Fetal and maternal outcomes after maternal biologic use during conception and pregnancy: A systematic review and meta-analysis.

BACKGROUND: Biologic medications, specifically tumour necrosis factor-α (TNF-α) inhibitors, have become increasingly prevalent in the treatment of chronic inflammatory disease (CID) in pregnancy. OBJECTIVE: To determine pregnancy outcomes in women with CID exposed to biologics during pregnancy. SEARCH STRATEGY: PubMed and EMBASE databases were searched through January 1998-July 2021. SELECTION CRITERIA: Peer-reviewed, English-language cohort, case-control, cross-sectional studies, and case series that contained original data. DATA COLLECTION AND ANALYSIS: Two authors independently conducted data extraction. A meta-analysis of proportions using a random-effects model was used to pool outcomes. Linear regression analysis was used to compare the mean of proportions of outcomes across exposure groups using the 'treated' group as the reference category. All studies were evaluated using an appropriate quality assessment tool. The GRADE approach was used to assess the overall certainty of evidence. MAIN RESULTS: Thirty-five studies, describing 11 172 pregnancies, were eligible for inclusion. Analysis showed pooled proportions for congenital malformations as follows: treated 0.04 (95% CI 0.03-0.04; I2  = 77) versus disease-matched 0.04 (95% CI 0.03-0.05. I2  = 86; p = 0.238); preterm delivery treated 0.04 (95% CI 0.10-0.14; I2  = 88) versus disease-matched 0.10 (95% CI 0.09-0.12; I2  = 87; p = 0.250); severe neonatal infection: treated 0.05 (95% CI 0.03-0.07; I2  = 88) versus disease-matched 0.05 (95% CI 0.02-0.07; I2  = 94; p = 0.970); low birthweight: treated 0.10 (95% CI 0.07-0.12; I2  = 93) versus disease-matched 0.08 (95% CI 0.07-0.09; I2  = 0; p = 0.241); pooled miscarriage: treated 0.13 (95% CI 0.10-0.15; I2  = 77) versus disease-matched 0.08 (95% CI 0.04-0.11; I2  = 5; p = 0.078); pre-eclampsia; treated 0.01 (95% CI 0.01-0.02; I2  = 0) versus disease-matched 0.01 (95% CI 0.00-0.01; I2  = 0; p = 0.193). No statistical differences in proportions were observed. GRADE certainty of findings was low to very low. CONCLUSION: We demonstrated comparable pregnancy outcomes in pregnancies exposed to biologics, disease-matched controls and CID-free pregnancies using the GRADE approach.

Helicobacter pylori: High dose amoxicillin does not improve primary or secondary eradication rates in an Irish cohort.

BACKGROUND: Helicobacter pylori (H. pylori) eradication rates have fallen globally, likely in large part due to increasing antibiotic resistance to traditional therapy. In areas of high clarithromycin and metronidazole resistance such as ours, Maastricht VI guidelines suggest high dose amoxicillin dual therapy (HDADT) can be considered, subject to evidence for local efficacy. In this study we assess efficacy of HDADT therapy for H. pylori eradication in an Irish cohort. AIM: To assess the efficacy of HDADT therapy for H. pylori eradication in an Irish cohort as both first line, and subsequent therapy for patients diagnosed with H. pylori. METHODS: All patients testing positive for H. pylori in a tertiary centre were treated prospectively with HDADT (amoxicillin 1 g tid and esomeprazole 40 mg bid × 14 d) over a period of 8 months. Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy. A delta-over-baseline > 4% was considered positive. Patient demographics and treatment outcomes were recorded, analysed and controlled for basic demographics and prior H. pylori treatment. RESULTS: One hundred and ninety-eight patients were identified with H. pylori infection, 10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing. In all 139 were included in the analysis, 55% (n = 76) were female, mean age was 46.6 years. Overall, 93 (67%) of patients were treatment-naïve and 46 (33%) had received at least one previous course of treatment. The groups were statistically similar. Self-reported compliance with HDADT was 97%, mild side-effects occurred in 7%. There were no serious adverse drug reactions. Overall the eradication rate for our cohort was 56% (78/139). Eradication rates were worse for those with previous treatment [43% (20/46) vs 62% (58/93), P = 0.0458, odds ratio = 2.15]. Age and Gender had no effect on eradication status. CONCLUSION: Overall eradication rates with HDADT were disappointing. Despite being a simple and possibly better tolerated regime, these results do not support its routine use in a high dual resistance country. Further investigation of other regimens to achieve the > 90% eradication target is needed.

Canine dystocia in 50 UK first-opinion emergency care veterinary practices: clinical management and outcomes.

Canine dystocia is a relatively common veterinary presentation. First opinion emergency care clinical data from 50 Vets Now clinics across the UK were used to explore dystocia management and outcomes in bitches. Caesarean section (CS) was performed on 341/701 (48.6 per cent (95 per cent CI 44.9 to 52.4)) of dystocia cases. The bulldog (OR 7.60, 95 per cent CI 1.51 to 38.26, P=0.014), Border terrier (OR 4.89, 95 per cent CI 0.92 to 25.97, P=0.063) and golden retriever (OR 4.07, 95 per cent CI 0.97 to 17.07, P=0.055) had the highest odds of CS among dystocic bitches compared with crossbreds. Brachycephalic dystocic bitches had 1.54 (95 per cent CI 1.05 to 2.28, P=0.028) times the odds of CS compared with non-brachycephalics. Oxytocin was administered to 380/701 (54.2 per cent) and calcium gluconate was administered to 82/701 (11.7 per cent) of dystocic bitches. 12 of 701 dystocia cases (1.7 per cent) died during emergency care. These results can help veterinary surgeons to provide better evidence on the risks to owners who may be contemplating breeding from their bitches. In addition, the results on the management and clinical trajectory of dystocia can facilitate clinical benchmarking and encourage clinical audit within primary care veterinary practice.

Medical school selection criteria as predictors of medical student empathy: a cross-sectional study of medical students, Ireland.

OBJECTIVES: To determine whether performance in any of the Health Professions Admissions Test (HPAT) sections, most specifically the interpersonal understanding section, correlates with self-reported empathy levels in medical students. SETTING: The study was conducted in University College Cork, Ireland. PARTICIPANTS: 290 students participated in the study. Matching HPAT scores were available for 263 students. All male and female undergraduate students were invited to participate. Postgraduate and international students were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary measures: HPAT-Ireland and Jefferson Scale of Physician Empathy (JSE) scores were compared including subsection analysis. Secondary measures: comparisons were made between groups such as gender and year of programme. RESULTS: A total of 290 students participated. Males scored significantly higher than females for total HPAT-Ireland (U=7329, z=-2.04, p<0.05), HPAT-Ireland section 1 (U=5382, z=-5.21, p<0.001) and section 3 scores (U=6833, z=-2.85, p<0.01). In contrast, females scored significantly higher than males on HPAT-Ireland section 2 (U=5844, z=-4.46, p<0.001). Females demonstrated significantly higher total JSE scores relative to males (mean score ± SEM: 113.33±1.05vs 109.21±0.95; U=8450, z=-2.83, p<0.01). No significant association was observed between JSE scores and any of the HPAT-Ireland measures (all p>0.05). There was no effect of programme year on JSE scores (all p>0.05). CONCLUSION: The introduction of the HPAT-Ireland test was partly designed to identify students with strong interpersonal skills. A significant finding of this study is that JSE values did not correlate with HPAT-Ireland scores. This study suggests no clear link between scores on a selection test, the HPAT-Ireland, which is designed to assess several skill domains including interpersonal skills, and scores on a psychometric measure of empathy, at any point during medical education.