331 The Role of Prophylactic and Therapeutic Fasciotomy in Acute Limb Presentations

Abstract Introduction Acute compartment syndrome is a surgical emergency that can be of traumatic or non-traumatic nature. Missed or delayed diagnosis can cause significant morbidity. The aim of this systematic review was to assess outcomes following prophylactic and therapeutic fasciotomies performed for acute limb presentations. Method This systematic review was undertaken following a predefined protocol registered with PROSPERO, in accordance with PRISMA guidelines. Searches of MEDLINE and Embase databases retrieved 623 articles; 19 articles were included in the study. A qualitative synthesis was performed due to heterogeneity between the studies. Results Overall mortality rates of 0–19 % were reported for traumatic causes and 24.5–27% for non-traumatic causes. In general, comparative studies reported lower amputation rates (0–21.7% vs 6.6–50%) and neurological deficit rates in the prophylactic versus therapeutic fasciotomy arms (8.8–18% vs 12.5–42%). Complication rates of up to 42% and 35% were reported in traumatic and non-traumatic cases respectively, which included wound infection, nerve injury and ischaemic contractures. Conclusions Prophylactic fasciotomies appear to have superior outcomes than therapeutic ones. There is insufficient evidence for a specific time cut-off for the performance of therapeutic fasciotomies; retrospective analysis of outcomes via a fasciotomy registry may help to guide future practice.

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Success Rates and Complications of Ventriculoperitoneal and Ventriculoatrial Shunting: A Systematic Review

Iranian Journal of Neurosurgery ◽

10.32598/irjns.7.1.1 ◽

2021 ◽

Vol 7 (1) ◽

pp. 1-14

Author(s):

Hamid Rezaee ◽

◽

Amin Tavallaii ◽

Ehsan Keykhosravi ◽

◽

...

Keyword(s):

Systematic Review ◽

Web Of Science ◽

Normal Pressure ◽

Mortality Rates ◽

Complication Rates ◽

Success Rates ◽

First Line ◽

Eligibility Criteria ◽

Shunt Obstruction ◽

Complications And Mortality

Background and Aim: The insertion of Ventriculoperitoneal (VP) or Ventriculoatrial (VA) shunt is the first line of treatment in patients with hydrocephalus and normal-pressure hydrocephalus. The provision of a safety profile for shunting in the treatment of hydrocephalus patients is very important. This study aimed to determine the success rates and complications of VP and VA shunting in patients with hydrocephalus. Methods and Materials/Patients: This systematic review investigated the complication rates of VP and VA shunting in managing patients with hydrocephalus. All the published studies were searched in three electronic databases of Web of Science, PubMed and Google Scholar from March 20 to April 10, 2020, using the keywords of “Ventriculoperitoneal” and “Ventriculoatrial” in combination with “Hydrocephalus”. Results: In total, nine articles met the eligibility criteria for being included in this review. Some studies showed a higher rate of shunt obstruction in patients undergoing VA shunting; however, other studies demonstrated no difference in terms of shunt obstruction. The rates of primary revision shunt were various within the ranges of 5.4%-48% and 9.1%-58% for VA and VP shunting, respectively. A higher rate of revision shunt was reported among the patients undergoing VP shunting, compared to that reported for VA shunting. The different mortality rates in various studies were estimated within the range of 0%-10% and at 13.9% for VA and VP shunting, respectively. Conclusion: In general, no difference was reported between VA and VP shunting regarding the rates of complications and mortality. Due to the ease of placement and revision, VP shunting could be considered the first-line treatment of hydrocephalus. However, this approach has been preferred in newborns, and there have been insufficient data on adults in this regard.

