Latest news with #systematicReview
Medscape
29-05-2025
- Health
- Medscape
Bariatric Surgery Linked With Psoriasis Improvement
Most patients with psoriasis experienced clinical improvement or remission after metabolic and bariatric surgery (MBS) in a systematic review. METHODOLOGY: Researchers conducted a systematic review of 14 studies that included 169 patients (mean age, 46.8 years; 74% women) with psoriasis who underwent MBS. Participants underwent various surgical procedures; gastric bypass was the most common (75.1%), followed by sleeve gastrectomy (17.8%), gastric banding (5.3%), and jejunoileal bypass (0.6%). Psoriasis treatments prior to surgery included topical treatments (46.2%), non-biologic systemic treatments (35.5%), and biologics (16.6%). At baseline, psoriasis severity was predominantly moderate (76.3%); 8.2% were severe and 15.6% were mild cases, based on psoriasis area and severity index and percent body surface area scores. TAKEAWAY: Average body mass index (BMI) decreased from 43.7 at baseline to 32.9after surgery, with BMI reduction ranging from 8 to 25 during follow-up periods of 4 months to 9 years. Psoriasis was either mild or had completely resolved in 97.2% of patients after bariatric surgery, whereas 2.4% experienced worsening of psoriasis. A total of 78.1% of patients continued psoriasis treatment post-surgery, but medications were downgraded to a lower category (such as systemic to topical treatments, or no treatment) in many patients. IN PRACTICE: 'MBS may improve psoriasis outcomes following surgery,' the study authors wrote. 'While initial findings are promising, further controlled trials are necessary to validate the long-term effects of MBS on psoriasis and explore its potential role as an adjunctive therapy.' SOURCE: The study was led by Miranda K. Branyiczky, BSc, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada, and was published online on May 24 in the Journal of the American Academy of Dermatology . LIMITATIONS: Limitations were reporting bias, variability in outcome measures, and the inclusion of case reports or series. DISCLOSURES: This study did not receive any funding. One author reported receiving grants, research support, speaker fees, and honoraria from multiple pharmaceutical companies including AbbVie, Alumis, Amgen, Arcutis Biotherapeutics, Bristol Myers Squibb, Eli Lilly and Company, Janssen Pharmaceuticals, Novartis, and Pfizer.
Medscape
28-05-2025
- General
- Medscape
Fast Five Quiz: Acute Management for Migraine
Migraine is a complex disorder characterized by recurrent episodes of headache often associated with visual or sensory symptoms, collectively known as an aura, that usually arise before the head pain but that might occur during or afterward. Further, migraine has a strong genetic component. Additionally, a variety of environmental and behavioral factors might precipitate migraine attacks in individuals with a predisposition to migraine. Acute management of migraine headache should provide rapid relief from headache pain and related symptoms, restore patient functioning, and prevent recurrence. What do you know about acute management for migraine? Check your knowledge with this quick quiz. Acute medications for migraine include triptans, ergotamine derivatives, gepants, and certain serotonin 5-HT1F receptor agonists, although nonspecific drugs such as NSAIDs can be used as well. A recent systematic review and network meta-analysis found that triptans have the best safety profiles and efficacy for treating migraine when compared with other drugs such as certain serotonin 5-HT1F receptor agonists, gepants, and NSAIDs. Featured head-to-head comparisons found that the triptans were the most efficacious for pain freedom at 2 hours. However, the same meta-analysis noted that cost effectiveness and cardiovascular risk should also be considered before use, as 'cerebrovascular events may present primarily as migraine-like headaches, and misdiagnosis of transient ischemic attack and minor stroke as migraine is not rare.' Learn more about triptans for migraine. For acute treatment of migraine, the American Headache Society (AHS) recommends administering medical therapy as soon as symptoms appear; more specifically, researchers note that within 30 minutes is preferable, according to a recent review. Other sources suggest utilizing therapy within 15 minutes for those who experience migraine with aura. This time frame is generally more effective for management rather than specifically waiting for aura phase to complete or when pain reaches moderate intensity. However, even if a patient is unable to take medication within that time frame, taking medication during the episode can reduce symptom severity and migraine duration. A recent meta-analysis also explored the difference in efficacy between different acute medications for migraine, which can be found here. Learn more about acute treatments for migraine. The AHS encourages the use of validated measures of migraine treatment