  
Neil A Goldenberg ◽  
Susan Kahn ◽  
Mark A. Crowther ◽  
Gili Kenet ◽  
Ulrike Nowak-Gottl ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Cohort Studies ◽  
Conflicts Of Interest ◽  
Single Case ◽  
Case Reports ◽  
Case Series ◽  
Cross Sectional ◽  
Medline Search ◽  
Post Thrombotic Syndrome

Abstract 2978 Poster Board II-949 BACKGROUND: Post-thrombotic syndrome (PTS) is a condition of chronic venous insufficiency following deep venous thrombosis (DVT) that affects both adults and children. Nevertheless, investigation of PTS in children has lagged behind that in adults. OBJECTIVE: This systematic review was undertaken to summarize evidence from the pediatric literature on the prevalence of PTS, the validity of proposed measures of PTS, and prognostic factors for PTS in children. METHODS: A comprehensive Medline search was performed employing the following terms: “[pediatric OR children] AND [post-thrombotic syndrome OR post-phlebitic syndrome]”. Single case reports, narrative reviews, and commentaries were excluded. RESULTS: Seven case series and cross-sectional studies, nine registries and cohort studies, and one uncontrolled clinical trial were identified that met inclusion criteria; these studies reported on a total of 1316 children with DVT (Table 1). The prevalence of PTS differed substantially between observational and non-observational studies: 15% of 1042 children versus 46% of 274 children, respectively. No pediatric studies have evaluated quality of life (QOL) associated with PTS. Two reports from a single-institutional cohort have identified elevated levels of factor VIII and D-dimer and non-use of thrombolytic therapies as potentially prognostic of PTS in children, particularly among those with veno-occlusive thrombi; these are the only reports employing a PTS outcome measure that has been validated in children (the Manco-Johnson instrument). CONCLUSIONS: Overall, high-quality evidence on pediatric PTS is lacking. Collaborative prospective cohort studies and trials that use validated measures of pediatric PTS are needed to assess the incidence of, prognostic factors for, and QOL impact of PTS in children. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives

2021 ◽  
Author(s):  
Jonathan P Rogers ◽  
Cameron Watson ◽  
James Badenoch ◽  
Benjamin Cross ◽  
Matthew Butler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Neuropsychiatric Symptoms ◽  
Case Series ◽  
Case Control ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Early Literature ◽  
Cross Sectional Studies

Objectives There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations. Methods We searched MEDLINE, Embase, PsycInfo and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence. Results 13,292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% [35.2-51.3], n=15,975, 63 studies), weakness (40.0% [27.9-53.5], n=221, 3 studies), fatigue (37.8% [31.6-44.4], n=21,101, 67 studies), dysgeusia (37.2% [30.0-45.3], n=13,686, 52 studies), myalgia (25.1% [19.8-31.3], n=66.268, 76 studies), depression (23.0 % [11.8-40.2], n=43,128, 10 studies), headache (20.7% [95% CI 16.1-26.1], n=64,613, 84 studies), anxiety (15.9% [5.6-37.7], n=42,566, 9 studies) and altered mental status (8.2% [4.4-14.8], n=49,326, 19 studies). Heterogeneity for most clinical manifestations was high. Conclusions Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic's early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.

scholarly journals Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Zouina Sarfraz ◽  
Azza Sarfraz ◽  
Alanna Barrios ◽  
Radhika Garimella ◽  
Asimina Dominari ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Infection ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Case Reports ◽  
Case Series ◽  
Infectious Complications ◽  
Care Physician ◽  
Cross Sectional ◽  
Infection Period

Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care. Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers. Results: We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids. Conclusion: Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.

scholarly journals Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

Breast Care ◽  
2018 ◽  
Vol 13 (2) ◽  
pp. 129-132 ◽  
Author(s):  
Susan R. Harris
Keyword(s):  
Breast Cancer ◽  
Cohort Studies ◽  
Systematic Reviews ◽  
Nurse Practitioners ◽  
Case Reports ◽  
Case Series ◽  
Diagnosis And Management ◽  
Oncology Nurse ◽  
Management Interventions ◽  
Axillary Web Syndrome

The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included ‘axillary web syndrome', ‘axillary cording', and ‘lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.

scholarly journals Probable Neuropsychological & Cognitive Complications due to Cytokine Storm in Patients With COVID-19

2021 ◽  
Vol 0 (0) ◽  
pp. 1-37
Author(s):  
Zahra Keshtgar ◽  
◽  
GH. Reza Chalabianloo ◽  
Niloofar Esmaeili ◽  
◽  
...  
Keyword(s):  
Nervous System ◽  
Case Reports ◽  
Case Series ◽  
Executive Dysfunction ◽  
Inflammatory Factors ◽  
Cytokine Storm ◽  
Case Control Studies ◽  
Necrosis Factor Alpha ◽  
Cross Sectional ◽  
Tnf Α

