https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.

/pdf/sexually-transmitted-infections-treatment-guidelines-2021-1pw20epe0h.pdf

Sexually Transmitted Infections Treatment Guidelines,2021

Mycoplasma genitalium infection contributes to 10-35% of non-chlamydial non-gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID). Transmission of M. genitalium occurs through direct mucosal contact. Asymptomatic infections are frequent. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. In men, urethritis, dysuria and discharge predominates. Besides symptoms, indication for laboratory test is a high-risk sexual behaviour. Diagnosis is achievable only through nucleic acid amplification testing (NAAT). If available, NAAT diagnosis should be followed with an assay for macrolide resistance. Therapy for M. genitalium is indicated if M. genitalium is detected or on an epidemiological basis. Doxycycline has a low cure rate of 30-40%, but does not increase resistance. Azithromycin has a cure rate of 85-95% in macrolide susceptible infections. An extended course appears to have a higher cure rate. An increasing prevalence of macrolide resistance, most likely due to widespread use of azithromycin 1 g single dose without test of cure, is drastically decreasing the cure rate. Moxifloxacin can be used as second-line therapy, but resistance is increasing. Uncomplicated M. genitalium infection should be treated with azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral), or josamycin 500 mg three times daily for 10 days (oral). Second line treatment and treatment for uncomplicated macrolide resistant M. genitalium infection is moxifloxacin 400 mg od for 7-10 days (oral). For third line treatment of persistent M. genitalium infection after azithromycin and moxifloxacin doxycycline 100 mg two times daily for 14 days can be tried and may cure 30%. Pristinamycin 1 g four times daily for 10 days (oral) has a cure rate of app. 90%. Complicated M. genitalium infection (PID, epididymitis) is treated with moxifloxacin 400 mg od for 14 days.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.13849

2016 European guideline on Mycoplasma genitalium infections

Sexually transmitted diseases and infertility.

This paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest. The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review. The hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS-centre. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanical CPR can be helpful. Delayed or intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern post-resuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimise pre-hospital triage, transport and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and post-resuscitation care. Based on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.

/pdf/accidental-hypothermia-an-update-the-content-of-this-review-57mo7lzuz0.pdf

Accidental hypothermia-an update The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

To determine the association between Mycoplasma genitalium infection and female reproductive tract syndromes through meta-analysis, English-language, peer-reviewed studies were identified via PubMed, Embase, Biosis, Cochrane Library, and reference review. Two reviewers independently extracted data. Random-effects models were employed to calculate summary estimates, between-study heterogeneity was evaluated using I(2) statistics, publication bias was assessed via funnel plots and the Begg and Egger tests, and methodologic quality was rated. Mycoplasma genitalium infection was significantly associated with increased risk of cervicitis (pooled odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.35-2.04]), pelvic inflammatory disease (pooled OR, 2.14 [95% CI, 1.31-3.49]), preterm birth (pooled OR, 1.89 [95% CI, 1.25-2.85]), and spontaneous abortion (pooled OR, 1.82 [95% CI, 1.10-3.03]). Risk of infertility was similarly elevated (pooled OR, 2.43 [95% CI, .93-6.34]). In subanalyses accounting for coinfections, all associations were stronger and statistically significant. Testing of high-risk symptomatic women for M. genitalium may be warranted.

/pdf/mycoplasma-genitalium-infection-and-female-reproductive-1wys22j56x.pdf

Mycoplasma genitalium Infection and Female Reproductive Tract Disease: A Meta-Analysis

Predicting outcome of drowning at the scene : a systematic review and meta-analyses

Motor vehicle collisions were the leading cause of unintentional injury deaths in children aged 1–17 years in the USA from 2011 to 2019 and was the fourth leading cause of death in King County, WA in children aged 0–17 in 2020. Cases included children 0–17 years of age who resided in King County Washington State and died between January 1, 2016 and December 31, 2020 due to motor vehicle collisions as identified by the King County Medical Examiner's Office and reviewed through the county's Child Death Review (CDR) process. Cases were then scrubbed of unique identifiers and presented to the Washington Traffic Safety Commission to identify additional priorities and strategies for prevention. CDR identified 22 traffic related deaths in pediatrics 0–17 years of age between 2016 and 2020. Of the deaths, 68.18% were male, 13.64% (n = 3) were American Indian/Alaskan Native, and 72.73% (n = 16) of cases were in South King County/Vashon Island. 59.09% (n = 13) were passengers in the vehicle. The most common contributing factor (59.09%, n = 13) was speed followed by alcohol and/or drugs 45.45% (n = 10), and unrestrained individuals 27.27% (n = 6). The CDR team developed recommendations for implementation to improve safety. The local CDR process and secondary review with state-wide partners can support the identification of critical prevention efforts and lead to lasting traffic safety changes to contribute to preventing future traffic related serious injuries and deaths. This combined process can be used as a model practice by other local CDRs for the identification and implementation of traffic safety prevention measures. 

Rebecca Lis

Papers

Mycoplasma genitalium Infection and Female Reproductive Tract Disease: A Meta-Analysis

Predicting outcome of drowning at the scene : a systematic review and meta-analyses

Pediatric motor vehicle related deaths in King County, Washington: Using Child Death Review to create meaningful change for traffic safety