Efficacy of Collagenase Clostridium Histolyticum for Dupuytren Disease: A Systematic Review

Introduction Collagenase Clostridium Histolyticum (CCH) has become a therapeutic alternative for Dupuytren disease. However, its efficacy in the medium to long term is unknown. The objective of our study is to carry out a systematic review of the studies conducted on the subject. Material and Methods Systematic bibliographic search. Analysis depending on the time of progression, looking into 2 groups with the follow-up cut-off point of 1 year. Analysis of the number of patients who reached the primary endpoint, of the mean correction in degrees, and of the proportional correction of each joint. Results The 50 selected clinical trials encompass a total of 4,622 patients (an average of 92.70). A total of 7,546 joints were treated with the mean being 148.15 joints per trial (3,925 metacarpophalangeal [MCP] and 2,350 proximal interphalangeal [PIP]). In less than one year of progression, the primary end point was reached in 48.9% of the joints (69.77% of the MCPs and 30.14% of the PIPs), the mean correction in degrees was 45.5 (standard deviation [SD]: 19.18) degrees; 40.8 degrees in the MCP (SD: 10.12) and 35.6 in the PIP (SD: 13.23), and the proportional correction of the joints was 72.9% (SD: 14.43) (83.9% for MCPs [SD: 12.58] and 64.2 for the PIPs [SD: 16.35]). In the follow-ups over 1 year, the primary end point was reached at a rate of 57.5% (68.9% of the MCPs and 43.3% of the PIPs), the mean correction in degrees was 37.6 degrees (SD: 10.93) (37.3 degrees in the MCPs [SD: 9.98] and 23.7 in the PIPs [SD: 16.33]) and the proportional correction of the joints was 87.3% (SD: 10.96) (90.3% for MCP [SD: 6.94] and 75% for PIP [SD: 13.54]). Conclusions The results indicate a satisfactory response to CCH treatment maintained in the short and medium term. The recurrence rate is uncertain given the available data.

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Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials

British Journal of General Practice ◽

10.3399/bjgp18x699041 ◽

2018 ◽

Vol 68 (675) ◽

pp. e663-e672 ◽

Cited By ~ 11

Author(s):

Sioe Lie Thio ◽

Joana Nam ◽

Mieke L van Driel ◽

Thomas Dirven ◽

Jeanet W Blom

Keyword(s):

Systematic Review ◽

Primary Care ◽

Care Physician ◽

Evidence Based ◽

Chronic Medication ◽

Primary Care Settings ◽

Number Of Patients ◽

The Mean ◽

Randomised Controlled

BackgroundPolypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process; however, there are several barriers to implementing this.AimTo examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, that is, primary care (or general practice) and nursing homes.Design and settingThis systematic review included randomised controlled trials published in 2005–2017, which studied withdrawal of long-term drugs prescribed in primary care settings and compared continuing medication with discontinuing.MethodPubMed and EMBASE searches were conducted and the extracted data included the number of patients who successfully stopped medication and the number of patients who experienced relapse of symptoms or restarted medication.ResultsA total of 27 studies reported in 26 papers were included in this review. The number of participants in the studies varied from 20 to 2471 and the mean age of participants ranged from 50.3 years to 89.2 years. The proportion of patients who successfully stopped their medication varied from 20% to 100%, and the range of reported relapse varied from 1.9% to 80%.ConclusionOnly a few studies have examined the success rate and safety of discontinuing medication in primary care, and these studies are very heterogeneous. Most studies show that deprescribing and cessation of long-term use seem safe; however, there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence-based decisions about deprescribing in primary care settings.

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Recovery of Renal Function after One-Year of Dialysis Treatment: Case Report and Registry Data

International Journal of Nephrology ◽

10.4061/2010/817836 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Ingela Fehrman-Ekholm ◽

Ann-Charlotte Bergenhag ◽

Olof Heimburger ◽

Staffan Schön

Keyword(s):

Renal Function ◽

Treatment Time ◽

Dialysis Treatment ◽

Tubular Necrosis ◽

Number Of Patients ◽

Common Diagnosis ◽

Regular Dialysis Treatment ◽

The Mean ◽

One Year

Objective. Uncertainty has arisen as to whether renal function can be recovered from after long-term regular dialysis treatment. We therefore conducted an analysis and scrutinized one patient report.Material and Methods. Swedish registry of patients with kidney disease and one patient case.Results. 39 patients (0.2%) from the Swedish registry comprising 17590 patients who commenced RRT (renal replacement therapy) between 1991 and 2008 had recovered from renal function after more than 365 days of regular dialysis treatment. The most common diagnosis was renovascular disease with hypertension but a large group had uremia of unknown cause. HUS, cortical/tubular necrosis, and autoimmune diseases were also found. The mean treatment time before withdrawal was 2 years.Conclusions. A small number of patients recover after a long period of regular dialysis treatment. One could discuss whether it is difficult to identify patients who have recovered while undergoing regular dialysis treatment. Regular monitoring of renal function may be important.

