scholarly journals Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 479
Author(s):  
Tatiana Sidiropoulou ◽  
Kalliopi Christodoulaki ◽  
Charalampos Siristatidis
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Randomized Controlled Trials ◽  
Success Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Technical Failure ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Meta Analyses

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

scholarly journals Almond Consumption and Risk Factors for Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2019 ◽  
Vol 10 (6) ◽  
pp. 1076-1088 ◽  
Author(s):  
Michelle A Lee-Bravatti ◽  
Jifan Wang ◽  
Esther E Avendano ◽  
Ligaya King ◽  
Elizabeth J Johnson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Body Weight ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Meta Analyses

ABSTRACT Evidence suggests that eating nuts may reduce the risk of cardiovascular disease (CVD). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating almond consumption and risk factors for CVD. MEDLINE, Cochrane Central, Commonwealth Agricultural Bureau, and previous systematic reviews were searched from 1990 through June 2017 for RCTs of ≥3 wk duration that evaluated almond compared with no almond consumption in adults who were either healthy or at risk for CVD. The most appropriate stratum was selected with an almond dose closer to 42.5 g, with a control most closely matched for macronutrient composition, energy intake, and similar intervention duration. The outcomes included risk factors for CVD. Random-effects model meta-analyses and subgroup meta-analyses were performed. Fifteen eligible trials analyzed a total of 534 subjects. Almond intervention significantly decreased total cholesterol (summary net change: −10.69 mg/dL; 95% CI: −16.75, −4.63 mg/dL), LDL cholesterol (summary net change: −5.83 mg/dL; 95% CI: −9.91, −1.75 mg/dL); body weight (summary net change: −1.39 kg; 95% CI: −2.49, −0.30 kg), HDL cholesterol (summary net change: −1.26 mg/dL; 95% CI: −2.47, −0.05 mg/dL), and apolipoprotein B (apoB) (summary net change: −6.67 mg/dL; 95% CI: −12.63, −0.72 mg/dL). Triglycerides, systolic blood pressure, apolipoprotein A1, high-sensitivity C-reactive protein, and lipoprotein (a) showed no difference between almond and control in the main and subgroup analyses. Fasting blood glucose, diastolic blood pressure, and body mass index significantly decreased with almond consumption of >42.5 g compared with ≤42.5 g. Almond consumption may reduce the risk of CVD by improving blood lipids and by decreasing body weight and apoB. Substantial heterogeneity in eligible studies regarding almond interventions and dosages precludes firmer conclusions.

Effect of mediterranean diets on cardiovascular risk factors and diseases in the primary prevention setting: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.V Hernandez ◽  
A Piscoya ◽  
K.M Marti ◽  
K.E Marti ◽  
V Pasupuleti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Primary Prevention ◽  
Randomized Controlled Trials ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Subgroup Analyses

Abstract Background The effects of Mediterranean diets (MED) on various health parameters suggest potential cardiovascular (CV) health benefits. Purpose We evaluated the effects of MED for primary prevention of CV risk factors and disease in overweight or obese adults. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed using PRISMA guidelines. PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, clinicaltrials.gov, and clinicaltrialsregister.eu were searched until January 2020. RCTs evaluating any type of MED compared to other diets or advice in adults were included. Predefined CV risk factors were lipid, liver, glucose, anthropometric, and blood pressure outcomes. Clinical outcomes were all cause mortality, CV mortality, myocardial infarction (MI), coronary artery disease, stroke, cerebrovascular disease, and diabetes. Meta-analyses of random effects models were performed and effects were described as mean difference (MD) and their 95% confidence intervals (CI). Subgroup analyses by weight, type of MED, type of control, and trial duration were performed when heterogeneity was high (I2&gt;60%). Results Eighteen RCTs (n=915) were included. Two RCTs evaluated only obese patients, 13 evaluated overweight and obese patients, and three did not specify. Fifteen RCTs evaluated MED alone while three evaluated MED combined with another diet. Thirteen RCTs evaluated effects of another diet while five evaluated diet advice or no treatment as controls. The median time to follow up was 6 months (range 6 weeks to 24 months). Clinical outcomes were only described in the revised 2018 PREDIMED trial where MED were associated with 35% lower risk of MI, stroke, and CV death vs advice (HR 0.65, 95% CI 0.50 to 0.85). MED were significantly associated with lower levels of triglycerides (TG) (MD −12.70 mg/dL, 95% CI −18.58 to −6.82), waist circumference (WC) (MD −1.92 cm, 95% CI −3.59 to −0.24), weight (MD −1.75 kg, 95% CI −2.82 to −0.69), and body mass index (BMI) (MD −0.69 kg/m2, 95% CI −1.11 to −0.27), and higher levels of HDL (MD 2.03 mg/dL, 95% CI 1.13 to 2.92) compared to other diets or advice. MED did not significantly change any other CV risk factors. Subgroup analyses showed some differences vs main analyses, but were based on a small set of RCTs in most of cases. Excluding five high risk of bias RCTs showed significant reductions in total cholesterol (MD −6.57 mg/dL, 95% CI −12.22 to −0.93), Fatty Liver Index (MD −23.30, 95% CI −30.20 to −16.40), HOMA-IR (MD −0.53, 95% CI −1.02 to −0.05), and SBP (MD −2.35 mmHg, 95% CI −4.02 to −0.68). Conclusion MED significantly decreased TG and anthropometric outcomes, and increased HDL when compared to other diets or advice. There was no significant association between MED and the other predefined CV risk factors. Newer RCTs without the flaws of PREDIMED are needed to further evaluate clinical outcomes. Funding Acknowledgement Type of funding source: None

scholarly journals Is Caloric Restriction Associated with Better Healthy Aging Outcomes? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2290
Author(s):  
Silvia Caristia ◽  
Marta De Vito ◽  
Andrea Sarro ◽  
Alessio Leone ◽  
Alessandro Pecere ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Status ◽  
Randomized Controlled Trials ◽  
Caloric Restriction ◽  
Healthy Aging ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Positive Effects ◽  
Randomized Controlled ◽  
Meta Analyses

Background: Global dietary patterns have gradually shifted toward a ‘western type’ with progressive increases in rates of metabolic imbalance. Recently, animal and human studies have revealed positive effects of caloric restriction (CR) on many health domains, giving new knowledge for prevention of ill and health promotion; Methods: We conducted a systematic review (SR) of randomized controlled trials (RCTs) investigating the role of CR on health status in adults. A meta-analysis was performed on anthropometric, cardiovascular and metabolic outcomes; Results: A total of 29 articles were retrieved including data from eight RCTs. All included RCTs were at low risk for performance bias related to objective outcomes. Collectively, articles included 704 subjects. Among the 334 subjects subjected to CR, the compliance with the intervention appeared generally high. Meta-analyses proved benefit of CR on reduction of body weight, BMI, fat mass, total cholesterol, while a minor impact was shown for LDL, fasting glucose and insulin levels. No effect emerged for HDL and blood pressure after CR. Data were insufficient for other hormone variables in relation to meta-analysis of CR effects; Conclusion: CR is a nutritional pattern linked to improved cardiometabolic status. However, evidence is limited on the multidimensional aspects of health and requires more studies of high quality to identify the precise impact of CR on health status and longevity.

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