EP.TH.37Radioembolization with yttrium-90 microspheres for management of breast liver metastases: a systematic review and pooled analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michael Feretis ◽  
Arturs Fedotovs ◽  
Andriy Solodkyy
Keyword(s):  
Systematic Review ◽  
Liver Metastases ◽  
Animal Studies ◽  
Patient Survival ◽  
Case Reports ◽  
Tumour Response ◽  
Pooled Analysis ◽  
Tumour Control ◽  
Number Of Patients ◽  
Yttrium 90

Abstract Aims Radioembolization with yttrium-90 microspheres is an emerging option for management of liver metastases of breast cancer when other systemic therapies have failed. The aims of this systematic review were to assess the effect of radioembolization on i) tumour response and ii) patient survival post -radioembolization. Methods The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was performed using the PubMed and EMBASE databases from January 2007 to December 2019. The initial search yielded 265 reports which were potentially suitable for inclusion in this review. Studies published in English reporting at least one outcome of interest were considered to be suitable for inclusion. Conference abstracts; case reports, animal studies and reports not published in English were excluded from this review. Results The final number of studies which met the inclusion criteria was 12 (n = 452 patients). There were no randomized controlled trials identified. The age of the patients included in this review ranged from 52 to 61 years. The duration of follow-up ranged from 6 to 15.7 months. The total number of patients with breast metastases not confined to the liver was 236 (52.2%). Cumulative analysis revealed that radioembolization conferred tumour control rate in 81% of patients. Overall survival post-radioembolization ranged from 3.6 to 20.9 months with an estimated mean survival of 11.3 months. Conclusion Radioembolization with ytrrium-90 appears to confer control of tumour growth rate in most patients, however its effect on patient survival need to be elucidated further.

A Systematic Review on Airbag-Induced Burns

2020 ◽  
Author(s):  
Sarah P Erpenbeck ◽  
Eva Roy ◽  
Jenny A Ziembicki ◽  
Francesco M Egro
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Good Prognosis ◽  
Chemical Burns ◽  
Automobile Crashes ◽  
Chemical Mechanisms ◽  
Number Of Patients ◽  
Common Risk Factors ◽  
The Common ◽  
Ocular Burns

Abstract Airbags significantly reduce fatalities and injuries in automobile crashes, but they have been found to be associated with burns. Specifically, airbags can cause burns through thermal or chemical mechanisms and commonly affect the arms, hands, face, and eyes. While most airbag-induced burns are minor, some may cause unfavorable outcomes. Our study aimed to systematically review airbag-induced burns to assess etiology, type, and treatment of these injuries. A systematic review of case reports pertaining to airbag-induced cutaneous and ocular burns was conducted. Data reviewed included type/location of burns, severity of burn, total number of patients, treatment, complications, and outcome after treatment. We identified 21 case reports that met our inclusion criteria with a total of 24 patients reported in the studies. Of the studies identified, 38% were chemical burns and 25% were thermal burns. Most commonly the upper extremities were burned in 42% of cases, followed by eyes (25%) and face (21%). Most burns identified were superficial partial thickness (58%). Treatment outcomes were good for cutaneous burns, with 95% healing without complication. However, ocular injuries lead to permanent impaired eye function in 71% of cases. In our systematic review, we highlighted the common risk factors, prognosis, and treatment for thermal, chemical, and ocular burns. Airbag-induced burns have a relatively good prognosis but must be recognized and treated immediately to reduce the risk of serious sequelae.

scholarly journals Pharmacological management of seizures in patients with COVID-19: a systematic review

2021 ◽  
Vol 4 ◽  
pp. 29
Author(s):  
Priscilla Kolibea Mante ◽  
Nana Ofori Adomako ◽  
John-Paul Omuojine ◽  
Paulina Antwi
Keyword(s):  
Systematic Review ◽  
Sodium Valproate ◽  
Case Reports ◽  
Meta Analysis ◽  
Descriptive Data ◽  
Pharmacological Management ◽  
Drug Choice ◽  
Number Of Patients ◽  
Clonic Seizures ◽  
Antiepileptic Drug Therapy

Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 19 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laminavir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.

scholarly journals Times to Key Events in the Course of Zika Infection and their Implications for Surveillance: A Systematic Review and Pooled Analysis

2016 ◽  
Author(s):  
Justin Lessler ◽  
Cassandra T. Ott ◽  
Andrea C. Carcelen ◽  
Jacob M. Konikoff ◽  
Joe Williamson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Supply ◽  
Zika Virus ◽  
Blood Donation ◽  
Case Reports ◽  
Fold Increase ◽  
Pooled Analysis ◽  
Control Measures ◽  
History Of ◽  
And Control