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Progress of leukoaraiosis is inhibited by correction of platelet hyper-aggregability

International Psychogeriatrics ◽

10.1017/s104161020500164x ◽

2005 ◽

Vol 17 (4) ◽

pp. 689-698 ◽

Cited By ~ 11

Author(s):

Shigekiyo Fujita ◽

Tetsuro Kawaguchi ◽

Toshiyuki Uehara ◽

Kazuhito Fukushima

Keyword(s):

Group Versus ◽

Adenosine Diphosphate ◽

White Matter Hyperintensity ◽

Number Of Patients ◽

Mri Scans ◽

The Mean ◽

The Difference ◽

Magnetic Resonance Imaging Mri ◽

Observation Period

Background: Platelet hyper-aggregability is an important risk factor for leukoaraiosis. In this study we investigated whether aggravation of leukoaraiosis can be controlled by means of long-term correction of platelet hyper-aggregability.Methods:Twenty-one patients with leukoaraiosis and uncorrected platelet hyper-aggregability were compared with 21 controls matched for age, grade of leukoaraiosis and observation period whose platelet hyper-aggregability was corrected. Platelet aggregability was estimated by an optical analytical method with a nine-stage display using two different concentrations each of adenosine diphosphate (ADP) and collagen (the double ADP method).Results:The mean observation period between two magnetic resonance imaging (MRI) scans for both groups was 4.1 years. In the non-corrected group, moderate to severe aggravation of leukoaraiosis was observed in a large number of patients. In the corrected group, only a small number of patients showed generally mild aggravation of leukoaraiosis. The number of patients showing aggravation of periventricular hyperintensity (PVH) was 7 in 21 in the non-corrected group versus 1 in 21 (p=0.022) in the corrected group, and for aggravation of deep white-matter hyperintensity, these values were 9 in 21 versus 4 in 21, respectively. Thus, the difference was more significant if the degree of aggravation was taken into account.Conclusion:The progress of leukoaraiosis is greatly inhibited by long-term correction of platelet hyper-aggregability.

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One-Year Visual and Refractive Outcomes following LASIK for Myopia and Myopic Astigmatism with MEL 90 versus Schwind Amaris 750S Excimer Laser: A Comparative Study

Journal of Ophthalmology ◽

10.1155/2021/9929181 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Sheetal Brar ◽

Dishitha P. Rathod ◽

C. R. Roopashree ◽

Sri Ganesh

Keyword(s):

Comparative Study ◽

Clinical Outcomes ◽

Excimer Laser ◽

Infectious Keratitis ◽

Safety And Efficacy ◽

Refractive Outcomes ◽

The Mean ◽

One Year ◽

Myopic Astigmatism

Purpose. To compare clinical outcomes following LASIK for myopia performed with MEL 90 vs. Schwind Amaris 750S excimer laser. Methods. Data were collected retrospectively for patients who underwent Femto-LASIK, using the MEL 90 and Schwind Amaris 750S excimer laser for correction of myopia and myopic astigmatism within the range of −1.00 to −10.00 D SE from January 2013 till June 2018. Outcomes were analysed at 12 months for safety, efficacy, enhancement rate, and long-term complications. Results. A total of 328 eyes of 328 patients were analysed. One hundred and sixty-three eyes were treated with Schwind Amaris and the remaining 165 eyes with the MEL 90 laser. Twelve months postoperatively, the mean UDVA, CDVA, residual SE, and cylinder in the Amaris group were −0.10 ± 0.09 logMAR, −0.14 ± 0.06 logMAR, −0.21 ± 0.22 D, −0.13 ± 0.18 D versus −0.05 ± 0.07 logMAR, −0.09 ± 0.08 logMAR, −0.23 ± 0.23 D, and −0.14 ± 0.21 D for the MEL 90 group ( p values >0.05). For the Amaris group, safety and efficacy indices were 1.12 and 1.02, whereas for the MEL 90 group, these indices were 1.08 and 1.00, respectively. No eye in either group had any postop flap-related complications, infectious keratitis, diffuse lamellar keratitis, or keratectasia. Two eyes in the Amaris and 4 eyes in MEL 90 group required enhancement for the progression of myopia. Conclusion. At 12 months, both Schwind Amaris 750S and MEL 90 lasers demonstrated comparable clinical outcomes for myopic LASIK in a single surgeon setting.

