Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis

Abstract Introduction The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article was to examine the current evidence on the surgical management and outcomes associated with HH after esophagogastric surgery for cancer. Materials and methods Systematic review and meta-analysis. Web of Science, PubMed, and EMBASE data sets were consulted. Results Twenty-seven studies were included for a total of 404 patients requiring surgical treatment for HH after esophagogastric surgery. The age of the patients ranged from 35 to 85 years, and the majority were males (82.3%). Abdominal pain, nausea/vomiting, and dyspnea were the commonly reported symptoms. An emergency repair was required in 51.5%, while a minimally invasive repair was performed in 48.5%. Simple suture cruroplasty and mesh reinforced repair were performed in 65% and 35% of patients, respectively. The duration between the index procedure and HH repair ranged from 3 to 144 months, with the majority (67%) occurring within 24 months. The estimated pooled prevalence rates of pulmonary complications, anastomotic leak, overall morbidity, and mortality were 14.1% (95% CI = 8.0–22.0%), 1.4% (95% CI = 0.8–2.2%), 35% (95% CI = 20.0–54.0%), and 5.0% (95% CI = 3.0–8.0%), respectively. The postoperative follow-up ranged from 1 to 110 months (mean = 24) and the pooled prevalence of HH recurrence was 16% (95% CI = 13.0–21.6%). Conclusions Current evidence reporting data for HH after esophagogastric surgery is narrow. The overall postoperative pulmonary complications, overall morbidity, and mortality are 14%, 35%, and 5%, respectively. Additional studies are required to define indications and treatment algorithm and evaluate the best technique for crural repair at the index operation in an attempt to minimize the risk of HH.

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Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis

Heart Asia ◽

10.1136/heartasia-2018-011069 ◽

2018 ◽

Vol 10 (2) ◽

pp. e011069 ◽

Cited By ~ 1

Author(s):

Nicholas Gregory Ross Bayfield ◽

Adrian Pannekoek ◽

David Hao Tian

Keyword(s):

Cardiac Surgery ◽

Smoking Status ◽

Meta Analysis ◽

Surgical Site Infections ◽

Neurological Complications ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Surgical Patients ◽

Short Term ◽

Increased Risk

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95% CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95% CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95% CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

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Prevalence and impact of frailty in patients with atrial fibrillation: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.0444 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Proietti ◽

G.F Romiti ◽

V Raparelli ◽

I Diemberger ◽

G Boriani ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Systematic Review ◽

Meta Analysis ◽

Frailty Index ◽

Prevalence Odds Ratio ◽

Frail Patients ◽

Pooled Prevalence ◽

Increased Risk ◽

Inconsistency Index

Abstract Background Frailty is a clinical syndrome characterized by a reduced physiologic function, increased vulnerability to stressors, and an increased risk of adverse outcomes. Patients with Atrial Fibrillation (AF) are often burdened with a high number of comorbidities and prone to frailty. The prevalence of frailty, its management and association with major outcomes in patients with AF are still unclear. Purpose To estimate the pooled prevalence of frailty in patients with AF, as well as its association with AF-related risk factors and comorbidities, oral anticoagulants (OAC) prescription, and major outcomes. Methods We systematically searched PubMed and EMBASE, from inception to 31st January 2021, for studies reporting the prevalence of frailty (irrespective of the tool used for assessment). Pooled prevalence, odds ratio (OR), and 95% Confidence Intervals (CI) were computed using random-effect models; heterogeneity was assessed through the inconsistency index (I2). This study was registered in PROSPERO: CRD42021235854. Results A total of 1,116 studies were retrieved from the literature search, and 31 were finally included in the systematic review (n=842,521 patients). The frailty pooled prevalence was 39.6% (95% CI=29.2%-51.0%, I2=100%; Figure 1). Significant subgroup differences were observed according to geographical location (higher prevalence found in European-based cohorts; p=0.003) and type of tool used for the assessment (higher prevalence in studies using the Clinical Frailty Scale and Tilburg Frailty Index tools; p<0.001). Meta-regressions showed that study-level mean age and prevalence of hypertension, diabetes, and history of stroke were directly associated with frailty prevalence. Frailty was significantly associated with a 29% reduced probability of OAC prescription in observational studies (OR=0.71, 95% CI=0.62–0.81). Frail patients with AF were at higher risk of all-cause death (OR=4.12, 95% CI=3.15–5.41), ischemic stroke (OR=1.55, 95% CI=1.01–2.38), and bleeding (OR=1.55, 95% CI=1.12–2.14), compared to non-frail patients with AF. Conclusions In this systematic review and meta-analysis analysis, the prevalence of frailty was high in patients with AF, and associated with study-level mean age and prevalence of several stroke risk factors. Frailty may influence the management of patients, and worsening the prognosis for all major AF-related outcomes. FUNDunding Acknowledgement Type of funding sources: None. Prevalence of Frailty among AF patients

