Autologous conditioned serum applications in the treatment of musculoskeletal diseases: a narrative review

Aim: Autologous conditioned serum has been studied as a treatment option in musculoskeletal disorders and resulted in varying outcomes. This study aims to pool the current data on this matter. Materials & methods: Major databases were searched for the topics, and after screening the results, the final 21 papers (level of evidence I or II) were included. Results & conclusion: This study showed a major focus of the literature on the effectiveness of autologous conditioned serum in osteoarthritis, in which there is much high-quality evidence suggesting its safety and efficacy. Also, some of the available experiments are assessing its application in tendinopathies and radiculopathies which, despite positive results, recommend further evaluations on this topic.

Passive immune therapies: another tool against COVID-19

Passive immune therapy consists of several different therapies, convalescent plasma, hyperimmune globulin, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing monoclonal antibodies. Although these treatments were not part of any pandemic planning prior to coronavirus disease 2019 (COVID-19), due to the absence of high-quality evidence demonstrating benefit in other severe respiratory infections, a large amount of research has now been performed to demonstrate their benefit or lack of benefit in different patient groups. This review summarizes the evidence up to July 2021 on their use and also when they should not be used or when additional data are required. Vaccination against SARS-CoV-2 is the most important method of preventing severe and fatal COVID-19 in people who have an intact immune system. Passive immune therapy should only be considered for patients at high risk of severe or fatal COVID-19. The only therapy that has received full regulatory approval is the casirivimab/imdevimab monoclonal cocktail; all other treatments are being used under emergency use authorizations. In Japan, it has been licensed to treat patients with mild to moderate COVID-19, and in the United Kingdom, it has also been licensed to prevent infection.

Society of Vascular and Interventional Neurology Standards and Parameters for Guideline Development and Publication

BACKGROUND As much of the scope of neurointerventional practice falls outside data covered by existing randomized clinical trials, and, as a result, may have failed to enter into existing guidelines, an evidence‐based framework for guideline and standards development is needed. We establish an evidence‐based framework to guide all subsequent guidelines and brief practice updates produced by the Society of Vascular and Interventional Neurology (SVIN). METHODS The SVIN formed the Guidelines and Practice Parameters committee to develop the structure and procedures for guidelines and brief practice updates. RESULTS In this article, the Guidelines and Practice Parameters committee has outlined the process by which the guidelines will be created and approved by the SVIN. Additionally, the Guidelines and Practice Parameters committee has adopted the American College of Cardiology/American Heart Association framework of Class of Recommendation and Level of Evidence. A unique, additional separation of the Expert Opinion endorsement category has been developed when high‐quality evidence does not exist at the time of the publication. CONCLUSIONS The SVIN has developed an evidence‐based framework for all guideline statements and brief practice updates. The SVIN guidelines and brief practice updates will guide clinicians in the field of interventional neurology to improve and standardize patient care.

Acupuncture For Major Depressive Disorder: A Systematic Review and Meta-Analysis of High-Quality Randomized Control Trials

Background: The effects of acupuncture for major depressive disorder (MDD) uncertain. This review aims to determine the effects of Acupuncture for MDD .Methods: Eight Database were searched to identify randomized control trials (RCTs) on Acupuncture for MDD. All RCTs with adult participants undergoing acupuncture treatment for MDD were included. The primary outcome measure was the 24-item Hamilton rating scale for depression (HAMD-24). We used random-effects meta-analysis to synthesis the results with mean difference or odds ratio. Furthermore, the potential heterogeneity was tested through meta-regression/subgroup analyses/sensitive analysis. The quality of evidence for each outcome was assessed by the Grading of Recommendations Assessment, Development and Evaluation approach.Results: Forty-three studies were included: 9 acupuncture versus sham-acupuncture (n=920), 26 acupuncture versus antidepressants (n=2169), 9 acupuncture plus antidepressants versus antidepressants (n=667). Of the 43 high-quality articles, 24 and 8 were determined to have a low and moderate risk of bias, respectively. The pooled results for HAMD-24 and SDS revealed the clinical benefits of Acupuncture or Acupuncture plus antidepressants compared to sham-acupuncture or antidepressants, with high quality evidence. Furthermore, high quality of evidence showed that acupuncture led to fewer adverse effects compared to antidepressants.Conclusions: Acupuncture or acupuncture plus antidepressants were significantly associated with reduced HAMD-24 scores, with high-quality evidence. More rigorous trials are needed to identify the optimal frequency of Acupuncture for MDD and integrate such evidence into clinical care to reduce antidepressant use.

Peripheral Nerve Stimulation for Treatment of Headaches: An Evidence-Based Review

Headaches are one of the most common medical complaints worldwide, and treatment is often made difficult because of misclassification. Peripheral nerve stimulation has emerged as a novel treatment for the treatment of intractable headaches in recent years. While high-quality evidence does exist regarding its use, efficacy is generally limited to specific nerves and headache types. While much research remains to bring this technology to the mainstream, clinicians are increasingly able to provide safe yet efficacious pain control.

