Diagnosis, Risk Factors, and Management of Sacral and Pelvic Fractures After Instrumented Lumbar Fusions: A Systematic Review

Study Design: Systematic literature review. Objectives: To evaluate risk factors, diagnosis, and management of sacral and pelvic fractures (SPFs) after instrumented fusions. Methods: A systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed using the PubMed database. Articles with patients with an SPF after a lumbar instrumented fusion were included. The articles addressing specifically proximal junctional kyphosis were excluded. Eleven small cases series (level of evidence IV) were reviewed. Results: The incidence of SPF was 1.86% in one study. The risk factors reported were elderly patients, multilevel surgery, long fusions stopping at L5 or S1 instead of the ilium, osteoporosis, obesity, and sagittal imbalance. Computed tomography scan was the preferential image modality for diagnosing. Nonsurgical treatment may be used in patients with tolerable pain and nondisplaced fracture. Persistent pain was an indication for surgery, as well as fracture displacement. The most common surgical treatment reported was an extension of the fusion to the iliac using iliac screws. Conclusion: SPFs after lumbar instrumented fusion are rare but clinically meaningful complications. The risk factors, diagnosis, and management of SPFs are described in our review.

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Pelvic Organ Prolapse in Countries of Different Economy: A Systematic Review

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v14i2.28436 ◽

2019 ◽

Vol 14 (2) ◽

pp. 7-21

Author(s):

Shishir Paudel ◽

Anisha Chalise ◽

Ganesh Dangal ◽

Tulsi Ram Bhandari ◽

Gehanath Baral

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Pelvic Organ Prolapse ◽

Uterine Prolapse ◽

National Income ◽

Significant Risk ◽

Pelvic Organ ◽

Reference List ◽

Medical Subject Headings ◽

Pubmed Database

Aims: This review was done to identify the reported prevalence rate of pelvic organ prolapse among the different world populations. Methods: Systematic review of Pelvic Organ Prolapse (POP) using the PRISMA checklist; PubMed database was searched on reportingthe prevalence of POP and its management measures in January 2020. Medical Subject Headings (MeSH) like "Pelvic Organ Prolapse"OR "Uterine Prolapse" OR “Vaginal Wall Prolapse” OR "Cystocele"AND "Prevalence [key word/s]" were used. Additional articles were identified through the reference list of the retrieved articles. Results: Out of 91 screened articles, 46 full articles were eligible and only 15 satisfied by selection criteria for the systematic review.The methodological score rated for the quality of studies is 4.5±1.7 (range=2-7) out of 8 points. The mean prevalence of POP diagnosis was 40%; with 42.44% in low and lower-middle-income countries,and 35.56%in upper-middle and high-income countries. Increasing age and parity, body mass indexand fetal macrosomia were found to be the significant risk factors irrespective of the country’s economy. Conclusions:The low and lower-income countries have almost twice the burden of prolapse than the countries of the higher economy. The major risk factors associated with prolapse remain common in all countries irrespective of national income or development.

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A Systematic Review of Etiological Risk Factors Associated With Early Mortality Among National Football League Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118813312 ◽

2018 ◽

Vol 6 (12) ◽

pp. 232596711881331 ◽

Cited By ~ 4

Author(s):

Arthur H. Owora ◽

Brittany L. Kmush ◽

Bhavneet Walia ◽

Shane Sanders

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Mortality Risk ◽

National Football League ◽

The United States ◽

Early Mortality ◽

Male Population ◽

Level Of Evidence ◽

Factors Associated ◽

Specific Mortality

Background: Multiple risks predispose professional football players to adverse health outcomes and, in extreme cases, early death; however, our understanding of etiological risk factors related to early mortality is limited. Purpose: To identify etiological risk factors associated with all-cause and cause-specific mortality among National Football League (NFL) players. Study Design: Systematic review; Level of evidence, 3. Methods: Articles examining all-cause and cause-specific mortality risk factors among previous NFL players were identified by systematically searching: PubMed, PsycINFO, Web of Science, and Google Scholar from 1990 to 2017. Study eligibility and quality were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: A total of 801 nonduplicated studies were identified through our search strategy. Of these, 9 studies examining 11 different risk factors were included in the systematic review. Overall, the risk of all-cause and cause-specific mortality was lower among NFL players than among the general male population in the United States. Nonwhite athletes, those in power positions, and those with a high playing-time body mass index (≥30 kg/m2) were associated with elevated all-cause and cardiovascular mortality risks. Conclusion: Methodological issues associated with the examined all-cause and cause-specific mortality risk factors preclude a definitive conclusion of etiological protective or risk effects. Comparison groups less prone to selection bias (“healthy worker effect”) and a life-course approach to the evaluation of suspected risk factors are warranted to identify etiological factors associated with early mortality among NFL players.

