Serum Levels of Interleukins in Endometriosis Patients: A Systematic Review and Meta-analysis

OBJECTIVE

The aims of this systematic review and meta-analysis were to produce a comprehensive survey of the serum levels of interleukins (ILs) in untreated people with endometriosis compared with people without endometriosis.

DATA SOURCES

A systematic literature search of English language studies within Cinahl, Medline Complete, PubMed, and Scopus from inception to May 2023 was performed.

METHODS OF STUDY SELECTION

We included studies that compared IL serum levels in people with endometriosis to those without endometriosis. Meta-analysis was performed on IL-1RA, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17A, IL-18, IL-23, and IL-37.

TABULATION, INTEGRATION, AND RESULTS

The systematic search retrieved 651 studies, of which 77 underwent a full-text review. A total of 30 studies met inclusion criteria for the meta-analysis. IL-1Ra, IL-6, and IL-37 serum levels were 2.56 (95% CI 2.20-2.92, p <.001), 1.38 (95% CI 0.58-2.17, p <.001), and 1.77 (95% CI 1.33-2.20, p <.001) standard deviations higher in the patients with endometriosis compared with patients without endometriosis while IL-23 serum levels 0.40 (95% CI -0.73 to -0.07, p = .02) standard deviations lower, respectively.

CONCLUSION

There is mounting evidence that ILs, especially IL-6, may be good candidates for unique noninvasive diagnostic tools and/or treatment pathways for endometriosis.

Role of discrimination and resilience on birth weight: A systematic examination in a sample of Black, Latina, and White women

Introduction:

Health inequities begin before birth with Black women being more likely to have low birth weight babies than White and Latina women. Although both Latina and Black women experience discrimination, only Black women appear to be affected.

Methods:

In this study using medical records and face-to-face interviews, we systematically examined the role of discrimination (daily, environmental, vicarious) on continuous birth weight (controlling for gestational age and baby’s gender) in a sample of 329 Black, Latina, and White pregnant women, as well as whether familism, prayer, and/or discrimination attribution buffered this association.

Results:

Linear regression analyses revealed that only prayer acted as a resilience factor, with Latina women appearing to benefit from prayer in the link between vicarious and daily discrimination on birth weight conditional on gestational age, whereas Black women showed no moderation and White women showed an exacerbation in the link.

Discussion:

The results of this study suggest that sociocultural norms may play a role in explaining the Latina epidemiological paradox, but more research is needed to understand the significance.

Severe acute respiratory syndrome coronavirus 2: a canary in the coal mine for public safety net hospitals

BACKGROUND

The coronavirus disease 2019 pandemic has exposed disproportionate health inequities among underserved populations, including refugees. Public safety net healthcare systems play a critical role in facilitating access to care for refugees and informing coordinated public health prevention and mitigation efforts during a pandemic.

OBJECTIVE

This study aimed to evaluate the prevalence ratios of severe acute respiratory syndrome coronavirus 2 infection between refugee women and nonrefugee parturient patients admitted to the hospital for delivery. Here, we suspected that the burden of infection was disproportionately distributed across refugee communities that may act as sentinels for community outbreaks.

STUDY DESIGN

A cross-sectional study was conducted examining parturient women admitted to the maternity unit between May 6, 2020, and July 22, 2020, when universal testing for severe acute respiratory syndrome coronavirus 2 was first employed. Risk factors for severe acute respiratory syndrome 2 positivity were ascertained, disaggregated by refugee status, and other clinical and sociodemographic variables examined. Prevalence ratios were calculated and comparisons made to county-level community prevalence over the same period.

RESULTS

The positive test percentage at the county-level during this study period was 21.6%. Of 350 women admitted to the hospital for delivery, 33 (9.4%) tested positive for severe acute respiratory syndrome 2. When refugee status was determined, 45 women (12.8%) were identified as refugees. Of the 45 refugee women, 8 (17.8%) tested positive for severe acute respiratory syndrome 2 compared with 25 nonrefugee patients (8.19%) who tested positive for severe acute respiratory syndrome 2 (prevalence ratio, 2.16; 95% confidence interval, 1.04–4.51). In addition, 7 of the refugee women who tested positive for severe acute respiratory syndrome coronavirus 2 were from Central Africa.

CONCLUSION

The severe acute respiratory syndrome coronavirus 2 outbreak has disproportionately affected refugee populations. This study highlighted the utility of universal screening in mounting a rapid response to an evolving pandemic and how we can better serve refugee communities. Focused response may help achieve more equitable care related to severe acute respiratory syndrome 2 among vulnerable communities. The identification of such populations may help mitigate the spread of the disease and facilitate a timely, culturally, and linguistically enhanced public health response.

Simulation training in contemporary obstetrics education

AIM: To investigate the use of the Gaumard’s Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.

METHODS: Twenty two (n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year (PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard’s simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort’s mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to the baseline pretest score using a paired student t-test.

RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7 (SD = 3.14) vs 7.9 (SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6 (SD = 5.5, 95%CI: 2.21-7.07), 4.4 (SD = 5.2, 95%CI: 2.13-6.70), and 5.6 (SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5 (SD = 2.27, 95%CI: 2.13-5.00), 7.25 (SD = 6.70, 95%CI: 1.50-13.00), 10.75 (SD = 1.5, 95%CI: 9.50-12.00), 12.17 (SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75 (SD = 1.49, 95%CI: 12.75-14.63), 10.25 (SD = 0.24, 95%CI: 4.25-14.00), 15.00 (SD = 1.16, 95%CI: 14.00-16.00), 15.17 (SD = 0.75, 95%CI: 14.67-15.67).

CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.