Background Evidence suggests that Zika virus has driven a 10-fold increase in babies born with microcephaly in Brazil, prompting the WHO to declare a Public Health Emergency of International Concern. However, little is known about the natural history of infection. These data are critical for implementation of surveillance and control measures such as protecting the blood supply. Methods We conducted a systematic review and pooled analysis to estimate the distribution of times from Zika infection to symptom onset, seroconversion, and viral clearance, and analyzed their implications for surveillance and blood supply safety. Results Based on 25 case reports, we estimate the median incubation period of Zika virus infection is 5.9 days (95% CI: 4.4-7.6), and that 95% of cases will develop symptoms by 11.1 days post-infection (95% CI: 7.6-18.0). On average seroconversion occurs 9.0 days (95% CI, 7.0-11.6) after infection, and virus is detectable in blood for 9.9 days (95% CI: 6.8-21.4). In 5% of cases detectable virus persists for over 18.9 days (95% CI: 12.6-79.5). The baseline (no screening) risk of a blood donation being infected with Zika increases by approximately 1 in 10,000 for every 1 per 100,000 person-days increase in Zika incidence. Symptom based screening reduces this by 7% (RR 0.93, 93% CI 0.86-0.99), and antibody screening by 29% (RR 0.71, 95% CI: 0.28-0.88). Conclusions Symptom or antibody-based surveillance can do little to reduce the risk of Zika contaminated blood donations. High incidence areas may consider PCR testing to identify lots safe for use in pregnant women.

Zirconia Biocompatibility in Animal Studies - A Systematic Review

2017 ◽  
Vol 376 ◽  
pp. 12-28 ◽  
Author(s):  
Sanda Mihaela Popescu ◽  
Horia Octavian Manolea ◽  
Oana Andreea Diaconu ◽  
Veronica Mercuţ ◽  
Monica Scrieciu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dental Implants ◽  
Animal Studies ◽  
Case Reports ◽  
Powder Injection ◽  
Mesh Terms ◽  
Meta Analyses ◽  
Abstract Screening

Zirconia is a metal used in dental implantology. Its biocompatibility was studied in vitro and in vivo, results of the studies being analyzed in reviews and meta analyses. The aim of this systematic review was to evaluate biocompatibility of zirconia in animal studies in vivo expressed as results of histomorphometric tests. Databases were searched from 1980 until February 2016, with different combination of the following MeSH terms: zirconium, biocompatibility, dental implants, in vivo, animal studies. Letters to the editors, case reports, commentaries, review articles and articles published in other languages then English were excluded. The search of PubMed, ScienceDirect and Google Scholar databases yielded 690 titles. After abstract screening and duplicate discarding 50 articles were identified and finally, 40 were included in the review. Most of the studies compared zirconia with titanium, a well established material for dental implants. In majority of the studies zirconia showed a similar osseointegration with titanium. Surface implant treatments, like sandblasted and etched zirconia (ZrO2-SLA), alumina toughed zirconia (ATZ), and powder injection molding (PIM) were used to improve osseointegration of zirconia with good results. In the light of histomorphometric test, zirconia, no matter physical and structural forms tested, is a biocompatible material.

The role of liver transplantation for colorectal liver metastases: A systematic review and pooled analysis

2020 ◽  
Vol 34 (4) ◽  
pp. 100570
Author(s):  
Dimitrios Giannis ◽  
Georgios Sideris ◽  
Christos D. Kakos ◽  
Ioannis Katsaros ◽  
Ioannis A. Ziogas
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Pooled Analysis

Treatment of heroin dependence with ibogaine

2016 ◽  
Vol 33 (S1) ◽  
pp. S10-S11
Author(s):  
A. Schellekens ◽  
T. Oosteren ◽  
T. Knuijver ◽  
R.J. verkes ◽  
M. Belgers
Keyword(s):  
Systematic Review ◽  
Substance Use ◽  
Animal Studies ◽  
Meta Analysis ◽  
Human Studies ◽  
Opiate Withdrawal ◽  
Close Monitoring ◽  
Qtc Prolongation ◽  
Self Administration ◽  
Number Of Patients

