Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jul 2007
ReviewWITHDRAWN: Maternal iodine supplements in areas of deficiency.
Iodine deficiency is the leading preventable cause of intellectual impairment in the world. Although iodine supplementation is generally considered to be safe, there is a possibility of high doses of iodine suppressing maternal thyroid function. ⋯ Iodine supplementation in a population with high levels of endemic cretinism results in an important reduction in the incidence of the condition with no apparent adverse effects.
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Cochrane Db Syst Rev · Jul 2007
ReviewWITHDRAWN: Cytomegalovirus prophylaxis with antiviral agents for solid organ transplantation.
Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality in solid organ transplantation. It is also associated with an increased risk of opportunistic infections, allograft injury and higher transplantation costs. CMV infection also seems to increase the risk of acute and chronic rejection of allografts via immune-mediated vascular injury. These serious consequences of CMV disease have lead to the development of effective strategies for the prevention, early diagnosis and treatment. However, there is no consensus on the necessity and the efficacy of CMV prophylaxis. ⋯ The use of antiviral agents for the prevention of cytomegalovirus disease and cytomegalovirus infection in solid organ transplantation is supported by this meta-analysis.
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Cochrane Db Syst Rev · Jul 2007
ReviewExercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal damage of the knee in adults.
The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. The ACL may be damaged in isolation but often other ligaments and menisci are implicated. The injury may be managed surgically or conservatively. Injury causes pain, effusion and inflammation leading to alteration in muscle function. Regaining muscular control is essential if the individual wishes to return to pre-injury level of function and patients will invariably be referred for rehabilitation. ⋯ This review has demonstrated an absence of evidence to support one form of exercise intervention over another. Further research should be considered in the form of large scale well-designed and well-reported randomised controlled trials with suitable outcome measures and surveillance periods. Suitable outcome measures should include a measure of functional outcome relevant to the individual.
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Cochrane Db Syst Rev · Jul 2007
ReviewWITHDRAWN: Antidepressants for depression in medical illness.
Depression in the physically unwell is common and an important cause of morbidity. There are problems with diagnosing depression in the physically ill which may lead to under-recognition and under-treatment. In clinical practice antidepressants are available and a feasible option for treating depressive disorders. Therefore we thought it would be a reasonable first step in addressing this problem to describe the literature of randomised controlled trials in this area. ⋯ The review provides evidence that antidepressants, significantly more frequently than either placebo or no treatment, cause improvement in depression in patients with a wide range of physical diseases. About 4 patients would need to be treated with antidepressants to produce one recovery from depression which would not have occurred had they been given placebo (NNT 4.2, 95% CI 3.2-6.4). Antidepressants seem reasonably acceptable to patients, in that about 10 patients would need to be treated with antidepressants to produce one dropout from treatment which would not have occurred had they been given placebo (NNH 9.8, 95% CI 5.4-42.9).The evidence is consistent across the trials, apart from 2 trials in cancer, where the "atypical" antidepressant mianserin produced significantly less dropout than placebo. Trends towards tricyclics being more effective than SSRIs, but also more likely to produce dropout were noted, but these are based on non-randomised comparisons between trials. Problems with the evidence include most of the trials' use of observers, rather than patients, to decide on improvement, and concentration mainly on symptoms rather than function and quality of life. There is also a possibility of undetected negative trials.Nevertheless, the review provides evidence that use of antidepressants should at least be considered in those with both physical illness and depression. Regarding diagnosis, the existence of a cheap and readily available treatment for depression should encourage detailed assessment of persistent low mood in the physically ill.
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Diabetes has long been recognised as a strong, independent risk factor for cardiovascular disease, a problem which accounts for approximately 70% of all mortality in people with diabetes. Prospective studies show that compared to their non-diabetic counterparts, the relative risk of cardiovascular mortality for men with diabetes is two to three and for women with diabetes is three to four. The two biggest trials in type 2 diabetes, the United Kingdom Prospective Diabetes Study (UKPDS) and the University Group Diabetes Program (UGDP) study did not reveal a reduction of cardiovascular endpoints through improved metabolic control. Theoretical benefits of the peroxisome proliferator activated receptor gamma (PPAR-gamma) activator rosiglitazone on endothelial function and cardiovascular risk factors might result in fewer macrovascular disease events in people with type 2 diabetes mellitus. ⋯ New studies should focus on patient-oriented outcomes to clarify the benefit-risk ratio of rosiglitazone therapy. Safety data and adverse events of all investigations (published and unpublished) should be made available to the public.