The Impact of Bacteriospermia on Semen Parameters: A Meta-Analysis

Objective: To evaluate the impact of bacteriospermia on semen parameters. Materials and methods: We used the Medline (1966-2017), Scopus (2004-2017), Clinicaltrials.gov (2008-2017), EMBASE, (1980-2017), LILACS (1985-2017) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases in our primary search along with the reference lists of electronically retrieved full-text papers. Meta-analysis was performed with the RevMan 5.3 software. Results: Eighteen studies were finally included. Men were stratified in two groups, healthy controls (5,797 men) and those suffering from bacteriospermia (3,986 men). Total sperm volume was not affected by the presence of bacteriospermia when all pathogens were analyzed together (MD 0.02 95%CI -0.13,0.17). Both sperm concentration (MD -27.06, 95% CI -36.03, -18.08) and total sperm count (MD -15.12, 95% CI -21.08, -9.16) were significantly affected by bacteriospermia. Decreased rates of normal sperm morphology were also found (MD -5.43%, 95% CI -6.42, -4.44). The percentage of alive sperm was significantly affected by bacteriospermia (MD -4.39 %, 95% CI -8.25, -0.53).  Total motility was also affected by bacteriospermia (MD -3.64, 95% CI -6.45, -0.84). In addition to this, progressive motility was significantly affected (MD -12.81, 95% CI -18.09, -7.53). Last but not least, pH was importantly affected (MD 0.03, 95% Cl 0.01, 0.04). Conclusion: Bacteriospermia significantly affects semen parameters and should be taken in mind even when asymptomatic. Further studies should evaluate the impact of antibiotic treatment on semen parameters and provide evidence on fertility outcome

Anti-Müllerian Hormone Levels in Preeclampsia: A Systematic Review of the Literature

Objective: Serum Anti-Müllerian hormone (AMH) has been implicated in the pathogenesis of cardiovascular disease. Its prognostic value in determining the risk of developing preeclampsia remains, to date, unclear. The purpose of the present systematic review is to accumulate current evidence in this field. Materials and methods: We searched Medline (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017), EMBASE (1980-2017), LILACS (1986-2017) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases. Results: Four studies were included in with a total number of 401 women. Among them 146 had preeclampsia while 232 were recruited as normotensive controls. Current data are suggestive of the potential predictive value of serum AMH as its levels seem to be lower among women that develop preeclampsia. One study reported that women with and AMH value below the 10th percentile of the studied population had a 3.3 increased risk of developing preeclampsia (OR 3.3, 95% CI 1.2–8.7, p = 0.01). Conclusion: Taking in mind these findings, future studies are needed in this field to establish optimal cut-off values and evaluate the specificity and sensitivity of this biomarker during the first trimester of pregnancy

Obstetric anal sphincter injury: a systematic review of information available on the internet.

OBJECTIVE: There is no systematic evaluation of online health information pertaining to obstetric anal sphincter injury. Therefore, we evaluated the accuracy, credibility, reliability, and readability of online information concerning obstetric anal sphincter injury. MATERIALS AND METHODS: Multiple search engines were searched. The first 30 webpages were identified for each keyword and considered eligible if they provided information regarding obstetric anal sphincter injury. Eligible webpages were assessed by two independent researchers for accuracy (prioritised criteria based upon the RCOG Third and Fourth Degree Tear guideline); credibility; reliability; and readability. RESULTS: Fifty-eight webpages were included. Seventeen webpages (30%) had obtained Health On the Net certification, or Information Standard approval and performed better than those without such approvals (p = 0.039). The best overall performing website was http://www.pat.nhs.uk (score of 146.7). A single webpage (1%) fulfilled the entire criteria for accuracy with a score of 18: www.tamesidehospital.nhs.uk . Twenty-nine webpages (50%) were assessed as credible (scores ≥7). A single webpage achieved a maximum credibility score of 10: www.meht.nhs.uk . Over a third (21 out of 58) were rated as poor or very poor. The highest scoring webpage was http://www.royalsurrey.nhs.uk (score 62). No webpage met the recommended Flesch Reading Ease Score above 70. The intra-class coefficient between researchers was 0.98 (95% CI 0.96-0.99) and 0.94 (95% CI 0.89-0.96) for accuracy and reliability assessments. CONCLUSION: Online information concerning obstetric anal sphincter injury often uses language that is inappropriate for a lay audience and lacks sufficient accuracy, credibility, and reliability

A systematic review of outcome and outcome-measure reporting in randomised trials evaluating surgical interventions for anterior-compartment vaginal prolapse: a call to action to develop a core outcome set