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Evidence-Based Management of Gout - A Systematic Search and Review

10.20944/preprints202012.0156.v1 ◽

2020 ◽

Author(s):

Md Abu Bakar Siddiq

Keyword(s):

Risk Factors ◽

Treatment Options ◽

Evidence Based ◽

Level Of Evidence ◽

Pharmacological Agents ◽

New Synthesis ◽

Pubmed Database ◽

Anti Inflammatory ◽

Clinical Conditions

Gout is the most common form of inflammatory arthritis. Hyperuricaemia is the pre-requisite for gout and is influenced by variable modifiable and non-modifiable risk factors. Clinical features unique for gout are due to deposition of monosodium urate (MSU) crystal in articular and extra articular tissues. Among various treating agents, anti-inflammatory drugs and urate lowering therapies (ULT) are used widely and successfully, however, non-medicinal means are also effective in the disorder. In their updated guidelines, ACR (2012) and EULAR (2016) recommended both medicinal and non-medicinal approaches that could be used in treating gout, though some of the recommendations are based on lower level of evidence. Moreover, researchers’ continued effort in finding new gout managing agents appear promising, for example, role of Lesinurad in gout management (CLEAR1, CLEAR2). In this new synthesis the author is aimed to provide updated information on gout management based on a systematic review including published work within last ten years between 2008 and 2018 and for this purpose, using ‘clinical trials in gout management’ string, published worked searched in PubMed database from 1st September 2018 to 30 October 2018. Besides the recent ACR and EULAR evidence based management guidelines, the author reviewed another 91 (total 93) articles to make this new draft – 39 articles describe role of pharmacological agents and 54 describe different gout risks, pharmacokinetics/pharmacodynamics of ULT, association between raised sUA level and renal impairment, efficacy of non-pharmacological agents in reducing sUA. According to published work, anti-inflammatory agent is the most appropriate drug group in mitigating inflammatory symptoms of gout, though they often adversely affect over other vital 2 organs with impaired function. Besides ULT, uricase analogues are also found useful in non refractory gout. Since anti-inflammatory agents and ULT contraindicate in some clinical conditions, intra-articular steroid and or adrenocorticotropic hormone (ACTH) are appropriate alternatives instead. However, head-to-head comparison between different NSAIDs, NSAID and prednisolone, NSAID and colchicine are yet to perform. Use of combined anti-inflammatory preparations in gout is also based on lower level of evidence. Regarding effective maximum dose and long-standing impact of ULT on vital organs we are yet to reach a conclusion. Likewise, non-medicinal approaches are widely using in achieving target sUA level, though some of them are based on biased study outcomes and or study with inadequate power, requiring further analysis. Among non-pharmacological approaches, life-style modification, restriction of purine rich diets, avoidance of gout inciting agents are important, but inconclusive. Educating patients’ about diseases, risk factors, available treatment options and side effects from them are also important in terms of achieving sUA level, nevertheless too much counseling sometimes could be worthless.

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The Fragility of Statistical Significance in Patellofemoral Instability Research: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/03635465211039202 ◽

2021 ◽

pp. 036354652110392

Author(s):

Michael Constant ◽

David P. Trofa ◽

Bryan M. Saltzman ◽

Christopher S. Ahmad ◽

Xinning Li ◽

...

Keyword(s):