Supporting policy and practice in Ontario through ICES’ Applied Health Research Question (AHRQ) Program

ICES upholds a strong reputation for generating high-quality evidence to inform policy and practice through its collaborations with a broad range of health system stakeholders including government policymakers and healthcare providers including clinicians. Supported by the Ontario Ministry of Health and Ministry of Long-Term Care, the ICES Applied Health Research Question (AHRQ) Program leverages the data holdings and, scientific and clinical expertise to generate evidence tailored to the information needs of requestors. This paper outlines the approach, process, strengths, challenges and the resulting influence and impact to the healthcare landscape in Ontario.

Fertility-Sparing Treatment of Patients with Endometrial Cancer: A Review of the Literature

Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries. Although it is more common in postmenopausal women, it may affect up to 25% in the premenopausal age and 3–5% under the age of 40 years. Furthermore, in the last decades a significant shift to pregnancy at older maternal ages, particularly in resource-rich countries, has been observed. Therefore, in this scenario fertility-sparing alternatives should be discussed with patients affected by EC. This study summarizes available literature on fertility-sparing management of patients affected by EC, focusing on the oncologic and reproductive outcomes. A systematic computerized search of the literature was performed in two electronic databases (PubMed and MEDLINE) in order to identify relevant articles to be included for the purpose of this systematic review. On the basis of available evidence, fertility-sparing alternatives are oral progestins alone or in combination with other drugs, levonorgestrel intrauterine system and hysteroscopic resection in association with progestin therapies. These strategies seem feasible and safe for young patients with G1 endometrioid EC limited to the endometrium. However, there is a lack of high-quality evidence on the efficacy and safety of fertility-sparing treatments and future well-designed studies are required.

Overview of potential drugs for the treatment of new coronavirus Infection (COVID-19)

The new coronavirus infection (SARS-CoV-2), better known as COVID-19, quickly evolved into a worldwide pandemic with a significant public health burden. Currently, there are no approved drugs or preventive therapeutic strategies to combat infection. Decisions about prescribing many medications are made based on the results obtained in in vitro studies, or expert opinions. Most of the drugs currently used to treat COVID-19 are approved antivirals or antibodies against other diseases. However, there are hundreds of clinical studies underway around the world to discover effective treatments for COVID-19. This article summarizes the results of clinical studies of potential therapeutic drugs used as COVID-19 therapy. Based on this review, it can be concluded that there is still no high-quality evidence to support any of the drugs described below. Until the unambiguous results of randomized controlled trials are available, the use of any of the following drugs is not clinically proven as an effective treatment for COVID-19.

Subxiphoid thoracoscopic thymectomy for myasthenia gravis

We investigated the efficacy of subxiphoid thoracoscopic thymectomy in patients with myasthenia gravis. The data of 37 consecutive cases were reviewed. 2 cases of postoperative myasthenia gravis crisis and 4 cases of residual mediastinal fat tissue were recorded. Moreover, 29 patients presented the neurological outcomes, and complete stable remission was achieved in 5 (17.2%) cases. Subxiphoid thymectomy is technically feasible. High-quality evidence is warranted before this approach can be recommended.

Is there an indication for surgery in patients with spinal deformities? – A critical appraisal

Background: High-quality evidence exists to support physiotherapy and brace treatment for scoliosis and other spinal deformities. However, according to previous systematic reviews, it seems that no evidence exists for surgery. Nevertheless, the number of research articles focussing on spinal surgery highly exceeds the number of articles focussing on conservative treatment.Objective: The purpose of this study is to conduct an updated search for systematic reviews providing high-quality evidence for spinal surgery in patients with spinal deformities.Method: A narrative review including PubMed and the Cochrane database was conducted on April 12, 2020, with the following search terms: (1) spinal deformities, surgery, systematic review and outcome; (2) kyphosis, surgery, systematic review and outcome; (3) Scheuermann’s disease, surgery, systematic review and outcome, and (4) scoliosis, surgery, systematic review and outcome.Results: No reviews containing prospective controlled or randomised controlled studies were found providing evidence for surgery.Conclusions: A general indication for spine surgery just based on the Cobb angle is not given. In view of the long-term unknown variables and the possible long-term complications of such treatment, a surgical indication for patients with spinal deformities must be reviewed on an individual basis and considered carefully. A current systematic review appears necessary in order to be able to draw final conclusions on the indication for surgery in patients with spinal deformities.Clinical implications: In view of the increasing number of surgeons with an affiliation to industry, the indication for surgery needs to be given by independent conservative specialists for spinal deformities in order to provide an objective recommendation.