INTRODUCTION: We assessed outcome and outcome-measure reporting in randomised controlled trials evaluating surgical interventions for anterior-compartment vaginal prolapse and explored the relationships between outcome reporting quality with journal impact factor, year of publication, and methodological quality. METHODS: We searched the bibliographical databases from inception to October 2017. Two researchers independently selected studies and assessed study characteristics, methodological quality (Jadad criteria; range 1-5), and outcome reporting quality Management of Otitis Media with Effusion in Cleft Palate (MOMENT) criteria; range 1-6], and extracted relevant data. We used a multivariate linear regression to assess associations between outcome reporting quality and other variables. RESULTS: Eighty publications reporting data from 10,924 participants were included. Seventeen different surgical interventions were evaluated. One hundred different outcomes and 112 outcome measures were reported. Outcomes were inconsistently reported across trials; for example, 43 trials reported anatomical treatment success rates (12 outcome measures), 25 trials reported quality of life (15 outcome measures) and eight trials reported postoperative pain (seven outcome measures). Multivariate linear regression demonstrated a relationship between outcome reporting quality with methodological quality (β = 0.412; P = 0.018). No relationship was demonstrated between outcome reporting quality with impact factor (β = 0.078; P = 0.306), year of publication (β = 0.149; P = 0.295), study size (β = 0.008; P = 0.961) and commercial funding (β = -0.013; P = 0.918). CONCLUSIONS: Anterior-compartment vaginal prolapse trials report many different outcomes and outcome measures and often neglect to report important safety outcomes. Developing, disseminating and implementing a core outcome set will help address these issues

Η επίδραση του υποθυρεοειδισμού στην ορμονική ρύθμιση των μεταβολών του επιθηλίου του μαζικού αδένα σε πειραματικό μοντέλο

In this experimental study conducted in 34 rats we failed to observe mitoses in both groups. However it was found that rats of the thyroidectomy group showed significantly more atrophy (p = 0.015) and fibrosis (p = 0.022) compared with those in the control group, conditions which seem to be implicated in the future development of breast cancer.The values of estradiol ten days after the surgery didn’t differ between animals treated with thyroidectomy and those representing the control group (72.95 pg / ml for the animals of the control group versus 78.70 pg / ml for operated animals p = 0.592) . However, values of FSH appeared to be significantly lower among animals treated with thyroidectomy (158.69 ng / ml for the control animals versus 118.97 ng / ml for operated p = 0.014). The explanation regarding the fall in the levels of both hormones when compared with baseline levels isn’t known.Conclusively we showed that the thyroid gland is clearly involved in the growth and preservation of the morphology of the mammary gland. Hypothyroidism, when established for a certain time period, seems to be associated with the emergence of atrophy and fibrosis or in more advanced stages of lobular dilatation, leading to a morphological appearance approaching that of menopause. We cannot rule out the possible occurrence of precancerous lesions when this status is maintained for a longer period of time.Στην παρούσα πειραματική μελέτη που πραγματοποιήθηκε σε 34 επίμυες δεν παρατηρήθηκαν πυρηνοκινησίες μεταξύ των δύο ομάδων. Ωστόσο παρατηρήθηκε ότι οι επίμυες της θυρεοειδεκτομηθείσας ομάδας εμφάνισαν σε σημαντικά μεγαλύτερο βαθμό τόσο ατροφία (p=0.015) όσο και ίνωση (p=0.022) σε σχέση με αυτούς της ομάδας ελέγχου, καταστάσεων οι οποίες φαίνεται να ενοχοποιούνται για τη μελλοντική ανάπτυξη καρκίνου του μαστού.Οι τιμές της οιστραδιόλης δέκα ημέρες μετά την επέμβαση δεν διέφεραν σε στατιστικά σημαντικό επίπεδο στα θυρεοειδεκτομηθέντα ζώα σε σχέση με τα ζώα της ομάδας ελέγχου (72.95 pg/ml για τα ζώα της ομάδας ελέγχου έναντι 78.70 pg/ml για τα θυρεοειδεκτομηθέντα ζώα p=0.592). Αντίθετα οι τιμές της θυλακιοτρόπου ορμόνης φάνηκε ότι ήταν σημαντικά χαμηλότερες από αυτές των ζώων της ομάδας ελέγχου (158.69 ng/ml για τα ζώα της ομάδας ελέγχου έναντι 118.97 ng/ml για τα θυρεοειδεκτομηθέντα ζώα p=0.014). Η εξήγηση ωστόσο της πτώσης των επιπέδων και των δύο ορμονών σε σχέση με τις τιμές τους στην αρχή του πειράματος παραμένει άγνωστη.Συμπερασματικά φαίνεται ότι ο θυρεοειδής αδένας σαφώς συμμετέχει στην ανάπυξη και διατήρηση της μορφολογίας του μαζικού αδένα. Η απουσία αυτού δε για ικανό χρονικό διάστημα φαίνεται να σχετίζεται με την εμφάνιση ατροφίας και ίνωσης ή σε ακόμα πιο προχωρημένα στάδια και με διάταση των λοβίων, οδηγώντας σε μία μορφολογική εμφάνιση που προσεγγίζει αυτή της εμμηνόπαυσης, ενώ δεν μπορεί να αποκλεισθεί η πιθανότητα της εμφάνισης προκαρκινικών αλλοιώσεων με επέκταση του υποθυρεοειδισμού σε μεγαλύτερο χρονικό διάστημα παρακολούθησης