Systematic Review ◽

Statistical Significance ◽

Patellofemoral Instability ◽

Fragility Analysis ◽

P Value ◽

Level Of Evidence ◽

Pubmed Database ◽

Orthopaedic Literature ◽

Comparative Trials

Background: Fragility analysis is increasingly utilized to evaluate the robustness of results within the orthopaedic literature and has frequently revealed instability of reported outcomes. Purpose/Hypothesis: The purpose of this investigation was to utilize a fragility analysis to evaluate the stability of reported results in the patellofemoral instability (PFI) literature. We hypothesized the demonstration of significant fragility in patellofemoral research to be similar to that identified throughout other areas of the orthopaedic literature. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed database was queried from January 1, 2000, to October 10, 2020 for comparative trials in 10 prominent orthopaedic journals that reported dichotomous outcomes related to the management of PFI. The fragility index (FI) and the fragility quotient (FQ) were calculated for each individual outcome event, and the overall FI and FQ were determined for all included studies. Results: A total of 22 comparative studies comprising 11 randomized controlled trials and 11 nonrandomized trials were included for the analysis. A total of 75 outcome events underwent a fragility analysis and revealed a median FI and FQ of 3 (interquartile range [IQR], 1-5) and 0.043 (IQR, 0.018-0.081), respectively. Also 27% of included studies reported loss to follow-up greater than the overall FI, therefore suggesting the maintenance of the follow-up may have resulted in the reversal of significance. Conclusion: The result of the comprehensive fragility analysis demonstrated a lack of robustness in PFI research with the alteration of only a few outcome events required to reverse statistical significance. We therefore recommend the triple reporting of the P value, the FI, and the FQ to aid in the interpretation of the statistical integrity of future comparative trials in the PFI literature.

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Injury Prevention Programs for Throwing Injuries in Softball Players: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120978161 ◽

2021 ◽

pp. 194173812097816

Author(s):

Jonathan Paul ◽

Symone M. Brown ◽

Mary K. Mulcahey

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Range Of Motion ◽

Injury Prevention ◽

Prevention Program ◽

Dynamic Range ◽

Lower Extremities ◽

Prevention Programs ◽

Level Of Evidence ◽

Injury Prevention Program

Context: Throwing-related injuries occur commonly in softball players. Preventative programs can be implemented to assist in identifying and correcting risk factors that could potentially lead to injury and therefore time missed from both practice and games. Objective: The purpose of this study was to determine if position-specific injury prevention programs have been developed to decrease the risk of throwing-related injuries in softball players. Data Sources: A systematic review was performed using the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) guidelines. PubMed, PMC, and EBSCO were searched for articles on injury prevention programs using the following key terms: softball, injury prevention, throwing injuries, pitcher, and shoulder. Study Selection: Studies that involved fast-pitch softball and included female participants as well as rehabilitation programs were included. Articles that highlighted slow-pitch softball or did not include female participants were excluded. Level of Evidence: Level 1. Data Extraction: The initial search identified 1605 articles. After implementing a filter, 131 articles remained. Thirteen articles were screened out as duplicates. After screening for inclusion criteria, 7 articles remained and were included in the systematic review. Results: Decreased range of motion (ROM) in both the upper and the lower extremities, unbalanced muscular strength, and fatigue were identified as risk factors for throwing injuries in softball players. Within the upper extremity, strength and ROM of the rotator cuff muscles, biceps, and extensors of the forearm were emphasized. The main focus of the lower extremity was the strength of the gluteal muscles and ROM of the lumbopelvic-hip complex. Only 1 study detailed an injury prevention program for softball players. The prevention program outlined was generalized for all softball players and was not position specific. Conclusion: There is a paucity of information about injury prevention programs for softball players. Of the evidence analyzed, balanced strengthening of the upper and lower extremities while maintaining dynamic range of motion was frequently utilized in developing an injury prevention program.

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Effect of Injury Prevention Programs on Lower Extremity Performance in Youth Athletes: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119861117 ◽

2019 ◽

Vol 12 (1) ◽

pp. 12-22 ◽

Cited By ~ 3

Author(s):