Introduction: COVID-19 (coronavirus disease 2019) was identified in China in December 2019 for the first time and is rapidly spreading throughout the world as a pandemic. As COVID-19 causes mild to severe acute respiratory syndrome, most studies in this context have focused on pathogenesis primarily in the respiratory system. However, evidence shows that the central nervous system (CNS) may also be affected by COVID-19. Since COVID-19 is spreading, it is imperative to study its possible cognitive effects in patients suffering and recovering from COVID-19. Methods: The articles used in this study were searched by keywords such as Cytokine storm and covid-19, covid-19 and executive dysfunction, cognitive disorder and covid-19, CNS and covid 19, Coronavirus, Neuroinvasion in science direct, Scopus, PubMed, Embase, and Web of Science databases based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. The study will assess all observational studies published between December 2019 and April 2021 in peer-reviewed journals, including cross-sectional, cohort, case-control studies, case reports and case series. The search result was 106 articles, of which 73 articles related to Covid-19, the stages of infection by this virus, its effect on the nervous system and neurological symptoms, the cytokine storm caused by this infection, and the possible cognitive consequences caused by this virus in patients, has been reviewed. Other articles were not checked due to their limited relevance to the topic under discussion. Results: Studies show that neurons may be directly affected by SARS-CoV-1 and SARS-CoV-2. Furthermore, various studies indicate that systemic inflammation (so-called "cytokine storm") is also responsible for brain damage induced by infection with SARS-CoV-1 and SARS-CoV-2. Such a way that this patients showed elevated levels of interleukin (IL-), 6, 8, and 10 and of tumor necrosis factor-alpha (TNF- α) in their blood. Conclusion: Various cognitive defects following an increase level of cytokines such as TNF-α and IL-6,8 have been observed. Therefore, due to the increase level of these pro-inflammatory factors in the brains of these patients, cognitive deficits can be expected, which need further investigation.

Rituximab for Eosinophilic Granulomatosis with Polyangiitis: a Systematic Review of Observational Studies

Rheumatology ◽  
2021 ◽  
Author(s):  
Vincenzo G Menditto ◽  
Giulia Rossetti ◽  
Diletta Olivari ◽  
Alessia Angeletti ◽  
Marco Rocchi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Granulomatosis With Polyangiitis ◽  
Case Reports ◽  
Case Series ◽  
Biologic Agents ◽  
Cochrane Library ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Extensive Literature ◽  
Eosinophilic Granulomatosis

Abstract Objective to analyze the available evidence about the use of rituximab (RTX) and other biologic agents in Eosinophilic Granulomatosis with Polyangiitis (EGPA) patients and to provide useful findings to inform the design of future, reliable clinical trials. Methods A systematic review was performed. A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science and the Cochrane library databases and an extensive literature search on other biologic agents. Results 45 papers pertinent to our questions were found: 16 retrospective cohort studies, 8 case series, 3 prospective cohort studies and 18 single case reports, for a total of 368 EGPA patients. More than 80% of evaluable patients achieved complete or partial remission with a tendency towards a higher rate of complete response in pANCA positive subgroup. Conclusion Although the majority of the evaluable EGPA patients treated with RTX appears to achieve complete remission, we strongly believe that a number of sources of heterogeneity impairs a clear interpretation of results and limits their transferability in clinical practice. Differences in design, enrollment criteria, outcome definition and measurement make a comparison among data obtained from studies on RTX and other biologic agents unreliable.

scholarly journals Manual Interventions for Musculoskeletal Factors in Infants With Suboptimal Breastfeeding: A Scoping Review

2018 ◽  
Vol 23 ◽  
pp. 2515690X1881697
Author(s):  
Cheryl Hawk ◽  
Amy Minkalis ◽  
Carol Webb ◽  
Olivia Hogan ◽  
Sharon Vallone
Keyword(s):  
Manual Therapy ◽  
Case Reports ◽  
Research Question ◽  
Case Series ◽  
First Year ◽  
Serious Adverse Events ◽  
Cross Sectional ◽  
Maternal Report ◽  
Suboptimal Breastfeeding ◽  
First Year Of Life

Exclusive breastfeeding for the first 6 months, and continuing for at least the first year of life, is strongly recommended. Suboptimal breastfeeding, which is breastfeeding that does not meet these recommendations, is a multifactorial issue. Some authorities, particularly in the nursing and lactation counseling professions, have identified musculoskeletal issues that may interfere with successful breastfeeding. The purpose of this project was to survey the literature on manual treatments to correct musculoskeletal dysfunctions in infants with suboptimal breastfeeding. Our research question was, “Have manual interventions been used to correct infants’ musculoskeletal dysfunctions thought to be linked to suboptimal breastfeeding?” We searched PubMed and Index to Chiropractic Literature, from inception through July 2018, as well as relevant gray literature. We assessed quality of randomized controlled trials (RCTs) and cohort studies using modified SIGN checklists, and the overall strength of evidence using GRADE. The search yielded 461 articles, with a final inclusion of 27 articles: 7 expert commentaries, 1 high-quality RCT, 1 low-quality cohort, 1 pilot study, 2 cross-sectional surveys, 5 narrative reviews, and 10 case series or case reports. Combining the 10 case series and reports in our search with 18 discussed in narrative reviews included in our review yielded 201 infants who received manual therapy for nursing dysfunction. No serious adverse events were reported and improvement in nursing ability was observed using various outcome measures, usually maternal report. Based on the GRADE criteria, there is moderate positive evidence for the effect of manual therapy on suboptimal breastfeeding.

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