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Cerebral microbleeds and risk of adverse outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.0448 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

B Corica ◽

G.F Romiti ◽

V Raparelli ◽

R Cangemi ◽

S Basili ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Meta Analysis ◽

Random Effect ◽

Adverse Outcomes ◽

Cerebral Microbleeds ◽

Funding Sources ◽

Conflicting Evidence ◽

Pooled Prevalence ◽

Increased Risk

Abstract Background Long-term anticoagulation in patients with atrial fibrillation (AF) imposes a careful balance between the thromboembolic and hemorrhagic risks. An association between cerebral microbleeds (CMBs) and an increased risk of intracranial hemorrhage (ICH) has already been described; however, conflicting evidence exist on the association with ischemic stroke (IS). Although CMBs are often observed in AF patients, the actual prevalence and the magnitude of the risk of adverse events in patients with CMBs is unclear. Purpose We aimed to estimate the pooled prevalence of CMBs in patients with AF through a systematic review and meta-analysis of the literature. Additionally, we evaluated the risk of ICH and IS according to the presence and burden of CMBs. Methods We perform a systematic search on PubMed and EMBASE from inception to 6th March 2021. We included all studies reporting the prevalence of CMBs, the incidence of ICH and/or IS in AF by presence of CMBs. Pooled prevalence and odds ratios (OR), along with their 95% Confidence Intervals (CI), were computed using random-effect models; we also calculated 95% Prediction Intervals (PI) for each outcome investigated. Additionally, we performed subgroup analyses according to the number and localization of CMBs. Results We retrieved 562 records from the literature search, and 17 studies were finally included. Pooled prevalence of CMBs in AF population was 28.3% (95% CI: 23.8%-33.4%; 95% PI: 12.2%-52.9%, Figure 1). Individuals with CMBs showed a higher risk of both ICH (OR: 3.04, 95% CI: 1.83–5.06) and IS (OR: 1.78, 95% CI: 1.26–2.49). Moreover, patients with more than 5 CMBs, as well as patients with both lobar and mixed CMBs, showed a higher risk of ICH. Conclusions CMBs were found in 28.3% of AF patients, with 95% PIs indicating a potentially higher prevalence. Moreover, CMBs were associated with an increased risk of both ICH and IS, with the effect potentially modulated by their number and localization. CMBs may represent an important and often overlooked risk factor for adverse outcomes in patients with AF. FUNDunding Acknowledgement Type of funding sources: None. Prevalence of CMBs in patients with AF

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Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis

Psychological Medicine ◽

10.1017/s0033291718003823 ◽

2019 ◽

Vol 49 (07) ◽

pp. 1057-1078 ◽

Cited By ~ 33

Author(s):

Ioannis Angelakis ◽

Emma Louise Gillespie ◽

Maria Panagioti

Keyword(s):

Systematic Review ◽

Childhood Abuse ◽

Childhood Maltreatment ◽

Emotional Abuse ◽

Suicide Attempts ◽

Meta Analysis ◽

Current Evidence ◽

Bibliographic Databases ◽

Increased Risk ◽

Different Types

AbstractThis comprehensive systematic review and meta-analysis aims to quantify the association between different types of childhood maltreatment and suicidality. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. Heterogeneity was quantified using theI2statistic and formal publication bias tests were undertaken. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Data from 68 studies based onn= 261.660 adults were pooled. All different types of childhood maltreatment including sexual abuse [odds ratio (OR) 3.17, 95% confidence interval (CI) 2.76–3.64], physical abuse (OR 2.52, 95% CI 2.09–3.04) and emotional abuse (OR 2.49, 95% CI 1.64–3.77) were associated with two- to three-fold increased risk for suicide attempts. Similar results were found for the association between childhood maltreatment and suicidal ideation. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR 5.18, 95% CI 2.52–10.63). Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce.