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Status Epilepticus: A Review, With Emphasis on Refractory Cases

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100013160 ◽

2012 ◽

Vol 39 (2) ◽

pp. 157-169 ◽

Cited By ~ 16

Author(s):

Gary Hunter ◽

G. Bryan Young

Keyword(s):

Status Epilepticus ◽

Treatment Options ◽

Mortality Rates ◽

Cognitive Outcomes ◽

Diagnostic Methods ◽

Significant Morbidity ◽

Clinical Presentations ◽

Recent Developments ◽

Poor Outcomes

Status epilepticus is among the most dramatic of clinical presentations encountered by emergency room physicians, neurologists, neurosurgeons and intensivists. While progress in its management has been aided significantly with an increasing number of effective treatment options, improved diagnostic methods and more effective monitoring, poor outcomes and diagnostic failures are still frequently encountered. Refractory cases still carry significant morbidity and mortality rates, including poor cognitive outcomes. This review discusses basic pathophysiology and management of status epilepticus, neuroimaging findings, the role of continuous electroencephalogram monitoring and nonconvulsive status epilepticusas well as recent developments in treatment options for refractory cases.

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The Role of White Matter in the Neural Control of Swallowing: A Systematic Review

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.628424 ◽

2021 ◽

Vol 15 ◽

Author(s):

Ann Alvar ◽

Rachel Hahn Arkenberg ◽

Bethany McGowan ◽

Hu Cheng ◽

Georgia A. Malandraki

Keyword(s):

Systematic Review ◽

White Matter ◽

Neural Control ◽

White Matter Lesions ◽

Internal Capsule ◽

Senior Author ◽

Sufficient Evidence ◽

Qualitative Synthesis ◽

White Matter Damage

Background: Swallowing disorders (dysphagia) can negatively impact quality of life and health. For clinicians and researchers seeking to improve outcomes for patients with dysphagia, understanding the neural control of swallowing is critical. The role of gray matter in swallowing control has been extensively documented, but knowledge is limited regarding the contributions of white matter. Our aim was to identify, evaluate, and summarize the populations, methods, and results of published articles describing the role of white matter in neural control of swallowing.Methods: We completed a systematic review with a multi-engine search following PRISMA-P 2015 standards. Two authors screened articles and completed blind full-text review and quality assessments using an adapted U.S. National Institute of Health's Quality Assessment. The senior author resolved any disagreements. Qualitative synthesis of evidence was completed.Results: The search yielded 105 non-duplicate articles, twenty-two of which met inclusion criteria. Twenty were rated as Good (5/22; 23%) or Fair (15/22; 68%) quality. Stroke was the most represented diagnosis (n = 20; 91%). All studies were observational, and half were retrospective cohort design. The majority of studies (13/22; 59%) quantified white matter damage with lesion-based methods, whereas 7/22 (32%) described intrinsic characteristics of white matter using methods like fractional anisotropy. Fifteen studies (68%) used instrumental methods for swallowing evaluations. White matter areas commonly implicated in swallowing control included the pyramidal tract, internal capsule, corona radiata, superior longitudinal fasciculus, external capsule, and corpus callosum. Additional noteworthy themes included: severity of white matter damage is related to dysphagia severity; bilateral white matter lesions appear particularly disruptive to swallowing; and white matter adaptation can facilitate dysphagia recovery. Gaps in the literature included limited sample size and populations, lack of in-depth evaluations, and issues with research design.Conclusion: Although traditionally understudied, there is sufficient evidence to conclude that white matter is critical in the neural control of swallowing. The reviewed studies indicated that white matter damage can be directly tied to swallowing deficits, and several white matter structures were implicated across studies. Further well-designed interdisciplinary research is needed to understand white matter's role in neural control of normal swallowing and in dysphagia recovery and rehabilitation.

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The Role of the Noradrenergic System in Eating Disorders: A Systematic Review

International Journal of Molecular Sciences ◽

10.3390/ijms222011086 ◽

2021 ◽

Vol 22 (20) ◽

pp. 11086

Author(s):

Jacopo Pruccoli ◽

Antonia Parmeggiani ◽

Duccio Maria Cordelli ◽

Marcello Lanari

Keyword(s):