Tranexamic acid for the prevention of postpartum hemorrhage in women undergoing cesarean delivery: an updated meta-analysis.

OBJECTIVE: This study aimed to assess the efficacy and safety of prophylactic tranexamic acid administration vs standard uterotonic agents alone among women undergoing cesarean delivery. DATA SOURCES: MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Google Scholar were systematically searched from inception to June 30, 2021. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials comparing intravenous tranexamic acid administration with placebo in women undergoing cesarean delivery and receiving standard prophylactic uterotonic agents were held eligible. STUDY APPRAISAL AND SYNTHESIS METHODS: The risk of bias of individual studies was appraised with the Risk of Bias 2 tool. Meta-analysis was conducted by fitting random-effects models using restricted maximum likelihood. Subgroup analysis was performed on the basis of country, protocol availability, double-blinding, risk of bias, sample size, and tranexamic acid dose. A 1-stage meta-analysis was performed as a sensitivity analysis. The credibility of outcomes was appraised with the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Overall, 36 studies with 10,659 women were included. Tranexamic acid administration was associated with significantly lower total blood loss (mean difference, -189.44 mL; 95% confidence intervals, -218.63 to -160.25), lower hemoglobin drop (mean difference, 8.22%; 95% confidence interval, 5.54-10.90), decreased risk of blood loss of >1000 mL (odds ratio, 0.37; 95% confidence interval, 0.22-0.60), transfusion requirement (odds ratio, 0.41; 95% confidence interval, 0.26-0.65), and need of additional uterotonics (odds ratio, 0.36; 95% confidence interval, 0.25-0.52). Subgroup analysis indicated a greater effect of tranexamic acid on total blood loss reduction in low-middle income countries. The outcomes remained stable by separately evaluating women at low bleeding risk. The 1-stage meta-analysis demonstrated similar outcomes with the primary analysis. The quality of evidence was judged to be moderate regarding total blood loss and hemoglobin percentage change and low for the other outcomes. CONCLUSION: This meta-analysis suggested that prophylactic tranexamic acid administration is effective among women undergoing cesarean delivery in lowering postpartum blood loss and limiting hemoglobin drop. Further research is needed to test its efficacy in high-risk populations and verify its safety profile

Helicobacter pylori infection increases the risk of developing preeclampsia: A meta-analysis of observational studies

BackgroundHelicobacter pylori has been previously linked with preeclampsia on the basis of altered angiogenesis and activation of inflammatory cytokines. PurposeThe purpose of the present systematic review is to summarise current evidence concerning the correlation of the two diseases. Materials and MethodsWe searched the Medline (1966-2017), Scopus (2004-2017), Clinicaltrials.gov (2008-2017) EMBASE (1980-2017), and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases. We selected all observational studies (both prospective and retrospective) that reported the incidence of preeclampsia among women with H. Pylori infection. Statistical meta-analysis was performed with the RevMan 5.3 software. ResultsFourteen studies were finally included in this review, which included a total number of 9787 women. Nine percentage of these had preeclampsia (879 women). The evaluation of studies with the ROBINS-I tool revealed low to moderate risk of bias. H. pylori IgG seropositivity was significantly more prevalent in preeclamptic than in healthy pregnant women (9391 women, OR: 2.32, 95% CI [1.55, 3.46]). The frequency of anti-CagA antibodies was also higher in pregnancies complicated with preeclampsia (3275 women, OR: 3.97, 95% CI [1.55, 10.19]). ConclusionThe findings of our study support that H. pylori infection doubles the risk of developing preeclampsia. The exact pathophysiological processes, however, remain poorly investigated and future experimental studies are needed to shed light on the underlying mechanisms