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Oral Health of Children With Attention Deficit Hyperactivity Disorder: Systematic Review and Meta-Analysis

Journal of Attention Disorders ◽

10.1177/1087054717743331 ◽

2017 ◽

Vol 24 (7) ◽

pp. 947-962 ◽

Cited By ~ 2

Author(s):

Yvonne C. Y. Chau ◽

Si-Min Peng ◽

Colman P. J. McGrath ◽

Cynthia K. Y. Yiu

Keyword(s):

Systematic Review ◽

Oral Health ◽

Meta Analysis ◽

Tooth Wear ◽

Children With Adhd ◽

Hyperactivity Disorder ◽

Pooled Prevalence ◽

Increased Risk ◽

Traumatic Dental Injuries ◽

Dental Injuries

Objective: This systematic review investigated the oral health of children with ADHD. Method: A structured search strategy was performed on five electronic databases: SCOPUS, Web of Science, COCHRANE, PubMed, and PsychInfo. Studies were included in the review if they reported clinical oral health outcomes on a population diagnosed with ADHD under the age of 18 years old. Qualitative and quantitative analysis was performed on pooled prevalence and mean/median values for caries, trauma, periodontal problems, and tooth wear. Results: Twenty-seven effective articles were reviewed by two calibrated assessors. Meta-analysis of the results found higher mean number of decayed surfaces, plaque index, and trauma prevalence among children with ADHD. Conclusion: Children with ADHD show increased risk for caries and traumatic dental injuries, and may have poorer oral hygiene compared with children without ADHD. More awareness among clinicians would promote better caries- and trauma-preventive advice and management.

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Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215117002390 ◽

2017 ◽

Vol 132 (1) ◽

pp. 14-21 ◽

Cited By ~ 8

Author(s):

P D Chakravarty ◽

A E L McMurran ◽

A Banigo ◽

M Shakeel ◽

K W Ah-See

Keyword(s):

Systematic Review ◽

Complication Rate ◽

Meta Analysis ◽

Case Series ◽

Current Evidence ◽

Voice Rehabilitation ◽

Pharyngocutaneous Fistula ◽

Voice Restoration ◽

Increased Risk ◽

Tracheoesophageal Puncture

AbstractBackground:Tracheoesophageal puncture represents the ‘gold standard’ for voice restoration following laryngectomy. Tracheoesophageal puncture can be undertaken primarily during laryngectomy or in a separate secondary procedure. There is no current consensus on which approach is superior. The current evidence comparing primary and secondary tracheoesophageal puncture was assessed.Methods:A systematic review and meta-analysis of articles comparing outcomes for primary and secondary tracheoesophageal puncture after laryngectomy were conducted. Outcome measures were: voice success, overall complication rate and pharyngocutaneous fistula rate.Results:Eleven case series met the inclusion criteria, two prospective and nine retrospective. Meta-analysis did not demonstrate statistically significant differences in overall complication rate or voice outcomes, though it suggested a significantly increased risk of pharyngocutaneous fistula in primary compared to secondary tracheoesophageal puncture.Conclusion:Primary tracheoesophageal puncture is a safe and efficient approach for voice rehabilitation. However, secondary tracheoesophageal puncture should be preferred where there is a higher risk of pharyngocutaneous fistula.