Systematic Review ◽

Eating Disorders ◽

Noradrenergic System ◽

Preclinical Studies ◽

Insufficient Evidence ◽

Genetic Studies ◽

Conflicting Evidence ◽

Pharmacological Studies ◽

The Relationship

Noradrenaline (NE) is a catecholamine acting as both a neurotransmitter and a hormone, with relevant effects in modulating feeding behavior and satiety. Several studies have assessed the relationship between the noradrenergic system and Eating Disorders (EDs). This systematic review aims to report the existing literature on the role of the noradrenergic system in the development and treatment of EDs. A total of 35 studies were included. Preclinical studies demonstrated an involvement of the noradrenergic pathways in binge-like behaviors. Genetic studies on polymorphisms in genes coding for NE transporters and regulating enzymes have shown conflicting evidence. Clinical studies have reported non-unanimous evidence for the existence of absolute alterations in plasma NE values in patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN). Pharmacological studies have documented the efficacy of noradrenaline-modulating therapies in the treatment of BN and Binge Eating Disorder (BED). Insufficient evidence was found concerning the noradrenergic-mediated genetics of BED and BN, and psychopharmacological treatments targeting the noradrenergic system in AN. According to these data, further studies are required to expand the existing knowledge on the noradrenergic system as a potential target for treatments of EDs.

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The Use of tPA in the Treatment of Frostbite: A Systematic Review

Hand ◽

10.1177/1558944718800731 ◽

2018 ◽

Vol 14 (1) ◽

pp. 13-18 ◽

Cited By ~ 8

Author(s):

Richard L. Hutchison ◽

Hannah M. Miller ◽

Spencer K. Michalke

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Case Reports ◽

Case Series ◽

Scientific Quality ◽

Complication Rates ◽

Outcomes Measures ◽

Study Results

Background: The use of tissue plasminogen activator (tPA) for the treatment of frostbite has been reported and advocated, but its efficacy has not been well established. We conducted a systematic review to guide physicians on the role of tPA in the treatment of frostbite. Our hypothesis was that the use of tPA improves clinical outcomes, as measured by amputation rate. Methods: We searched MEDLINE (PubMed) and EMBASE for primary research articles on the use of tPA for the treatment of extremity frostbite. Information related to study design, outcomes, and complications was extracted. A total of 204 citations were screened, and then 35 abstracts and 24 reports were reviewed. Fifteen studies met the standard for final review. Results: One randomized, prospective study; 3 cohort studies; 8 case series; and 3 case reports were found. A total of 208 patients were treated. Differences in protocols, inclusion criteria, and outcomes measures prevented combining the study results. In all the studies, the authors reported that the use of tPA was or may have been useful in reducing amputation rates or increasing tissue salvage. Complication rates ranged from 0% to 100%, with a combined rate of 13%. The quality of the evidence was low. Conclusions: Due to the low scientific quality of the studies, the efficacy of tPA in reducing amputation rates cannot currently be established. Randomized, prospective trials or well-controlled cohort studies are needed to better assess the role of tPA. Consideration should be given to limiting its use to research protocols.

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Systematic review and meta-analysis of the effect of metformin treatment on overall mortality rates in women with endometrial cancer and type 2 diabetes mellitus

Maturitas ◽

10.1016/j.maturitas.2017.04.001 ◽

2017 ◽

Vol 101 ◽

pp. 6-11 ◽

Cited By ~ 16

Author(s):

Faustino R. Perez-Lopez ◽

Vinay Pasupuleti ◽

Ximena Gianuzzi ◽

Gabriela Palma-Ardiles ◽

Wendy Hernandez-Fernandez ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Endometrial Cancer ◽

Meta Analysis ◽

Mortality Rates ◽

Metformin Treatment ◽

Overall Mortality

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Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review

Journal of Intensive Care Medicine ◽

10.1177/0885066617737756 ◽

2017 ◽

Vol 33 (8) ◽

pp. 447-455 ◽

Cited By ~ 8

Author(s):

Leonardo Jönck Staub ◽

Roberta Rodolfo Mazzali Biscaro ◽

Rosemeri Maurici

Keyword(s):