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Improved Biochemical Parameters in Patients Who Undergo Early Resection in Isolated Ileocaecal Crohn’s Disease

Surgery Research and Practice ◽

10.1155/2017/4396573 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Mirzafaraz Saeed ◽

Hari Hullur ◽

Amro Salem ◽

Abbas Ali ◽

Yousif Sahib ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Surgical Resection ◽

Complete Blood Count ◽

Long Term Results ◽

Number Of Patients ◽

Long Term Follow Up ◽

One Year

Introduction. The aim of this study is to evaluate the outcome of introduction of early surgery in the course of isolated ileocecal Crohn’s disease, where there is no absolute indication of surgery. Methods. Observational study involving patients with isolated ileocecal Crohn’s disease who underwent early surgical resection (within one year of the presentation of the hospital). A complete blood count, ESR, and CRP were done and compared between the preoperative value, 1st postoperative visit (3-4 weeks), and last follow-up visit. Statistical analysis was done using Analysis of Variance (ANOVA) to compare the different figures. Results. There was a statistically significant increase in the hemoglobin levels between preoperative, postoperative, and long-term follow-up and a significant decrease in leukocyte count between the pre- and postoperative values (F=19.8, p<0.001 and F=8.9, p=0.002, resp.). Similarly, the ESR and CRP values were decreased significantly at long-term follow-up (F=8.5, p=0.019 and F=8.3, p=0.013, resp.). Conclusion. Early surgical resection in isolated ileocaecal Crohn’s disease achieved significant biochemical improvements. These successful results in this small number of patients indicate that early surgical intervention may provide better outcomes. These initial results encourage larger and comparative studies of long-term results versus long-term use of biological agents.

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Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review

Foot & Ankle Specialist ◽

10.1177/19386400211053947 ◽

2021 ◽

pp. 193864002110539

Author(s):

Francesco Di Caprio ◽

Massimiliano Mosca ◽

Francesco Ceccarelli ◽

Silvio Caravelli ◽

Marco Di Ponte ◽

...

Keyword(s):

Systematic Review ◽

Hallux Rigidus ◽

Prosthetic Replacement ◽

Interposition Arthroplasty ◽

Level Of Evidence ◽

Advantages And Disadvantages ◽

Number Of Patients ◽

Pubmed Search ◽

End Stage

Purpose Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. Methods A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. Results The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. Conclusion Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. Level of evidence III (systematic review of level III-IV-V studies)

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Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett’s esophagus: a systematic review and meta-analysis

Endoscopy ◽

10.1055/a-0869-7960 ◽

2019 ◽

Vol 51 (07) ◽

pp. 665-672 ◽

Cited By ~ 8

Author(s):

Viveksandeep Thoguluva Chandrasekar ◽

Nour Hamade ◽

Madhav Desai ◽

Tarun Rai ◽

Venkata Subhash Gorrepati ◽

...

Keyword(s):

Systematic Review ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Significant Heterogeneity ◽

