ABSTRACT
The main aim of this study was to determine the level of evidence in the literature for the main indications of osteopathy as recommended by the French osteopathy societies. This systematic review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and evaluated articles published between January 2012 and January 2022 with one modification: when level one evidence studies were available, level two to five studies were excluded. Sources included PubMed, the Cochrane library, the French National Health Authority (HAS) and its affiliates. Inclusion criteria were level one published studies on the indications for osteopathic treatment in French and English, and level two to three studies when no level one studies were available. The level of evidence assessment was based on the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence classification. The primary outcome was the level of evidence in the literature supporting osteopathic practices. The secondary outcome was to assess French professional osteopathy recommendations and French HAS guidelines in relation to the scientific literature. A total of 51 articles and nine recommendations from the HAS and its affiliates met the inclusion criteria for the systematic review. Analysis of the studies revealed 41 osteopathic indications from French osteopathy societies for musculoskeletal, neurosensory, psychological, pediatric, gynecological, digestive, and pulmonary disorders. High-level scientific evidence supported the use of osteopathy for low back pain, sciatica, cervical radiculopathy, and ankle sprain. There was moderate evidence for tension headache, temporomandibular joint disorder, endometriosis, and low back and pelvic pain in pregnant women. HAS recommended five indications, while nine indications were supported in the scientific literature. Osteopathy has been shown to have evidence-based benefits for a range of conditions, in particular for musculoskeletal and neurosensory disorders.
ABSTRACT
Sodium-glucose cotransporter-2 inhibitors are drugs that regulate blood sugar by decreasing glucose reabsorption from the proximal renal tubules. Primary hyperparathyroidism masked by empagliflozin is very rare and only a few cases are reported in the literature. We report a case of a 57-year-old man with a known history of diabetes on empagliflozin for two years who presented with hypercalcemia and equivocal parathyroid hormone level. Upon cessation of this medication, he had persistent hypercalcemia with a raised parathyroid level, which confirmed the diagnosis of primary hyperparathyroidism. We believe this case is one of the first cases reported in the literature.
ABSTRACT
Background The time to hypothyroidism post hemithyroidectomy is variable. There are multiple risk factors for developing hypothyroidism. The aim of this study was to identify the time of hypothyroidism and other predictors of hypothyroidism in euthyroid patients following hemithyroidectomy. Methods This was a retrospective study. Of 170 euthyroid patients who underwent hemithyroidectomy for benign disease between 2006 - 2014, age, gender, pre-operative thyroid function tests, body mass index (BMI), and other co-morbidities were examined to determine predictors of early (<3 months) or late (>3 months) hypothyroidism. A high normal preoperative thyroid stimulating hormone (HN-TSH) was defined as ≥2.01 uIU/ml, and a low normal TSH (LN-TSH) was defined as <2.01 uIU/ml. Results A total of 63 of the 170 patients (37%) became hypothyroid. At 3 months, 21.5% of patients were hypothyroid. At 6 months after operation, an additional 5% had become hypothyroid, and after 1 year, 8% more were hypothyroid. The only independent predictor of hypothyroidism was preoperative HN-TSH (≥2.01) (p<0.001) on multivariate analysis. Conclusion In addition to known predictors of hypothyroidism following hemithyroidectomy for benign disease, such as the size of the thyroid remnant, a history of neck irradiation, and coexisting thyroid autoimmune disease, a BMI ≥35 kg/m2, age ≥45, and preoperative HN-TSH are risk factors for postoperative hypothyroidism within 3 months of operation. Such patients should be closely monitored.