Systematic Review ◽

Lung Ultrasound ◽

Clinical Score ◽

Community Acquired Pneumonia ◽

Ventilator Associated Pneumonia ◽

Qualitative Synthesis ◽

Diagnosis Accuracy ◽

Ultrasound Score

Background: Lung ultrasound (LUS) is an accurate tool to diagnose community-acquired pneumonia. However, it is not yet an established tool to diagnose ventilator-associated pneumonia (VAP). Purpose: To assess the evidence about LUS in the diagnosis of VAP, we conducted a systematic review of the literature. Methods: We searched PubMed, Embase, Scopus, Web of Science, and LILACS. Two researchers independently selected the studies that met the inclusion criteria. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the studies. In a qualitative synthesis, 3 questions guided the review: Q1. What are the sonographic signs of VAP? Q2. How can LUS be combined with others tests or signs of VAP? Q3. What is the role of LUS in VAP screening? Main Results: Three studies (n = 377 patients) with different designs were included. In terms of Q1, the 3 studies assessed the accuracy of sonographic consolidations. In patients suspected for VAP, lobar or hemilobar consolidation alone was not sufficient to diagnose VAP but seems useful to exclude it. The most useful signs were small subpleural consolidations (sensitivity: 81%; specificity: 41%) and dynamic air bronchograms (sensitivity: 44%; specificity: 81%). Two studies were assessed for Q2, when the 2 signs above were included in a clinical score (Ventilator-associated Pneumonia Lung Ultrasound Score associated with quantitative culture of endotracheal aspirate—VPLUS-EAquant), the accuracy was amplified (sensitivity: 48% and specificity: 97% for score ≥4; sensitivity: 78% and specificity: 77% for score ≥3 points). Finally, regarding Q3, no studies have assessed the use of LUS in screening of VAP. Conclusion: Small subpleural consolidations and dynamic air bronchograms were the most useful sonographic signs to diagnose VAP in suspected patients. Clinical scores including LUS had better diagnosis accuracy than LUS alone. There are no data on LUS for VAP screening.

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The Morbidity of Trauma Nephrectomy

The American Surgeon ◽

10.1177/000313480907501118 ◽

2009 ◽

Vol 75 (11) ◽

pp. 1112-1117

Author(s):

Norma M. Edwards ◽

Jeffrey A. Claridge ◽

Raquel M. Forsythe ◽

Jordan A. Weinberg ◽

Martin A. Croce ◽

...

Keyword(s):

Patient Outcomes ◽

Trauma Registry ◽

Penetrating Trauma ◽

Mortality Rates ◽

Infectious Complications ◽

Complication Rates ◽

Severely Injured ◽

Prognostic Information ◽

Improve Patient ◽

Overall Mortality

Mortality has been shown to be high in patients after trauma nephrectomy (TN). However, there are little data regarding morbidity in survivors. The objective of this study was to determine the morbidity rates associated with TN with attention directed to renal failure (RF) and formation of intra-abdominal abscess (IAA). Patients who underwent TN over a 9-year period (1996 to 2004) were identified from the trauma registry. Records were reviewed for all complications after TN in patients surviving at least 48 hours. Eighty-nine patients were identified with TN; 61 per cent resulted after penetrating trauma. Overall mortality was 34 per cent. Seventy-one patients survived greater than 48 hours; 51 (72%) experienced at least one morbidity. There was no difference in morbidity rates between patients undergoing blunt trauma and those undergoing penetrating trama. Patients with morbidities were significantly older, more severely injured, and had higher mortality rates and longer hospital courses. Infectious complications were seen in 52 per cent, respiratory in 48 per cent, gastrointestinal in 30 per cent, coagulopathy in 25 per cent, and RF and IAA were each seen in 14 per cent of patients. Patients undergoing TN are severely injured with significant morbidity. The results from this study allow us to establish benchmarks to assess complication rates for patients who undergo TN, which can provide prognostic information and goals to improve patient outcomes.