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Current Evidence of 2019 Novel Coronavirus Disease (COVID-19) Ocular Transmission: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2020/7605453 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Kai Cao ◽

Brad Kline ◽

Ying Han ◽

Gui-shuang Ying ◽

Ning Li Wang

Keyword(s):

Systematic Review ◽

Prevalence Rate ◽

Meta Analysis ◽

Current Evidence ◽

Prevalence Rates ◽

Ocular Symptoms ◽

Pooled Prevalence ◽

Conjunctival Swab ◽

Positive Rate ◽

Novel Coronavirus

Objective. To estimate the prevalence rate of ocular symptoms and the positive rate of conjunctival swab samples of patients diagnosed with 2019 Novel Coronavirus Disease (COVID-19). Methods. We performed a systematic review and meta-analysis. A comprehensive literature search was done based on PubMed, Embase, MedRxiv, and the Cochrane Library. The primary outcomes are the prevalence rate of conjunctivitis/conjunctival congestion and the positive rate of conjunctival swab samples. Rates were expressed as proportions with 95% confidence intervals (CIs). Results. A total of 12 studies with 1930 participants were included for meta-analysis. The pooled prevalence rate of conjunctivitis/conjunctival congestion was 8% (95% CI: 5%-12%). 1% (95% CI: 1%-4%) of COVID-19 patients were diagnosed with conjunctivitis/conjunctival congestion as the initial symptom. The pooled positive rate of conjunctival swab samples was 3% (95% CI: 2%-5%). We also assessed other ocular symptoms reported in the 12 studies, including foreign body sensation, increased secretion, and eye itching. The pooled prevalence rates were 6% (95% CI: 3%-10%), 10% (95% CI: 8%-12%), and 9% (95% CI: 7%-10%), respectively. Conclusions. The evidence on the positive rate of conjunctival swab samples and the prevalence rates of ocular symptoms indicated that COVID-19 ocular transmission was possible but less likely.

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Comparative safety of the sodium glucose co-transporter 2 (SGLT2) inhibitors: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-022577 ◽

2019 ◽

Vol 9 (1) ◽

pp. e022577 ◽

Cited By ~ 42

Author(s):

Jennifer R Donnan ◽

Catherine A Grandy ◽

Eugene Chibrikov ◽

Carlo A Marra ◽

Kris Aubrey-Bassler ◽

...

Keyword(s):

Systematic Review ◽

Bone Fractures ◽

Meta Analysis ◽

Kidney Injury ◽

Sglt2 Inhibitors ◽

Current Evidence ◽

Random Effects Models ◽

Relative Risks ◽

Increased Risk ◽

Tract Infections

ObjectiveTo estimate the association between the use of sodium glucose co-transporter-2 (SGLT2) inhibitors and postmarket harms as identified by drug regulatory agencies.DesignWe conducted a systematic review and meta-analysis of randomised controlled trials (RCT). Six large databases were searched from inception to May 2018. Random effects models were used to estimate pooled relative risks (RRs).InterventionSGLT2 inhibitors, compared with placebo or active comparators.Primary outcomesAcute kidney injury (AKI), diabetic ketoacidosis (DKA), urinary tract infections (UTI), bone fractures and lower limb amputations.ResultsWe screened 2418 citations of which 109 were included. Most studies included one of four SGLT2 inhibitors, dapagliflozin, canagliflozin, empagliflozin and ipragliflozin. When compared with placebo, SGLT2 inhibitors were found to be significantly protective against AKI (RR=0.59; 95% CI 0.39 to 0.89; I2=0.0%), while no difference was found for DKA (RR 0.66; 95% CI 0.30 to 1.45, I2=0.0%), UTI (RR 1.02; 95% CI 0.95 to 1.09, I2=0.0%) or bone fracture (RR 0.87; 95% CI 0.69 to 1.09, I2=1.3%). Three studies reported on amputation, with one finding a significant increase risk. No increased risk for either outcome was found when compared with active controls. Subgroup analysis did show an increased risk of UTI with dapagliflozin only (RR 1.21; 95% CI 1.02 to 1.43, I2=0.0%), but no other analysis supported an increased risk of AKI, DKA, UTI or fracture.ConclusionsCurrent evidence from RCTs does not suggest an increased risk of harm with SGLT2 inhibitors as a class over placebo or active comparators with respect to AKI, DKA, UTI or fracture. However, wide CIs for many comparisons suggest limited precision, and therefore clinically important adverse events cannot be ruled out. Dapagliflozin, appears to independently increase the risk of UTI, although the mechanism for this intraclass variation in risk is unclear.PROSPERO registration numberCRD42016038715.