Colleen Hanlon ◽

Joseph J. Krzak ◽

Janey Prodoehl ◽

Kathy D. Hall

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Lower Extremity ◽

Injury Prevention ◽

Injury Risk ◽

Prevention Programs ◽

Force Generation ◽

Level Of Evidence ◽

Youth Athletes ◽

Lower Extremity Performance

Background: Understanding how existing youth injury prevention programs affect specific modifiable injury risk factors will inform future program development for youth athletes. Objective: To comprehensively evaluate the effects of injury prevention programs on the modifiable intrinsic risk factors associated with lower extremity performance in youth athletes. Data Sources: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of the literature was performed using multiple databases (PubMed, EBSCOhost [including CINAHL, Medline, and SPORTDiscus], and PEDro). Secondary references were appraised for relevant articles. Article types included randomized or cluster randomized controlled trials and randomized cohort designs with youth athletes engaged in organized sports, along with outcomes that included at least 1 physical performance outcome measure. Study Selection: Eight studies met inclusion and exclusion criteria and were reviewed by 2 independent reviewers, with a third consulted in the case of disagreement, which was not needed. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Included studies underwent review of methodological quality using the Physiotherapy Evidence Database scale. Results: Studies included mixed-sex samples of youth athletes who predominantly participated in soccer at different skill levels. The FIFA 11+ series was the most commonly used injury prevention program. Among studies, the mean percentage of improvement identified was 11.3% for force generation, 5.7% for coordination, 5.2% for posture, and 5.2% for balance. The lowest mean percentage improvement was in speed (2.2%). Endurance was not significantly affected by any of the programs. Conclusion: This systematic review shows that injury prevention programs improve several modifiable intrinsic risk factors of lower extremity performance among youth athletes, particularly force generation. However, several intrinsic risk factors were either not significantly affected or specifically addressed by existing programs.

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Overuse Physeal Injuries in Youth Athletes

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117690847 ◽

2017 ◽

Vol 9 (2) ◽

pp. 139-147 ◽

Cited By ~ 29

Author(s):

Amanda Arnold ◽

Charles A. Thigpen ◽

Paul F. Beattie ◽

Michael J. Kissenberth ◽

Ellen Shanley

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Treatment Strategies ◽

Sports Participation ◽

Overuse Injuries ◽

Original Research ◽

Training Volume ◽

Level Of Evidence ◽

Prevention And Treatment ◽

Accelerated Growth

Context: Despite rising awareness of the risks associated with sports participation, overuse injuries continue to increase in youth athlete populations. Physeal injuries are one type of overuse injury exclusive to pediatric populations that are often sustained during athletic practice or competition. Overuse physeal injuries are, in theory, preventable; however, little consensus has been reached surrounding the risk factors, prevention, and treatment strategies. Objective: This systematic review summarizes the best available evidence concerning overuse physeal injuries in youth and adolescent athletes. It can be used to develop prevention and treatment programs specific to this population. Data Sources: PubMed and Academic Search Complete (EBSCOhost) were explored using the keyword physeal injuries from January 1950 through May 2015 to identify 24 studies. Study Selection: Original research studies of athletic populations with mechanisms of injury related to sport were chosen. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Data were extracted as available from 24 eligible studies. Study quality was rated using the Oxford Centre for Evidence-based Medicine (OCEBM) guidelines. Results: Risk factors for injury include periods of accelerated growth, chronological age, body size, training volume, and previous injury. Injury prevention strategies currently emphasize participation limitations and sport-specific training programs in skeletally immature athletes. The most effective treatment after an overuse physeal injury was an extended period of active rest and joint immobilization when necessary. Conclusion: Overuse physeal injuries are multifactorial in nature. Muscular imbalances after accelerated growth periods predispose young athletes to overuse injuries. Modifiable risk factors such as flexibility, strength, and training volume should be regularly monitored to prevent these injuries.

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Natural History and Treatment Strategies of Advanced PEComas: A Systematic Review

Cancers ◽

10.3390/cancers13205227 ◽

2021 ◽

Vol 13 (20) ◽

pp. 5227

Author(s):

Agathe Bourgmayer ◽

Simon Nannini ◽

Paul Bonjean ◽

Jean-Emmanuel Kurtz ◽

Gabriel G. Malouf ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Natural History ◽

Case Reports ◽

English Literature ◽

Treatment Strategies ◽

Risk Category ◽

Mesenchymal Tumors ◽

Entire Cohort ◽

Pubmed Database

PEComas is a family of rare mesenchymal tumors. This systematic review aims to better understand the natural history of advanced PEComas. After a search on the PubMed database and main oncology meeting libraries according to the PRISMA guidelines, 88 articles reported in the English literature were included. Data on clinical and histological features, treatments and outcomes were collected. To identify risk factors, univariate and multivariate analyses were performed. Seven cohorts of patients and 124 individual patients were identified. Focusing on case reports, most patients were metastatic, and the median overall survival (OS) of the entire cohort was 60 months (95%CI 33; NA). Risk factors significantly associated with OS in the multivariate analysis were the presence of metastasis at diagnosis (HR: 2.59, 95%CI 1.06;6.33, p = 0.036) and the grouped-Bleeker’s risk category (HR: 4.66; 95%CI 1.07;20.19; p = 0.039). In the metastatic population, only the presence of lymph node metastasis was associated with OS (HR: 3.11; 95%CI 1.13;8.60, p < 0.05). Due to a lack of events, it was not possible to conclude on other factors. This review of the literature highlights the heterogeneity of literature data and shows the great diversity of clinical management strategies.