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Experiences of fathers of children with a life-limiting condition: a systematic review and qualitative synthesis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003019 ◽

2021 ◽

pp. bmjspcare-2021-003019

Author(s):

Victoria Fisher ◽

Lorna Fraser ◽

Johanna Taylor

Keyword(s):

Systematic Review ◽

Citation Index ◽

Social Science Citation Index ◽

Well Being ◽

Qualitative Synthesis ◽

Role Conflicts ◽

Everyday Activities ◽

Neurological Conditions ◽

Limiting Condition

BackgroundChildren with a life-limiting condition often require extensive and complex care, much of which is provided by their parents at home. There is a growing body of research that aims to understand the experiences of these parents, but the majority of this research is from mothers’ perspectives, meaning that fathers’ experiences are not well understood.ObjectivesTo identify and synthesise findings from existing qualitative studies that have explored the experiences of fathers of children with a life-limiting condition.MethodsA systematic review of qualitative research was conducted using thematic synthesis. Searches were conducted in MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index.ResultsFindings from 30 studies were included, representing the experiences of 576 fathers of children with a range of diagnoses including cancer, cystic fibrosis, genetic and neurological conditions. Themes detailed fathers’ experiences of uncertainty and shock around the time of their child’s diagnosis, their accounts of a ‘new normal’, difficulties in discussing their emotions, forming relationships with and seeking support from professionals and working fathers’ role conflicts. They discussed the life-changing nature of their child’s diagnosis, an event that affected all aspects of their lives from everyday activities, to their relationships, spirituality, values and ambitions.ConclusionsFathers experience many difficulties in response to their child’s diagnosis and ongoing treatment. Findings highlight the need for healthcare professionals to recognise individual family dynamics and the evolving role of the father. Fathers’ responses are not widely understood, and research that directly addresses their own well-being is warranted.

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Intravenous Iron Decreases Rehospitalizations but Does not Change mortality in Patients Admitted with Acute Heart Failure and Iron Deficiency: A Systematic review and Meta-analysis

10.1101/2021.07.11.21260344 ◽

2021 ◽

Author(s):

Nischit Baral ◽

Nabin Raj Karki ◽

Imran Akram ◽

Ashiya Khan ◽

Govinda Adhikari ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Iron Deficiency ◽

Cohort Studies ◽

Meta Analysis ◽

Placebo Control ◽

Hospitalization Rates ◽

Iv Iron ◽

Overall Mortality

Introduction: The role of intravenous (IV) iron in chronic heart failure has been well studied, however, its role in acute heart failure (AHF) is less well-known. Including the recent AFFIRM-HF trial, we performed a systematic review and meta-analysis to highlight the role of IV iron in AHF with iron deficiency. Hypothesis: We hypothesized that IV iron does not change mortality or heart failure re-hospitalization rates in patients with AHF with iron deficiency. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies published from inception till June 30, 2021. We searched PubMed, MEDLINE, EMBASE (embase.com), and Cochrane database including only RCTs and Cohort studies. We also included one prospective and one retrospective Cohort studies and two RCTs in our meta-analysis. Eligible studies included adults with AHF, left ventricular ejection fraction less than 40%-50%, and able to receive IV iron therapy. Outcomes included re-hospitalization rates and overall mortality from 30 days to 52 weeks post randomization (in one RCT). We used random-effects model calculating Risk Ratio (RR) with 95% confidence interval (95% CI) using Review Manger 5.4 software. I2statistics was used to assess heterogeneity. Results: There were total 1561 participants in both groups (IV iron and placebo/control) of four studies. The controls were comparable in both cohort studies and both the RCTs were well matched. Our results showed re-hospitalization in 278 of 833 (33.37%) patients in the IV iron/exposure group and 337 of 728 (0.46%) patients in the placebo/control group. The pooled result showed that the risk of re-hospitalization was comparable across both groups (RR 0.85, 95%CI 0.62-1.17; I2=45%, P=0.14). However, subgroup analysis, including RCTs only showed that IV iron decreases re-hospitalization rate by 28% compared to placebo (RR 0.72, 95% CI: 0.64, 0.82, I2=0%, P<0.00001) but did not improve mortality when compared to placebo (RR 0.97, 95% CI: 0.73, 1.30, I2 =0%). Conclusions: IV iron showed significant improvement in re-hospitalization rate for AHF hospitalizations in iron deficient patients but did not improve overall mortality. We need larger RCTs to further validate its effect on mortality.

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