BackgroundThe use of the hallucinogen ibogaine as an anti-addiction agent has been described in several case reports, dating back to the eighties. The anti-addiction properties of ibogaine have been confirmed in a large body of animal work. Ibogaine has been shown to be effective in reducing withdrawal severity and substance use for a variety of substances, including cocaine and opiates. Animal studies also show some potentially dangerous adverse reactions, including cerebellar toxicity and potential cardiac effects. While pharmacological treatment options for opiate and cocaine dependence are still limited, ibogaine assisted treatment might be a promising new option. Therefore more systematic studies on its toxicity and efficacy are warranted. In our studies we address these two research questions: is ibogaine treatment for opiate dependence safe and effective for treating opiate withdrawal and relapse prevention? A secondary objective is to explore the pharmacokinetic properties of ibogaine.MethodsAnimal work: first we performed a systematic review and meta-analysis of animal studies on ibogaine. Thirty studies were included in the systematic review, of which 27 could be analyzed in meta-analysis. Human studies: fifteen opiate dependent patients will be treated with ibogaine (10 mg/kg), on top of treatment as usual. Ibogaine toxicity will be assessed through close monitoring with electrocardiography, with QTc prolongation as main outcome measure, repeated assessments of ataxia using the (SARA) and observation of psychotic symptoms by using the Delirium Observations Scale (DOS). Ibogaine efficacy will be measured, using repeated evaluations of opiate withdrawal severity (Subjective Opiate Withdrawal Scale: SOWS; Objective Opiate Withdrawal Scale: OOWS), craving intensity (using a Visual Analogue Scale) and substance use, with a six-month follow-up. Clinical observations in ibogaine treated individuals will be compared with a cohort of opiate dependent patients treated with a rapid detoxification procedure. Both acute and long-term effects will be linked with serum ibogaine and noribogaine levels.ResultsAnimal work: overall, ibogaine reduced drug self-administration, particularly during the first 24 hours after administration. Ibogaine had no effect on drug-induced conditioned place preference. Ibogaine administration resulted in motor impairment in the first 24 hours after supplementation, and cerebral cell loss even weeks after administration. Data on ibogaines effect on cardiac rhythm as well as on its neuropharmacological working mechanisms are limited. Human studies: human data are still being collected. Treatment of the first patients confirmed strong effects of ibogaine on heart rhythm (QTc prolongation) and ataxia, while the opiate withdrawal symptoms were relatively mild. The first observations on the clinical effect of ibogaine on craving and substance use will also be shared.ConclusionsBased on our meta-analysis of animal data, there is strong evidence that ibogaine is effective in reducing drug self-administration in animals. This warrants further studies into the clinical efficacy of ibogaine in substance dependent patients in reducing craving and substance use. Our first clinical experiences in a limited number of patients confirm that ibogaine treatment may be effective in reducing opiate withdrawal, but can potentially have transient cardiac and cerebellar toxicity.Disclosure of interestThe authors have not supplied his declaration of competing interest.

scholarly journals Epidemiological approximation of the enteric manifestation and possible fecal-oral transmission in COVID-19: A preliminary systematic review

2020 ◽  
Author(s):  
Javier Pamplona ◽  
Rubén Solano ◽  
Cristina Soler ◽  
Miriam Sàbat
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Scientific Evidence ◽  
Severe Disease ◽  
Gastrointestinal Symptoms ◽  
Pooled Analysis ◽  
Fecal Excretion ◽  
Test Results ◽  
Oral Transmission ◽  
Stool Samples

Abstract Objectives: to conduct a systematic review to describe the epidemiological scientific evidence on gastrointestinal symptoms (GIS), enteric involvement and fecal excretion of SARS-CoV-2 viral RNA and to discuss the possible fecal-oral transmission pathway of COVID-19.Methods: We have reviewed GIS, enteric involvement, and fecal test results of SARS CoV-2 from case reports and retrospective observational studies related to the digestive system published about the outbreak.Results: The prevalence of GIS in patients infected with SARS CoV-2 ranges from 1.7% (1/56)-100% (10/10), GIS included diarrhea 1/99(1%)-8/10(80%), nausea/vomiting 1/28(3.6%)-5/10 (50%), abdominal pain 2/103(1.9%)-1/3(33.3%). A total of 3% of infected patients may experience GIS in the absence of respiratory symptoms. A pooled analysis of the results showed 16.1% GIS, 8.3% diarrhea and 12% nausea-vomiting. A higher percentage of diarrhea in patients with severe disease (5.8%) than in non-severe disease (3.5%), and a more severe course in patients with GIS (22.97%) than in those without GIS (8.12%) was found. Histological studies demonstrated the presence of ACE2 receptors and the nucleocapsid of the virus in gastrointestinal. The RNA of the virus has been detected in 27-53% of patients with COVID-19 in whom respiratory and stool samples have been analyzed, and it may persist in stool for up to an average of 11.2 days after negativization of the respiratory samples.Conclusions: GIS are common in SARS CoV-2 infection at the time of patient admission, sometimes represent the only clinical manifestation. Infection of the GI tract is possible due to the presence of ACE2 receptors, and there may be viral replication with fecal elimination.