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Migraine, migraine aura, and cervical artery dissection: A systematic review and meta-analysis

Cephalalgia ◽

10.1177/0333102411401634 ◽

2011 ◽

Vol 31 (8) ◽

pp. 886-896 ◽

Cited By ~ 65

Author(s):

Pamela M Rist ◽

Hans-Christoph Diener ◽

Tobias Kurth ◽

Markus Schürks

Keyword(s):

Systematic Review ◽

Migraine With Aura ◽

Meta Analysis ◽

Current Evidence ◽

Artery Dissection ◽

Effect Estimate ◽

Cervical Artery Dissection ◽

Migraine Aura ◽

Increased Risk ◽

Cervical Artery

Objective: We evaluated the current evidence on the association between migraine, including aura status, and cervical artery dissection. Methods: We performed a systematic review and meta-analysis of studies investigating the association between migraine or migraine subtypes (e.g. migraine with aura) and cervical artery dissection published through October 2010. Results: We identified five case-control studies investigating the association between migraine and cervical artery dissection. In pooled analysis, migraine doubled the risk of cervical artery dissection (pooled odds ratio [OR] = 2.06, 95% confidence interval [CI] 1.33–3.19). All studies allowed evaluation of migraine aura status. While the effect estimate for migraine without aura (pooled OR = 1.94, 95% CI 1.21–3.10) was similar to overall migraine, the association was weaker for migraine with aura (pooled OR = 1.50, 95% CI 0.76–2.96). However, there is no evidence that aura status significantly modifies the association between migraine and cervical artery dissection (meta-regression on aura status p = .58). The risk does not appear to differ between women and men; however, only few studies presented gender-specific data. Heterogeneity among studies was low to moderate. Conclusion: In this meta-analysis migraine is associated with a two-fold increased risk of cervical artery dissection. This risk does not appear to significantly differ by migraine aura status or gender.

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1388Risk factors for chronic cough in adults: A systematic review and meta-analysis

International Journal of Epidemiology ◽

10.1093/ije/dyab168.749 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Jingwen Zhang ◽

Jennifer Perret ◽

Anne Chang ◽

Nur Idrose ◽

Dinh Bui ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Chronic Cough ◽

Meta Analysis ◽

Adult Population ◽

Occupational Exposures ◽

Current Evidence ◽

Increased Risk ◽

Lower Education ◽

Longitudinal Associations

Abstract Background Despite the challenges of diagnosing and managing adult patients with chronic cough, a systematic synthesis of evidence on aetiological risk factor is lacking. Methods We systematically searched PUBMED and EMBASE to synthesize the current evidence for longitudinal associations between various risk factors and chronic cough in the general adult population, following the meta-analysis of observation studies in epidemiology (MOOSE) guidelines. The Newcastle-Ottawa scale was used to assess the quality of the included studies. Fixed-effect meta-analysis was conducted where appropriate. Results Of 26 eligible articles, 16 domains of risk factors were assessed. There was consistent evidence that asthma (pooled adjusted OR (aOR) = 3.01; 95%CI: 2.33-3.70; I2=0%, number of articles (N)=3) and low education levels/socioeconomic status (SES) (pooled aOR=1.46; 95%CI: 1.20-1.72; I2=0%; N = 3) were associated with an increased risk of chronic cough after adjusting for smoking and other confounders. While continuous smoking was associated chronic cough (aOR =1.81; 95%CI: 1.36,2.26; I2=57%; N = 3), there was too little evidence to draw conclusions for occupational exposures, outdoor air pollution, early-life exposures, diet, snoring and other chronic conditions. Conclusions Asthma, persistent smoking and lower education/SES were associated with increased risk of chronic cough. Longitudinal associations between other factors frequently mentioned empirically need further investigation. Key messages Our systematic review found asthma, smoking and lower education to be associated with adult chronic cough. More longitudinal studies are needed to understand other potential risk factors for adult chronic cough.

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