Neoplastic Progression ◽

Number Of Patients ◽

The Mean ◽

Surveillance Endoscopy

Abstract Background Although shorter lengths of Barrett’s esophagus (BE) have been associated with a lower risk of neoplastic progression, precise estimates have varied, especially for non-dysplastic BE (NDBE) only. Therefore, current US guidelines do not provide specific recommendations on surveillance intervals based on BE length. We performed a systematic review and meta-analysis of the published literature to examine neoplastic progression rates of NDBE based on BE length. Methods PubMed, Cochrane, Google Scholar, and Embase were comprehensively searched. Studies reporting progression rates in patients with NDBE and > 1 year of follow-up were included. The number of patients progressing to esophageal adenocarcinoma (EAC) and high grade dysplasia (HGD)/EAC in individual studies and the mean follow-up were recorded to derive person-years of follow-up. Pooled rates of progression to EAC and HGD/EAC based on BE length (< 3 cm vs. ≥ 3 cm) were calculated. Results Of the 486 initial studies identified, 10 met the inclusion/exclusion criteria. These included a total of 4097 NDBE patients; 1979 with short-segment BE (SSBE; 10 773 person-years of follow-up) and 2118 with long-segment BE (LSBE; 12 868 person-years). The annual rates of progression to EAC were significantly lower for SSBE compared with LSBE: 0.06 % (95 % confidence interval 0.01 % – 0.10 %) vs. 0.31 % (0.21 % – 0.40 %), respectively; odds ratio (OR) 0.25 (0.11 – 0.56); P < 0.001, as were the rates for the combined endpoint (HGD/EAC): 0.24 % (0.09 % – 0.32 %) vs. 0.76 % (0.43 % – 0.89 %), respectively; OR 0.35 (0.21 – 0.58); P < 0.001. There was no significant heterogeneity among studies. Conclusion The results demonstrate significantly lower rates of neoplastic progression in NDBE patients with SSBE compared with LSBE. BE length can easily be used for risk stratification purposes for NDBE patients undergoing surveillance endoscopy and consideration should be given to tailoring surveillance intervals based on BE length in future US guidelines.

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Obesity and 1-Year Mortality in Adults After Sepsis: A Systematic Review

Biological Research For Nursing ◽

10.1177/1099800419876070 ◽

2019 ◽

Vol 22 (1) ◽

pp. 103-113

Author(s):

Jamie Robinson ◽

Theresa Swift-Scanlan ◽

Jeanne Salyer

Keyword(s):

Systematic Review ◽

Obesity Paradox ◽

Obese Patients ◽

Sepsis Mortality ◽

Number Of Patients ◽

Comprehensive Search ◽

Nonobese Patients ◽

Comprehensive Search Strategy ◽

Long Term Mortality

Purpose: In recent years, researchers have noted an “obesity paradox,” where individuals with obesity survive sepsis at higher rates than their nonobese counterparts. This systematic review summarizes the literature on studies examining the association between obesity and 1-year mortality among patients admitted with sepsis, severe sepsis, or septic shock. Materials and Methods: Using a comprehensive search strategy, a systematic review was conducted to identify studies examining the association of obesity and sepsis mortality. PubMed, Cumulative Index of Nursing and Allied Health Literature, and Elton B. Stephens Company host databases were searched for the terms sepsis, obesity, mortality, and adult. Results: The initial search identified 189 studies, 9 of which met inclusion criteria. Of these, four provided evidence that obese or very obese patients with sepsis have lower mortality than nonobese patients. Methodologic differences in the remaining five studies, which reported conflicting results, limit generalizability. Conclusion: This systematic review on the association of obesity and sepsis mortality found three studies that demonstrated lower sepsis mortality among obese patients in the first 30 days and one showing that this protective effect extends up to 1 year. Given the increased number of patients surviving sepsis, it is important to consider long-term mortality and further describe the variables associated with increased survival.

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Evaluation of the Meniscal repair in Bucket handle. Systematic review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00209 ◽

2018 ◽

Vol 6 (12_suppl5) ◽

pp. 2325967118S0020

Author(s):

Damián Bustos ◽

Lucas Marangoni ◽

Pablo Bertiche ◽

Javier Núñez ◽

Iván Bitar ◽

...

Keyword(s):

Systematic Review ◽

Treatment Options ◽

Meniscal Repair ◽

Level Of Evidence ◽

Meniscal Lesions ◽

Number Of Patients ◽

Bibliographic Search ◽

Rate Of Failure ◽

Bucket Handle

Introduction: Faced with a bucket meniscal lesion we have two treatment options. A frequently practiced option is to remove the bucket handle, another is to repair it. Generally, they are associated with ligament injuries. In this context, it has been shown that meniscal repair has a good result, but the evolution of isolated meniscal repairs is not entirely clear. The purpose of this systematic review is to determine the results after the repair of bucket handle injuries. Materials and Methods: A bibliographic search of the computerized database was carried out pubmed. Eight articles were included according to the inclusion and exclusion criteria. The results of interest included, level of evidence, number of patients, follow-up, average age, surgical technique,% cure,% failure, complications, associated injuries and average time from injury to surgical repair. Results: The works studied, on average, 43 patients, with ages between 16 and 33 years making 341 patients. The follow-up period was focused on 58 months. The percentage of cure varies from 52% to 98%. Conclusion: The isolated repair of this type of meniscal lesions has a good overall evolution associated with a low rate of failure and complications Level of evidence: IV Type of study systematic review

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