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SEDENTARY BEHAVIOR AND CARDIOVASCULAR RISK IN CHILDREN: A SYSTEMATIC REVIEW

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220192505168868 ◽

2019 ◽

Vol 25 (5) ◽

pp. 433-441 ◽

Cited By ~ 2

Author(s):

Karina Lúcia Ribeiro Canabrava ◽

Paulo Roberto dos Santos Amorim ◽

Valter Paulo Neves Miranda ◽

Silvia Eloiza Priore ◽

Sylvia do Carmo Castro Franceschini

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Sedentary Behavior ◽

Sedentary Time ◽

Population Level ◽

Level Of Evidence ◽

Level I ◽

Sedentary Bouts

ABSTRACT In recognition of the increasing time spent in sedentary activities in modern life, an emerging area of study linking sedentary time to health has highlighted its role in the development of chronic diseases. Therefore, the objective of this systematic review was to investigate the indicators and characteristics of sedentary behavior associated with cardiovascular risk factors in children and adolescents. The databases SciVerse Scopus, MEDLINE®/PubMed and LILACS were selected as a source of reference, using the associated terms “sedentary lifestyle” or “sedentary behavior” or “sedentary” AND “cardiovascular diseases” AND “child or adolescent” to identify studies published from January 2006 to March 2019. The methodological quality of the studies was evaluated and a score was assigned. Fifty articles were included in this review at the end. Extensive sedentary time, especially greater screen and TV exposure time, were associated with cardiovascular risk factors. In addition, the accumulation of prolonged sedentary bouts with few breaks in sedentary time tended to compromise the cardiometabolic profile. These findings highlight the importance of differentiating and considering these various indicators and characteristics of sedentary behavior. Further studies are needed to elucidate the multiple and overlapping facets of sedentary behavior and their relationship with health, and to encourage the development of evidence-based recommendations for this population. Level of Evidence I; Systematic Review of Level I Studies.

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HIIT, RESISTANCE TRAINING, AND RISK FACTORS IN ADOLESCENTS: A SYSTEMATIC REVIEW

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220202606201837 ◽

2020 ◽

Vol 26 (6) ◽

pp. 558-564

Author(s):

Waynne Ferreira de Faria ◽

Filipe Rodrigues Mendonça ◽

Rui Gonçalves Marques Elias ◽

Raphael Gonçalves de Oliveira ◽

Antonio Stabelini Neto

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Resistance Training ◽

Physical Exercise ◽

Cardiometabolic Risk ◽

Randomized Clinical Trials ◽

Current Knowledge ◽

Cardiometabolic Risk Factors ◽

Fat Percentage ◽

Level Of Evidence

ABSTRACT It has been shown that combined physical exercise is an efficient non-pharmacological approach in the context of public health, since it has demonstrated satisfactory results in the prevention, treatment and control of various morbidities. Therefore, it is essential to systematize current knowledge to enable professionals involved in the prescription of physical exercise to do so based on evidence. Thus, the objective of this study was to perform a systematic review of randomized clinical trials to verify changes in cardiometabolic risk factors induced by high-intensity interval training (HIIT) and resistance training (RT) in adolescents. The systematic search was performed in the following databases: Pubmed, ScienceDirect, Cochrane, LILACS and Scielo. Initially 933 studies were identified, then two researchers eliminated duplications and manuscripts that did not meet the eligibility criteria. Thus, two articles were included that met these criteria: a randomized clinical trial conducted with adolescents (10 to 19 years) of both sexes, an intervention lasting for at least four weeks, which prescribed HIIT and RT in the same session or not, and evaluation of at least one cardiometabolic risk factor. The results demonstrated that eight to 12 weeks of HIIT and RT without nutritional intervention were effective in significantly reducing waist circumference and body fat percentage. However, data pertinent to the efficacy of this combination on risk of developing type 2 diabetes mellitus and arterial hypertension are controversial. In view of the above, it is ascertained from the included studies that the combination of HIIT and RT has the potential to reduce cardiometabolic risk factors in adolescents; therefore, further studies should be conducted to determine the effectiveness of this prescription of physical exercise. Level of Evidence II; Systematic review of Level II or Level I Studies with discrepant results.

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