response to guide management decisions. Specifically, they suggest mTOQ for assessing acute treatment, as well as the Migraine Assessment of Current Therapy (Migraine-ACT), Patient Perception of Migraine Questionnaire (PPMQ-R), Functional Impairment Scale (FIS). In the same guidelines, the AHS suggests PGIC, MFIQ, or MSQ v2.1 as valid instruments for measuring response to preventative migraine treatment. Learn more about migraine severity measures. REN is approved for use by the FDA for both prophylactic and acute treatment of migraine in adults and pediatric patients ages 8 years and older. For migraine prevention and treatment, eTNS and TENS are approved only for adults, and eCOT-NS is approved only for acute treatment in adults with migraine. Of the approved devices, eTNS, REN, and noninvasive vagus nerve stimulation (nVNS) are specifically mentioned by the AHS for use alone or in conjunction with pharmacotherapy, and single-pulse transcranial magnetic stimulation (sTMS) can also be used as monotherapy for preventive treatment. Further, nVNS and sTMS can be used in both patients 12-17 years and adults. Learn more about the acute management for migraine. Before a patient can initiate acute treatment for migraine with gepants, ditans, or neuromodulatory devices, the AHS recommends trialing at least two oral triptans. Treatment failure can be assessed by validated patient-reported outcome questionnaires (mTOQ, Migraine-ACT, PPMQ-R, FIS, PGIC) or clinician attestation. Risk factors for an inadequate response to triptan include severe baseline headache severity, nausea, depression, photophobia, and phonophobia. Further, triptans are contraindicated for patients with vascular diseases. CGRP inhibitors are usually not recommended as an initial acute treatment for migraine. Though caffeine can be used as an adjuvant to initial analgesics for migraine, it usually does not determine the initiation of gepants, ditans, or neuromodulatory devices. Inadequate response to combination therapy including NSAIDs, a recommended non-pharmacologic regimen, and CGRP inhibitors are not part of the criteria for initiating acute treatment with gepants, ditans, or neuromodulatory devices from the AHS. Learn more about acute treatments for migraine.
Medscape
23-05-2025
- Health
- Medscape
Ultrasound Achieves 95% Accuracy for Testicular Torsion
A systematic review and meta-analysis found that ultrasound had a high diagnostic accuracy for testicular torsion, with colour Doppler sonography achieved a sensitivity of 95.3% and a specificity of 98.3% in its detection. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 63 studies that included men presenting to secondary or tertiary care with suspected testicular torsion and who subsequently underwent diagnostic assessment with ultrasound. The analysis included colour Doppler sonography as the primary index test, with surgical scrotal exploration or clinical follow-up as reference standards. Of the studies included, 54 (85.7%) assessed colour Doppler sonography, and the others examined spectral Doppler sonography, contrast-enhanced ultrasound, or alternative ultrasound technologies. TAKEAWAY: Across 42 studies involving 4422 participants, colour Doppler sonography demonstrated high diagnostic accuracy, with a sensitivity of 95.3% (95% CI, 91.4-97.5) and a specificity of 98.3% (95% CI, 96.2-99.3) in detecting testicular torsion. The positive predictive value was 96.1% (95% CI, 91.4-98.4) and the negative predictive value was 97.9% (95% CI, 96.2-98.9), based on 1358 cases of testicular torsion. The analysis revealed that younger patient age, non-radiologist user status, and the implementation of point-of-care ultrasound did not have a significant effect on diagnostic accuracy. IN PRACTICE: "There is evidence to suggest that ultrasound is highly sensitive and specific for TT [testicular torsion] detection. The ideal patient pathway for suspected TT should integrate timely access to ultrasound alongside clinical assessment, with careful patient counselling," the authors wrote. SOURCE: This study was led by Cameron E. Alexander, Luton and Dunstable University Hospital, Luton, England. It was published online on May 13, 2025, in European Urology Focus . LIMITATIONS: Insufficient data reporting prevented the assessment of the effect of several predefined factors on diagnostic accuracy. Although the accuracy has improved over time with modern technology, previous studies demonstrated that junior radiologists were more likely to yield false negative results in a multicentre European study. DISCLOSURES: This study did not receive any specific funding. One author reported receiving infrastructure support from the National Institute for Health and Care Research Imperial Biomedical Research Centre and Imperial College Experimental Cancer Medicine Centre, research funding from the Urology Foundation, consultation fees from Janssen and Varian, and funding to attend scientific conferences from Janssen and Sonablate Corp.