scholarly journals Current Therapeutic Approaches to Subglottic Stenosis in Patients With GPA: A Systematic Review

2021 ◽  
pp. 014556132110362
Author(s):  
Ashjan Almuhanna ◽  
Ayshah Almahboob ◽  
Ahmed Alhussien ◽  
Reem Aljurayyed ◽  
Ahmed Alammar
Keyword(s):  
Systematic Review ◽  
Animal Studies ◽  
Case Reports ◽  
Surgical Techniques ◽  
Activity Grade ◽  
Subglottic Stenosis ◽  
English Studies ◽  
Therapeutic Approaches ◽  
Transcervical Approach ◽  
Endoscopic Techniques

Background: The management of subglottic stenosis (SGS) in granulomatosis patients with polyangiitis (GPA) has no clear guidelines. This systematic review aimed to identify different surgical techniques and evaluate the outcomes of applied procedures. Methods: An electronic search was performed using 3 major databases, CINAHL, PubMed, and Clinical key, to include relevant studies published from the databases from inception through January 2017. All primary studies reporting treatment of SGS in cases with GPA were included. Articles were excluded if not relevant to the research topic or if they were duplicates, review articles, editorials, short comments, unpublished data, conference abstracts, case reports, animal studies, or non-English studies. Results: Thirteen papers were included in our systematic review with a total of 267 cases for the qualitative review Endoscopic approaches showed favorable outcomes with the need to use multiple procedures to achieve remission. The open transcervical approach showed excellent results mainly after failure of other endoscopic techniques. Tracheostomy was necessary for severe respiratory obstruction symptoms. Medical treatment was essential for stabilizing the active disease and therefore may enhance the success rate postoperatively. Conclusion: Subglottic stenosis in patients with GPA requires a multidisciplinary approach to provide optimal management regarding disease activity, grade of stenosis, and severity of symptoms.

scholarly journals Conundrum of re-positives COVID-19 cases: A Systematic review of Case reports and Case series

2020 ◽  
Author(s):  
Arun Kumar Yadav ◽  
Subhadeep Ghosh ◽  
Sudhir Dubey
Keyword(s):  
Systematic Review ◽  
Animal Studies ◽  
English Language ◽  
Case Reports ◽  
Case Series ◽  
Contact Tracing ◽  
First Episode ◽  
Rt Pcr ◽  
Registration Number ◽  
Age Range

AbstractIntroductionThere have been case reports and case series published for RT PCR positive COVID - 19 cases that became RT PCR negative but subsequently became RT PCR positive after a symptom free interval following a negative RT PCR test. These cases may include re-positive, reactivated and re-infection cases. Hence, the systematic review to summarize and synthesize evidence from all available case series and case reports published was undertaken.MethodologyThe systematic review of case series and case reports was registered with Prospero with registration number CRD42020210446. PRISMA guidelines were followed for conducting the systematic review. Studies published in English language only were considered for the Systematic Review. Inclusion criteria for studies included case reports and case series which have documented cases of positive RT-PCR after a period of improvement or negative RT PCR. Reviews, opinions and animal studies were excluded. Case reports which described clinical presentation or manifestations of COVID-19 cases were also excluded from the studies. Methodological quality was assessed using modified Murad scale.ResultsA total of 30 case reports/case series were included in the study, wherein a total of 219 cases were included. In re-positive cases, the age range varied from 10 months to 91 years. The pooled proportion using random effects was 12% with 95% CI from 09% to 15%. Among the re-positives, a total of 57 cases (26%) of the cases had co-morbidities. A total of 51 (23.3%) and 17 (7.8%) re-positive cases had been treated with antivirals and corticosteroids respectively. Among the symptomatic cases, the disease severity was lesser as compared to the initial episode of illness. Only a few studies have confirmed the presence of antibodies after the first episode. The few studies that had done contact tracing of re-positives did not find any positive cases among those in contact with re-positives.ConclusionThis systematic review presents the review of all the case reports and case series on recurrence of COVID 19 disease. Although limited evidence has been generated due to paucity of such studies and shortcomings in the study designs of case reports and case-series, nonetheless, the evidence generated can still be used in making clinical decisions and framing policy guidelines

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